Cold Start

Get The Facts: Objective Stats About Optometry Cold Starts

Photo Credit: Getty Images

By Robert J. Steinmetz, OD, FAAO

Jan. 22, 2026

With every new year comes new beginnings and, inevitably, resolutions. I have spent more than a decade helping doctors through their journey to cold start optometric practices from conception through profitability. Yet my team and I are always fascinated by the sheer volume of cold start inquiries we receive after the ball drops on New Years Eve.

For most people, their New Year’s resolution may involve losing weight, building muscle, reducing stress or spending more time with loved ones. However, studies show fewer than 10% of people stick to their resolutions for the entire year, with the majority abandoning them before the end of January.

Cold starts are the anomaly.

They follow through.

COLD-START MOTIVATION

Why? Many individuals set lofty goals with timelines or expectations that become unattainable. One could argue that outside of refracting an engineer to 20/20 perfection, there are few professional challenges more daunting than starting a practice from scratch. So why do optometrists follow through on their resolutions to cold start?

Cold starting is extremely fulfilling and can be very profitable.

Cold starts organically create a practice from their own vision and mission. It is personal. We often see doctors begin this journey after spending time with loved ones, often during the holidays, receiving encouragement from those they care about and respect most. Family and friends are fully invested as they pursue their dream and are critical to their success.

Not only is there meaningful motivation, but there is also a proven track record.

12 SURPRISING STATS AND FUN FACTS ABOUT COLD STARTS

These stats and facts about cold starts may help you decide if cold starting in 2026 should be part of your New Year’s resolution.

LOANS

1. In 2026, the average cold start loan is $575,000 with current interest rates ranging from ~5%-6% through a preferred cold start lender.

Loan structures have never been more favorable with 15 year terms, graduated repayment and 100% financing available. It is important to have proper guidance through the application process to ensure that you’re in the best position for approval.
Build out cost is the largest variable impacting cold start loan size.

2. 80% of cold starts have student loan debt of over $250,000, yet 100% financing is still achievable.

CLIENTS AND THEIR COMMUNITIES

3. The majority of iCare Advisors’ cold start clients are female and/or minorities.

4. Those who choose to practice in their hometown or current community tend to grow quicker due to established patients and built-in support from family and friends.

Geospatial analytics are vital when helping to choose a viable location.

PATIENT AND EXAM VOLUME

5. Patient volume is the primary driver of early cold start success.

6. The average cold start sees 54 comprehensive exams in their first month.

7. iCare Advisors’ cold start clients average $476 revenue per patient despite participating in multiple vision insurance plans.

SPECIALTIES AND TECHNOLOGY

8. 90% of cold starts incorporate specialties such as myopia management, medically necessary contact lenses and urgent care on day one.

9. 99% of cold starts begin with an Optos California or an OCT/Fundus photo combination.

HOW SUPPORT HELPS

10. The record for private Slack messages exchanged between a client and the iCare Advisors team in one year is 1,816.

Successful cold starts require active support both before opening and well into profitability. Those clients that reach out more for personalized advice tend to gross more than others. As the saying goes, “You don’t know what you don’t know.”

11. Over the last ten years, the record collections for year one of an iCare Advisors cold start client is $1,024,689 and record collections for month one is $95,912. Impressive, but not the norm!

12. iCare Advisors’ cold start client revenue in 2025 would place them in the top 15 of Vision Monday’s Top 50 U.S. Optical Retailers.

ARE YOU DRIVEN TO COLD START?

Cold starting is not for everyone. It is important to remember that not all cold starts have the same mission or the same goals so proper guidance needs to be tailored accordingly.

Cold start private practice is constantly evolving and ever changing. However, we continue to see new interest at the dawn of every year. What begins as a dream—or a New Year’s resolution—can ultimately become a thriving, established practice: the greatest decision and best investment of their lives.

The above stats are pulled from objective data from over 350 cold starts over the last ten years.

Read another article from Dr. Steinmetz here.

Read more on cold starts here.