Welcome to Optometry Simplified.

Every week, I curate clinical evidence, practical ideas, and enduring principles that can help us care for patients thoughtfully and lead our practices wisely. Here's what I'm learning and applying this week.

Resources to Remember

Your guide to AI adoption in your practice.

Most AI content stops at “this is exciting.” This guide is a six-part playbook that covers knowing your numbers, auditing your workflow, vetting vendors, and naming an internal champion to carry the rollout, with real stories from ODs using AI for scribing, hiring, dry eye workups, and frame selection. AI in Eyecare​

Are you cleaning your tonometry tips the right way?

A new AGS and AAO position statement says an alcohol wipe after physical cleaning is enough for most patients, and that the bleach protocol many of us were taught can actually damage the tip and skew IOP readings. Save disposable tips for patients with signs of infection or a history of chronic viral disease. American Academy of Ophthalmology​

Articles to Apply

Always read the original sources.

It likely won’t change your clinical decisions right now, but it’s the best way to separate hype from reality. This is the US trial behind Stellest’s FDA authorization: showing reduction in refraction and axial length, with the biggest benefit in the youngest kids (6 to 8). JAMA Ophthalmology​

Quotes to Consider

"One of the secrets of productivity is to have a VERY BIG waste basket to take care of ALL invitations...productivity in my experience consists of NOT doing anything that helps the work of other people but to spend all one's time on the work the Good Lord has fitted one to do, and to do it well. People are effective because they say no." - Peter Drucker, quoted in Greg McKeown's Essentialism​

My Observations

Another presbyopia drop just got FDA approval. Ryzumvi (phentolamine 0.75%) was approved for presbyopia on October 16.

This one is a little different. It isn’t new to our offices. It has been on the market since 2024 for reversing dilation. What’s new is the indication and how you use it.

My overall take: interesting, but don’t get too excited. Here’s what the two phase 3 trials (VEGA-2 and VEGA-3) showed:

• Patients: 902 randomized, ages 40 to 64, with no data in patients 65 and older
• VEGA-2: 22.6% gained 3+ lines of near acuity vs 11.0% on vehicle (163 vs 164 patients). NNT of 9.
• VEGA-3: 27.2% vs 11.5% (341 vs 228 patients). NNT of 7.
• When it was measured: Day 8, 12 hours after the seventh nightly dose

Roughly one in four patients got a meaningful near gain. That’s in Vuity’s range (remember that drop?), not a leap forward.

The more useful question may be what makes this drop different.

1. It works differently. Every other approved drop leans on a cholinergic agent to pull the pupil smaller, and most tug on the ciliary muscle too. Ryzumvi blocks the dilator muscle and leaves the ciliary body alone. That likely explains why headache was uncommon. It also explains why the label carries no night driving or retinal detachment warning, which the cholinergic drops do.
2. It’s dosed at bedtime. It’s the first presbyopia drop dosed at night. Patients take one drop before bed, and the benefit shows up the next day. There’s no bottle to carry and no midday redose.
3. The trade-off is redness. Red eyes (21%) and stinging (16%) were the most common side effects. Bedtime dosing may hide some of that overnight, but nobody has studied it.
4. The logistics add friction. It comes in single-use, preservative-free vials that need refrigeration (35 days at room temperature). Tell patients to give it a full week before judging it, since that’s how the trials measured it.

What this means for you: Ryzumvi isn’t the drop for the patient who wants to ditch readers all day. It’s for a new cue: the patient who wants modest help, hates daytime drops, and would rather build it into a bedtime routine. Add that cue to your presbyopia conversation, and keep your current lineup for everyone else.

Can you do me a favor? If you found any of these resources helpful, share this newsletter with one of our colleagues!

KYLE KLUTE, OD, FAAO Curating optometric wisdom

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