In this episode of The 20/20 Podcast, host Dr. Harbir Sian sits down live at the BCDO Conference with the one and only Dr. Richard Maharaj, widely known in Canadian optometry as the “Dry Eye Jedi.” Dr. Maharaj is the Managing Partner of Optometry Services at Prism Eye Institute and one of the most respected voices in dry eye disease, ocular surface disease, chronic eye pain, and optometric research. But this conversation goes far beyond tear breakup time, MMP-9, meibography, and treatment algorithms. Instead, Harbir and Richard explore the human side of clinical care: how we speak to patients, how we handle chronic pain, why patients often carry anxiety into the exam chair, and why clinicians need to pause before delivering information that may unintentionally create fear. The episode dives deep into the biopsychosocial model of pain, the difference between pain and visible clinical signs, how to approach patients with symptoms that do not match what we see on the ocular surface, and why mental health support can be an important part of the care pathway. Dr. Maharaj also shares emerging insights into the role of vitamin B, vitamin D, nutrition, corneal nerve health, oxidative stress, and ocular surface disease, including how B vitamins may support patients with chronic ocular pain and neurosensory symptoms. This is a reflective, clinically rich, and deeply human conversation about dry eye, pain, gratitude, patient communication, and the responsibility optometrists have as trusted healthcare providers. 3 Key Takeaways 1. Chronic eye pain must be understood beyond the ocular surface Dr. Maharaj explains that pain is not simply a direct reflection of visible tissue damage. In many patients, especially those with chronic ocular pain, the experience of pain is shaped by the brain, psychology, anatomy, and social context. Optometrists need to recognize that “normal-looking eyes” do not mean the patient’s symptoms are not real. 2. Patient communication can either calm or catastrophize Patients often come into the exam room after consuming online information about dry eye, gland loss, or chronic disease. Dr. Maharaj encourages clinicians to avoid fear-based messaging and instead focus on measurable improvement, realistic timelines, reassurance, and clarity. Most patients improve, but they need to understand that progress is not always linear. 3. Nutrition may play a growing role in ocular surface disease Dr. Maharaj discusses emerging research around vitamin B, particularly B12, in corneal nerve health, oxidative stress, and chronic pain. While topical treatments and procedures remain important, nutrition and supplementation may become an increasingly relevant part of dry eye and ocular surface management. Love the show? Subscribe, rate, review & share! http://www.aboutmyeyes.com/podcast/
