,

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

Don't miss binocular vision issues in myopia management.

If I had led with "measure fusional reserves," you would have never read this sentence. Or maybe you enjoy and remember binocular vision more than I. Regardless, it is important to understand its place in myopia management and know how to quickly do it in clinical practice. Myopia Profile​

Are diabetic patients without retinopathy really just routine?

Maybe not. This piece walks through real cases where diabetic patients had a completely normal-looking dilated exam, no hemorrhages, no exudates, nothing obvious, yet OCT A and peripheral imaging picked up microvascular changes that standard fundus exam missed entirely. Review of Optometry​

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

How effective is punctal occlusion?

Another paper on punctal occlusion just released, and it lands about where the last decade of evidence has: meh. This meta-analysis of 14 studies found no significant improvement in tear film breakup time, Schirmer scores, or corneal staining compared to controls, mirroring what Cochrane concluded back in 2017. DEWS III doesn't move the needle either, still citing that same review and treating punctal occlusion as a supporting player rather than a proven fix. Clinical Ophthalmology​

Deep Thoughts

The AOA just opened its updated Comprehensive Pediatric Eye and Vision Exam guideline for public peer review.

It's the second edition since 2017, and the board hasn't approved it yet, and that's what the comment period is for.

Most of us will never open it. I get why for many reasons.

For one, we are busy, and sitting down to read such a document requires a lot of time. Further, no one really reads anymore.

Also, many optometrists openly support the American Academy of Ophthalmology's Preferred Practice Patterns and forget we have our own. Granted, AAO PPPs do cover a lot of topics and get updated more often, so it's genuinely easier to reach for them.

But we have our own evidence base, built and reviewed by our own profession, and as a new member of the AOA's Evidence-Based Optometry guidelines committee, I'd rather help strengthen what's ours than keep quietly borrowing someone else's.

Back to the new Pediatric guidelines - I went through both editions side by side to see what actually changed, and what should change in how we practice.

Here's what's different, and what it means on a Tuesday morning:

1. Autism, ADHD, concussion, and abusive head trauma now have their own graded recommendations. In 2017, autism only showed up on a general "at-risk, refer them" list, concussion got a paragraph with no formal recommendation, abusive head trauma got a clinical note, and ADHD wasn't mentioned at all. All four now have standalone, evidence-graded action statements.
2. A newborn eye assessment protocol is new. This new protocol sits alongside, not in place of, the 6–12 month comprehensive exam.
3. Digital eye strain counseling is brand new, and the blue light language actually got more careful. 2017 had no digital eye strain section, and its blue light language was more alarmist than 2026's: it said blue light "has the potential to cause photochemical retinal damage" with no qualifier. 2026 walks that back and states plainly there's no evidence normal screen use damages the eye.
4. "Spend more time outdoors" is gone as its own recommendation and folded into a broader myopia counseling statement. 2017 had this as its own Grade B action statement. 2026 retires it and builds a Grade A statement around parental myopia, near work, screen time, and treatment options together. Outdoor time is still worth mentioning, but it's one piece of a bigger conversation now, not the whole conversation.
5. Annual exams for all school-age children move from consensus to a Grade A strong recommendation. The recommendation for annual exams is stronger than it was previously.
6. School-based eye care programs get real evidence backing for the first time. The screening critique itself isn't new; 2017 already had the data showing Snellen alone misses 75% of binocular and oculomotor problems, and that most kids who fail a screening never get follow-up care. What's new is a randomized trial showing that screening plus free exams and glasses improved test scores, while screening alone didn't. A separate finding: even inside these programs, one in seven kids examined has, or is at risk of, something like amblyopia or strabismus that needs outside referral.
7. Cycloplegic refraction guidance got a specific update, not an overhaul. The dosing details — cyclopentolate 0.5% under 12 months, 1% for older kids, tropicamide as an alternative, and caution with spray in dark irides—were already in 2017. What's new is a 2024 trial confirming tropicamide as safe and effective in non-strabismic kids ages 3–16, and better language on when cycloplegic autorefraction can stand in for retinoscopy.

This comment period is short, and most drafts like this get very little feedback from working ODs, which means the final language usually gets shaped by whoever bothered to respond. If something here doesn't match what you see in your own exam lane, that's what peer review exists for.

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

1515 S 152 Avenue Circle, Omaha, Nebraska 68144
​Unsubscribe · Preferences​