Dry Eye

How a Boutique Dry Eye Clinic in an Unexpected Spot Drew $45,000 in the First 9 Months

Dr. Hofacre administering an IPL treatment to a patient. Dr. Hofacre found that the large retail store where her practice is based has ideal shopper demographics for a dry eye center.

Dr. Hofacre administering an IPL treatment to a patient. Dr. Hofacre found that the large retail store where her practice is based has ideal shopper demographics for a dry eye center.

Creating a dry eye “spa” in a place you probably wouldn’t expect it.

By Marinda Hofacre, OD

March 6, 2024

Building a dry eye clinic was an easy decision for me, an opportunity to offer my patients the care they need while developing new revenue. But the location of my boutique clinic takes some people by surprise: a “big box” retail store known for helping people stock up on popular merchandise at good prices.

As I’ll explain, my practice is the perfect location for a dry eye clinic—and the changes that helped us bring in over $45,000 in the first nine months can apply to any practice.

Demographics and My DED Patient Base 

My practice is located in a Costco. Though patients don’t have to be members of the store to come to my practice, most of my patients are Costco shoppers. Who are they? With 124.7 million members1 at 591 stores in the U.S. (136 here in California), the clientele is naturally diverse, but a recent study showed that the “average” Costco shopper is a middle-aged woman earning over $125,000 per year.2

Middle-aged women are a key demographic for both dry eye disease (DED) and aesthetic treatments, which I offer as an upgrade to DED therapies. And although I recommend cash-based DED procedures that reflect patients’ clinical needs, regardless of income, it’s likely that these patients have the means to pursue DED treatments.

These demographics are promising, but when I started building a dry eye disease (DED) specialty a year ago, I was even more excited to delve deeper into my existing patient base, a database with 350,000 patients.

With studies estimating that the prevalence of DED is up to 50 percent of the population,3 the practice’s potential patient base for DED services is enormous.

DED treatment also presents a unique opportunity to bring more money into a corporate practice. The optical is Costco’s business, so it’s not an area for revenue-building. Although Costco doesn’t control my exam fees, I don’t freely increase them because it makes sense to maintain a rate that fits customers’ expectation of value and stays close to the rates at other Costco practices.

Editor’s Note: There are other options for ODs who think they might like to own a practice located within, or adjacent, to a large retail store. Those options include Walmart, Sam’s Club and Target, among others.

Thus, the key to profitability in this model is volume, which is why our patient base is so large. And all aspects of patient care, from routine exams to co-managing LASIK and cataract, fall under my practice—including dry eye care.

Investment and Revenues in the Dry Eye Clinic

In the past, I’d been treating DED with punctal plugs, medications and at-home therapies, with limited success. Then I learned about OptiLIGHT (Lumenis) in-office intense pulsed light (IPL) treatment, and I knew it was the clear next step for me, the cornerstone of a new dry eye clinic. Here’s a breakdown of my investments, fees, and ROI.

Editor’s note: There are other IPL systems to choose from such as MDelite iPro X (IPL/RF), Essilor epi-c plus (IPL/LLLT), Envision by InMode (IPL/RF) and Optometric Aesthetic’s iLight IPL Pro (IPL/RF) and OCCULUS’s LUVO Darwin, among other technologies.

Starting with a cornerstone in-office treatment: I chose OptiLIGHT because it addresses DED due to MGD, the most common cause of DED. Now that I’ve been using it for nine months, I’ve seen my patients’ tremendous success, with significant improvement in signs and greater freedom from self-care.

When I purchased my IPL, I knew that I only needed to treat one patient per month to make the financing payments. I set my IPL fee for four treatments at about $100 less than other practices in the region, in keeping with Costco’s image. I also set up incentives such as a $75 discount to pay for all four sessions upfront and specials like a free fifth session with the purchase of four.

In the first nine months, my treatment volume and revenues started strong and continued to grow, yielding over $45,000 in the first 30 patients.

Building with additional treatments: I was so happy with OptiLIGHT that I bought OptiPLUS (Lumenis) dual-frequency RF treatment, which uses heat to target meibomian glands.4 My patients with significantly blocked meibomian glands get fast, exceptional results when we pair OptiLIGHT for inflammation with OptiPLUS.6

I also perform in-office ZEST (Zocular Eyelid System Technology) treatment (Zocular) for blepharitis. This quick procedure removes debris and bacteria from the lid margins, alleviating the condition and reducing its contribution to dry eye disease.

Positioning the aesthetic effects: Intense pulsed light has long been used by dermatologists as an aesthetic treatment, and also has the capability to rejuvenate skin and even out skin tone.5 My patients love the effects on the periocular area, and most of them upgrade their IPL treatment to cover the full face (a $300 charge). In addition, I chose OptiPLUS over other heat-based treatments because it has the aesthetic benefit of rejuvenating the skin.6

Investing in new diagnostics: I generally diagnose DED based on a patient’s exam and our discussion. When I started building the dry eye clinic, I bought a handheld meibographer (MeiboVue, VisuScience). I don’t need it to help convert patients, but it does allow them to see their treatment results over time.

With over $45,000 in new revenue in just nine months, I’m highly pleased with the success of my new dry eye clinic. I anticipate that the revenues will grow as we continue to flag more patients for DED management.

We’re even getting referrals from our LASIK and cataract partners in ophthalmology for preoperative treatment of DED. I think it’s a rewarding model for both independent optometrists and those of us who thrive in a corporate setting.


  1. Company Profile. Costco Wholesale. Accessed 12/8/2023: https://investor.costco.com/company-profile/default.aspx
  2. Reuter, D. Meet the typical Costco Shopper, a 39-year-old Asian American woman earning more than $125,000 a year. Business Insider. February 2, 2023. Accessed 12/8/2023: https://www.businessinsider.com/typical-costco-shopper-demographic-asian-american-woman-earning-high-income-2021-7
  3. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15(3):334-365. doi:10.1016/j.jtos.2017.05.003
  4. Chelnis J, Garcia CN, Hamza H. Multi-Frequency RF Combined with Intense Pulsed Light Improves Signs and Symptoms of Dry Eye Disease Due to Meibomian Gland Dysfunction. Clin Ophthalmol. 2023;17:3089-3102. Published 2023 Oct 20. doi:10.2147/OPTH.S426564
  5. Goldberg DJ. Current trends in intense pulsed light. J Clin Aesthet Dermatol. 2012;5(6):45-53.
  6. Javate RM, Cruz RT Jr, Khan J, Trakos N, Gordon RE. Nonablative 4-MHz dual radiofrequency wand rejuvenation treatment for periorbital rhytides and midface laxity. Ophthalmic Plast Reconstr Surg. 2011 May-Jun;27(3):180-5. doi: 10.1097/IOP.0b013e3181fe8e5a. PMID: 21283035.

Marinda Hofacre, ODMarinda Hofacre, OD, is the owner of Hofacre Optometric Corporation & Dry Eye Care, with locations in Chino Hills and San Dimas, Calif. To contact her: drmindydee@gmail.com

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