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
A visual showing the efficacy of all the current presbyopia drops.
Jason Ng, OD, manually created a graph comparing the efficacy of all the FDA-approved presbyopia drops. Take that, AI. The differences are quite striking when you see it displayed like this: LinkedIn.
AI is, and should be, a decision-support tool, not a standalone diagnostician.
Hamza Shah, OD, and Michael Twa, OD, review a new paper summarizing the recent AI developments in eye care. Along with their discussion of the paper, they unpack a philosophy toward AI that we all need to adopt: AI is an algorithmic tool to aid, not supplant, our ability to improve individualized care for our patients. Optometry Times
Research I'm Reading
What is the prevalence of horizontal strabismus?
Prevalence data tells you how often a condition should be showing up in your chair — which directly shapes how hard you're looking for it. And when you do find it, having a number to share with patients ("you're not alone — this affects X% of people") does something clinical language rarely does: it makes them feel seen. Survey of Ophthalmology
Deep Thoughts
Nothing raises the temperature in a room of optometrists faster than the conversation about what to do when a diabetic patient presents to the office with a vision plan.
I've watched it happen in almost every teaching setting I've been in. We can disagree calmly about dry eye protocols, glaucoma suspects, and even the scope of practice.
But bring up the question of how to handle the diabetic patient who walks in with a managed vision care plan and something shifts. Shoulders go up. Someone in the back row crosses their arms.
The tension of the situation is worth sitting with, because it tells you something important about how a practice actually understands its own role.
Instead of telling you exactly how to handle these patients, I want to give you some truths to be clear on so that you can apply them to your specific practice modality and location.
Diabetic management is a litmus test.
How a practice handles diabetic patients with a vision plan is a reliable indicator of whether the doctor genuinely believes that chronic disease management is worth more in time, expertise, and cost to the patient than a wellness screening.
I've watched doctors sit through an entire coding seminar, take detailed notes, and then continue billing every diabetic patient to the vision plan because the alternative felt too uncomfortable. The knowledge was never the problem. The belief was. If you don't actually think disease management is categorically different from a wellness visit in clinical weight, in what you owe the patient, in what it costs to deliver, then no billing system will fix that.
The insurance question is downstream of a more fundamental one: Do you believe what you are doing is worth what it actually costs?
The chief complaint drives the encounter and therefore the payor.
A vision plan is a wellness benefit. It was designed for the healthy patient with no active disease, no chronic systemic condition affecting the eyes, no management decisions being made.
When a diabetic patient walks in, that description doesn't fit regardless of whether retinopathy is present. The chief complaint, the actual clinical reason for the encounter, is diabetes with its ocular implications. That is a medical visit. The billing follows the encounter, not the calendar, and not whichever plan is easiest to bill.
Know your contracts and keep your encounter types clean and separate.
Most managed vision care contracts state explicitly that if a medical condition is the purpose of the visit, the medical plan is primary. This isn't a gray area. Billing to medical when the encounter is medical is not gaming the system; it is following the rules of both plans. The coordination of benefits language exists precisely for this reason.
The deeper problem with using vision plans as a convenience payor for medical encounters is that it builds your management system around a variable you don't control.
What happens when the patient's employer changes their vision benefit? What happens when you're in-network with one plan but not the other? You've anchored your clinical workflow to something that can disappear. That's not a system but a risk.
Stop organizing these patients around the annual comprehensive exam and start organizing them around the condition.
A wellness visit is appropriate for a healthy patient with a vision plan once a year. A disease management visit is a medical billing visit documented by complexity and scheduled by clinical indication. The two can serve the same patient over time. They should never be conflated because one is administratively easier.
Practice Performance Partners Pick
How do you manage the claims and insurance credentialing components when using a temporary fill-in at your office?
Peter Cass, OD, unpacks the details in this excellent article — rare in content but super relevant for practice owners.
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