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 treatment plan for kids with DED and MGD.
We've all seen plenty of kids with dry eye and lid disease. But how do we approach it? Is it different than how we approach adults? Not really; just know the most common etiological drivers and treat accordingly (just like DEWSIII says - see more below). Optometric Management
How do we find our way in the world? How do we navigate life's major events?
Jim Collins is the genius behind business/leadership classics like Good to Great and Built to Last. Now, he tackles how to live a good life in his latest book, What to Make of a Life. Or, if you'd rather listen to him talk through his book in podcast format, here is his interview with Andy Stanley and/or Tim Ferriss.
Protecting your practice starts with understanding your biggest risks.
PPP Practice Risk Assessment helps identify potential compliance, billing, HR, and operational gaps that could be impacting your growth and profitability — before they become bigger problems.
Research I'm Reading
What do B vitamins have to do with AMD?
This industry-funded commentary (support from Bausch+Lomb, maker of the AREDS2 formula) makes the case for tacking B6/B9/B12 onto the next-gen AREDS3 supplement. To be honest, it reads more like a pre-launch marketing brief than a research synthesis. Nearly all the supporting data are observational: dietary/serum-level correlations and post-hoc subgroup analyses of the AREDS/AREDS2 cohorts, not trials designed to test B vitamins for AMD. The one actual RCT signal (WAFACS, a secondary analysis from a cardiovascular trial in women) used B-vitamin doses far higher than any OTC B-complex on shelves today, so I'd hold off on believing this is settled science until AREDS3 itself reports. Ophthalmology and Therapy
Deep Thoughts
Stack, don't stage.
That's the shift DEWS III makes explicit.
DEWS II gave us a staged algorithm: treat, wait, then escalate. It was reasonable given what we knew in 2017. But it built decision-making around picking one dominant subtype and moving up a ladder only when that failed.
DEWS III drops that architecture. Dry eye has multiple drivers that operate simultaneously, wax and wane together, and rarely present in isolation. Grouping it into discrete stages was never going to capture that.
The recommendation now is simple. Identify what's actually driving the disease in front of you, and treat those drivers concurrently.
Most of us were trained to stage. However, many patients show up with two or three drivers active at the moment. Treating sequentially means undertreating for months.
Here's how I make that practical, for my team and for my patients. I sort every treatment option into three buckets a patient can actually understand:
- At home: OTC, supplements, environmental changes, etc.
- In office: any procedure administered at our office.
- Pharmaceutical: any topical or oral requiring a pharmaceutical prescription.
For any finding, I pick two or three treatments across those buckets, not one from each out of habit, but whatever the evidence and the patient's situation call for.
Take a low tear meniscus height or a low Schirmer's test. At home, that's a preservative-free artificial tear, sometimes paired with a nutritional supplement like Blink NutriTears. In office, it's punctal plugs. Pharma: cyclosporine, Tyrvaya, or Tryptyr. I'm not stacking all of these on every patient. I'm choosing two or three based on each patient's history, findings, severity, and what they can tolerate and afford.
Or take lid telangiectasia alongside a positive MMP-9. Those two findings point at the same inflammatory process from different angles. I treat them together. At home: omega-3s and lid hygiene. In-office: IPL has the strongest evidence in this category for improving both the vascular and inflammatory picture. Pharma: a short course of topical steroid, or topical azithromycin or doxycycline if IPL isn't available or appropriate for that patient.
One side note worth mentioning. The evidence for stacking itself is thin. DEWS III is a consensus document, extraordinarily well referenced, but it isn't a trial testing combination therapy against staged therapy. Almost every study cited tests one intervention against a comparator. The idea that two or three treatments add up rather than overlap or compete is mechanistic reasoning and clinical experience, not head-to-head data. I think DEWS III is right. I just don't think we should pretend the proof is stronger than it is.
None of that changes what to do Monday morning. The point is simple. Use the finding you see to drive you toward two or three treatments at once, not one at a time.
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