Optometry Diversification

Thriving in today’s competitive optical retail environment requires constant attention and innovation.  Independent eye care practitioners are facing increased online and budget bricks-and-mortar competition. Big box and even grocers and pharmacies are competing for optical retail product revenues. How do clinics thrive in this environment? How can they grow revenues? The answer:  Optometry diversification of your revenue streams.

Here are some of the evolving opportunities.

Medical Model
The scope of optometric practice continues to expand providing optometry diversification opportunities. Optometrists can prescribe a variety of topical and oral therapeutic pharmaceuticals for an ever-widening scope of pathologies. Potential future scope expansion may include the use of lasers or other nouveau procedures.

There is high prevalence of macular degeneration and glaucoma in our patient populations. Diagnosing and managing treatments of these diseases can indeed provide consistent revenue streams into the future.

Unfortunately, many optometrists, despite having the requisite scope to treat these diseases, refer the patient for treatment to their local ophthalmologist’s office. Macular wellness centres and efficient management of glaucoma can be quite professionally satisfying while fulfilling a need in the medical eye care community.

In many instances, patients appreciate the elevated level of care despite the requirement of private pay in many instances. Keeping these patients in the optometry universe allows for continued refractive and ancillary care such as dry eye services while adding to the practice’s profitability.

Diversify through Practice Niches
Vision therapy, Dry Eye centres, Myopia Management, Low Vision, AMD wellness and optometric aesthetics are examples of growing business divisions within optometric settings. When incorporated in an efficient manner through delegated effective treatments, these services can be very accretive to optometric practice profitability.

The need for skilled optometrists in these subspecialties is growing. Care for these patients is making tangible improvements in patients’ vision and their lives. It is important to treat each of these business divisions as unique with separate budgets, with training costs and bonuses attached to each.

Incentivizing a key staffer as a “Champion” of the specialty can assist in training and marketing to promote the service to the public and to referring optometrists, ophthalmologists, and other health care practitioners.

Sunglasses, nutraceuticals, and dry eye products
Optometry Diversification opportunitiesRetailing all the products that can help improve and preserve vision is important. These optometry diversification opportunities help raise revenue per patient while increasing the “mind space” that allows your patient to think of you and your offerings when it comes to eye care and eyewear.

Providing readily accessible high quality products through an omnichannel strategy can improve patient outcomes and bottom line profits. E-Commerce should be readily accessible through the office’s online portals to allow easy reordering.

Consider a subscription strategy to improve affordability perceptions and smooth out revenues over time. We use Avocado lenses for contact lens subscriptions. If carrying various products is too onerous as a new or smaller clinic, consider partnering with retailers to share profits such as “The Drop Shop”. This strategy eliminates stale dating of products while still being able to offer a wide product array.

Professional fees versus Commodity products
Your professional fees for services should be commensurate with your education and offerings. My standard recommendation for struggling practices is to raise your professional fees and annually increase them in order to keep pace with inflation.

The Golden Rule is to wow every patient with world class service, care and technology. When retailing products, ensure the products are lower or within 10% of exactly the same product found in other retail settings. If coming closer to your competitors’ pricing is too challenging, consider choosing products not readily available in big box and online channels.

Consider including budget options to compete with online or low-cost operators while still providing boutique and premium products as a primary offering. Gaining and retaining trust is of utmost importance for independent offices. Misrepresentation of our intent will continue and intensify by retail entities looking to crush independents.

In three of our five clinics, we have integrated hearing services. This symbiotic relationship with the vision and hearing clinics allows for economies in practice through sharing of resources.

Hearing services can provide additional sources of revenue for optometric practices while offering patients access to this much needed service. On average, patients with hearing loss take seven years to seek help thus reducing their rehabilitative capacity and reducing their enjoyment of life.

The battle for our patients will continue. As an independent will you tolerate direct to patient competitors that still supply high margin product to optometrists?

When will Independent practices refuse to be led down the garden path by multinational conglomerates looking to monopolize via an omnichannel strategy?

As an independent optometrist it is crucial to invest in internal and external marketing. Guerrilla marketing will allow one to compete with a nimbleness that the big companies cannot match. SEO, digital marketing, word of mouth campaigns and low cost social media outreach are pillars of the independent optometric strategy.

Pursuing these optometry diversification opportunities will benefit practice profitability.

View other articles from Dr. Miranda.



Dr. Miranda is a partner in a multi-doctor, five-location practice on Vancouver Island.

He is a strong advocate for true Independent Optometry.

As a serial entrepreneur, Trevor is constantly testing different patient care and business models at his various locations. Many of these have turned out to be quite successful, to the point where many of his colleagues have adopted them into their own practices.


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There are a number of grocery stores we can choose from in our smallish town. I always find it interesting to find out where other locals like to frequent and why.

The smaller of the grocery store options is well known for its friendly and familiar faces, which make the slighter higher prices on produce worthwhile.

The largest of the stores is known for having more unique products, in amongst the tried and true products. Some choose the local health food store, where they feel good about the sustainable efforts put into growing and making the food. Still others make a point of visiting the Saturday Market to support local farmers.

Clearly, we are not all seeking the same experience or value proposition. This holds true for customers in every industry.

Importance of Strategic Intent
So how do you apply this to your full scope optometric practice? It starts by intentionally creating a strategy for your office.  Take a look at your competition. What are other optometrist offices offering in the area? How are the opticals in your neighbourhood making themselves unique?

Then decide what you want your office to be known for. If you are going to offer the most popular brands, make it a priority to regularly check prices online. Consumers will often ask for this product – but this product is also the easiest for the consumer to compare prices for.

If this is your strategy, be sure your patient hand off is tight and your staff are well trained to assist patients in the gallery. This strategy is heavily dependent on exceptional customer service. The patient knows they could get the product from a number of different sources but chooses to reward a great experience with their business.

Consider Independent Frame Stories
Another strategy is offering independent frames, with brands not readily recognized or available. With these frames, you are creating the story about the frames and the onus is on the practice to engage the patient and relay that story.

I work with a practice in the West who does this particularly well. They source frames from manufacturers from all over North America – and then share their stories on placards placed in the gallery. This strategy seems to appeal to a younger generation in particular as are looking for products that have a unique value proposition.

The most successful businesses are the ones that clearly define their offering and deliberately work towards making sure every aspect of their business stays true to that message.

I encourage you to carve out some time to reflect on what you are currently offering the marketplace. What if your goal was to have patients who are excited to see what you just go into inventory? What frame lines do you need to carry? What message do you need to convey to stir that enthusiasm for your product offering?

Think like the patient, what frames and experience would YOU like to receive? This mind shift could be the first step in moving from ordinary to extraordinary.


is the co-founder and managing partner of Simple Innovative Management Ideas (SIMI) Inc. and expert Practice Management contributor for Optik magazine. She can be reached at info@simiinc.com.


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Glen Chiasson discusses all things Vision Therapy with Dr. Virginia Donati, president of Vision Therapy Canada.

About the Guest

Dr. Donati attended the Pennsylvania College of Optometry where she first learned about vision therapy by becoming a patient herself and graduated in 2006. Upon returning to Canada she brought her passion for vision therapy to her own patients and to the profession at large as the founding VP of COVT&R and the current President of its successor organization, Vision Therapy Canada.  She is an Instructor of the  Optometric Extension Program’s Clinical Curriculum in Vision Therapy and the lead instructor for VTC’s Practical Vision Therapist Accreditation Program (PVTAP). She lectures across North America in the field of binocular vision and is keenly interested in the education and training of new and existing Vision Therapists and Optometrists.


Episode Notes

Virginia Donati shares her personal story of how a life changing experience while studying at PCO cemented her intense interest in and passion for Vision Therapy.

Glen plays devil’s advocate around some of the professions perceptions of vision therapy, including on “the science”, and the perceptions of expense to patients.

Donati, of course, stands her ground, and opines as to why the medical profession, and even many in the optometry world including optometric educators, do not take VT as seriously as it deserves.

She outlines the challenges facing the sub-specialty and encourages ODs to think about their future role with Vision Therapy being a part of their practice and how Vision Therapy can help differentiate their practice.

Lastly, Dr. Donati outlines specific steps that can be taken by ODs to learn more and become a VT specialists if they so desire.

Key Quote:  “Demand is there, patients are there but this may not be recognized”.



Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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Host Glen Chiasson speaks with Warren Modlin, founder of NeuroDynamicVision.org and a trained optometrist with 25 years of optical industry experience, about how optometry should be at the forefront of the eye-brain connection and how to make sports vision a rewarding practice differentiator.



Warren Modlin

About the Guest

Warren Modlin is a trained optometrist with 25 years of optical industry experience. As VP of product strategy for Oakley, Warren helped develop sports vision eyewear for a broad range of sports specific verticals including cycling, golf, baseball and more. He is the founder and CEO of NeuroDynamicVision.org.


Episode Notes

NeuroDynamic Vision (NDV) was founded by Optometrist Warren Modlin, an industry veteran with over 25 years of experience including eight years at Oakley. NeuroDynamic Vision was created as a resource for eye care professionals to expand their value in a highly competitive market place with retail consolidation, online competition, AI and technology in the area of vision performance for athletes.

In this podcast, Warren explains where to find the latest scientific evidence  and resources on the subject of vision performance. He explains how the techniques used by NeuroDynamic Vision can evaluate concussion protocols and help bring athletes back on the road to wellness.

According to Warren, “The core of what we offer is the understanding that vision goes beyond 20/20.” Optometry is at the forefront of eye-mind-body connection and optimizing human performance.

Warren shares his insights on how Optometrists can bring vision performance into their practice and how to market and manage a practice conducive to athletes. He walks through an athlete’s experience in his practice, from assessment to developing an 8- to 12-week plan for an athlete’s sensory-cognitive training.




Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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Jean Rickli, at the #AliveSummit Podium in Vancouver.

Jean Rickli from JC Williams, a retail consultant group with offices in Toronto and Montreal, spoke to attendees of the Essilor Canada Alive Summit in Vancouver in March 2017. Rickli’s seminar focused on the importance of creating community around your optical practice. Shoppers today – especially Millennials – are seeking an experience when they shop. While brick-and-mortar shops may not be able to beat online prices, Rickli says nothing replaces the experience of going out to shop.

Here are some of the Alive Summit and Rickli’s suggestions on how your clinic can compete with online shops:

1.   Be Unique

Offer specialty services that aren’t available to customers online. For example, La Fabrique de Lunettes, in France, offers the exclusive service of frame rentals. How would it affect your sales if you could counter every, “I wouldn’t wear that frame everyday.” with, “you can rent this fabulous pair of sunglasses for that trip to Vegas!” Not into rentals? Stocking vintage frames creates a quick and easy way to set your practice apart.

Freshly backed Cookies from MayFair Optometry.

Find a way to offer more in store by creating a new shopping environment. Frank and Oak started off only selling clothing. Today, some Frank and Oak stores offer coffee and even hair styling services to their customers! Mayfair Optometric Clinic, in Victoria, BC, installed a cookie oven in their lab so they can bake cookies for their customers every Saturday. Office manager, Mary Lou Newbold says customers love coming into their clinic to the smell of freshly baked cookies. It also entices the customers to stay a little longer and enjoy a warm cookie!

Some optical offices dispense their glasses with artisan chocolates, or even sit down and share a beer or glass of wine with their customers. If you’d rather not involve food, gift wrap up those complimentary sprays, cleaning cloths, and cases so customers feel like they’re receiving a present from you. If you make your customer’s experience memorable they’ll be more likely to return and share their experience with others.

2. Show Your Expertise

Whole Foods built a greenhouse on top of one of their stores to demonstrate that they not only sell food — they grow it too! Take a cue from this idea and do adjustments in plain sight to highlight your expertise in optics. If you’re designing or redesigning your store, consider having the lab clearly in view behind a window. Customers love behind the scenes peeks. Your clients will be delighted to see lenses edged on site and how you make each pair of eyeglasses specially to order.

3. Share the Love

Does your office contribute to the community? Sponsor an event or team? How do you share your involvement? Many offices do good deeds around the community, but forget to share this to their customers. Frame pictures of your team helping out with a cause, or exhibit contribution awards your clinic has received. By displaying your office gives back, you’ll demonstrate that a purchase at your office also helps the community.

Environmental impact is important to consumers. Showcase brands that have low environmental impact and reuse production materials or recycled items. What about your office’s environmental impact? Are you a paperless office? Proudly proclaim your environmental commitment on your website or other materials.

4. If You Can’t Beat Them, Join Them

If you can’t compete with online shopping — join them, but with a different angle. If you have extra storage space, you can provide the convenience of online shopping for your customers by adding the Penguin Pick Up service to your store. With Penguin Pick Up, customers can direct their online purchases to be delivered to your store.

Penguin Pick Up is available in many Canadian Locations

They no longer have to wait at home for a delivery, or risk missing it while they’re out. The customer is notified by Penguin Pick Up that their package is ready at your store, which they can collect when it’s convenient for them. Aside from providing convenience to your customers, this service may help introduce new people to your location and encourages traffic to your store.

Rickli acknowledges that online options have made optical shopping more competitive, but, there is a silver lining. Take the online shopping industry shift as an opportunity to reach out to your customers. If your patients are buying online, ask them: Why? You may assume price is the only reason to shop online, but your customer might have a different reason.

Perhaps your clinic could work on speeding up delivery of services, or change up your frames stock. Don’t be afraid to ask the tough questions and have a hard look at your clinic. Online comparison may seem like a hardship, but it might be the motivation your clinic needs to hone your strengths and grow your store into an extraordinary place in your community.


Sarah worked as an ECP for 12 years before co-founding Mass Velocity Media. Now she helps ECPs and other professionals achieve success through web and graphic design and development, social media, SEO, and copywriting. Her clients range from global pop superstars to non-profits.


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Low vision, caused by diabetic retinopathy, macular degeneration, glaucoma and other conditions, is affecting more and more of your patients. By the year 2030, the National Eye Institute projects that nearly 5 million in the U.S. will be classified as having low vision.

Dr. Richman works with a low vision patient, showing the patient how to use a magnifying tool that projects small type onto a large screen

We have focused on low vision care, and have built up this niche, so that approximately 30 percent of our three-OD practice is now considered low vision, and 100 percent of my part of the practice is visually impaired or legally blind. I personally see only visually impaired and legally blind patients, but my husband and partner in the practice, Harvey Richman, OD, sees visually impaired children in addition to his other patients.


Everything from premature birth to age-related macular degeneration can create a low vision patient. Providing this type of care has allowed me to see patients with conditions so rare that there are less than 10 documented cases in the medical literature, and others who have traveled from Europe and Africa to see me.


The retinoscope, as refraction is so important, is an essential tool to help you serve low vision patients. All good low vision exams require the appropriate starting point, and finding the appropriate prescription is invaluable. We have treated patients who were classified legally blind, and by simply giving them the right corrective lenses, they were able to enjoy the activities of daily living, or even drive!

Visual acuity assessment needs to be modified to be able to be done at different working distances. Charts that vary in size and format should be available, depending on the patient’s needs. Additionally, having appropriate magnifiers, lighting options and wavelength-specific filters is paramount.

A basic retinoscope can cost as little as around $70, while the more advanced ones can be over $1,000. A few magnifiers are available for less than $50, but the electronic devices are thousands of dollars.


The American Optometric Association used to have a Low Vision Rehabilitation Section that had materials and courses available. That is now merged into the online database for members. There is a large program called Envision that occurs annually in Kansas, and offers continuing education annually. The most effective option for educating yourself about caring for low vision patients, though, is to communicate with other doctors who are doing low vision currently and pick their brain. Most of us are happy to share our experiences, good and bad.

Wavelength-specific filters that Dr. Richman’s practice sells. Offering the products in-house gives patients “one-stop-shopping” ease, enabling them to get the products you prescribe without having to travel to another location.

The primary low vision-oriented eyewear that we stock are wavelength-specific filters (450-550nm) in frames. We have a few prism readers with high plus, but primarily prescribe the appropriate prescription to be filled, as we don’t have an optical.


In our office, much of the profit is in the service end. Devices are opportunities to make additional income, but we still focus on the professional component. Often, doctors double their cost for retail. This is a personal decision, as is prescribing glasses. That being said, profit occurs from day one as the first patient who is successful tells their friends, and the referring physician, and more patients roll in the door.

More significant than the revenues that come directly from low vision patients is the loyalty of these patients, who stick with the practice for years, and often refer friends and family, and speak highly of your practice in your community, and even online sometimes.


Our community learns of our low vision services through word-of-mouth (satisfied patients who refer others), our practice web site, the telephone book (yes, we still
use it because many older patients still look to it), and by meeting with low vision support groups and senior citizen community groups.

We receive referrals for consults from dozens of ODs and MDs. The OD referrals are more diverse, but the MDs referrals come primarily from retina specialists.


The primary areas reported problematic are reading and driving. Near activities are usually the easiest to manage with either a high-add reading glass or hand or stand magnifier. Some patients need a CCTV (electronic magnifier) to read longer or smaller print. Driving and television are more difficult due to state regulations and optical options. As mentioned earlier, sometimes an update in their glasses is enough, but when a telescope is needed, it is much more time consuming for the doctor and the patient.


Much of what differentiates a good low vision doctor from a great one is their ability to empathize and counsel the patient through their loss-of-vision grieving process. Although the doctor’s primary job is to get the patient functioning again, at times we act as social workers or lay psychologists. There are times, however, that we need to get outside support also, which is when you would refer the patient to a licensed social worker or psychologist for assessment and management.

Initially, we live at my practice by the idea that if the patient is willing to work to help themselves, we can offer them the tools to meet their goals.


The first thing to remember about low vision patients is that they are visually impaired, not blind or deaf. Most low vision patients come with a family member or friend to help with filling out forms and to do other detailed tasks. Otherwise, the paraoptomtretric will help with the documents. Next, you have to modify the way you do pre-testing as the patients may not see the chair as well, and definitely have difficulty maintaining fixation on automated equipment. The other issue is discussing the financial variables of the examination. This can get pretty complex as the patient may think that everything is covered by their insurance, and often that is not the case.

Patients are seen for an initial visit, then usually a few weeks later for the dispensing of devices, training of devices or follow-up if dispensed the first day. Then, they are seen again about three months later to ensure that the devices are successful. We work with the referring doctor to make sure that all medical follow-up is done with them.

Third-party payers often cover the evaluation and management components of the low vision exam. Medicare specifically excludes the refraction, which is a primary component of the visit, so that is private pay. Depending on the severity of the impairment, training with the devices is billable to the insurance carriers also. Devices are rarely covered, but there are some plans that do.


Maria Richman, OD, FAAO, is co-owner, along with her husband, Harvey Richman, OD, of Shore Family Eyecare in Manasquan, N.J. To contact: drrichman@lowvision-nj.com


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