Welcome to Optometry Simplified.
In this weekly newsletter, I've curated the best resources to help you grow personally and professionally.
My mission is to find what's best for my patients and my practice.
Here's what I've found...
Links I Liked
All things new blood vessel growth in the eye
If you know how to identify new blood vessels and their differences in the eye, you'll know when to intervene, says Sara Weidmayer, OD. For a comprehensive and practical overview of the many types of angiogenesis in the eye, check out her fantastic article. Review of Optometry
Ever wondered how a drug’s history shapes the diseases we see every day?
A great new podcast, Drug Story, dives into the disease business and the real impact of pharmaceuticals on health and care decisions. Essential listening for evidence-minded primary care providers. Drug Story
Research I'm Reading
For most of us, this won’t change next week's clinical care.
But as GA treatments expand and optimal timing becomes more critical, understanding subtle vascular changes on OCTA can help us identify higher-risk patients earlier and
improve the precision of our referral timing. If you have OCTA in your office, start looking for CC flow deficits in your AMD patients. Clinical Ophthalmology
Deep Thoughts
I don't always allow someone else to write my deep thoughts, but when I do, it's my good friend and colleague, Christopher Wolfe, OD.
Here is his take on the recent FDA denial of atropine 0.01%:
(If you haven't read it already, here is my alternative take)
We often hear that myopia management is no longer controversial.
In a general sense, that’s probably true. Most of us agree that there are interventions that can slow progression in at least some children, and very few would argue against the goal of reducing long-term myopia-related risk.
But I don’t think that means the field itself is free of controversy.
I think the controversy has shifted.
What feels unsettled to me is not whether myopia management can help, but how confident we sometimes sound when we talk about specific treatments, even when the underlying evidence is complicated, incomplete, or highly dependent on who was studied and how outcomes were defined.
The tension isn’t really between people who “believe” in myopia control and those who don’t.
It’s between probability and certainty.
That distinction matters when we’re talking about treatments given to children over many years, often based on population-level data rather than direct evidence for the individual patient sitting in the chair.
The recent FDA decision regarding low-dose atropine has brought that tension into sharper focus. Much of the reaction has centered on access and intent, both of which are important conversations to have.
What has gotten less attention is the quality and completeness of the data most of us are actually reacting to. Right now, that data largely consists of a scientific poster and secondary interpretation, not a full peer-reviewed manuscript.
That doesn’t invalidate clinical experience, nor does it make expert opinion irrelevant.
But it does suggest that some caution is warranted before we move too quickly from evidence to belief, and from belief to certainty.
One of the more helpful contributions to this discussion, in my view, has been Kyle Klute’s recent piece here on Optometry Simplified, where he looks at myopia control through the lens of effect size using Number Needed to Treat.
I’m intentionally not recreating his analysis here, and I would strongly encourage anyone interested in this topic to read his article directly.
What makes that framework useful isn’t that it declares one modality good and another bad. It’s that it forces us to think about magnitude.
A treatment can be statistically effective yet yield an average benefit that is modest, variable, and highly dependent on patient selection. That difference matters a lot in real-world practice, where adherence is imperfect, outcomes accumulate slowly, and baseline progression risk varies widely.
The STAR trial data highlight this challenge. The emphasis on refractive, threshold-based endpoints makes results easy to communicate, but they are also sensitive to how those thresholds are set and to the heterogeneity of the enrolled population.
Small shifts in mean progression can be real and still fail to inspire broad regulatory confidence, especially when subgroup consistency is limited, and uncertainty remains.
The lack of axial length as a central required outcome further complicates interpretation for many clinicians. Refractive change is important, but axial elongation is what drives long term risk.
When axial length is not clearly emphasized, it becomes harder to talk confidently about disease modification rather than refractive slowing, even if refractive outcomes look favorable.
Dose selection raises similar questions. Much of the broader atropine literature suggests stronger effects at higher low dose concentrations. In everyday practice, once compounding logistics are in place, prescribing higher concentrations is not particularly difficult.
The real work is in education, monitoring, and follow-through. Approving the weakest effective dose as the first defining standard risks anchoring expectations around a modest signal, particularly for higher-risk children who may need a more assertive approach.
It’s also worth being honest about what FDA approval does and does not guarantee.
Approval does not always translate into easier access, lower cost, or smoother workflows. Many of us have seen examples in other areas of eye care where approval narrowed options and increased administrative friction. That doesn’t make approval a bad goal, but it does mean we should be cautious about assuming it automatically improves care delivery.
For clinicians, the takeaway isn’t to abandon atropine or wait indefinitely. It’s to be intentional. Establish baseline risk. Match the intervention's strength to the rate of progression. Monitor response and be willing to adjust. And communicate in probabilities rather than promises.
Modest effects can still matter, but only if we’re clear about what they are.
I don’t see this moment as a referendum on myopia control or atropine as a category. I see it as a reminder that evidence, interpretation, and urgency don’t always move at the same speed.
Kyle’s analysis helps ground the discussion in effect size. The STAR poster raises important questions about endpoints, consistency, and robustness. Neither tells the full story on its own, but together they help explain why regulators may have paused.
At the very least, this should encourage all of us to slow down a bit and reexamine how confidently we describe benefit, especially when we’re talking about treating children for many years.
That pause isn’t a weakness. It’s part of practicing careful, honest medicine.
Practice Performance Partners Pick
I recently needed to review this article for a situation in my practice, and it’s a timely reminder that patient access to medical records is far more expansive than many offices realize.
Patients are entitled to timely access to their full records in the format they request, and adding unnecessary hurdles can create real compliance risk.
If your team isn’t clear on what is and is not allowed under HIPAA, this is a practical, must-read refresher from Joe DeLoach, OD.
Can you do me a favor? If you found any of these resources helpful, share this newsletter with one of our colleagues!
See you next week!
--Kyle Klute, OD, FAAO