Advice Column / Health & Wellness

Make Mental Health A Priority

By Meredith Young 12.18.20

COVID, elections, zoom, family, friends, sanity. The list goes on and on. It can be difficult to step out of your own bubble to realize everyone around you is going through their own version of the same thing. We worry about our loved ones’ health and safety; we worry about the state of our nation; we worry about keeping up with countless online platforms just to stay on track with school, and all while maintaining our personal and romantic relationships.  

 

It can become very easy to feel desensitized by all the negativity we are bombarded with on the internet and it has become almost normal to expect the worst in the year 2020. We’ve all heard the jokes and the seen the memes. It feels almost unnatural to continue regularly scheduled curriculum while the world around us seems to be in a state of instability. Add the presidential election to the mix, and you have yourself the perfect recipe for anxiety. Not only is the abrupt transition having an impact on our learning, but also on our mental health.  

 

I challenge you to take charge of your mental health and reach out to various resources available to you. Many universities offer counseling/therapy free of charge to their students and you would be surprised how beneficial it is to talk about your personal experience with someone outside of your close circle. Personally, I had never participated in counseling sessions until recently, but it took a small weight off my shoulders and that made all the difference. Normalize saying no to others once in a while and take time for yourself to catch a breath. I know a lot of us are overachievers and want to do it all, both in our personal and academic lives, but it is important to take a step back and remind yourself how far you’ve come and to put yourself first. As someone who’s always had trouble reaching out for help, I can understand the hesitation.  

 

The first few months into the pandemic it seemed easier to stay productive with projects, trying new recipes, learning TikTok dances and even catching up on schoolwork. Now that we are more than half a year into the new normal, motivation can be harder to come by. For those 1st years who are beginning their journey in optometry virtually, for those 2nd years that are struggling to keep your clinical skills up to date with limited in person practice, for those 3rd years that are struggling to study for boards and keep up in clinic, and for those 4th years that are trying to learn as much as they can on rotations before setting forth onto the real world, remember that we are all doing the best we can and that is all anyone can ask of you.  

Student Experience

Optometry Externship In Bush, Alaska

By Meredith Young 12.16.20

After three crazy years of trying to balance classes, clinic, labs, and life, everyone in my class at Southern College of Optometry (SCO) was looking forward to our fourth-year clinical rotations. At SCO, we select two sites— one institutional and one private— in addition to our in-house rotation. In the summer of my second year, I was introduced to an institutional site in Bethel, Alaska: the Yukon-Kuskokwim Health Corporation (YKHC). This site is an Indian Health Service located in the heart of the Yukon-Kuskokwim Delta in the southwest Alaskan tundra. After researching all night when I should have been studying for pathology or pharmacology, I began counting down the days until I could begin my journey in the Last Frontier.  

When SCO closed secondary to the pandemic, my first thought was: Would this carry over into the summer? Fortunately, I was still able to fly north to work at the hospital, and I am extremely thankful both SCO and YKHC Optometry granted me this incredible opportunity.

Helping at-risk populations and those in need of eye care has always been a burning passion of mine, and this past summer in Bush, Alaska, re-fueled that love. 

 So, what is optometry like in an area surrounded by water that is only accessible by plane, boat, or snow machine in the winter? I was wondering the same thing about four months ago. 

The YKHC provides comprehensive care— medical, dental, optometric, auditory, and more—to the village of Bethel as well as the 58 surrounding villages in the Delta. The region is about the size of Oregon and contains over 23,000 people. There are five sub-regional clinics in the area, and each village has its own clinic that houses traveling workers, such as nurses, dentists, and optometrists. The YKHC opened a brand-new hospital last year, including an eye clinic with an in-house optical, a technology room with a fundus camera, OCT, visual field, an anterior segment camera, and over 10 exam lanes for patient care. 

In the summer, optometry does not travel out to villages as frequently because most people are fishing or at fish camp smoking and preparing their fish. Due to this, more patients travel to the YKHC to receive eye care. Usually, there are a plethora of flights bringing people into Bethel, but flights were very limited this summer as a result of the pandemic. Most of our patients took a boat from their villages, some traveling several hours both ways to receive care. To offset this, YKHC Optometry traveled to eleven villages between May and August; I was fortunate enough to partake in two of these village trips. 

For my first trip, we traveled via plane to Akiak, and on my second trip, we took my preceptor’s family’s boat upriver to Kwethluk. The populations of these villages were just under 400 and about 750 people, respectively. Our housing was located at the back of each clinic as there was a room with bunk beds and a kitchen, as well as a private bathroom with a shower. Both trips were similar in that it was me with one other extern and one staff doctor providing care to as many people as we could in one week. Case history, chair skills, and ocular health examination took place in a nurse’s exam room, and we performed refraction in the dental room. Between the two clinics, we saw a total of 136 people. Most of the patients were either young children or elderly people who were either unable or uncomfortable to travel to Bethel due to the circumstances. There were a few patients we had to refer to Bethel for specialty testing or emergency follow– up care at the hospital.  

To protect ourselves and our patients, all of us providers had to be tested for COVID-19 before traveling to the villages. In the clinic, masks were required at all times, and if a patient did not have one, face shields were provided. Tonopen was performed to check IOPs, and between patients, we completely sanitized our rooms, including chairs, equipment, and anything the patient had contact with during the exam. Patients were scheduled in 15–minute increments to cut down on the number of people in the waiting room at a time. When choosing glasses, there were only a few options, and each frame was disinfected afterward. Additionally, a janitor cleaned the entire facility twice a day, including our housing quarters in the back of the clinics. 

 My experiences this summer in Bethel, Akiak, and Kwethluk were unforgettable, despite the impact from the pandemic. I could not have asked for a better rotation as my preceptors, fellow externs, and patients all greatly contributed to my growth as a fourth-year clinician. Alaska has a special place in my heart that I will cherish as I wrap up my optometric education and begin my dream career. 


Autumn Killop (SCO) with Danielle Dyke AZCOPT(left), and Dr. Krystle Peñaflor (right)

 

 

Advocacy

Why Advocacy?

By Meredith Young 12.16.20

Advocacy: not exactly the first word that came into our minds when we decided to become doctors of optometry. Most of us decided on optometry because we wanted to help people, not argue with them. Yet, why are we constantly talking about advocacy, and why is it that we must advocate so much, when it feels like our colleagues in other health professions do not have to? Well, the truth is, they do. It is easy to look out at the world and think that our own circumstances are unique, and in some ways they are. However, when it comes to advocacy, every profession must advocate for themselves in some way. Some health professions must advocate that they are the specific medical specialty that should be doing a procedure within their own communities. Others, such as optometry, must advocate to help create/change laws that more accurately reflect our capabilities as doctors. This is why we advocate: because at the end of the day, no one knows what a doctor of optometry can do better than a doctor of optometry.  

Then why is it that so many of us feel such distain for the word? Well, I think that one of the main reasons is that a lot of people have a distaste for politics in general, and a word like advocacy makes most of us think of politics. That is not all that being an advocate means though. The Oxford English Dictionary defines advocacy as, “public support for or recommendation of a particular cause or policy.”  Advocating for our profession means that we show it our support, but that does not necessarily mean you have to be involved in the political world. While yes, it would be amazing if everyone had the desire to go out and lobby for our profession, that is just not in some people’s comfort zone/skill sets and that is fine! Being an advocate for optometry can manifest in other ways. Staying up to date on the current issues facing our profession, voting for people who support our cause, or even just discussing some of the issues we face with your friends and family can all have positive impacts for our profession.  

However, if you are on the fence about becoming even more involved with advocacy, let me assure you that there are many opportunities out there for you! The AOSA and AOA do an outstanding job with educating and providing us with opportunities to present our profession to people in a positive light.For example, in September I was a part of the Virtual AOA on Capitol Hill event where we as students got to meet with politicians and staffers to discuss some of our concerns within the field. At first, I was nervous and thought that I would screw up or say something wrong, but the AOSA did a remarkable job briefing us and providing us the information that we needed to competently speak to these representatives. Another really interesting takeaway I got out of this event was just seeing how much politicians and people in general value and respect our opinions as future doctors of optometry. I know it is hard to believe when most of us are so young, but we worked very hard to get where we are, and people know and respect that.

I hope that if you can take anything away from this, it is that every one of us is important to the future of optometry, and if we want it to continue to be the best it can be, we all have to be good advocates and show people what we’re capable of.  

 

Health & Wellness

Optometry: Opening The Door To Disease Prevention

By Meredith Young 12.16.20

It is well known that chronic disease is a driving force for doctor visits today and comprises a large component of health care expenses. However, it has been found that a strong link exists between preventing chronic illness and proper education on smoking cessation, alcohol consumption, physical activity, and nutrition.

Overall wellness involves not just the physical aspects of one’s health, but the mental and social as well.The concept of an integrated health care team is becoming even more essential in the management of patient care.  

As optometrists-in-training, we have the knowledge to educate and guide our patients towards the right information and resources needed to achieve optimum wellness. Optometry in particular is especially unique in that the doctor-patient relationship created from examining the eyes sets up an opportunity to offer preventative health advice. Patient education on nutrition is just one important component in the multimodal approach to the management and prevention of chronic health problems. However, what healthful information we tell our patients is just as important as how we present it to them. In this article, we’ll talk about why optometrists are in a critical position to influence disease prevention, how to open up conversation about health to our patients, and what pieces of nutritional advice we can provide during patient education.  

In optometry school, we are taught to gather information along every step of the comprehensive exam: beginning with the key elements of a thorough patient history and ending with a complete vascular and neurologic assessment of the back of the eye. We get to know our patients’ personalities and lifestyles by asking targeted questions and using careful listening to deeply understand the entirety of their complaint and condition. By the end of the exam, we have a wholistic picture of our patients’ mental and physical wellbeing. This unique perspective places optometrists in a critical position to be able to impact the health of our patients. However, the manner in which we communicate with our patients is a crucial step in initiating change in their lives.  

Patients with chronic health conditions may feel overwhelmed and rarely motivated to act when given a laundry list of health checks they must meet.

Adopting a patient-centered approach by showing empathy, carrying open, non-judgmental conversation, and seeing the patient’s perspective is important in order to leave them feeling empowered to change.

Motivational Interviewing (MI) techniques have been found to be an effective mode of communicating to increase intrinsic motivation, particularly in diabetics. Below is a list of example questions, some of which have been adopted by the MI technique, that can be used to spark open conversation about health and establish rapport during patient education, a concept shown to leave patients feeling more confident about taking charge of their health.  

  • “With your permission, I’d like to propose a plan…” or “If you don’t mind, may I share a bit of information with you…”1  
  • Replace “I think…” or “You should…” with “Perhaps you could start with…” or “One option you may consider…”1 
  • “Tell me what you prepare for breakfast in the morning…” 
  • “Patients in the past have found that…”1 

With the immense amount of health literature that we have access to today, it can be difficult to narrow down the most important take-home message regarding nutrition and health. Vitamins, minerals, and antioxidants play a critical role at the micronutrient level at impacting our metabolism, microbiome, and cognitive function as well as preventing eye diseases like age-related macular degeneration and diabetic retinopathy. While patients may have a generalized understanding that proper nutrition can affect their physical health and weight, not many are aware of the nutrients essential to eye health. Patients often respond the best when given a single piece of advice, and are surprised to hear that such small changes can make a large difference in their overall health.  Included below is a list of important elements in nutrition and eye health to steer patients towards healthier habits. 

  • Lutein & zeaxanthin. Xanthophylls are one of the two categories of carotenoids, antioxidants that play a role in protecting the health of the macula, ocular surface disease, cognitive function, and skin health. Add 1 cup steamed or 2 cups raw spinach to your meal each day. This could be in the form of a smoothie, a salad, or sautéed into your dinner. Sidekicks are kale, collard greens, swiss chard, arugula, and bok choy.2  
  • Carotenes. The second of two categories of carotenoids. Color your plate with red and yellow peppers, sweet potatoes, squash, cantaloupe, apricots, peas, and broccoli.2  
  • Vitamin C is a water– soluble, potent antioxidant that plays a role in immune function and wound healing, among others. The most abundant natural sources include guavas, kiwis, and bell peppers, though a dissolvable supplement in a glass of water may be necessary in order to reach adequate levels.  
  • Vitamin D is a prohormone that has a supportive role against autoimmune disease, fractures and falls, depression, heart disease, influenza, and type 2 diabetes.2 For fair– skinned individuals, spending a few minutes outside without sunscreen, or for darker pigmented skin, up to 15 minutes, would be enough.  
  • Healthy fats, specifically polyunsaturated Omega-3 fatty acids (EPA, DHA, ALA), have been found to support ocular surface disease, fight inflammation, improve cognitive function, and contribute to hormone production. One handful of walnuts, five times per week, or incorporating wild salmon, Alaskan halibut, or canned, chunk, light tuna (1,000-2,000mg/day) is recommended.2  
  • Absorption of vitamins with healthy fats. In order for proper absorption of vitamins, supplements or foods should be taken with or cooked in healthy fats including avocado, nut butters, and olive oil.  

While these are just a few aspects of health that we encounter during patient care, the optometric exam opens the door to caring for so many other areas of overall wellbeing. As largely a medical profession, we can positively impact our patients’ lives beyond their eyesight and significantly contribute to disease prevention in our community today.  

  1. Welch, G., Rose, G., et al. (2006). Diabetes Spectrum. Motivational Interviewing and Diabetes: What Is It, How Is It Used, and Does It Work? 19(1). 6-8. 
  2. Richer, S., Poteet, J., Summerton, S, et al. (2018). Review of Optometry. Wellness Essential for Clinical Practice. 1(1), 6-17.   
Student Success & Residency

A Survey Of Study Methods: What Works?

By Meredith Young 12.16.20

‘Tis the season for studying here at the University of Houston College of Optometry. The third years are busy with boards, the second years are tackling pharm, and the first years are just now realizing what they have gotten themselves into.  

 As a third year myself, it has been a time of reflection; as I began studying for boards, I realized that there was a lot of information that I had “learned” in my classes, but never retained. Then the big realization hit: I had been cramming for tests my entire academic career. 

 So, as a reasonable person in a state of reflection, I mass-emailed the entire student body of first, second, and third years asking for some advice on studying. It was disguised as a survey of study methods, saying it was for an article I was writing, but the real reason for sending out the survey may have been two-fold.  

Everyone, of course, is different when it comes to learning styles. It’s best to know yourself and your own preferences. Unfortunately, I had no time for that. What I needed was DATA and I needed it quickly.  

Here are the findings (n=151 unless otherwise stated): First, I should say that the classes were almost equally represented. If you really want to extrapolate, it means that I have only a slight skepticism for the current first years.  

People overwhelmingly thought that the best study method was writing and re-reading notes.

 

Many people are happy with their methods for studying, but a good amount are not. Interestingly, the OPT IIIs were proportionally the least likely to be happy with how they study. 

Most people had to change their style of studying for optometry school. 

Finally, I asked for some thoughts if anyone was willing to share. Zebin Dholasaniya, a second year, gave some practical advice by saying that tables allow him to visualize relationships between related or opposing concepts and that color-coding material surprisingly makes recollection of material easier. Some other interesting study methods people reported included teaching others the material, walking around while talking through the material, and spaced recall. 

Brandon Le, another second year said that “[everyone] has different methods. Not one thing works for everyone. It’s important to realize that especially when giving advice; you don’t want to project your own experience onto someone else as gospel. What works for me might not work for others; everyone learns differently and it’s ultimately up to that individual to figure out what works best for her or him.”  

 As much as I hate to take someone’s advice about giving advice, I had to agree with him. There’s only so much that data can do, but if anything, it’s a place to start. From this I have started to incorporate more study methods to see what works for me. This was also a good reminder that as challenging as school can be, reaching out to classmates who are going through the same struggles can help.