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
AI wants to be in your exam room.
I've been watching this space closely, and this article reinforced why it matters specifically for primary care ODs. ChatGPT Health and Claude for Healthcare are now being built as healthcare infrastructure, not just productivity tools, which means patients will arrive more "informed" but may still need more clinical correction, not less. AI in Eye Care
Give your patients all their options.
As full-scope primary care optometrists, we should include both surgical and optical options for our patients with myopia. Here is a good roundup of the current landscape of surgical options for myopia patients, big and small. Eyes On Eyecare
Research I'm Reading
Do you dilate your post-YAG capsulotomy patients?
A recent study prompted me to reassess my own protocols for post-YAG capsulotomy evaluations. The study found that patients with NPDR who undergo YAG capsulotomy have a significantly increased risk of progression to PDR, vitreous hemorrhage, tractional RD, and need for PRP within one year. Journal of Cataract & Refractive Surgery
Deep Thoughts
How often do you dilate your patients?
Since the advent of ultra-wide field imaging (UWFI), there's been a persistent tension in our profession: the "dilate everyone annually" crowd on one end, and the "UWFI replaces dilation" crowd on the other.
Where do you land? Where should you land?
Let me name what I think is actually happening: this is a false dichotomy. Dilation and UWFI are not opponents. They are complementary tools.
In an ideal world, every patient gets both: a dilated exam and a quality widefield image. The image is permanent, shareable, and gives you time to linger over pathology. Dilation gives you stereopsis, dynamic evaluation, and access to the extreme periphery that even the best UWFI systems still struggle to capture.
That's the ideal. Reality is messier. Performing both on every patient isn't practical for most practices. And patients despise it. So the real question becomes: when does each tool earn its place in the visit?
To answer that well, I pulled together summaries from 18 clinical practice guidelines from the AAO and AOA. Here's what they actually say.
General Population
For healthy, asymptomatic adults, the AAO and AOA aren't fully aligned. The AAO recommends exams every 5–10 years for adults under 40, scaling up with age: every 2–4 years from 40–54, every 1–3 years from 55–64, and every 1–2 years at 65 and older. The AOA takes a stronger stance — recommending annual exams for all adults to catch sight-threatening conditions early. For children, both organizations agree: a first assessment between 6–12 months, at least once between ages 3–5, and annually once school-age.
Diabetes
This is where dilation is unambiguous, as it remains the gold standard for diabetic retinopathy screening. Type 1 patients should have their first dilated exam 5 years after diagnosis, then annually. Type 2 patients need an exam at diagnosis and at least yearly thereafter. Pregnant patients with pre-existing diabetes should be seen prior to conception, early in the first trimester, and then again if retinopathy exists.
Once retinopathy is present, the intervals tighten considerably:
- No DR or Mild NPDR → every 12 months
- Moderate NPDR → every 6–12 months
- Severe or Very Severe NPDR → every 2–4 months
- Proliferative DR → every 2–4 months
This is not the population for a "just image it" approach.
Glaucoma
Glaucoma suspects should be observed with dilation every 12 months depending on risk level. Diagnosed POAG patients need individualized follow-up: every 3–12 months if stable and at target IOP, every 1–3 months if unstable or not at target. Dilation should be strongly considered at each interval to ensure adequate stereoscopic views and imaging of the optic nerve.
Macular and Vitreoretinal Conditions
- Early AMD → every 6–12 months
- Intermediate AMD → every 6 months
- Advanced AMD (unilateral) → the fellow eye every 3-6 months to catch asymptomatic neovascularization
- Symptomatic PVD, no break → dilation plus repeat exam in 4–6 weeks
- PVD with vitreous hemorrhage → weekly until hemorrhage clears or a tear is ruled out
- Lattice degeneration → annually
- Asymptomatic atrophic holes → every 1–2 years
- Central RVO or ischemic CRVO → as often as monthly for the first 6 months to monitor for neovascular complications
So Where Does UWFI Actually Fit?
UWFI earns its place with lower-risk patients: younger, healthy, presenting for routine care. It creates a permanent record, enhances peripheral evaluation, and is genuinely valuable for patients who dilate poorly (cataracts, sphincter damage, small pupils).
There's also a well-documented reality: some retina specialists (me too) have missed tears on BIO that were later identified on widefield photos, and the reverse is true too. These tools catch different things.
But UWFI has a ceiling as a replacement. Dilation still defines a comprehensive exam both clinically and medicolegally. The extreme superior and inferior periphery remain challenging even for the best systems. And a clinician who has let their BIO skills atrophy because "the Optos handles it" is not serving their high-risk patients well.
The Practical Bottom Line
Let the guidelines drive your dilation decisions for disease-state patients. Use UWFI to augment those exams, not replace them. For lower-risk patients, UWFI may be a reasonable primary tool when dilation isn't practical. But when the clinical stakes are high — diabetes, glaucoma, retinal pathology, high myopia, symptomatic PVD — your full skill set needs to be in play.
The best clinicians aren't asking "dilation or UWFI?" They're asking, "What does this patient, right now, actually need?"
That's the question worth sitting with.
For more on this topic, see how seven gurus talk about UWFI vs. dilation.
Practice Performance Partners Pick
Rock stars, influencers, unicorns, and game changers.
All of these phrases are heavily used in consumer marketing. Should we use them when describing new medical technologies and pharmaceuticals?
Here's my own game-changing article in the Journal of Medical Optometry.
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