HCDM 49 | Opportunities In Optometry

 

If you’re looking for a profession that offers visible results – literally – then becoming an optometrist may be the one for you! Taking us into the wealth of opportunities this profession can give to its practitioners and professionals is Dr. Harbir Sian, an optometrist and the owner of Clarity Eyecare. In this episode, he joins Dr. Richard Marn to share the important facts and insights into becoming an optometrist. Dr. Harbir talks about the 3 O’s – optician, optometrist, and ophthalmologist – and how they differ from each other. Bringing with him his vast experience, he also discusses what a career in optometry entails and what the typical day of an optometrist looks like.

Listen to the podcast here:

Uncovering The Wealth Of Opportunities In Optometry With Dr. Harbir Sian 

I’m glad you’re here. Thank you so much for joining me. In this episode, we’re going to talk with someone that has a career specializing in eyes. There are a wealth of different opportunities in this profession. We will also learn about the three Os and the differences between optician, optometrist and ophthalmologist. We are going to be talking about a career in optometry or as an optometrist. The guest I have is Dr. Harbir Sian. He’s an optometrist in Vancouver, Canada. He’s doing many wonderful things to help people and patients in his chosen field. We’re going to learn about that. He’s going to be a great guest where he can learn a real in-depth assessment of what it’s like to be an optometrist. 

Before we jump into this, I’d like to say I appreciate all your support and any feedback that you have provided me. As always, please do not forget to hit subscribe, hit like or leave a five-star rating or even leave a comment. You can also find me on Instagram and TikTok @DrRichardMarn. If there are any topics that you’d like me to cover or anything that you’d like me to go a little bit more into detail or in-depth in, I’d love to hear from you and hear those suggestions. 

Dr. Harbir Sian from British Columbia, Vancouver, Canada. Thanks for joining me. 

Thank you for having me, Dr. Marn. I appreciate it. 

Please call me Richard. If you don’t mind let’s do first names. 

Absolutely. 

Harbir, could you please give me a quick bio of yourself? 

I am an optometrist. I live in Vancouver. I did my undergrad here near Vancouver. I did my Optometric Education in Boston at the New England College of Optometry. I graduated in 2010. I am co-owner of two practices in the Vancouver area. 

Someone gets an idea about the profession. What does an optometrist do? 

We like to look at ourselves as primary care for the eyes. That can go from checking your vision, but more importantly, eye health, treating a lot of different eye diseases and eye conditions. 

How does one become an optometrist? What are the typical steps to achieve that degree? 

Four years of undergrad in whichever study you choose, matching all the prerequisites, and then four years of optometry school. Eight years of university in total. There’s an optional one-year residency if you choose to specialize in a certain area. That’s essentially it as far as the education side. 

What is the best part of your career? 

I feel like the best part is the potential variety if you choose to. You could practice as a more traditional family practitioner or you could specialize in different areas. There are opportunities to educate, volunteer, and all these other things. I think that would probably be the best thing for me. 

What’s the least favorite part of your profession? 

HCDM 49 | Opportunities In Optometry

Opportunities In Optometry: We need to distinguish ourselves as a profession, as practitioners, as being able to do other things.

 

It would be doing some of the more monotonous things, which is better, 1 or 2. I don’t want to say I don’t like doing it but if I was going to rate it, that would probably be near the bottom of the list. I enjoy doing it because I know that at the end of it, I’m going to be able to give patients clear vision most of the time. They’ll be happy with what they see literally. Based on all the other things that I’m capable of doing, that would probably be lower on the list. 

Let’s do a deep dive into some of the other questions I had about your profession and your career. What are the types of patients that you typically help? What do you do to help them? 

There are a lot of different things. There’s a lot of variety to my day-to-day job. I’m treating that more middle-of-the-road patient who’s coming in for the routine eye exam, they want to have their prescription for glasses and contact lenses updated. We’re fine-tuning their vision. We’re looking at their ocular health and treating particular conditions, whether it’s glaucoma or ocular surface conditions and other things like that. There’s the option to specialize in a lot of different areas depending on where you practice. Unfortunately, in Canada, our scope of practice is a little bit narrower than a lot of the states in the US. Glaucoma, but dry eye or ocular surface disease in general is a big area where a lot of patients, especially these days during COVID, cooped up indoors and spending a lot of time on screens. 

There are a lot of things going on on the ocular surface like dry eyes and inflammation that we’re treating in a lot of cool ways. There are a lot of new devices and treatment options for patients in that realm. If we’re talking more about visual conditions, myopia or nearsightedness is a common condition that we see in a lot of people and a lot of kids. There’s a pretty big increase in the number of people that we see the prevalence of myopia now. There’s a subspecialty there of myopia management we call it, where we’re able to slow down the progression of nearsightedness so a child doesn’t end up having high nearsightedness in the long-term. 

That could help potentially improve their health or health outcomes as well as the visual outcomes in the long-term. There are a lot of different things that I like to do and there are a lot of options out there. If you’re practicing in the US, there are options for potentially using lasers or other techniques to help patients with different conditions. It depends on how you like to practice. For me, I like to keep a lot of variety to my days to keep myself on my toes. I look forward to the next day and all the different things I can do. 

Are you helping a wide range of ages as well? 

Yeah. The youngest age that we usually see is six months. That’s normally not a very in-depth eye exam. That’s usually to look for very specific things. Maybe they have red eyes or watery eyes. Essentially from that age, all the way up to, I believe the oldest patient I’ve seen is around 100. We see the full range. If there’s a condition that I am not able to treat, we refer them to our medical or ophthalmology colleagues. 

What’s your typical day like as an optometrist? When do you come in? When do you leave? How many patients do you see? What’s the typical day like for you? I know there’s no typical day, but on average, what can you expect? 

My days have become more structured and predictable. When I was a little bit younger, I like things to be all over the place. In the earlier days of our business, you’re staying late but these days, I usually get in the office around 9:00, maybe a little earlier and I’m there until about 5:00. It was like a 9:00 to 5:00 these days for me, which I never thought it would be. I’m seeing these varieties of patients. I’ll usually pull up my schedule first thing so I can get mentally prepared for the day. That’s something I learned from an ophthalmologist in Florida when I was doing my internship down there. He showed me that he would always have his list of patients prepared for him and highlighted to show that he’s got this type of surgery or this type of treatment, so he’s mentally in the right space for it all. I like to do that myself as well. I’m seeing patients until lunch, which is usually 1:00-ish. Lunch doesn’t always exist. It’s a theoretical space on the schedule, but it could easily be filled with patients if it has to be. We’re usually wrapping up around 5:00 or 5:30, maybe later, depending on what’s happened in the day. I like to try to get home in time for dinner. I have two young kids and it’s nice to be home at dinnertime together. That’s my average day. 

You said it was a little different than before. What was it like before? Why are there different types of days for you as an optometrist from before and where it is now? 

Before in my practice, there are maybe three stages that I could describe to you. The one that I just described is me as a little bit more of an established business owner. We have staffs that run things efficiently. I have a couple of associate doctors that cover these other days that I don’t have to work late anymore. As often, once in a while, I still do. That stage was in 2020. I’ve been practicing for many years now. The bulk of that was early business owner first in one clinic and then we opened the second clinic a few years later. 

An optometrist provides primary eye care for the eyes. Click To Tweet

I was in that early business owner stage for a while. You have to do a lot of stuff yourself. You come in early, trying to get a bunch of stuff done, then you’re staying late because you got to get a bunch of other stuff done, staff training, or whatever it might be. You’re covering days that I’m not having to cover these days. My schedule used to be quite different. There were days that I would work until 8:00 PM, just because we have late days on the schedule. I was doing those days. That was that middle period. What came before that was me working not as a business owner, but as an associate at someone else’s practice. 

At that time, I was not married and no kids. I had a lot of free time. I worked a lot in different capacities. In the middle section, where I was the business owner, I was working on my own business a lot of those extra hours. Before that, I was working to make money, pay off bills and debt. I was working 6 or 7 days a week in someone else’s practice because I had nothing better to do. I was like, “I’ll go work and make some extra money.” I’m glad I did save up some money in those first few years and helped through the first few years of being a business owner. 

It allowed you to get to where you are now. What are some typical misconceptions people have about your profession? 

The most common misconception is that as an optometrist, I’m just doing the 1 or 2, “Which is better 1 or 2.” I’m just checking vision. Even now on a daily basis, patients will come in like, “I want my glasses updated.” That’s fine because that is a cornerstone of what we do. These days, it’s not even a big piece of it. It’s a small piece of what we do. Optometry has a very broad scope of practice for the most part. We are healthcare practitioners, not just checking vision. That would probably be the most common misconception. A lot of students will ask, “Is the profession growing? Is it declining? Is that all you do, 1 or 2?” Depending on your mode of practice, that may be a big part of what you do. One of our offices is next door to LensCrafters. Often if you practice in that type of setting, especially depending on which state you’re in, you may be just spinning the dial for the most part. 

What do you mean by spinning the dial? 

I mean you go behind that device that everybody knows. 

The big black device. 

Justin Timberlake, The 20/20 Experience cover photo. That’s called a phoropter. That’s what I mean by spinning the dial because that thing’s loaded with a bunch of lenses. You’re switching and flipping the dials to check a patient’s vision. Often in that office, a chunk of my day will be quickly checking somebody’s vision so they can go get their glasses. We set up that practice as well when we opened it to be more as focused on medical as we could, as well as spinning the dials. 

Our second practice is a private practice where we focus on the health side, and then we also do the spinning the dials thing. It depends on what you want to focus on, but the profession as a whole has moved away from just checking your vision. In BC, we’ve almost been forced to do it in the last ten or so years because regulatory changes have made it so patients can get their vision checked in other places, not just from the optometrist. We don’t need that to be our bread and butter anymore. We don’t want it to be our bread and butter anymore because we know people can get that done somewhere else. We need to distinguish ourselves as a profession, as practitioners, as being able to do other things. That’s probably the biggest misconception still is that an optometrist’s job is to just spin the dials where it’s got so much more to it. 

There are several optical professions that people are aware of. The main three ones that come to mind is an optician, an optometrist and an ophthalmologist. Can you please describe the differences and similarities between those, also if it’s different in terms of their role and functions whether you’re in Canada or the US? 

We call them the three O’s, opticians, optometrists, ophthalmologists. They’re very different in many ways, but there is also some overlap. Let’s start with opticians. They are masters of the refractive arts. They’re the ones who understand or trained in optics lenses, whether that’s glass lenses, potentially contact lenses, depending on their training. I don’t want to minimize what an optician does. It’s easy to say, “They’re the ones who make your glasses.” I know a lot of opticians, some are good friends of mine, and they know stuff about lenses, glasses and optics far better than I do. 

They know that well, and they know if somebody comes in with a high prescription or a complicated prescription, what type of lens to put them in, how it’s going to look on their face when the frame is tilted. We call it pantoscopic tilt and wrap all these other things. They know how to calculate all these things to make sure they’re limiting aberrations, distortions and things so patients can see as well as possible. Those are what their focuses are on optics. In BC, one of the things is there’s some overlap. May years ago, the entire eyecare industry was completely deregulated in British Columbia. None of the other provinces. Since then, deregulation has hit one, maybe Ontario. I’m not 100% sure. 

Not anywhere in the US, although there have been some whispers of some FTC changes that are leaning towards that, but not there yet. Hopefully, it doesn’t get there. In 2010, BC provincial government decided patient no longer needs to see any type of doctor or any kind of eyecare provider to get a valid prescription before they can buy glasses or contacts. I’m going to go off on a bit of a tangent here. I was hugely vocal about this many years ago. Now I’m a little more subdued, but I still like to make sure that the word is out there as an advocate for my profession. 

The government decided that it was in the public’s best interest to not have to go get your eyes checked to go buy a pair of glasses or contact lenses. Contact lenses are classified as medical device. A patient and since 2010 can go online. This entire change was motivated, advocated and pushed through by an online company based here in Vancouver. They were the ones who benefited from this change. Since 2010, I can go online and punch in whatever number I want and buy whatever contact lens is offered. No matter the material, how old or how poorly it permeates oxygen. I can do that and they will be at my door tomorrow or the day after.  

The same goes for glasses. I can go use my five-year-old glasses prescription, buy glasses online and put in whatever pupil distance number I need without worrying about optical height, which as any optometrist and optician will tell you is as important as pupil distance. Horizontally and vertically, you need to know where your eyes sit in a frame. I can order those and whatever I want without any validation. That’s been the case here in BC for years. Since that happened, we’re like, “We fought it, it didn’t get reversed. Now we have to adapt.” That was part of broadening our scope. We are telling patients, “We’re not just giving you your glasses prescription because now apparently you don’t need that anyway. We’re going to check the health of your eyes. We’re going to do all these other things and offer these other specialties that we didn’t offer before.”  

HCDM 49 | Opportunities In Optometry

Opportunities In Optometry: Horizontally and vertically, you need to know where your eyes sit in a frame.

 

Opticians can refract. One of those changes that happened there was opticians can spin the dials. Before that, they weren’t able to do that. That’s fine. That’s what they’re trained. I’m okay with that. They get trained to do that. It’s infinitely better than somebody who’s going online and buying a pair of glasses that they don’t have a prescription for. They are trained to do it. I’m going to bring you back to the 3 O’s here. One of the overlaps between an optician and optometrist is that we both do the phoropter or refraction to check vision. That’s where the overlap will stop. Optometrist offices will dispense glasses, but we’ll usually hire trained opticians to do it. They still have that as their realm. Opticianry program is usually a six-month diploma program or maybe a year, depending on where you are. Optometrists, that second O, is a four-year Bachelor’s and then a four-year graduate program, Doctor of Optometry degree. It’s eight years of university. 

Your degree that you get is an OD. 

Yes. Doctor of Optometry. DO would make sense but DO are Doctors of Osteopathy. 

Osteopathic Doctor or Doctor of Osteopathy. 

We’re optometrists. Doctors of Optometry, OD degree is a designation. We have four years of undergrad, four years of optometry schooling. In that four years, a very small piece of it is spent learning refraction, and then a majority is spent learning the different types of ocular disease, contact lens specialties, other types of treatments, co-management with ophthalmology, all other things that we get trained on. These days, students are getting trained on doing certain small procedures, lid procedures, even laser therapies. It’s cool what they are learning these days, injectables, subcutaneous injections and things like that that they’re able to do now that I didn’t get trained on. I’m okay not doing those things anyway. 

We go from the refraction, spinning the dials to treating ocular diseases, diagnosing ocular diseases, and then that part overlaps with ophthalmology, but we stopped at some of the more significant diseases, some of the treatments and procedures that would be more invasive and more involved. That’s where ophthalmology takes over. Ophthalmologists are medical doctors. They are medically trained. They graduate from medical school. They do their residency and fellowship in ophthalmology. They are highly trained and specialized in their area of specialty and subspecialty in many cases. 

You have your general ophthalmologist who will see some of the stuff that overlaps with what I do like treating glaucoma, diagnosing these diseases, treating ocular surface issues, and then they will do their specialty of treating the more difficult diseases, and doing cataract surgery, potentially laser surgery, lid procedures. Within that, in the ophthalmology realm, there are sub-specialized retinal specialists, corneal specialists and all these other things. All of that will depend on their residency and fellowship. Those are the 3 O’s. As you see there, there’s some overlap but some pretty defined spaces as well that each of us is practicing. 

As optometrists, you are doing a number of procedures if you choose to do so. Do you ever see blood? 

I did but it’s rare. From a procedure that I’m doing, it’s rare that I would cause any external bleeding. There’s one time that I had to remove a piece of metal from somebody’s eye. It was right at the limbus. The limbus is the edge of the cornea, which is the clear dome over the front of the part of the eye. It’s where the cornea meets the coating or the covering over the white part of the eye, which is the conjunctiva. There are blood vessels that go in the white part of the eye. They end right at the edge of the cornea, right at the limbus. This guy had a piece of metal right at the limbus. As I removed it, there was a little blood vessel right next to it. That was broken. There was a tiny bit of bleeding there externally, but that healed up quickly. 

Some students get a little squeamish with blood. I want to know if that was a big deal in your profession. It doesn’t seem like it. 

That was one patient every few years that I see a little bit of blood. It’s rare. 

How would you describe your work-life balance as an optometrist? We talked about it already. You have a much more 9:00 to 5:00 profession. Is that your weekends off as well? 

If you choose to, yes. It’s possible. As a younger doctor, if you want to be busy, it’s almost a requirement. If you’re trying to get a job, you would likely have to work Saturday. Saturdays are the busiest days for most offices because it’s the day off. 

Especially when you first starting out. 

I did seven days a week for a little bit. I would do seven-day stints. I was even working Sundays for a good chunk of time. If you find the right job or after you’ve worked a little while, you work your way into a certain level where you get to choose, it can be Monday to Friday, 4 or 5 days of the week if you want it to be. It could be from 9:00 to 5:00. Having said that, if you have a thrill for loading your schedule and filling your plate with all different things, it offers the opportunity to do that too. Whether that’s teaching, educating, volunteering or starting your own business so you can do all those things. 

What is the most rewarding part of your job? Could you give an example of where that happened for you with regard to a patient? 

I love the interactions that I have with my patients day-to-day. That’s one of my favorite things on a daily basis that balances out some of the monotony that comes with any job. One of the reasons I became an optometrist was the optometrist that I was volunteering for was very personable with his patient. I always looked at that and I said, “This is something that aligns with my personality. I’d like to engage. I love doing that.” On my daily scale, daily basis, I love that part of the job. One of the most rewarding things is treating ocular surface issues. 

The biggest misconception still is that an optometrist’s job is to spin the dials where it’s got so much more to it. Click To Tweet

Most of these patients that I see who have dry eye or ocular surface issues have been dealing with them for a long time. They haven’t been diagnosed correctly or they’ve been told, “Here, use these eye drops. They’ll help you.” The drops will help temporarily but they don’t fix the root cause of the problem. They don’t make the patient feel better in the long term. We’ve been focusing on this dry eye, ocular surface realm in our practices for a little while. These symptoms that people have with the ocular surface disease have been ranked up as high as severe and systemic. I saw one thing where somebody rated the effect that their dry eye has on their quality of life. It ranked as high as having severe angina or something like that. Just because it affected their ability to focus, it gave them headaches and they couldn’t see well, it affected their quality of life. 

It’s a sensitive organ. 

I’ve had some of these patients. They’ve been suffering this for years. To be able to resolve those symptoms and treat that condition using the different treatment options that we have, and maybe even taking a step back from that, just hearing them out because for years they’ve been told, “It’s just dry eye.” Listening to them and saying, “I get it. Let me show you what’s going on. Let me show you these pictures of your eyes. Here’s the issue. Here’s what we’re going to do to fix it.” If I stopped there, the patient says, “Thank you so much,” but then we go ahead and fix it. They then want to hug you. Those are rewarding experiences. We’re having those frequently now as we’re starting to diagnose and treat those issues. 

Changing gears a little bit. The outlook of your profession. In a few years, what do you think the future is going to hold for your profession? Does it look positive, stable or declining? What’s your impression?  

There are always people in our profession who are looking out for the growth and the best of the profession, who are always looking to see what’s the new endeavor, what’s the new frontier. I’d like to be one of those people as much as I can to advocate for the profession. I think there is growth. There are some areas that are maybe shrinking, but there are some that are growing at the same rate, if not at a greater or faster pace. Those things are myopia management and dry eye disease, people are using lasers and all these other things. Our profession is evolving. Generally speaking, I would say it’s growing. Maybe not as fast as it has grown in the past, but if somebody is looking into going into it, I will encourage you to look at it as a profession that’s evolving and as a profession that has a new face to it. Treating eye diseases as a healthcare practitioner versus traditionally looked at it as someone who spins the dial. 

I want to jump into these rapid-fire questions I have for you. Favorite sport to watch? 

Football, NFL. 

Favorite sport to play? 

Soccer. 

Least favorite type of movie genre you like to watch? 

Horror. 

What has been your most favorite vacation? 

Thailand. 

Can you touch your toes without bending your knees? 

No chance. 

Ideal outside temperature. 

Summer weather. Warm enough to be on a beach with your shirt off. 

Were you raised in abundance, modesty or poverty? 

Modesty. 

What is your least favorite attribute about yourself? 

I’m working on being more patient. 

What is one thing you do that people marvel at, in the humblest way that you could communicate this? 

The people ask me how I’d do all the things I do. Maybe they are impressed by my ability to do a lot of different things. 

How are you juggling it all? 

Yes, I guess so, which if I can add something, I’m not the one juggling all the things. I’m blessed to have an extremely supportive wife, other family members, and my emotionally supportive parents. It’s not just me. I’d highly encourage the readers to develop that support system, whether it’s your friends or your family. Have good people around you. 

Where can our readers go to reach you and learn more about you? You have a bunch of different projects going on. Can you tell us what you’re doing? You have a career as an optometrist, but what are you doing as well? Could you talk to us about what you’re doing as an optometrist and how you are helping people? 

HCDM 49 | Opportunities In Optometry

Opportunities In Optometry: Optometry is a profession that’s evolving and has a new face to it, treating eye diseases as a healthcare practitioner versus traditionally looked at as someone who spins the dial.

 

First, you can find me on social media. I’m frequently active on social media. Most often on Instagram, @HarbirSian.OD. I have a YouTube channel, YouTube.com/harbirsianod and LinkedIn. I like creating content in the educational forum. I’m not so much the dancing musical type of person on social media. I’m more so like, “Let me tell you about this thing that I can help you with.” I love educating. Social media gives me an outlet for that. I do speak and present for certain companies within our industry. I’m also finding that as a form of education. 

The thing that I’m most excited about is my eyewear brand was bought out by a company called Lensbox, which is emerging. One role that I was honored to take on is as Executive Director of the Lensbox Foundation. Our foundation is going to try to reach a lot of people. We’re in the early stages, but we’re looking to provide mental health resources to eyecare providers. We’re looking to reduce the environmental impact of our industry through recycling programs and different things that we are partnering with certain companies on. The third one is to continue to do eyecare types of outreach, providing eyecare resources for patients who don’t have access in more remote areas, indigenous populations and things like that. That’s what I’m super excited about doing. It’s where a lot of my focus is going to be. 

It’s a project that you’re involved in. Those are some lofty goals but awesome. If you can get it done, that would be great. Thanks for joining me. I appreciate you coming on this episode. 

Thank you so much, Richard. I appreciate it. 

That’s our show. Thanks for tuning in. To learn more about our guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. If you’d like what you learned in this show, then please go to my website, add your name and email to my email list. That way you can get the latest announcements and news as they arise. You can also find me on Instagram, @DrRichardMarn. Thank you so much for reading and catch you on the next episode. 

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About Dr. Harbir Sian

HCDM 49 | Opportunities In OptometryDr. Harbir Sian is an award-winning Optometrist whose passion lies in education and his profession.

Harbir studied Kinesiology and attained his Bachelor of Applied Science degree at Simon Fraser University. He then moved to Boston to study at the New England College of Optometry and graduated with a Doctor of Optometry degree in 2010.

Dr. Sian returned to Vancouver to begin practicing and it soon became abundantly clear that too many people were unaware of the importance of their eye health. Harbir knew he needed to spread the word… And so began AboutMyEyes.com.

Since then, Dr. Sian has written many blogs; started multiple video series including For Your Eyes Only with and Chiasma; launched The 20/20 Podcast; traveled to South America and the Middle East to perform eye exams in underdeveloped areas; and been awarded Young Optometrist of the Year by the BC Doctors of Optometry.