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
Read and learn to use the guidelines.
Clinical practice guidelines in retina and glaucoma are not about practicing cookbook medicine. They are about anchoring decisions in the best available evidence, reducing unnecessary variation, and knowing when a finding should change what you do next. If you want more consistency in your clinical outcomes and more confidence in your decision-making, learning to use guidelines well is one of the highest-leverage skills you can develop as a primary eye care doctor. Review of Optometry
Eyelids might be the most overlooked diagnostic clue in primary care optometry.
This is a practical, clinic-ready guide to diagnosing and managing common eyelid disorders without overcomplicating things. The cheat sheet format helps you quickly differentiate inflammatory, infectious, and structural lid conditions and ties each one to clear management pathways. If you want more consistency, confidence, and efficiency when patients present with “red, irritated lids,” this is a resource worth bookmarking and revisiting. Eyes On Eyecare
Research I'm Reading
Don't want invasive surgery? Don't be a myope.
New evidence from a nationwide population-based cohort confirms what many primary care eye doctors suspect: Myopia, and especially high myopia, substantially increases not just the risk of developing glaucoma, but the likelihood of requiring glaucoma surgery. For practices aiming to manage chronic eye disease effectively, this study reinforces the value of early identification and proactive disease management in myopic populations. Ophthalmology
Deep Thoughts
With two FDA-approved presbyopia drops now available, the clinical question for primary care optometrists has shifted.
It’s no longer do these work?
It’s how do we decide which one to use?
There are no head-to-head trials comparing Qlosi™ and VIZZ™, so any comparison must be indirect. That means we have to take the trial results as they are, understand what each study was actually designed to measure, and then apply that information thoughtfully to everyday patient care.
The Phase 3 programs for Qlosi™ and VIZZ™ were designed differently, and that difference matters.
Qlosi™ (NEAR-1 and NEAR-2) defined its primary endpoint monocularly, based on the study eye. The endpoint was a ≥3-line improvement in mesopic distance-corrected near visual acuity at 40 cm without loss of ≥1 line of distance acuity.
At that primary endpoint:
- 40.1% of Qlosi™-treated patients met the responder definition
- 19.1% of vehicle-treated patients met the same endpoint
That yields an absolute risk reduction of ~21%, translating to an NNT of approximately 5. In other words, about five patients need to be treated for one additional patient to achieve that level of near improvement compared to placebo at the prespecified endpoint.
VIZZ™ (CLARITY-1 and CLARITY-2) used a different approach. The primary endpoint was binocular, measuring the proportion of patients achieving a ≥3-line improvement in distance-corrected near visual acuity without loss of distance vision.
At that primary endpoint:
- 65–71% of VIZZ™-treated patients achieved the responder definition
- 8–12% of control patients did
That yields an absolute risk reduction of ~53–63%, translating to an estimated NNT of approximately 2.
These numbers are not interchangeable. They come from different endpoints, at different time points, using different testing conditions. But they are still informative when interpreted within the framework of each trial.
In broad terms, the VIZZ™ trials show that a higher proportion of patients are likely to experience a meaningful near-vision benefit at the primary time point studied.
Qlosi™ shows a more modest responder rate at its prespecified endpoint, while still delivering clinically meaningful improvement for many patients.
Another component of the results to consider is the onset and duration:
- Qlosi™: onset ≈20 minutes; duration reliably described as up to 8 hours, with BID flexibility.
- VIZZ™: onset ≈30 minutes; duration commonly framed as up to 10 hours on a single QD dose.
What about side effects?
Because VIZZ™ produces a stronger miotic effect, it also increases the likelihood of trade-offs such as dimming. Additionally, conjunctival hyperemia and instillation discomfort were reported in the trials, and many of my patients have experienced them as well.
Likewise, because Qlosi™ produces a milder miotic effect with shorter duration, that could mean better tolerance, less impact in low-light conditions, and greater flexibility in timing and use.
There are also patient-specific factors, such as pseudophakia, high-order aberrations, and IOL centration, that can influence outcomes.
There was a thoughtful discussion among colleagues on LinkedIn about that topic. For those interested in going deeper, the broader professional conversation on this topic is worth exploring.
Neither profile is inherently right or wrong. They simply represent different balances between efficacy and tolerability.
Applying this in primary care
The point of understanding the trial data and even calculating NNT is not to crown a winner. It’s to help frame a transparent conversation with patients.
This isn’t about committing to one product. It’s about sequencing, setting expectations, and matching the treatment to the patient’s priorities.
Bottom line: this kind of decision-making is the work of the primary eye care provider. As additional agents enter the market, the choices will become more nuanced, not less.
Our role is to understand the evidence, respect the limits of each medication, be transparent about trade-offs, and apply it all thoughtfully in the exam room.
Practice Performance Partners Pick
Are you using G2211 yet?
If not, there’s a good chance you’re undervaluing the longitudinal, relationship-based care that defines primary care optometry.
This concise breakdown from Peter Cass, OD, at Review of Optometric Business explains what G2211 is, why it matters in 2026, and how it fits into everyday medical optometry without adding unnecessary complexity.
It is worth a careful read before you leave money (and meaning) on the table.
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