Take a look at this article written by Dr. Golson on how setting your office environment will in return change the way patients view your establishment.

Set Your Office Environment for Your Patients

 The following article was co-written by our associate doctor, Dr. Melanie Denton, O.D., F.A.A.O.,  with Dr. Scott Morris, O.D., F.A.A.O., explaining the common differences between these two conditions.  

Is it Allergy or Dry Eye?

Here’s how to identify the two pathologies, even when they coexist and confound the diagnosis.

Scot Morris, O.D., F.A.A.O. Conifer, Colo.
Melanie J. Denton, O.D., F.A.A.O., Asheville, N.C.

One of the most challenging issues we, as optometrists, deal with clinically is how to differentiate ocular allergy from dry eye disease. What makes this especially challenging is that, though superficially these two conditions seem like separate entities, they often coexist; and, in many cases, confound the diagnosis of each other. The presenting symptoms may closely overlap (see figure 1, page 38). Even more confusing is the idea that each of these conditions can independently lead to the other. Think of the old adage: Which came first, the chicken or the egg? That is, allergy sufferers may be on systemic, anti-histamine medication which leads to decreased tear production. Dry eye sufferers may have lacrimal plugs that cause antigens to stay on the ocular surface longer or insufficient tear production to reduce the antigen load, thus increasing the allergic response. This leads to difficulty in diagnosing the primary culprit and choosing the correct therapeutic strategy.

Figure 1 lists the common signs and symptoms of allergy and dry eye, including those symptoms that crossover and may apply to both pathologies.

In this article, we discuss both a symptom-based approach, as well as clinical differentiation.

“Symptomology”

The hallmark of an allergy is certainly the itch response, which is sometimes localized in the caruncle but is oftentimes described as a generalized sensation. However, other symptoms that commonly present with acute allergic response are puffy eyelids, red eyes and tearing (which is more prominent temporally). All these symptoms have a tendency to be exacerbated by antigen exposure and can also be manifested after a mild time delay from exposure. Patients may or may not suffer from seasonal allergies in the usual form of rhinitis or dermatitis though, making it potentially harder to detect from just the “obvious” symptoms.

Unlike allergic conjunctivitis, dry eye tends to be a disease that is more prevalent in symptoms than signs, especially in its earliest stages. In fact, in the earliest stages of dry eye disease, no signs are exhibited while more than one symptom may be present. Common symptoms of aqueous deficient dry eye disease often present as burning eye, foreign body sensation, nasal epiphora (secondary to reflex tearing) and fluctuating vision. Patients may also report increased redness of their eyes with dry eye disease. As mentioned earlier, however, many of the common symptoms overlap, so specific and detailed questioning is necessary to elucidate the true etiology. Typically careful clinical observation is also necessary.

Clinical observations

In considering clinical observations for a diagnosis, ponder this: Allergic issues are typically confined to the bulbar and tarsal conjunctiva. Conjunctival follicles, papillae, hyperemia, bulbar conjunctivochalasis and edema are commonplace. In more acute cases, limbal follicles and limbal infiltrates may be present. Common eyelid findings include edema and hyperemia. Though the lacrimal system itself is rarely involved primarily, mucin filaments and debris may be found in the inferior tear prism. In cases in which oral or topical antihistamine therapy is already in place, the patient may suffer from a decreased tear prism secondary to the drying effects of the medications. Allergies may also have concomitant systemic manifestations including rhinitis, dermatitis and respiratory maladies. In addition, there is no lacrimal lake in ocular allergy.

Unlike allergic conjunctivitis, dry eye syndrome is not localized to the bulbar and tarsal conjunctiva, but typically has a greater effect on the cornea. Dry eye disease typically presents as only an ocular problem though obviously there may be many co-existing systemic issues, such as a multitude of medications, hormone changes and inflammatory or autoimmune diseases, that may exacerbate the condition.

In dry eye disease there is predominantly ocular surface staining present with a vital dye in either the nasal bulbar conjunctiva or cornea. Generalized hyperemia of the bulbar conjunctiva may be noted. There is typically a decreased lacrimal lake (opposite of allergies). Typically, papillae and follicles are absent from the tarsal conjunctiva.

The basis for treatment

Although dry eye and allergic conjunctivitis can overlap in symptomatology and clinical signs, their correct differentiation using both diagnostic approaches is key in developing a treatment strategy. OM

	Dr. Morris is the director of Eye Consultants of Colorado, LLC, and Morris Education & Consulting Associates. E-mail him at smorris@eyeconsultantsofco.com.
	Dr. Denton is an optometrist at Aldridge Eye Institute in Burnsville, N.C. She completed a residency in ocular disease at the Bascom Palmer Eye Institute at the University of Miami. E-mail her at melaniedenton@gmail.com, or send comments to optometricmanagement@gmail.com.

 This is a good idea because it creates camaraderie and focus.  It requires forethought as to what is the priority for the current week.  When a goal is in writing, it makes it concrete and more likely to be attained. In addition, it creates a marker for a team member’s ongoing performance for the team member and leadership.  The success of the week is also beneficial because it allows the team member to take pride in her accomplishments and provides a feeling of empowerment to create future successes.  Successes spread positive thoughts throughout the office within the team as well.

 The goal benefits the practice by allowing for greater efficiency and incentive to accomplish what’s important at any given week.  A boat without a destination is destined to float aimlessly across the sea of practice operations. A boat with a destination almost always reaches its port.

 Send an email or cover the new directive at a weekly team meeting. It’s important to describe why you are asking the team to perform this activity to gain acceptance and willingness to take it seriously.

Written by Dr. Larry Golson, OD.

      Dr. Denton, OD, FAAO, is a graduate of the University of Michigan-Ann Arbor (2005) and the Michigan College of Optometry (2009).  In 2010, she completed a one-year residency in Ocular Disease at the prestigious Bascom Palmer Eye Institute at the University of Miami.

    Dr. Denton is currently in private practice in Asheville, NC. She is involved locally with Young Professionals and the Junior League of Asheville. Nationally, in addition to the Women of Vision executive board, Dr. Denton serves on the Ocular Surface Society of Optometry executive board, is a fellow of the American Academy of Optometry, and a member of the American Optometric Association.  Her current clinical interests include pediatric optometry, ocular disease, and dry eye management.

    Dr. Denton will be seeing patients at Envision Eyecare on Monday’s.  Come by today or call our office and set up your appointment with this awesome doctor that truly follows Envision’s mission and is one of a kind!

Check out our Facebook page to view a photo of our new associate doctor; Dr. Denton!  www.facebook.com/myenvisioneyecare

      After years of being curious about the art of meditation, I began talking with Dr. Golson about the topic.  He informed me of its benefits and is a firm believer in its healing power.  After listening to how passionate he was on the topic, he shared with me the following email that he wrote to a friend of his who too was interested in the power of meditation.  After reading this email I became inspired to really give meditation a try.  The idea of allowing your mind to have a completely clear moment of reflection absolutely fascinates me.  The art of meditation is definitely a skill that is learned and takes time and patience, but the overall outcome can tremendously change your life.  

      Read below to see why Dr. Golson practices meditation and how it benefits him in all aspects of his life; both in and out of the office.  

      I’m writing you today because I’ve recently returned from a 10 day meditation retreat and I wanted to tell you about it.  Religion, Spirituality, Meditation, the Ego, Self-cultivation, Therapy, the Mind/Intellect, Emotions.  These are the stomping grounds of my education when I’m not doctoring eyes.  There are certain times in life that an event has a profound effect on a person, and for me, this is one of those times.  I had to share…

 Background:

        For the past 8 years, I’ve been fascinated with the human psyche.  I’ve been fortunate to have several mentors that have been placed in my path throughout that time. The effects and knowledge gained through this investigation have changed me forever and have furthermore convinced me that part of my reason for being is to be a lifelong learner in the field of self-cultivation.  Perhaps I could even be of service to others by sharing my story and the following is the most recent chapter.

        Historically, I’ve never meditated with consistently, but decided to try it toward the end of 2011.  I was looking for a way to slow the rush of life down, reduce stress and live a more fulfilling/content life in the present; another pathway to know myself better.  I began to meditate 20 minutes in the morning and in the evening each day, and it quickly became apparent that it was next to impossible to concentrate my mind on my breath.  My thoughts repeatedly took over.  (Try it for yourself for 5 minutes and see what a powerful force our minds are.  My guess is that it is impossible for the majority of us to focus on our breaths without thoughts repeatedly interfering for even 30 to 60 seconds.)  After a few months, I became frustrated, feeling my efforts were futile and I was “wasting” time, so I discontinued my meditation practice.

 The Seed is planted:

         A few years ago, I was having lunch with a friend and business colleague.  He told me about a type of meditation called Vipassana meditation.  He has a wife, two young children and a bustling, growing business with 25 employees, yet manages to meditate in the morning and evening each day for over a decade.    He has told me that his practice has transformed his life from being an impatient, angry person to one of greater generosity, happiness and compassion.  When I hear someone say that, my ears perk up.  I’d considered trying this form of meditation ever since that day, but never made the time to learn the technique, which requires a 10 day meditation retreat.  At the time I became frustrated with my own efforts meditating, I decided it was time to bite the bullet and commit to the 10 day retreat.

 The Retreat:

           On May 9^th, I drove down to Jesup, GA and sat for a 10 day silent meditation retreat.  It was definitely one of the hardest things I’ve done, and like most things in life, it was also one of the most rewarding.  See, I thought I was going down to Georgia to learn how to focus my mind, to live in the present, to reduce stress and to get to know myself.  I quickly discovered that Vipassana meditation is all of that, and a whole lot more.  It’s a spiritual path with the highest aim of purifying and liberating the mind.  Although it’s a bit challenging to describe this process in an email, I’ll give it a go.  It breaks down like this…

         Human suffering and misery is a universal malady.  It doesn’t matter if you are black or white, male or female, American or French, Christian or Jewish, we all suffer to some extent.  (By the way, Vipassana is not religious in nature and therefore can be practiced by anyone, regardless of race, religion or belief system.)  Turn on the news, grab a newspaper or pick up a history book from any period of human history to verify this fact.  Personally, my life has oscillated between happiness and malcontent over the years, and there’s been an ever-present feeling that I may be overlooking an important aspect of living a completely authentic, fulfilling life with consistency.  According to Gottama the Buddha (the person responsible for teaching Vipassana 2500 years ago), all of human misery arises from the mind’s habitual reactions to pleasant and unpleasant experiences in one’s life.  One develops cravings to pleasant experiences and aversions to unpleasant experiences.

           To understand this meditation technique, one has to first understand the nature of the mind.  The mind is never satisfied with the present moment and lives in the past or the future. The mind always wants more or less of something; it desires something different from whatever the reality of the present moment is; it craves something just out of reach.   Of course, the game of the mind is such that if this desire is satisfied, it will shift its focus onto the next unfulfilled desire.  It’s the grass is always greener mentality, and all minds are programmed to systematically search for the next greener pasture.  It’s been described as the restless monkey mind, which shifts its attention from one fixation to the next. The mind’s natural state is reminiscent of attention deficit disorder, and prevents us from being present in the moment and accepting the current status of life.

            Look at the American/Western culture—it’s all about satisfying cravings, quick fixes, pills and medicines to curb mental distress and physical ailments, superficial materialism as a means to be “happy,” addictions to work, sex, drugs, alcohol, gambling, tobacco, etc.  Interestingly, the teacher of the meditation course, S. N. Goenka, states that people are not addicted to the ________(fill in the blank), but are actually addicted to the sensation the ________ produces.  

         There is a direct link between one’s mind and sensations in one’s body.  If one has a pleasurable experience, that person’s mind will crave the sensation generated in the body as a result of that experience.  Alternatively, if one has a negative experience, that person’s mind will develop an aversion to that particular sensation generated in the body as a result of that experience. 

          According to this philosophy, these cravings and aversions get stored in our bodies as reactions called “Sankaras.”  Goenka states that the mind does not actually have an unconscious component.  The unconscious mind is considered the “deep mind” in this context and is linked to one’s body directly in the mind-body phenomenon. These sankaras get stored within one’s body when one reacts with cravings or aversions to life’s experiences.  They get activated, and strengthened, when a positive or negative experience occurs and we react with craving or aversion.  One reacts to the experience on the surface/thinking/intellectual mind, but in addition, reacts within the deep mind.  The deep mind’s reaction is associated with an accompanying sensation in the body that is activated by that experience.  (Think of a time when there was a resulting sensation in the body when someone screamed at you; think of the resulting sensation in the body when someone praised or complimented you.  In the deep mind, this negative and positive experience has led to aversions and cravings below the surface/thinking mind.) 

       In Vipassana meditation, one’s goal during meditation is to feel sensations in the body and to remain equanimous to those sensations.  If one doesn’t react to pleasant or unpleasant sensations while meditating, then one is training the mind not to react when one is not meditating.  

            Throughout our lives, each of us will have good things happen to us and bad things happen to us.  We perceive these events as good or bad, but in “The New Earth,” Eckhart Tolle argues there is no good or bad, only our reaction to what occurs in life.  Our perception of “good and bad” is colored by our past experiences. How many times have we initially been upset about something that “happened to us” (victim-hood) only to find out later that that particular event had an overall benefit?   Hindsight is 20/20. Goenka argues that if one doesn’t identify with the events in one’s life by taking them personally (see “The 4 Agreements” by Ruiz), then one will not create aversions or cravings; that if one can remain equanimous to whatever life throws one’s way, then one will live a more peaceful and happier life.  Being equanimous to sensations frees one to shed previously stored sankaras because it frees one from reacting to good or bad occurrences in one’s life; what follows is liberation from the mind—one is free from reacting to events in life.

             Goenka states that the law of nature of our universe is one of impermanence; that everything is in a state of change; that the universal law of nature is all things arise and then pass away.  If nothing is permanent and everything will change, then this good thing I’m feeling right now will end.  Or…this negative thing that I’m feeling right now will change.  With this wisdom, it becomes possible for one not to react…it’s going to change eventually.  Therefore, what’s the rationale to become attached to or cling to anything?  It will change.  Then when something “bad” happens, one takes it in stride, realizes it is not a personal affront to oneself, and does not react with negativity or aversions.  The opposite is also true.

            If I’ve adequately explained this philosophy, it makes sense at an intellectual level that these concepts have the capacity to generate a profound amount of peace and happiness in one’s life.  BUT…here’s the rub—the intellectual level of the mind is the surface level.  In order to benefit from these ideas, one has to experience these truths below the surface in the deep mind (aka, the unconscious mind).  During meditation, when one experiences pleasant or unpleasant sensations and remains equanimous to them, then that person is training the mind to remain equanimous to pleasant and unpleasant experiences in life and is therefore on a path to liberation.  What follows is peace and happiness for one’s self, and compassion and love for others. 

          Imagine seeing one person beating another.  The normal reaction is to feel compassion for the one being beaten.  Vipassana helps a person to generate an even greater degree of compassion for the person beating the other person.  It is that person who is deeply miserable. 

      Imagine being yelled at, shamed and condemned by another, and while this is happening, having the Presence to not take it personally; to feel detached and compassionate for that person because he/she is suffering and angry.  It’s not about you at all.  Now that would be truly powerful, an example of unconditional love and mastery of the mind.

        Goenka states that the mind is a tremendously powerful instrument.  Left wild and unattended, it can inflict tremendous suffering on oneself and others.   Look at all of the injustice and atrocities that have occurred and are still occurring in our world.  However, a mind that is tamed and controlled can promulgate healing, peace and happiness to the bearer and to the world.  Eckhart Tolle describes this level of consciousness in” The New Earth,” and argues that it is an inevitable reality that will be achieved by humans.  In fact, he says this shift is already in process.

           Since I’ve returned I keep getting the question: “Has this experience changed you?”  Well, the concepts are quite compelling to me.  What I’ve experienced on a daily basis has been a higher degree of being present with patients and with friends.  I’ve noticed that I can concentrate with greater efficiency.  I have a greater awareness of my thoughts at an objective level, and I’m not as reactive to them, but can accept them for what they are…thoughts.  These changes aren’t gigantic shifts and were already in process at some level before the meditation, but the meditation retreat has given these changes a context and has catalyzed them as well.  

           If you’re still reading this, I hope in sharing my experience that it may invoke or strengthen an interest for self-cultivation and/or meditation.  I don’t believe in soliciting philosophies or trying to change another person’s beliefs.  I am not sharing this in any way to serve my own ego.  Rather I would feel remiss to keep something of such positive potential to myself.  If this can help you, serve you or stimulate you toward further exploration in any way, then I have succeeded in my intent.  Thank you for joining me on this journey and I’m open to discussing this further with you anytime if you would like.

Here are a few links to learn more:  

http://www.dhamma.org

http://www.youtube.com/watch?v=JS1PhpbLvGw

 Be happy!   

Larry

     Check out the link below to read an article that Dr. Denton wrote for the Review of Optometry about successfully fitting patients in multifocal contacts. 

http://www.revoptom.com/content/d/contact_lenses___and___solutions/c/31611/

       Welcome everyone to the 2012 year’s end celebration!  It is with deep gratitude and abiding joy that I get to treat you all to a lovely dinner and year end appreciation party for a year well done!  This practice means a great deal to me.  Thank you for allowing this Doctor to practice in the only way that makes total sense from a perspective of integrity and service to others.

 When I look back at 2012, I’m amazed at how far we have come.  In many ways and numerous levels, it has been a year of transition.  For me, it can be easy to lose sight of the forest when we work within the trees each day. This is the fifth team Gratitude letter I have written and read to the team at the year’s end and looking back, each and every year has brought its unique challenges and its rewards.  Speaking from the heart, it is a true joy to work with you and be a part of this exceptional practice.  You each embody the Envision Mission, Vision and Golden Rule statement in your actions every step of every day.  Let’s take a step back for a moment and take a bird’s eye view at the many changes and advancements in our humble, local, private, Optometry practice.

 Technology/Software category:  We improved our utilization of Solution Reach and Eyemaginations.  We purchased three new computers, and one printer.

Optometry Equipment category:  We purchased an OCT instrument.  This instrument will provide a new age of patient care and convenience.  We have three new lines of amazing eye wear which is a continuation and further step to making our optical legendary, and finally, we have developed a new way to treat dry eye. 

Office improvement category:  More workspace has been created in our lab and pretest organization has improved.

Team Category:  We added Katie, Lauren and Kia to our team:  all extremely beneficial additions, and we lost Jeni as a teammate but not a friend .

Marketing Category: Social Media expansion—blog, FB fans and interaction with Patients-go Katie! Of all the Asheville eye care practices out there, Envision has the most google reviews and highest ranking.  We are happy to be becoming a part of Angie’s list as well, soon!  

Awards/Honors Category: Small Biz Leader of the year, 40 Under 40’s Award, 2^nd place in WNC Best of 2011 Eye Care—1^st place is coming in 2013 ,  four Cleinman Awards (growth and Pearl), Retained designation as Living Wage Certified with JE.

Growth Category:  Keeping pace with 30% growth in 2012!  December will tell the tale! Our success as a small biz is not an accident.  It is through talent, dedication, loyalty, team work, compassion and consistent, genuine care for others that have allowed us to experience the growth we’ve seen in 2012. 

 Observing how you each show up and are present each day, I’d like to re- quote an excerpt from “The Prophet,” by Kahlil Gabran.  “Always you have been told that work is a curse and labor a misfortune.  But I say you work that you may keep pace with the soul of the earth.  And in keeping with labor, you are in truth loving life.  And all work is empty save when there is love.  And when you work with love you bind yourself to yourself, and to one another, and to your higher power. It is to charge things you fashion with your own spirit.  Work is love made visible.”

 I’d like to share my observations noticed in the past year for each of you in your work.

Jess:  You continue to broaden your leadership skills as Envision Eyecare Office manager.  You have managed to maintain day-to-day operations skillfully and with precision so that your teammates, patients and I have what we need.  You have the courage to, in a kind and effective manner; give me upward feedback to make me a better leader.  You also have the humility to accept feedback to make you a stronger manager and leader.  You have an ever firmer grasp on what this organization needs to be successful from an operation and financial perspective and you consistently do what is needed toward that end, while keeping our patients best sight and eye health the primary focus decision-making.  I’m excited to watch your skills continue to evolve into 2013.   My hope is that our practice will grow to a level in which we can have another optician to give you even more resources to devote to office management.  Very few practices in the country can boast to have such a devoted and talented office manager that cares for her practice as a mother cares for her child.

 Jeni: your contribution to Envision over these past 3+ years has been immense.  For the next several years I’m going to have to hear patients say, “What happened to Jeni, she was so friendly and sweet!”  You laugh, but with each team member we’ve lost, our patients return and express their appreciation for your care. Sometimes it’s hard to know how we truly affect our patient’s lives.  I’ve heard it said that my job as a leader is to develop a person and then send them out into the world to continue challenging and developing themselves. My hope is that you will be able to use some of the skills you learned at Envision to further broaden your talents.  Thank you for staying on and training Katie in the art of Opticianry, which not only helps her, but also our team and entire practice at large.   We hope that you won’t be a stranger and will visit often.  At a level that is hard to put into words, I’m going to miss saying, “Hey Jeni.”

 Maria: you have added to your skill set: Insurance Specialist.  That is a very important part of the success in our practice and the amount of diligence and perfection you operate that area with is noticed and appreciated. You have stepped up in a big way to fill in the gaps at the front desk with your willingness to contribute and be flexible in serving the needs of Envision. You have done an exceptional job training Kia in short order which lets us all rest easy knowing that important position is in good hands.  We will miss you the next few months as you pursue your dreams and also bring smiles to theatre patrons during the holidays.  Thank you for logging in and contributing to Envision even during that time. We look forward to having you back in the office once again and feel fortunate we get to celebrate with you this time around!

 Bonnie: your skill set as medical assistant and capable IT facilitator has truly blossomed in the past year.  You set patients at ease when they first start the examination and it sets the tone for the Doctor to carry on the thorough care in the exam room.  You have done a tremendous job training Lauren to follow in your footsteps as a superb medical assistant.  You are a joy to work with each day and embody the positive attitude that is so important to Envision’s success. 

 Dr. Denton: we are all sorry you could not be with us tonight.  You fit into this practice seamlessly and I hope we can continue to add days onto your Envision schedule.  I can’t tell you how fortunate I feel to have my first associate Doctor at Envision be of your caliber.  You are intelligent, knowledgeable and genuinely care about our patients who have quickly embraced your personality and expertise and there are already those that are requesting you by name.  Thank you for trusting in our practice to a level that you are proud to be an important part of the Envision team.

 Katie: you may never know exactly how hard it was finding you to fill the much needed role of rock star Optician.  You are well on the way to becoming just that and you have moved mountains in the few months you have been here. Your skills with communication have and will continue to help set our patients at ease so they can be open to making good decisions about their eyewear—something they typically know little about.  At times, it’s hard to know how we truly affect our patient’s lives.  In being an Eye doctor that has been in practice over 10 years and that has traveled to third world countries to deliver eye care, our effect on our patient’s lives is transforming.  Just ask the patient you recently helped purchase her first pair of glasses in five years.

 Kia: you have moved rapidly into the challenging and detailed role of patient experience coordinator.  Your willingness to ask questions to learn your role with greater intimacy helps make every single person on this team’s job easier and more streamlined.  As you have gained experience, I’ve noticed that you greet our patients immediately as they enter the practice.  You do this with a type of sweetness and kindness that sets the tone for overall impression of our practice.  You are super helpful with all the little things I need on a daily basis and I appreciate knowing you are up front as the first face our patients see when they arrive.

 Lauren: it was clear to Jess upon first impression that you were hired!  She was so excited when she told me about you that I became excited before even meeting you in person.  You think quickly on your feet and although not even here for three months, you can roll and jive like a seasoned medical assistant.  You ask good questions and have a tremendous work ethic.  It is clear with more experience and time at Envision that you are going to be a powerhouse at this practice.

 Overall, my sense of Envision is that we have a “dream team” in place at this time.  We have a special place here and my hope is that this thought will surface for you often.  There are times when our office is crammed with our wonderful patients, and watching you all shuck and jive to manage their needs with a kind, efficient and effective intention is magical.  Each day, you are making people’s lives better.  That’s important to remember when times are stressful.  You not only make practice at Envision possible, you make it proliferate and shine.  At a personal level, you enrich my life with your positive attitudes, your unique individuality and a belief in importance of work and its inherent ability to strengthen character and benefit others. Thank you for all that you do.

 A look at 2013:  As we continue to gain momentum in the year to come the path is laid for a major expansion in 2013.  This means we all win: our community of patients, our team and our practice. We will continue to find innovative ways to deliver top tier care by improving our systems.  We will continue to support our community through donating eye care, donating to worthy causes and helping our patients in times of need.  We are poised to descend on Asheville in an even more-encompassing way to raise the bar of health care in one of the finest cities in the U.S.  In my opinion, it is an exciting time for our practice.

 I said it last year at this time and I’ll say it again now, “our future is so bright we have to wear UV/HEV shades!”

     As part of NPR’s ‘Talk of the nation’ programming, Science Friday is a weekly science talk show, broadcasted all over public radio stations.  The show focuses on science topics in the news and brings an educated, balanced discussion about the current scientific issues at hand. 

  In a recent broadcast, Los Angeles artist Julian Hoeber’s “Demon Hill,” optical illusion room was discussed.  The room is on display at the Harris Lieberman Gallery in New York.  The room is tilted on a compound angle resulting in disorienting the viewer’s sight and creates an optical illusion where the rules of gravity don’t apply as you expect them to. 

  Take a look at this video to see how the room works and why it drew 20,000 individuals when it first appeared in Los Angeles.

Boost employment performance to greatness–with the help of employee reviews. Performance improves when you appreciate staff–and also let them know where improvement is needed.

 I believe in the importance of good communication with my employees, or “team members,” as we call staff in my practice. It is essential to ensure that team members have the same understanding of their roles and the practice goals as I have. Further, they must be able to each carry out our mission: to provide the best vision and maintain the best eye health for our patients.. Conducting regular staff evaluations helps to make that happen.

 Evaluate a Minimum of Once a Year

Each team member receives their first review at 90 days after they are hired. The purpose is to make sure they are on track. In addition, they have at least one comprehensive review each year going forward, but often, team members will meet with me a few additional times a year. I call for this when I notice something about their work performance that I want to praise or point out for improvement. If I’m doing my job, I’m telling people along the way where they are doing a good job and where they are just doing a sufficient job.

 I offer interim mini-reviews so team members know what they should keep doing and what they need to alter. The annual performance review then just becomes about setting a plan for further growth and development. For example, if I notice that a team member took patient service to the next level by spending extra time explaining a form or office process that the patient found confusing, I want to encourage a repeat performance of that behavior. On the other hand, if a patient complains to me that he waited unrecognized in our reception area for 10 minutes or that no one seemed to care when he had questions about pre-testing, I want to make a correction right away.

 Performance Appraisal Form (downloadable)

We utilize a Performance Appraisal form that rates an employee on a 1-5 scale in a dozen areas. These include: achievements, initiative, conceptual ability, planning, organization, communication, professional skills, leadership skills, patient satisfaction, interpersonal skills, job knowledge/performance. and overall performance. We look for areas of strength, areas for improvement, and ways to motivate the team member to improve their performance.   

 Identifying New Opportunities

A key to conducting effective evaluations of team members is remaining flexible about their role in your office. As you observe their performance strengths as well as weaknesses, you can meet with them periodically throughout the year to help them craft the job that will best suit them and your patients. Sometimes I will conduct a mini-review with employees to point out a new opportunity for a team member.

 For example, I met with one of my opticians to ask, “Would you be interested in becoming our office manager?” I saw this person taking my practice vision and mission statement and living by it on a daily basis. She would anticipate patients needs without being asked, use easy-to-understand language so patients could understand what we were communicating and innovating to come up with new solutions to make the office run more efficiently. After commending her for her superior performance, I asked her; “If you could craft your perfect job in this office, what would it look like?” The role she explained to me in response to my question fit the role of office manager, so I had no hesitation letting her move into that role.

 Job Descriptions Play a Role

As we’ve grown, we’ve found it necessary to develop job descriptions. We’ve moved from a small number of team members, all of whom were cross-trained, to a team of eight, including myself and an associate, where specific assigned task are a necessity. Job descriptions will become part of an evaluation. During an evaluation, employees may cite tasks they’ve done done that go above and beyond their initial job description. We, as employers, are challenged to explain that jobs are always in the process of changing. The key is to manage expectations: Be clear on the front end that a job will grow over time; just the same, let the team member know that exceptional performance will be rewarded financially.  

 Ask Employees How You Can Help Them

When I conduct mini-reviews throughout the year to assess high and low points of performance, the idea isn’t merely to point out the good and bad. My ultimate goal is finding out from team members how I, as a leader, can help them achieve the goals we have agreed on. Sometimes that means adjusting time tables we’ve already agreed upon.

 For example, one of my employees agreed with me in an annual performance review that it would be beneficial if he could attain para-optometric assistant certification. We originally agreed that he would attain this certification in six months. The deadline we set passed and he still had not attained certification. Rather than harshly assessing him, I asked if there was a reason he had missed the deadline. It turned out that he had some personal matters that had gotten in the way of achieving the certification. I then worked with him to set a new, more realistic timeline so that he could achieve his goal. By finding out this team member’s unanticipated challenges and then making adjustments to our plan, I was able to help him achieve his goal.

This article by Dr. Golson was featured in Review of Optometric Business. 

               I have worked with children for as long as I can remember.  From babysitting, to teaching, to Nanning for three; when it comes to kids, you name it, I’ve done it! 

               Children are a huge responsibility, and even though I have never had any of my own, I know how hard it can be to keep up with all of the appointments a child needs. From the point a baby is born you are constantly going to the pediatrician every few months for checkups, followups, or shots.  Many of my friends have children, and not one of them have ever thought to add the eye doctor to their list of routine doctor visits for their infant.  With everything else a mother needs to remember, the normal doctor visits ( pediatrician, ear, nose and throat doctor, etc) are really the ones most people cover.  Even with my work in childcare, I never thought about taking a baby to the eye doctor.  “If they can’t talk to tell you what their seeing, how can we know that there is a problem with their vision,” is what I always thought; and that was the majority of the responses I got from my friends when talking to them about taking their babies to the optometrist.  Truth be told, many eye problems can occur without noticeable symptoms.

             After being educated by the Envision Eyecare team about the importance of taking your infant to the optometrist, I knew I needed to spread the word about early preventative eye care for infants to all of my friends.  The team at Envision shared with me the amazing benefits of a program called InfantSee.  The InfantSee program was developed to provide a one-time, no cost eye and vision assessment for babies six to twelve months old.  This early preventative care is to evaluate the overall health of the eye and detect any discrepancies a child may have, early on.  It was shortly after learning about the InfantSee program that I read an amazing article about Dr. Golson’s college classmate, Dr. Jerry Gerdes, OD, who was just recognized for saving a child’s life through this phenomenal eye health benefit.

       Dr. Gerdes detected a cancerous tumor behind a little girls eye that was life threatening.  She had, had no warning signs that her parents noticed and acted like a perfectly normal baby.  After discovering the BB sized tumor, the little girl was taken to surgery where it was removed.  She received treatment but unfortunatley lost the eye after about three months.  If she had not been evaluated by Dr. Gerdes the day of her appointment, she may have lost more than her eye; she could have lost her life.   

             Visit the Oakdale Journal’s website (link below) and take a look at the article about Dr. Gerdes and read this breathe taking story about how preventative care really does make a difference.  Envision Eyecare is a participant in the InfantSee program, and we would love to evaluate your child at your earliest convenience.  Come by our office to learn more about this program and pick up a pamphlet of information.  Dr. Golson and the team are ready to serve your child’s eye health needs, and we are always looking for kids to spoil with hugs and stickers! Bring your infant by today, and let us take care of you!

Visit http://www.etypeservices.com/SWF/LocalUser/oakdale1//Magazine14399/Full/index.aspx?id=14399 to view the article about Dr. Gerdes.