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How cash-pay retinal monitoring can serve undiagnosed, high-risk patients while unlocking a new revenue stream
By Walker Shaffer, OD
Sept. 18, 2026
Every week, one of two types of people walk into Eyecare of Lehi with similar concerns. First are those who watch us treat their family members for conditions like age-related macular degeneration (AMD), glaucoma and diabetic retinopathy and ask: “How do I know if I’m going to get this? What can I do right now to protect my eyes?” Second are health-conscious 20- and 30-somethings looking to optimize their healthspan and prevent chronic eye disease before it starts.
Third-party vision and medical insurance make this very difficult. Insurance operates on a model of sick care, requiring a concrete diagnosis before covering advanced diagnostic testing or specialized management. Patients with family histories or systemic risk factors are left with out-of-pocket expenses for preventive monitoring, or worse, no clear pathway for proactive intervention at all.
To bridge this gap and differentiate our practice, I created a Vision Protection Plan. Launched in March after extensive research, this cash pay program helps us deliver proactive, personalized retinal care to undiagnosed, high-risk patients—all while diversifying our revenue.
UNDERSTANDING THE RETINAL RESERVE
The foundation of our plan relies on a concept I call the “retinal reserve.” Think of this as the retina’s inherent capacity to resist functional decline and structural damage caused by ongoing metabolic stress.
Systemic stressors—such as systemic inflammation, dysregulated blood glucose or fatty acid imbalances—cascade to the retina via pathways like the gut-eye axis. Over time, these cumulative metabolic burdens wither away the retinal reserve. Long before structural damage manifests as geographic atrophy, optic nerve fiber loss or retinal hemorrhages, subtle functional declines occur.
If we rely solely on standard disease metrics and wait until visual acuity drops or structural loss appears on a scan, we have missed the boat on true proactive care. Our goal is to identify systemic stressors early, diminish cumulative risk and preserve that retinal reserve.
STRUCTURING THE PLAN INTO TWO TIERS
To make the program structured and accessible, I established two pricing tiers:
- Prevention Tier ($2,000): Designed for undiagnosed patients with high risk factors or family history. Because insurance cannot be billed without a primary diagnosis, this fee covers all baseline functional/structural testing, blood panels and lifestyle consultations.
- Protection Tier ($1,000): Designed for patients who are already diagnosed with a chronic posterior segment condition. Because their primary diagnostic imaging can be billed through medical insurance, this reduced cash fee covers the specialized systemic blood work, functional health coaching and customized lifestyle interventions.
Patients can pay upfront for a 15% discount ($1,700 for Prevention, $850 for Protection) or utilize patient financing through Cherry. Currently, we have 15 patients enrolled—five in the Prevention tier and 10 in the Protection tier—and patient reception has been overwhelmingly positive.
THE PATIENT JOURNEY: A THREE-VISIT PROTOCOL
The program spans a six-month intensive care cycle divided into three key visits, preceded by an intake process.
1. Intake and Blood Work
Patients first complete a multi-tiered questionnaire covering personal/family medical history, current exercise, diet, supplement intake and willingness to make lifestyle adjustments.
We then send them to a local functional medicine clinic with an in-house laboratory. We order specialized blood panels targeting core systemic stressors: ESR and CRP to gauge systemic inflammation; blood glucose and HbA1c for glycemic control; and omega-3 to omega-6 ratios for fatty acid balance.
2. Visit One: Baseline Diagnostics and Game Plan
Once the lab results are in, the patient attends their first in-office visit. I establish structural baselines using optical coherence tomography (OCT) and fundus photography. For objective functional metrics, I use electroretinography (ERG) and Rabin cone contrast testing. I also plan on adding retinal oximetry to evaluate oxygen metabolism efficiency directly.
From there, I synthesize these findings into a concise, three- to four-point actionable health plan. For example, if an AMD-risk patient exhibits elevated inflammatory markers and an imbalanced omega ratio, I target those specific drivers. I provide nutritional guidance, recommended cross-training exercises (combining weight training and aerobic workouts) and two weeks of Mediterranean-style meal plans crafted by one of our trained staff members.
Patients are then given 12 weeks—the time frame necessary to see meaningful metabolic shifts—to implement these changes.
3. Visit Two: Midpoint Check-In
At the three-month mark, we meet again to review progress, troubleshoot barriers and offer encouragement. We do not conduct repeat diagnostic testing during this check-in.
4. Visit Three: Re-Evaluation
At six months, we repeat both the functional/structural testing and the lab panels. We review the data together, highlighting stability or improvements in systemic markers and retinal function.
Following this visit, patients transition into an annual subscription model for long-term monitoring.
NO NEED TO OVERTURN THE PRACTICE
To implement a similar cash-pay model, the following key infrastructure is necessary:
- Diagnostic Tools: Advanced structural imaging (OCT) paired with objective functional testing (ERG or specialized contrast sensitivity) is essential for detecting subtle changes.
- Lab Partnerships: Establishing a streamlined relationship with a local lab or functional medicine clinic to run systemic panels.
- Branded Deliverables: High-quality, professionally designed intake forms, educational trifold pamphlets and customized meal plan templates elevate the experience to feel like a high-end concierge healthcare service.
The initial investment involved my own time to research ocular nutrition and early biomarkers. But because the package fees account for technician time, specialized testing and clinical consultation, the time spent with each patient is well compensated.
An educated patient equipped with personalized data is far better positioned to preserve their vision than a doctor who sees them once a year. By moving beyond traditional insurance boundaries, I can deliver meaningful eyecare that protects my patients’ vision for the long haul—all while building a niche that strengthens my practice’s bottom line.
Read more from Dr. Shaffer here.
Read more on the medical model here.
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Walker Shaffer, OD, practices optometry in Utah with a clinical focus on proactive retinal care, early detection of retinal disease and integration of metabolic, functional and structural diagnostics. His work explores and implements strategies for identifying dysfunction earlier and preserving retinal health through lifestyle, nutritional and emerging metabolic therapies. |
