North Carolina has always been a very progressive state as far as optometry is concerned, so I assumed that all the states were like North Carolina.
Where did you grow up?
I grew up in nowhere, North Carolina, an hour south of Raleigh and 20 minutes north of Fayetteville. It was really in the middle of tobacco country, and I grew up barning tobacco. Started when I was four or five years old. They would let the kids come to the barn and pick up leaves and, you know, after awhile of doing that you start asking, “Can I get some money for this?” So, they would slot me a quarter an hour to pick up leaves and bring them back over to the barn. It’s an interesting process…until I was 18 in summers we would put in a few barns in the morning and then I would go wait tables at night. I spent a lot of time trying to make money when I was a kid; I was quite the entrepreneur.
What led you from pharmacy into optometry?
That’s the million-dollar question. I wish I had a quarter for every time they’ve asked me. [Laughs] I went to the University of North Carolina; I thought I would go into some type of medical field. Then I met a guy-you know how that can change your life’s course-he was going to pharmacy school. So I started looking around to see what that entailed. I finished up my degree and went to the hospital in a nearby town, which had helped contribute to my schooling. Even though I really like pharmacy, I realized pretty quickly that I didn’t have a lot of control over what happened with the patient. I could make recommendations, but I didn’t have any final say. So after a year of being there, I realized I wanted to further my education. At the same time, pharmacy schools were saying that all programs would go to a doctorate program. That meant people like me who had just graduated would be in competition with a six-year doctorate. At that time if you were already out, you would have to go back for two more years to get the doctorate. I thought, if I’m going to go back for two years and basically have the same degree I already have, I might as well plunge into something else. That’s how I ended up in optometry school. I called the University of Houston and told them I was a pharmacist and I was interested in going back to school. They wanted me to come down the next week. They were very open to having me come in and I didn’t get any trepidation some schools and universities had given me.
How do you find the two disciplines complementing one another?
North Carolina has always been a very progressive state as far as optometry is concerned, so I assumed that all the states were like North Carolina. Once I found that was not the case, especially in Texas, it started to open my eyes at how much there was a lack of orals and understanding and education that goes along the pharmaceutical route of ocular diseases. It was nice to put those two together. I’ve been able to be that liaison in education, lecturing, and write about what medications can be used and ease optometrists into the realm of pharmaceuticals, especially oral pharmaceuticals in ocular disease.
Should ODs have more education about pharmaceuticals?
I’m going to say yes, of course. We have to because of the increase of disease, the increase in aging population, and the decrease in ophthalmology available. Ophthalmologists go through med school learning everything about the body first, and then they add the eye later. When they see a patient, they think of ocular disease and what kind of organism is this most likely to be given the state of this patient. We’re not trained that way. We learn about keratometry values first, and we learn about how to read glasses. Then at the end, they start throwing in hypertension and all those things. It’s like you think eye first, body later instead of body first, eye later. I think that hinders our ability to understand some ocular disease states. If we’re going to continue to take over more of those things, that has to be changed as well.
What common drug interactions or side effects should ODs be more aware of?
For a long time, people were thinking about antibiotics and interference with birth control. That’s a myth out there. People are always concerned about using topical sulfa-meds, such as glaucoma medication that have a sulfide chain, in patients who are sulfa-allergic. We have to remember that sulfa-allergic patients are generally allergic to sulfa-antibiotics. In optometry, you’re not usually going to have patients on long long-term therapy. Most of the drugs that we start, especially orally, you’re talking about seven to ten days in most cases. In pain medications, probably two or three. So, in general most of the things we’re doing are short term.
What medications should ODs be more cautious with?
States have been reluctant to allow a lot of oral steroid use in optometry, and I can’t say I really blame them until we’re much more educated. Steroids are one of our biggest concerns for how they can change people’s basal metabolic rate, there are diabetic concerns, and they have to be tapered appropriately. Oral steroids are going to be the biggest hurdle we face in making sure we are properly educated and understand the decisions and contraindications that go with them.
Where can ODs go to keep abreast of regulatory changes in pharmaceuticals?
The two I turn to most are CenterWatch.com and RXList.com. The first talks about newer medications that are coming out, what’s in the pipeline, if there’s Phase II or III trials. It covers all types of medications. The second is a great resource for getting good information on medications and any changes. Some of the best information I find in nursing handbooks because they’re always looking to find the most common side effects or what will come up most often. I always tell interns to buy a pocket nurse’s handbook on drugs.
How did lecturing and continuing education enter your career?
The first lecture I did was for the local county optometric society meeting here in town. Once you start, it snowballs. The next thing you know, someone asks you to do the same one, and it just goes from there. I became more popular, if that’s the right word, after I lectured at SECO. So many people hear you, take that back to their home states, and it goes from there.
How did Tropical CE come about?
An optometrist near Houston had referred patients to our clinic, and he and his wife had this going on for years themselves. It started that they and some buddies liked to dive and go to great locations, and they thought, let’s add some continuing education in. It snowballed for them and became not just friends but friends-of-friends. So, they had built Tropical CE already. Unfortunately, the doctor died in a crash with his private plane about the time I had done a few lectures for him. So it was open for someone who was interested in taking it over. My husband had just sold out from his engineering company and was looking for something to keep him busy, so it fell in our lap only because I knew the doctor and his wife personally.
When do you have down time and what do you do?
I’m not a good down-timer. That’s on my New Year’s Resolution list. We have two boys, 8 and 9, so they keep us busy. I’m not a very good idler, I don’t watch television. Because I’m the farm girl, I still get up very early in the morning. It’s hard to sleep in. The only thing I do that’s considered down time that a lot of people wouldn’t is Cross Fit. I don’t have a lot of hobbies. I don’t sit very well.
If you could do it all over again, what would you change?
I don’t know that I’d change anything. Some people would say I should have become an ophthalmologist. I think that if I had went to med school, I probably would have never ended up in ophthalmology. I probably would have ended up in internal medicine or maybe neuro. I think I ended up in the right place. Some of that has to do with making the right choices and some of that has to do with just damn luck, you know. My course in life was certainly altered by meeting Dr. Edward Raith, the surgeon who I worked with. He taught me so much. The pharmacy helped me understand his language. Without running in to him, I would have had a completely different course.
What's the craziest thing you've ever done?
Things that shouldn’t be discussed. Yeah, that would not make me look as good as I think I should. Yeah, I’ll plead the Fifth.