5: Reframing Myopia Management: Atropine, Axial Length, and Engaging Young Patients (ft. Brianna Rhue, OD, FAAO)

5: Reframing Myopia Management: Atropine, Axial Length, and Engaging Young Patients (ft. Brianna Rhue, OD, FAAO)

In Episode 5 of From Paper to Clinic, “Reframing Myopia Management: Atropine, Axial Length, and Engaging Young Patients,” host Hamza Shah, OD, sits down with Brianna Rue, OD, to reframe myopia as a looming public health crisis rather than a routine refractive error. Rue highlights striking projections: by 2050, up to 90% of some Asian populations and more than 60% of Americans may be myopic, with epigenetic and environmental factors driving much of this surge. She connects these epidemiologic trends to real-world economic and human costs—from lost productivity estimated at $250 billion globally to the lifelong burden of complications such as retinal detachment, myopic maculopathy, glaucoma, and cataract. The conversation then moves from population-level data to chairside strategy. Rue argues that clinicians must stop thinking in diopters and start thinking in millimeters, emphasizing axial length as the true determinant of structural risk. Using the analogy of a fitted bed sheet stretching over a mattress to describe the retina under axial elongation, she explains why even small changes in millimeters matter. Shah and Rue dig into practical management: age- and phenotype-based atropine concentration selection, the pitfalls of relying on spectacles that kids won’t wear enough hours per day, and the advantages of dual-focus soft lenses and Ortho-K in real-world adherence. Rue also shares communication strategies for engaging both parents and children in behavior change—especially around device use and outdoor time—and makes a strong case for prophylactic treatment in at-risk 6- and 7-year-olds. The episode closes with a call for more clinicians to build robust myopia management programs, charge for their expertise, and see myopia control as both a professional responsibility and a key practice growth opportunity. The paper inspiring this discussion is "Myopia Progression Management: Current Trends and Future Directions [https://doi.org/10.1111/ceo.70024]" by Zhang and colleagues, published in Clinical & Experimental Ophthalmology.

4: Retire 'Artificial Tears': A Call for Updated Terminology in Eye Care (ft. Kaleb Abbott, OD, MS)

In Episode 4 of From Paper to Clinic, “Retire 'Artificial Tears': A Call for Updated Terminology in Eye Care,” Kaleb Abbott, OD, MS, joins the show to challenge the entrenched language and assumptions in dry eye care. He argues that the term “artificial tears” is fundamentally misleading—based on an outdated 1988 FDA monograph and bearing less than 1% similarity to true human tears—while natural tears themselves form an extraordinarily complex, biologically active “rainforest” of thousands of proteins, lipids, vitamins, growth factors, and mucins. The pair also critiques other misnomers such as “dry eye” and even “ocular surface disease." They also spoke to the clinical management of these patients, exploring common pitfalls such as underestimating patients’ motivation for relief, being too conservative with treatment intensity, and failing to identify the true origin of discomfort—whether evaporative or aqueous-deficient disease, meibomian gland dysfunction, or non-ocular neuropathic pain. Abbott highlighted underutilized therapies like blood-derived products (autologous serum and platelet-rich plasma tears), which more closely approximate natural tear composition, while Shah underscored the value of amniotic membranes as a powerful “reset button” for severely compromised ocular surfaces. The paper inspiring this discussion is "It's time to retire the terms artificial tears and rewetting drops: A call for accurate terminology and updated clinical usage in eye care [https://www.sciencedirect.com/science/article/abs/pii/S1542012425001107?via%3Dihub]" by Abbott and Andrew D. Pucker, OD, PhD, published in The Ocular Surface.

3: AI in Eye Care: From Diabetic Retinopathy to the Clinic of the Future (ft. Michael Twa, OD, PhD)

In Episode 3 of From Paper to Clinic, “AI in Eye Care: From Diabetic Retinopathy to the Clinic of the Future,” Michael Twa, OD, PhD, joins the show to discuss artificial intelligence (AI). In the conversation, the pair discusses how AI is reshaping eye care, beginning with its success in retinal image analysis for diabetic retinopathy and expanding to more complex conditions like AMD, where challenges in sensitivity, specificity, and nuanced image interpretation become more pronounced.  They also discuss how AI can primarily serve as a decision-support tool rather than a standalone diagnostician, emphasizing the inevitability of false positives and negatives and the importance of clinician oversight, as well as the rise of chatbots and agentic AI, from tools handling routine post–cataract surgery follow-ups to future systems that could coordinate appointments, labs, referrals, and population-level outcome analysis via EHR-integrated AI.  The paper inspiring this discussion is "A Review of Recent Developments in Artificial Intelligence and Big Data Technologies for Ophthalmology Referrals and Clinical Practice [https://pmc.ncbi.nlm.nih.gov/articles/PMC12822609/]" by Paredes et al, published in Medical Science Monitor.

2: Is Geographic Atrophy a Peripheral Retinal Disease? (ft. Raman Bhakhri, OD, FAAO)

In Episode 2 of From Paper to Clinic, host Hamza Shah, OD, MS, FAAO, is joined by Raman Bhakhri, OD, FAAO, to discuss geographic atrophy. In their conversation, they discuss the theory that peripheral retinal pigment epithelium (RPE) cells might contribute to macular geographic atrophy (GA) by migrating inadequately. They also discuss the analogy with limbal stem cells in the cornea and the importance of monitoring the peripheral retina. Bakri highlights the limitations of current research, such as the lack of clinical trials and the applicability of animal studies to humans, and the pair explores potential new therapeutic strategies and the role of optometrists in patient care, emphasizing the importance of preventive medicine and low-vision assistance. The paper inspiring this discussion is "Is geographic atrophy a peripheral retinal disease? [https://www.ophthalmologyretina.org/article/S2468-6530(25)00454-3/fulltext]" from Del Priore, published in Ophthalmology: Retina.

1: The Interventional Glaucoma Paradigm (ft. Austin Lifferth, OD, FAAO)

In Episode 1 of From Paper to Clinic, host Hamza Shah, OD, MS, FAAO, is joined by Austin Lifferth, OD, FAAO, to discuss interventional glaucoma. In their conversation, they emphasize a proactive approach over only traditional topical treatments, highlighting the benefits of procedural treatments like selective laser trabeculoplasty (SLT), which offers better disease control, reduced productivity loss, and improved patient outcomes. They also discuss the importance of goniotomy as an initial step and the need for optometrists to adopt interventional glaucoma practices. Lifford also outlines the stages of glaucoma and the frequency of follow-ups, stressing the importance of correlation between tests. They collectively predict a future shift towards more procedural treatments, aiming for a proactive approach to glaucoma management. The paper inspiring this discussion is the "Interventional glaucoma consensus treatment protocol [https://www.tandfonline.com/doi/full/10.1080/17469899.2025.2465330]" from Funke et al, published in Expert Review of Ophthalmology.