Building Legacies in Optometry with Dr. Trevor and Nyah Miranda

10/21/24 • -1 min

In today’s rapidly evolving landscape of eye care, generational differences have come into sharper focus. The practice of optometry, like any other healthcare profession, is shaped by the unique perspectives, challenges, and goals of different generations. This generational gap is often seen when seasoned optometrists and new graduates come together in practice. The goal is to bridge these differences and create a harmonious, future-forward approach to patient care, practice management, and leadership.

Dr. Trevor Miranda, Optometrist, Practice Owner, and Podcast Host of Optometry Unleashed

The Defocus Media podcast recently explored this topic in a special episode featuring Dr. Trevor Miranda, a seasoned optometrist with over two decades of experience, and his daughter, Nyah Miranda, a third-year optometry student at New England College of Optometry. The discussion delved into how generational perspectives influence the profession and how they can be integrated to elevate the field of optometry.

Topics Covered:

The Current Landscape of Optometry Mentorship and Growth Opportunities Bridging the Gap: Leadership and Ownership Creating Meaningful Relationships in Eye Care The Importance of Leadership in Eye Care

The Current Landscape of Optometry

Optometry has evolved tremendously over the years. Where private practice ownership was once the ultimate goal for most graduates, today’s new optometrists focus on work-life balance, career flexibility, and diverse professional opportunities. The changes in mindset reflect the broader societal shifts in work preferences, with younger generations placing higher value on personal fulfillment and balanced living.

Dr. Trevor Miranda shared insights from his early career, where the traditional path involved opening or buying into a private practice soon after graduation. “When I graduated in 1995, everyone wanted to own a practice,” he recalls. “It was almost assumed you’d end up as an owner or at least buy into a practice after a few years as an associate.”

Fast-forward to today, and the younger generation—represented by students like Nyah Miranda—often takes a different approach. “Our generation really values work-life balance,” says Nyah Miranda. We want fulfilling careers, but we don’t want to burn out. We’re seeking workplaces that offer that balance while also providing opportunities for professional growth.”

This shift in perspective isn’t about laziness or lack of ambition; it’s about creating a sustainable career. Optometry students and young professionals are still driven and hardworking, but their focus on personal well-being reshapes the profession’s operations.

Mentorship and Growth Opportunities

One area where both generations agree is the importance of mentorship. Having a mentor is critical to success for young optometrists entering the field. Mentorship guides clinical skills and the business side of optometry, helping young optometrists navigate the complexities of practice ownership, patient management, and leadership.

Nyah Miranda emphasized that many optometry students actively seek mentorship when they enter the workforce. “We want to know there’s a path for growth, whether it’s leadership within the clinic or the potential for ownership down the line,” she explains. “Knowing that there’s room for advancement and that the clinic is invested in our future makes a big difference.”

Nyah Miranda, Optometry Student at NECO

For seasoned optometrists like Dr. Trevor Miranda, offering mentorship is just as rewarding as it is for the mentees. “It’s about recognizing the talent in the younger generation and helping them develop their skills,” he says. “Mentorship allows us to pass on our knowledge while learning from their fresh perspectives.”

Bridging the Gap: Leadership and Ownership

The question of ownership in optometry is another point where generational differences become apparent. Many young optometrists aren’t as eager to take on the responsibilities of running a practice. The financial bu...

Dr. Trevor Miranda, Optometrist, Practice Owner, and Podcast Host of Optometry Unleashed

Topics Covered:

The Current Landscape of Optometry

Mentorship and Growth Opportunities

Nyah Miranda, Optometry Student at NECO

Bridging the Gap: Leadership and Ownership

Previous Episode

Eye Stroke – Latest Treatment Options for Central Retinal Artery Occlusion

Dr. Rani Banik dives into the complexities of retinal strokes, specifically central retinal artery occlusion (CRAO), a vision-threatening condition often called an “eye stroke.” Joined by esteemed retina specialist Dr. Richard Rosen, who brings decades of expertise and cutting-edge insights into retinal care, the episode explores the latest treatment advancements transforming CRAO outcomes.

From interventional radiology to swift diagnostic techniques, Dr. Rosen shares groundbreaking approaches that provide new hope in preserving sight when every second counts. “Time is of the essence with retinal strokes; every second counts for salvaging sight,” notes Dr. Richard Rosen, a leading retina specialist.

What’s Covered:

What is Central Retinal Artery Occlusion?Traditional Treatment Approaches Cutting-Edge Treatments in CRAO Post-Treatment Care and Monitoring Educating Patients and the Public

What is Central Retinal Artery Occlusion?

CRAO occurs when a blockage forms in the central retinal artery, typically from an embolus originating in another part of the body, like the carotid artery or the heart. CRAO presents as sudden, painless vision loss in one eye, with minimal chance of natural visual recovery. If left untreated, the retina’s oxygen-deprived state rapidly damages photoreceptors, leading to permanent vision impairment.

Traditional Treatment Approaches

Historically, CRAO treatment was limited to methods like:

Reducing intraocular pressure (IOP) by using glaucoma medications or paracentesis.
Dilation methods include breathing into a paper bag, which increases CO2 levels to dilate ocular blood vessels.
Carbogen therapy is a mixture of carbon dioxide and oxygen that dilates blood vessels, allowing the possibility of embolus dislodgement.

These interventions, however, produced limited results, prompting the medical community to explore more effective, science-driven solutions.

Cutting-Edge Treatments in CRAO

Interventional radiology is one of the most promising developments in CRAO treatment. It utilizes catheter-based procedures to deliver clot-busting drugs directly to the retinal artery. Here’s an overview of the procedure and its benefits.

Interventional Radiology

In interventional radiology, a catheter is threaded from the patient’s femoral artery to the ophthalmic artery. Here, a small dose of a thrombolytic drug, such as a tissue plasminogen activator (tPA), is injected directly into the occlusion site. Imaging technology, like choroidal blush, enables physicians to visualize the restoration of blood flow in real-time. Below are the advantages:

Enhanced precision: Direct administration of tPA minimizes the risk of systemic complications.
Extended treatment window: While earlier methods were limited to six hours, interventional radiology can restore vision up to 12 hours post-onset in some cases.

Incorporating OCT for Early Diagnosis

Incorporating optical coherence tomography (OCT) has been pivotal in early detection. Hospitals with advanced setups like the Mount Sinai system perform OCT scans immediately for patients presenting sudden vision loss, even before dilation. Automated OCTs in emergency departments allow quick access to imaging data, accelerating diagnosis and treatment initiation. “OCT’s role in detecting retinal ischemia early cannot be understated. It’s a crucial first step in mobilizing the care team swiftly,” says Dr. Rosen.

Post-Treatment Care and Monitoring

After initial intervention, a comprehensive cardiovascular assessment is essential, as CRAO patients have an elevated risk of stroke. This includes carotid ultrasounds, echocardiograms, and continuous monitoring for atrial fibrillation. For eye care providers, post-treatment care also involves vigilant observation for neovascularization, particularly in the first six months, to prevent secondary complications such as neovascular glaucoma. Below are some key recommendations:

Monthly follow-ups: Follow-ups are necessary to detect neovascularization, which, if untreated, can lead to increased intraocular pressure and potential blindness.
Gonioscopy: This should be conducted regularly to monitor for anterior segment neovascularization, a common complication in CRAO.

Educating Patients and the Public

A critical e...

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undefined - Top 3 Vision Solutions for Shooters: Contacts, Glasses, and Surgery for Presbyopia

Understanding Presbyopia and Its Impact on Athletes

Presbyopia begins to show in one’s late 30s and is marked by a gradual loss of the eye’s ability to focus on nearby objects. It may start subtly but eventually hampers the lives of those who rely on precise, rapid shifts in focus—like athletes. For shooters, presbyopia affects contrast sensitivity, glare tolerance, reaction times, and near-vision clarity. These subtle changes can significantly impact their performance and overall experience, making presbyopia more than just an annoyance; it’s a genuine performance inhibitor.

Dr. Cunningham, whose work has brought presbyopia to light in the world of competitive sports, emphasizes that presbyopia doesn’t only affect older athletes. “We see early presbyopia effects in the late 30s. It impacts contrast sensitivity, glare tolerance, and even the ability to change focus dynamically, which is essential for shooters,” he explains.

Case Study: Real-World Insights from the Sports Vision Pros Panel

The Sports Vision Pros panel, featuring Drs. Smithson, Cunningham, Black, and shooting champion Chris Ripley, shared valuable insights into treating presbyopic shooters. Each panelist emphasized that precision and focus are everything in competitive shooting, making the right eyewear and refractive solutions vital.

Dr. Black, a former Olympic shooter, highlighted the importance of fitting athletes with precise prescriptions based on the unique needs of each sport. He describes the adjustments shooters often require based on the sport type: “In Olympic shooting, most athletes focus on the distance target. But in pistol competitions, they may focus on the front sight of the weapon, requiring different vision adjustments.” This nuanced understanding of vision demands is essential for optometrists looking to support shooters effectively.

Solution 1: Eyewear Options for Presbyopic Athletes

Corrective lenses tailored for shooting sports are the first line of defense against the impacts of presbyopia. These range from single-vision lenses for distance vision to more specialized bifocals or multifocal options. Each option allows shooters to focus on targets at multiple distances, ensuring the highest precision possible.

Dr. Smithson notes that presbyopic athletes may prefer lined bifocals or progressive lenses, especially if their sport requires frequent refocusing between near and far targets. Dr. Black adds that precision refraction is essential: “Shooter patients often have higher demands than a standard 20/20 prescription. Many can see better tha...