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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...

My Favorite Links

• Huberman on Vision & Eyesight: The popular podcaster, Andrew Huberman, PhD, walks through the neuroscience and behavioral protocols for maintaining and improving visual function. It's not optometry-specific, but it's packed with clinical pearls and lifestyle-based strategies you can share with patients (and maybe apply yourself). Listen to the episode​
• Agency is the New Superpower: This short essay from Jeff Giesea hits home for any doctor feeling stuck. Intelligence, credentials, and CE hours aren’t enough anymore—you need agency. The most fulfilled ODs I know don’t wait for permission to lead. They build, act, and take ownership. Read the piece​
• Therapeutics in the 2025 Pipeline: Modern Optometry delivers a solid preview of drugs in development—from retinal gene therapy to new dry eye agents. It’s a reminder that staying current on pharma is part of our job as primary eye care providers. Check out the pipeline​

Journal Articles I'm Applying to Practice

• Preservatives and Dry Eye: This review (Acta Ophthalmologica, 2024) reinforces what many of us have already sensed: long-term exposure to BAK and other preservatives drives ocular surface inflammation. For chronic users, preservative-free is more than a marketing label—it’s a clinical decision. View the article​
• MiSight + Atropine = Better Myopia Control? New evidence suggests a synergistic effect between MiSight lenses and low-dose atropine (0.05%), with better axial length outcomes than either therapy alone. For fast progressors or borderline cases, this could be the next step in our toolbox. Read the summary from Myopia Profile or the Full article​
• SLT as a Secondary Treatment: Still Effective: This large 2024 trial (JAMA Ophthalmology) confirms what many of us see clinically—SLT still provides meaningful IOP reduction even after patients have started on drops. While SLT-first gets a lot of attention, this study validates the way we've been using it for years - as a second-line or adjunctive therapy when medical therapy isn’t enough. Read the study​

Deep Dive

In an era of new technology constantly knocking on the door of primary care optometry, it’s tempting to believe that more data automatically means better care.

I wrestle with this often because I am prone to delaying decisions before I get just one more piece of information.

Which is why I've labored over whether or not to add ERG to my practice. I've had it in the past (via Diopsys) but have yet to add its new incarnation in the RETeval.

Why have I chosen to hold off? Here are my reasons:

1. ​Surrogate endpoints don’t automatically translate to better patient outcomes. ERG primarily provides a functional assessment of retinal health, but it’s a surrogate marker. In many cases, it’s unclear if early changes in electrical activity predict meaningful disease progression or if they create noise without changing the ultimate course of care.
2. Let’s say a patient shows mild dysfunction on an ERG: What would I actually do differently? For many conditions like diabetic retinopathy, macular degeneration, or glaucoma, our clinical decisions are still driven by structural findings (OCT, fundus exam) and standard functional measures (VA, visual fields). To me, ERG rarely provides actionable information that would shift these established protocols.
3. We don’t have strong evidence that using ERG improves patient outcomes. Technology is only valuable if it changes lives, not just if it produces beautiful graphs. As of today, there’s little or no high-level evidence (RCTs or long-term cohort studies) showing that incorporating ERG into primary care screening or monitoring improves vision outcomes, reduces progression rates, or changes morbidity. (Please fact check me here I'm wrong. I'm happy to learn!)
4. Specialists' treatment decisions are still based on structure and standard function, not ERG. Retinal specialists managing DME, wet AMD, or proliferative diabetic retinopathy don’t use ERG to guide injections or surgical decisions. They use OCT, fundus imaging, fluorescein angiography, and visual acuity. If our referral partners aren’t relying on ERG to guide management, it’s questionable whether we should preemptively insert it into our protocols.
5. Risk of overtreatment, over-monitoring, and patient anxiety. Introducing a test that shows “abnormalities” that don’t yet require intervention can cause unnecessary patient anxiety, increase follow-up burden, and even create pressure to treat or refer prematurely — all without real benefit to the patient.
6. Financial pressures can distort clinical judgment. Let’s be honest: new devices often come with an economic incentive to use them, regardless of whether they’re always clinically indicated. If ERG reimbursement were similar to OCT — and not $60+ more per test, would it still be as popular? That’s an important question we have to ask ourselves. I want to be incredibly cautious that my recommendations are always in the patient’s best interest, not driven by a need to justify a device purchase.
7. Good medicine is about clarity, not just complexity. Adding another layer of testing needs to make care simpler, safer, and better for patients — not just more complex. Right now, ERG feels like it adds complexity without corresponding clarity.
8. Some patients do benefit from additional functional testing, but it’s not always necessary. I don’t doubt there are patients where OCT and VF don’t provide enough clinical certainty, and in those cases, functional testing is extremely helpful. I have those patients, too. But I’ve grown comfortable making decisions despite the increased uncertainty — weighing risk, monitoring closely, and communicating clearly — without needing to add functional testing to every workflow.

What about you? Agree? Disagree?

P.S. This isn’t a criticism of those using ERG — it’s a snapshot of why I’m personally cautious. Perhaps these guys in the video below can convince me otherwise!

New at Practice Performance Partners

You read my take.

Now, listen to Dr. Christopher Wolfe and Dr. Bradley Grant share their clinical experiences with ERG and how they have adopted it successfully into their high-volume disease practices.

Perhaps I'll even give them an opportunity in the next edition to refute my arguments!

Stay tuned.

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

See you in 2 weeks!

--Kyle Klute, OD, FAAO

1515 S 152 Avenue Circle, Omaha, Nebraska 68144
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