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
Can we predict who is at risk for Alzheimer's disease based on the eye?
A review from Duke Eye Center's iMIND group outlines where retinal diagnostics for Alzheimer's disease actually stand. Check out the article for some pretty interesting correlations between OCTA findings and those at risk for Alzheimer's disease. Retina Today
The entire DEWS III treatment algorithm in one simple tool.
Alcon and the World Council of Optometry published an interactive map that allows you to generate management plans based on diagnostic findings. Save this link in your exam lane to help you remember the new DEWS III treatment guidance. World Council of Optometry
Research I'm Reading
A good reminder of how to pick the right drop.
A new review on ocular pharmacokinetics offers practical reminders worth remembering: one drop is enough, BAK adds up, DED changes how drops behave, and lid closure after instillation matters. Survey of Ophthalmology
Deep Thoughts
There is a significant paradigm shift happening in glaucoma right now. The success of SLT, MIGS, and now implantable, sustained-release pharmaceuticals has reached a tipping point.
These are no longer just interesting additional options but effective and safe enough to serve as primary treatment strategies.
Many of us may already be choosing SLT as first-line and referring for minimally invasive surgeries in our cataract patients. But we may still be underestimating how much the philosophy is changing among glaucoma surgeons and researchers.
Recently, a group of 10 glaucoma specialists published an “Interventional glaucoma consensus protocol.” It is a stage-specific treatment framework that, with a strong and growing evidence base, argues that topical medications should not be the automatic default first-line treatment for every patient.
Here is the core idea that underlies the shift: Doctor-administered treatment is better than patient-administered treatment.
If you zoom out, this is less about new technology and more about solving old problems.
Drops have always had limitations: adherence is inconsistent, IOP control is variable over 24 hours, preservatives impact the ocular surface, and long-term use can complicate future surgical outcomes.
We’ve just learned to live with those limitations.
Earlier intervention with procedural and surgical care challenges those limitations.
When you perform SLT, place a MIGS device, or use a sustained-release implant, you remove a major variable: the patient.
That’s not cynical. That’s clinical reality.
So what do these experts propose in their paper?
At a high level, their approach can be boiled down to:
- Ocular hypertension: preserve tissue, preserve future options
- Mild disease: intervene earlier than we used to
- Moderate disease: be more aggressive to prevent functional loss
- Severe disease: stop thinking sequentially and move decisively
The paper makes this clear: there is no one-size-fits-all pathway. Each stage carries a different balance of risk, urgency, and acceptable intervention
The easiest place to apply this is with new patients.
New diagnosis. Clean slate. Easy conversation.
“I recommend a one-time, in-office treatment first to lower your pressures without the annoyance of using a daily eye drop.”
That should be a relatively easy conversation for us to have with our patients.
However, where we may have more difficulty at the primary care level is with our longstanding glaucoma patients.
The ones who have been on latanoprost for years. The ones who look “stable.” The ones who come back every 6 months without complaining.
This is where the shift actually matters and where what the evidence says about the value of intervening earlier with treatments other than drops really matters.
So we'll need to ask ourselves with each patient encounter:
- Are they truly controlled, or just not obviously progressing?
- Are they truly adherent, or just reporting that they are?
- Is the ocular surface quietly deteriorating?
Additionally, ask yourself: what would I do if I just newly diagnosed this patient today? What treatment would I choose?
This is not anti-drop. It’s important to say this clearly. This is not about eliminating topical therapy. Drops still work. They still have a role.
But if the evidence is real (I believe it is) then they are no longer the obvious, automatic starting point for every patient.
So what about our role as the primary care optometrist? Does it change it?
If anything, this elevates our role.
Because none of this changes what happens in your exam lane.
You are still responsible for:
- diagnosing disease
- establishing target IOP
- monitoring structure and function
- identifying progression
These patients don’t disappear into a surgical center. They come back to you.
The difference is that now, your referral has a clearer purpose, and your treatment plan is more intentional. You refer the patient for a specific treatment. Not, "this patient is progressing, get them out of my chair!"
What this looks like in real life is not overhauling your entire glaucoma protocol tomorrow.
It's making a few practical shifts:
- Read the paper, know the stepwise approach for each stage
- Stop defaulting every new diagnosis to a drop
- Identify a trusted glaucoma surgeon you can collaborate with
- Revisit your “stable” patients with a more critical lens
For a long time, we’ve managed glaucoma in a way that was heavily dependent on patient behavior.
Now we have the ability to manage it in a way that is more controlled, more consistent, and in many cases, more effective.
The evidence isn’t asking us to abandon what we’ve done.
It’s asking us to think more carefully about why we’re doing it.
That’s not more complicated.
It’s just better medicine.
Practice Performance Partners Pick
Are you giving advice or are you coaching? What is the difference?
Your team doesn't need more of your answers; they need better questions.
This podcast episode from Ted McElroy, OD, breaks down the "advice monster" trap that keeps ODs stuck in operator mode and offers a practical reframe for building a practice that can run without you in the room for every decision.
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