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 refresh before your next diplopia workup.
In primary eye care, ocular motor palsies are rare enough to forget the details but common enough that you can't afford to. Here's a good refresher by Erin Draper, OD, on how to work up your next diplopia patient. Optometric Management
How does Neurolens compare to conventional prism lenses for headaches?
The study adds to a growing real-world signal that contoured prism can meaningfully reduce symptomatic load beyond just vision correction. Read the full report for yourself here, or read the breakdown from Primary Care Optometry News.
Research I'm Reading
Your patients saw the headlines. Here's what the research actually says.
21% of news articles reporting on the association between semaglutide and NAION used causal language. The original JAMA Ophthalmology study explicitly said causality could not be inferred. A new content analysis in the Journal of Neuro-Ophthalmology reviewed 71 news articles on the topic and found 48% used misleading or exaggerated language. Your patients are reading these headlines. Understanding where the media got it wrong helps you have a better conversation in the chair. Journal of Neuro-Ophthalmology
Deep Thoughts
There is a conversation happening right now in optometry about the value of a refraction. My friend Aaron Werner and his podcast guest, Ben Thayil, had a version of it on a recent podcast. It is a good conversation (see the link below). Worth your time.
Ben, if I understood him correctly, believes the refraction is the most valuable thing we do. Aaron believes we tie our identity to it in ways that ultimately limit us. Both are making real arguments. Both are partially right.
But I want to offer a different frame. Not a third opinion added to a debate, but a different way of seeing what the debate is actually about.
Because I do not think the problem is the refraction. I think the problem is that we have compartmentalized it.
Here is the question I want you to sit with before you read any further.
When was the last time you performed a refraction outside the annual exam?
Not the comprehensive (or whatever you like to call it - routine, annual, etc) exam. I mean a refraction at a glaucoma follow-up. Or an AMD evaluation. Or an ocular surface disease visit. A refraction where selling glasses was not remotely the point.
If you cannot remember the last time you did that, that tells you something.
It tells you how you have categorized the refraction. And the category reveals the philosophy.
Early in my career, I had the privilege of training alongside a clinician widely regarded as one of the best glaucoma specialists in optometry. We saw referrals only. There was no optical. There were no glasses to sell.
And yet, routinely, in the middle of a glaucoma evaluation, with OCT data on the screen and visual field printouts in hand, he would pull the phoropter in front of the patient and refract.
The first few times I watched this, I was annoyed because I was thinking: Why are you spending time on this? The real data is right there on the screen.
He was not wasting time. He was gathering information.
A careful refraction and best corrected visual acuity, measured precisely, told him something the OCT and the visual field could not. It gave him a window into functional status. It helped him answer the question that every glaucoma visit is really about: is my patient stable?
The refraction was not a prelude to an optical recommendation. It was a clinical tool. No different in kind from the OCT or the IOP measurement. Different in what it measured. But valid in what it contributed to the decision.
That moment changed how I think about what we do.
Here is what I believe is actually happening in too many practices and too many professional conversations.
We have set up two categories and placed them in opposition.
Category one: refractive care. The refraction. The glasses. The contact lens fitting. The optical sale.
Category two: medical care. The OCT. The visual field. The IOP. The fundus exam. The disease management.
And we have been operating, sometimes explicitly and sometimes unconsciously, as if these two categories are in tension. As if the more serious and medical we become, the less we should emphasize refraction. As if the refraction belongs to one version of optometry and OCT belongs to another.
That is a false opposition. And it is costing our patients (and our practices).
The argument I want to make is not that refraction is the most important thing we do, or that we should double down on our refractive identity at the expense of medical care. Aaron's concern is legitimate. Optometrists who reduce their clinical identity to the phoropter are limiting their patients and limiting themselves.
But the solution is not to minimize the refraction. It is to understand what the refraction actually is: refractive status is a clinical signal.
A change in refraction tells you things. Myopic shift in a diabetic patient or a cataract patient is a signal. Changing BCVA at one AMD eval and another is a signal.
These signals are often subtle. They can confirm what your technology is telling you or complicate it. They can add certainty in a close call. They can surface something that was not on your radar before the refraction happened.
This is why the refraction belongs in more clinical settings than the annual exam. Not because we need to sell more glasses. Because we need more information to make better decisions.
And if you are performing it, charge for it. A refraction at a glaucoma visit is a separately billable service. Treating it as one is not aggressive billing. It is an accurate documentation of the care you actually provided.
Optometrists are, I have argued before and will argue again, the best-trained and best-positioned primary eye care providers. I believe that with conviction.
But the reason for that conviction is not that we are great at fitting glasses, and it is not that we are increasingly competent at disease management. The reason is the combination. The complementary nature of our training is what makes us different.
We are the only providers who routinely assess both refractive status and ocular health in the same clinical encounter. We hold both simultaneously. We can track how functional vision and structural integrity move together or diverge over time. That dual fluency is rare. It is also genuinely valuable to patients.
But we only express that value if we actually integrate both perspectives clinically. If we segment them — if refraction is the glasses department and OCT is the medical department — we cut the integration in half and lose the advantage that makes us uniquely useful.
We should not be debating whether the refraction is central to our identity. We should be asking: Are we using the refraction to its full potential?
Are we performing refractions at our disease management visits? Are we incorporating refractive status into our clinical practice guidelines for OSD, for glaucoma, for macular disease? Are we teaching the next generation of optometrists to see the refraction as a clinical tool rather than a billing appendage to the annual exam?
Because if we are not, we are leaving clinical intelligence on the table. We are seeing half the picture.
And if we are the best-positioned primary eye care providers, that is not a claim we can make with partial data.
The refraction was always medical care. We just need to practice like it.
Practice Performance Partners Pick
Here is the conversation between Dr. Ben Thayil and Dr. Aaron Werner about the value of refraction. What is your take?
Email me your thoughts and comments. I'd love to hear how you think about this topic.
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