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Optometry is built on measurements, clinical findings, and treatment plans. But some of the most challenging patient encounters cannot be fully explained by what appears under the slit lamp. On The 20/20 Podcast, host Dr. Harbir Sian sits down with Dr. Richard Maharaj to explore a more human approach to care, one that considers pain, psychology, communication, nutrition, and the value of simply slowing down. Their conversation challenges eye care professionals to look beyond clinical signs and consider the whole person sitting in the exam chair.
Slowing Down Changes the Patient Experience
A recurring theme throughout the conversation is the importance of being present. Busy clinics can make it easy to view a patient with multiple complaints as another obstacle in an already packed schedule. Maharaj offers another perspective: that patient’s willingness to share is an expression of trust.
Rather than immediately focusing on closing the chart or moving to the next appointment, clinicians can recognize these interactions as opportunities for connection. A few extra moments of patience may change how a patient experiences not only the appointment, but healthcare more broadly.
That philosophy also extends to patient education. Maharaj cautions against fear-based messaging, particularly as patients increasingly arrive with information gathered online. Worst-case scenarios can create anxiety before the clinical conversation even begins.
Instead, clinicians can focus patients on measurable progress. Improvement may not be linear, but showing patients how their findings have changed over several visits can replace catastrophizing with perspective.
Understanding the Biopsychosocial Nature of Eye Pain
Chronic eye pain demonstrates why clinical signs alone may not tell the entire story. Maharaj describes pain through a biopsychosocial model, where physical structures, psychological factors, and a patient’s social environment can all influence how pain is experienced.
This becomes particularly important when symptoms appear disproportionate to observable ocular surface findings. Rather than dismissing the patient’s experience, Maharaj argues that clinicians should acknowledge that current measurements may simply be unable to capture everything contributing to the pain.
That can broaden the care team. Questions about sleep, hydration, mental health, and access to professional support may uncover factors that traditional ocular surface testing does not. When appropriate, collaboration with psychologists, social workers, primary care providers, or other professionals can become part of a more comprehensive strategy.
The goal is not to suggest the pain is “all in the patient’s head.” It is to recognize that the brain is an important part of how pain is processed.
Could Nutrition Become a Bigger Part of Ocular Surface Care?
The conversation also explores emerging interest in nutrition, particularly B vitamins. Maharaj discusses research examining vitamin B across ocular disease and highlights the potential relevance of B12 to corneal nerve health and pain, alongside other B vitamins involved in oxidative stress and ocular surface health.
For Maharaj, nutrition represents another potential tool alongside topical therapy and other established treatments—not necessarily a replacement for them. He describes incorporating B vitamins and vitamin D into his approach for some pain patients while emphasizing the need for continued research into dosing, absorption, formulations, and appropriate patient selection.
It reflects a broader shift in ocular surface care: treatment may increasingly consider not only what clinicians put on the eye, but what patients put into their bodies.
True, Kind, and Necessary
Perhaps the simplest lesson comes at the end of the conversation. Maharaj shares a three-part filter he uses before speaking: Is it true? Is it kind? Is it necessary?
For eye care professionals, those questions can extend far beyond difficult conversations. They can shape patient education, clinical recommendations, interactions with colleagues, and even the information shared online.
Better care does not always begin with another diagnostic test or treatment. Sometimes it begins with slowing down long enough to understand the person in front of the clinician and choosing words that help rather than frighten.
