One of the key metrics we track in SIMI Analytics is Revenue Breakdown. What products and services are bringing in the most revenue? We compare this to how much time is spent to offer these products and services on the exams side to evaluate the effectiveness of the time invested.

According to SIMI Analytics, a healthy primary care practice brings in 26% of their revenue from exams, diagnostics contribute 10%, spectacles 50%, contact lenses 12% and miscellaneous (OTC products and optical accessories) 2%.

Detailed Breakdown

We often break this down further to look at how much chair time is being dedicated to services as compared to products. For instance, we always evaluate the revenue generated from contact lens assessments in comparison to how much revenue is being generated from contact lenses (both gross and net dollars). As contact lenses have become a commodity, it has become even more important to the financial health of the practice to ensure that the chair time associated with the care of contact lenses is covered.

A number of practices we work with have successfully introduced Specialty Contact Lenses, Vision Therapy, and Dry Eye Clinics as a means to both meet patient needs and increase revenue. In these practices, the Revenue Breakdown in SIMI Analytics looks a little different.

Here’s how you can expect to generate your revenue:

Impact on Staffing Decisions

Note in particular how primary care practices are much more dependent on optical sales for financial health. A practice offering Vision Therapy generates a much greater percentage of their revenue from the services of Vision Therapy versus selling frames and lenses. From this information, the practice can make more sound business decisions. For instance, if your practice is predominantly offering Vision Therapy as the main means of revenue, our recommendation would be to hire a frame stylist for the optical instead of an optician and concentrate your staff cost resources on hiring skilled and passionate therapists for Vision Therapy.

For practices offering medical contact lenses, such as Ortho-K and Scleral lenses, the differences to note are the increased revenue sources from both Exams and Contact Lenses. In this case, the products are much more profitable and it makes sense to expect more revenue from this source as compared to Eyeglass Revenue. Another metric we like to follow in our Contact Lens clinics is sunglass sales. Our expectation is that the revenue from plano sunglasses should be significantly higher. Again, staff decisions will be impacted by this information. Not only do you want to hire someone who is knowledgeable in contact lens care to assist your patients but you will want that person to also be passionate about sun protection. There is also an implication to your inventory decisions. This practice will carry a large selection of plano sunglasses.

The most interesting change in revenue generation for a Dry Eye clinic, besides the increased Exam revenue, is the increase in sales of OTC products. Drops, vitamins, wipes and make-up all contribute to increased revenue in this type of clinic. Given this, it is our recommendation to hire a dedicated staff member to be your Dry Eye Clinic coordinator. This is the person who will confidently explain all the products and solutions to each patient and follow through with after-care instructions.

Whether you choose to differentiate or remain focused on Primary Care, the key to success is to decide on one and stay focused. Keep track of the time it takes you to generate your income and use that information when making decisions about changing or adding extra staff, services, and products.



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


5 / 5. 1

Our aging population, along with the heavy use of digital devices and dry environments of work and living, mean more cases of dry eye. Creating a practice specialty–a dry eye center–as our practice has done, enables you to capture the opportunity to treat these patients, and keep them in your practice with services that address their needs.

I practice in a shared OD-MD practice with two ODs, including myself, and three MDs, and we seethousands of patients a year who experience dry eye.

The MDs and ODs typically share the same patients. Some cases are easily managed with lid hygiene and palliative care. More difficult dry eye cases are managed by the ODs through our dry eye center, which we call the Advanced Tear Analysis (ATA) clinic.

Our clinic is about 10,000 square feet. The exam room for ATA is about 100 square feet, so it does not require much space. The only thing that separates it from the other rooms is the addition of a LipiFlow machine.

The ATA exam can be used for any dry eye patients. However, the process is very thorough. Some cases of dry eye may not require the extensive testing. Patients who do not improve with treatment after one office visit will be referred to the ATA clinic, which is the minority of the patient population.
Each half-day may average from 9-13 post-operative and acute care patients. The ATA clinic will schedule only up to two additional patients for a half-day. Due to scheduling and post-operative care demands for time slots, the ATA schedules patients on two half-days a week. The exams can range from 45 minutes to an hour. We may see four ATA exams a week per OD. These exams take longer, but are 50 percent more profitable than a traditional office visit.


As the volume of dry eye patients grows, the OD can serve an unmet need. The OD can treat most cases of dry eye. For severe cases, the MD can do surgical procedures such as tarsorrhaphy, gold or platinum weighted eyelid implants, intraductal probing and punctal cautery.


The ATA exam represents the new exam that is dedicated to the diagnosis, management and treatment for the more difficult cases of dry eye. The patient must have had an initial comprehensive examination beforehand either at the practice, or at another practice. ATA exams share clinic space with post-operative exams and walk-in patients.

Comprehensive exams have their own set of rooms as these exams typically take the longest amount of time. The initial dry eye, or ATA, exams are held on two half-days a week for the initial testing and evaluation. Re-checks typically take less time, and can be scheduled throughout the week if necessary. LipiView II (TearScience) imaging is done on all patients, and the machine is centrally located near other pre-testing equipment. The exam room with the LipiFlow is reserved for the ATA clinic during scheduled treatments or possible treatments.

The Advanced Tear Analysis center at Durrie Vision. Having a specialized place, protocol and instrumentation for dry eye analysis and treatment.enables the practice tocare for a growing population of dry-eye patients.

There are many opportunities for managing dry eye in a refractive surgery practice, even if it is only during post-operative healing. Some post-operative patients need extra help with dryness. The majority of my exams are geared toward treating the ocular surface. Treating the ocular surface in general creates better surgical candidates, leads to improved visual outcomes and increases patient satisfaction.


The prevalence of dry eye is estimated to be as high as 30 percent in some larger population studies for adults over age 50, with women suffering in greater numbers than men. Medications contribute to dryness. Environment and climate can also exacerbate dryness.

An unfortunate, newer trend of dry eye is that we now see younger patients in our practices. A less nutritious diet as compared to previous generations, increased electronic device screen time and contact lens overwear contribute to a poor tear film.

Dry eye is complex and multi-factorial. It is only getting worse, and the patients are increasing. Effectively managing dry eye is one of the greatest challenges in eyecare. Many patients who suffer from dryness struggle with vision, comfort, as well as quality of life. To ease the suffering of one of these patients is a rewarding experience. —Suzanne LaKamp, OD, FAAO


All dry eye patients need comprehensive exams. The following dry eye exam services incorporate additional testing for the ocular surface, that could not have otherwise been performed at the comprehensive exam.

The ATA patients get entrance testing with repeat retractions. The technician will then take the patient through HD analyzer imaging. The imaging is helpful in looking at image scatter from either problems with tear film or changes to the natural lens. It is a non-invasive test. Patients may get LipiView imaging if not already done at a previous exam. The patients all take the SPEED questionnaire.

At initial or subsequent visits, there may be various types of staining, tear break-up time, inspection for lid abnormalities, and Schirmer’s testing with anesthetic. A slit-lamp exam with meibomian gland functional testing is performed using either the Korb evaluator or with a cotton-tip applicator. There is no additional cost to providing questionnaires or a slit-lamp exam, other than chair time. LipiView and other equipment can be costly to a practice, and need to fit the practice budget. Dry eye exams services can help recover this cost, as well as performing LipiFlow.

Palliative treatments include a wide array of artificial tears (not sold in office) and punctal plugs. Specific artificial tears are recommended (Systane Balance and Retiane MGD are common), and samples are given. Our practice does temporary and permanent plugs. Plugs are a billable service for patients with insurance. Reimbursement for permanent plugs is typically good.

There are pharmaceutical options for treating dry eye. Patients are sometimes prescribed Restasis for tear film insufficiency. We have a new product, Xiidra, which is a promising treatment. More treatment options can lead to increased success. Corticosteroids and Doxycycline are prescribed for dry eye patients who experience a lot of inflammation, but carry a degree of risk with side effects. Many patients are now being treated with Omega 3 supplements or fish oil. We typically recommend higher quality brands such as PRN Omega Dry Eye formula or Nordic Naturals. Supplements can be sold in office, but we do not currently carry them.

Any patients with severe dry eye, such an non-healing epithelium or exposure, would be referred out of our practice. These cases could include surgical intervention, scleral lens fits, serum tears or amniotic membranes.


For managing meibomian gland dysfunction-related dry eye, therapeutic treatments include LipiFlow and BlephEx. We recommend all patients with meibomian gland dysfunction perform lid hygiene and warm, moist compresses for at-home maintenance. We sell the Bruder eye mask. While there are many warming moist eye masks on the market, patients like the convenience of having the mask available in office. Depending on quantity purchased, the Bruder mask can cost the practice $8-$12.50 each. Recommended mark-up would be at least 50 percent or greater.

We also sell Avenova lid cleanser. Most pharmacies charge the patient an average of 3x more for Avenova than for what we sell. It is much more affordable to get the product at our practice. The products are available at the check-out, where the patient will also schedule any following appointments. The warming eye masks and Avenova have been instrumental in helping our dry eye patients, as the majority have meibomian gland disease.


While all of the doctors at my current practice manage dry eye disease, the OD plays a larger role. The MDs spend more clinic time performing comprehensive examinations on surgical candidates, which is the largest revenue generator in the clinic. The OD sees a variety of patients including pre- and post-operative surgical care, acute care and patients for dry eye management.

Some of the dry eye patients include acute, resolving post-surgical dryness. There are also patients with chronic dryness for years without a history of surgery. The ATA clinic exams are performed exclusively by the ODs.


Most dry eye is evaporative, and some of the newer technologies work to improve meibomian gland dysfunction. The most valuable imaging equipment in diagnosing meibomian gland disease is the LipiView II. It is also one of best resources for educating our patients. For patients who suffer from meibomian gland disease, the LipiFlow is a great tool to have in clinic. LipiView and LipiFlow are essential to any dry eye clinic. While cost was previously a big hurdle for patient and practice alike, a recent decrease in activator pricing for the LipiFlow improves accessibility. More clinics will likely purchase the equipment, and hopefully the number of patients who get treatment will increase.

For patients with plaques along the lid margins, lid debridement is an effective procedure in restoring meibomian gland function. A golf club spud can be used in office, as well as the BlephEx.

Practices typically purchase the LipiView/LipiFlow and the BlephEx equipment. Length of time to profit varies per practice, and depends on what each practice charges for treatment. A typical yearly budget may require four LipiFlow treatments a month and 24 BlephEx treatments a month to be profitable.

As a cash-pay practice, we are fortunate to perform whatever testing we feel is best for the patient without concern for the varying insurer reimbursement policies. The testing aids in diagnosis and patient education. The patients are very receptive to testing. We charge for treatments such as BlephEx, LipiFlow, and punctal plugs. We also charge for products sold in-office such as the Bruder compress and Avenova. Each exam, including follow-ups, has a fee. We are reimbursed 100 percent for what we charge. For managed care patients, there is no current insurance coverage for meibomian gland dysfunction.


Dry eye services are marketed within the practice by word of mouth. The doctors will refer current and new patients to the ATA clinic if the dry eye patients need further testing and follow-up. Current plans involve integrating the ATA online link into the main web site. We have one that we can give out to patients, but is not yet accessible to the general public.

We developed a dry eye handout that is available in all exam rooms. The handout includes various treatments for dry eye. LipiFlow and BlephEx are some of the listed treatments. It is helpful to have a handout that advertises provided services, which the patient may elect to later choose if palliative therapy is not enough.

The dry eye clinic is not currently advertised on the web site, but will be in the near future. The services are relatively new, and were mainly developed as a way to better serve our current patients. The practice model is direct business-to-consumer. Within a few months of beginning the dry eye clinic, patients new to the practice are scheduling. This was surprising considering we have not actively advertised outside of the practice. There have also been a few referrals from outside practitioners. The addition of LipiFlow has been driving some of this outside business for the dry eye clinic. Word-of-mouth is also contributing to the increase in new patients.


Suzanne LaKamp, OD, FAAO, is an associate at Durrie Vision in Overland Park, Kan. To contact:


0 / 5. 0