To learn more about Harbir Sian and the 20/20 Podcast, visit: https://aboutmyeyes.com/
Dr. Harbir Sian is an award-winning optometrist based in Vancouver, Canada. In The 20/20, Dr. Sian interviews guests from various backgrounds and industries to share their struggles and successes. Guests include business owners, entrepreneurs, world-class athletes, media personalities, medical professionals, and more.
Through conversations with these guests, Canada’s number 1 optometry podcast brings clarity to business, entrepreneurship, and eyecare. Dr. Sian also shares his personal experiences through his shorter Eye2Eye segment. In these short episodes, Dr. Sian opens up and provides a vulnerable look into the challenges he has faced (and overcome) in his personal and professional life.
The 20/20 Podcast gives you a look through different lenses and helps you focus on your growth.
In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with internationally recognized dry eye expert and ophthalmologist Dr. Laura Periman from Seattle, Washington. Rather than focusing on rigid protocols or step-by-step treatment algorithms, the conversation zooms out to explore how clinicians should think about dry eye disease in an era of rapidly evolving science.
Dr. Periman explains why “dry eye” is an oversimplified label for an incredibly complex and multifactorial disease process involving inflammation, neurosensory dysfunction, pain pathways, microbiome disruption, blink mechanics, ocular surface disease, and more. She describes the field as a constantly expanding landscape where curiosity, innovation, and questioning old assumptions are essential.
The discussion dives into emerging innovations in dry eye care, including molecular therapies aimed at repairing corneal tissue, targeted approaches to recurrent corneal erosion, novel pain-signaling pathways, and therapies addressing neurosensory compromise. Dr. Periman shares insights from presenting recent dry eye innovations at the American Society of Cataract and Refractive Surgery, highlighting how advances in the field are reshaping our understanding of ocular surface disease.
The conversation also explores personalized medicine in dry eye management. Rather than applying generic treatments, Dr. Periman advocates identifying the specific mechanistic contributors in each patient—whether that’s Demodex, rosacea, incomplete blinking, inflammation, dysbiosis, blepharitis, or neurosensory dysfunction—and selecting targeted interventions accordingly.
Finally, the episode touches on the growing importance of ocular surface optimization before refractive and cataract surgery. Dr. Periman discusses evidence suggesting that preoperative management with immunomodulators may improve surgical outcomes, patient satisfaction, and visual quality. She also challenges long-held beliefs about how quickly these therapies work, emphasizing the importance of revisiting old dogma as new evidence emerges.
At its core, this episode is a reminder that the best clinicians remain curious, question assumptions, and continually evolve alongside the science.
Key Moments
1. “Dry eye isn’t just dry eye.”
Dr. Periman reframes dry eye as an enormous umbrella term covering multiple overlapping disease mechanisms, emphasizing the need for deeper thinking beyond traditional categories.
2. The future of treatment is molecular and personalized.
The conversation explores emerging therapies targeting recurrent corneal erosion, connexin signaling, pain pathways, and tissue repair—pointing toward increasingly precise, individualized care.
3. Better surgical outcomes may start weeks before surgery.
Dr. Periman discusses evidence supporting pre-treatment of ocular surface inflammation prior to refractive and cataract procedures, potentially improving outcomes and patient satisfaction.
Guest Contact Information
Dr. Laura Periman
https://dryeyemaster.com/
Instagram: @dryeyemaster
Love the show? Subscribe, rate, review & share! http://www.aboutmyeyes.com/podcast/
