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Optometry Simplified: July 9: How Practices Decline, Genetic Testing in Glaucoma, Scleral Lens Lessons, and more
Published 17 days ago • 4 min read
Welcome to Optometry Simplified.
In this biweekly 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
They've Fit Over 5000 Patients With Scleral Lenses. Learn From Them.
Scleral lens fitting isn't something I do every day, so refreshing my knowledge from those who do it all day, every day is extremely helpful. Here are some great clinical pearls from the experts. Review of Cornea & Contact Lenses
When Medical Experts and Practice Guidelines Get it Disastrously Wrong.
History shows that expert panels and clinical guidelines can sometimes get it wrong. The rise of pediatric peanut allergies in the US is one example. Poorly interpreted data was used to promote total peanut abstinence in children in the Pediatric guidelines. This led to a dramatic rise in peanut allergies. The lesson for optometrists is not to avoid the experts and the guidelines, but to read with caution and remain critical. Sensible Medicine
Would You Treat or Monitor This Glaucoma Suspect? I Wouldn't, but This MD Did.
It is important to know that polygenic risk scores (PRS) are being used in various diseases in medicine, including glaucoma. This seemingly low risk glaucoma suspect (borderline IOP and family history) was ultimately treated by one MD due to the results of the PRS. Glaucoma Today
Research I'm Reading
Is It Optic Disc Drusen or Edema? How Do You Know? What Do You Do?
Optic disc drusen is a common finding in the every day experience of the primary care optometrist. Until now, no specific algorithm has been proposed to determine low risk vs. high risk patients for papilledema. This paper reviews the role of imaging modalities and proposes a management protocol. I thought it was worth the $10 purchase for the full article. Acta Ophthalmologica
We Are Still Terrible at Educating the Public About Pediatric Eye Exams
About 1/3 of children are receiving eye exams. How many of them visit the dentist? I'm guessing more. What are the common barriers to eye exams? Cost and appointment availability. To me, this is a marketing problem. Our marketing problem. American Journal of Ophthalmology
How Often Does SLT Go Severely Wrong?
SLT as first line therapy in ocular hypertension and glaucoma is growing in popularity due to recent research showing its efficacy and safety. But how often do things go wrong? Severely wrong? Acta Ophthalmologica
Deep Thoughts
How could mighty optometry practices suddenly decline?
Jim Collins wrote How the Mighty Fall to map out how once-great companies decline.
Turns out, optometry practices aren’t immune.
When I read this, I couldn’t help but translate each stage into real-world leadership traps I’ve seen, and occasionally fallen into, in private practice.
Here are Collins' 5 Stages of Decline and how they show up in our world:
Stage 1: Hubris Born of Success
“We’re doing great—why change?”
Complacency with Practice Growth: Assuming current success means future success, leading to stagnation in clinical advancement or business strategy.
Ignoring Staff or Culture Issues: Letting team dynamics deteriorate under the illusion that good revenue means a healthy culture.
Neglecting Market Shifts: Dismissing changes like increased online optical retail or the rise of medical optometry.
What to do instead: Stay curious. Also, don't neglect "why" you do what you do and focus too much on "what" you do. Running your practice should be a process of what Collins calls "never-ending creative renewal."
Stage 2: Undisciplined Pursuit of More
“Let’s expand! More locations, more tech, more services!”
Rapid Expansion Without Infrastructure: Opening new locations or hiring without foundational systems and clarity.
Adding Services Without Strategy: Jumping into aesthetics or specialty lenses without evaluating patient demand or team capability.
Over-leveraging Through Loans or Tech: Buying expensive equipment without a clear ROI or staff readiness.
What to do instead: Move at the speed of the right people.
Stage 3: Denial of Risk and Peril
“It’s just a rough patch—we’ll be fine.”
Blaming External Forces: Insurance, competition, or the economy is blamed instead of internal operational gaps.
Minimizing Negative KPIs: Rationalizing falling revenue or poor recall rates instead of investigating root causes.
Refusing to Confront Brutal Facts: Avoiding team feedback, ignoring operational inefficiencies, or patient dissatisfaction.
What to do instead: Face the brutal facts and unify your team around confronting those brutal facts.
Stage 4: Grasping for Salvation
“Let’s hire a rockstar OD, buy a new machine, or run a promo to fix it all!”
Hail Mary Marketing: Desperate promotions or deep discounts instead of building long-term patient loyalty.
Over-reliance on One Person: Hiring an associate or consultant and expecting them to solve systemic issues.
Technology as a Silver Bullet: Buying new tech to ‘fix’ declining revenue without training, strategy, or staff alignment.
What to do instead: Recommit to the fundamentals of your business. Here's my favorite quote of the entire book: "The signature of mediocrity is not an unwillingness to change. The signature of mediocrity is chronic inconsistency."
Stage 5: Capitulation to Irrelevance or Death
“It’s not worth fighting anymore.”
Selling to Private Equity Prematurely: Burning out and exiting without a plan or full practice valuation.
Letting Culture Collapse: Staff apathy, high turnover, and no leadership engagement.
Losing the ‘Why': When the mission becomes only about survival, not patient impact or legacy.
What to do instead: Collins says it best: "Never give in. Be willing to change tactics, but never give up your core purpose. Be willing to embrace loss, to endure pain, to temporarily lose freedoms, but never give up faith in the ability to prevail. Be willing to form alliances with former adversaries, to accept necessary compromise, but never - ever - give up on your core values."
Preach it.
New at Practice Performance Partners
Want to hear how other practice owners are applying the lessons from How the Mighty Fall?
Check out our latest Book Nerds episode where we dive into the 5 Stages of Decline—and what they mean for optometry. Listen here
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