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 dozen more medical exams are needed per week.
Richard Edlow, OD, aka the "Eyeconomist" sees opportunity (and potential bottlenecks) for optometrists to increase medical eye care. He estimates that demand for routine exams will increase by 2 million per year, and demand for medical eye care by 9 million per year. That 11 million translates to 12-13 additional exams per week in the 30% of offices already doing medical eye care. Review of Optometric Business
Visual field interpretation cheat sheet.
Lily Arendt, OD created a fanstastic cheat sheet for all things glaucoma visual field interpretation. Bottom line, according to the data, optometrists are underperforming visual fields. Use this article and cheat sheet to sharpen your interpretation skills and know how often you should be running fields for your glaucoma patients. Eyes On Eyecare
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
Can meibomian gland dropout get better?
Yes, say the authors of a new paper called "Effect of Meibomian Gland Expression on Meibomian Gland Regeneration and Function: A Randomized Controlled Trial." Their small study showed a mild improvement in meibomian gland morphology after intervention: "This serves as proof of concept that the MG can regenerate." Clinical Ophthalmology
Deep Thoughts
I've been reading and hearing lots about photobiomodulation for AMD lately.
So what follows is an honest attempt to summarize where I am after spending some real time with the evidence and thinking about what it means for a practice like mine.
The short version: photobiomodulation (PBM) is real, FDA-authorized, already in use by colleagues reporting good results, and still not as well supported by the literature as the marketing would suggest. Both things are true at the same time.
The Science
The biological premise is sound. PBM uses specific wavelengths of light to stimulate cellular activity in the retina to improve function and reducing oxidative stress, two key factors in AMD progression.
The clinical evidence is more complicated. The best data comes from the LIGHTSITE program, specifically LIGHTSITE III, published in 2024. That trial showed PBM improved best-corrected visual acuity versus sham at 13 months and showed less new geographic atrophy. Safety was favorable.
The AAO's Preferred Practice Pattern acknowledges this, noting that LIGHTSITE III showed photobiomodulation appears to decrease the onset of new geographic atrophy, though they rate the evidence as insufficient quality. That's not a dismissal. It's an honest reading of where the data sits.
The Cochrane review lands a bit more skeptical, concluding that PBM may make little or no difference to vision or disease progression after about one year, with low to very low certainty evidence because of small sample size, a high risk of bias (company conducted studies), and the statistically significant gains didn't meet prespecified thresholds for clinical meaningfulness.
So we have positive RCT signals, a regulatory authorization, and bodies of systematic evidence that are somewhere between uncertain and unconvinced. That's the reality.
I think it's important to say that plainly. Not to talk colleagues out of offering this, but because the patients sitting in our chairs deserve our honest interpretation of what we know and don't know.
The Protocol
The general framework used in LIGHTSITE III and by practices currently offering this involves nine sessions over three to five weeks, repeated every four months. Each treatment session takes around 15 minutes and is fully delegable to trained technicians. The physician's role is in patient selection, interpretation, and ongoing monitoring.
Patient selection is the clinical crux. The candidates are early to intermediate dry AMD patients, particularly those with documented drusen on OCT and those beginning to notice subtle functional changes — contrast sensitivity, color, clarity. The underlying logic is intervening while there's still meaningful function to protect. Once geographic atrophy is established, the window closes.
For a fantastic and practical article from a colleague who has already successfully implemented PBM in their practice, see Walker Shaffer, OD's excellent write up.
The Economics
Running through a realistic first-year protocol involving the annual comprehensive evaluation, serial OCT monitoring, and three rounds of treatment, the total revenue generated for one patient approaches $3,800 with roughly one hour of physician time invested.
Yes, you read that right, the revenue per OD hour of an AMD protocol involving PBM would be $3-4K. That includes three evalutions with an OCTA, 3 treatments/rounds of PBM and supplements in that calculation. All things that a good protocol for AMD would include. Try to beat that with any other chronic disease protocol!
Before You Consider the Equipment
Are you systematically identifying your AMD patients? Are you bringing them back at guideline-appropriate intervals? Are you performing OCT and fundus photography consistently and documenting progression over time? Are you counseling them on supplements, smoking, cardiovascular risk, and diet? Are your OCT per refraction ratios reflecting a practice that actually manages this disease, or one that monitors it passively from a distance?
If the honest answer is no or even maybe, that's where the work starts. Build the protocol. Dial it in. Make sure your AMD patients are getting what they need from you right now, with the tools you already have. Once that system is running, you're in a position to evaluate whether PBM belongs in it.
Adding photobiomodulation to a practice without a strong AMD foundation is adding a treatment to patients you're not yet fully serving. That's not good for them, and it won't produce the outcomes that make the investment worth it.
The question isn't whether PBM is a breakthrough or a gimmick. It looks more like an early-stage, biologically sensible intervention with a meaningful signal in the data, an approved device, and a patient population that currently has almost nothing else to offer them.
The question is whether your practice is actually ready for it.
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