Photo courtesy of Dr. Nishi Mehdiratta, seen here with her practice team.
Independent optometry survival strategies
By Nishi Mehdiratta, OD
August 13, 2025
Independent optometry practices face a rapidly evolving landscape marked by staff recruitment struggles, stagnating insurance reimbursements and fierce local competition.
In an era when patient expectations are rising and operational costs continue to climb, private-practice ODs must find creative ways to sustain profitability, boost staff morale and deliver an experience that sets us apart.
Here is how I confronted and surpassed these obstacles in my practice all the while reigniting my professional passion.
Why One-On-One Staff Check-Ins Boost Morale and Retention
If you ask any independent OD what their biggest challenge is, their answer will likely be staffing—both finding and retaining motivated team members. I know I’m not alone in this. High turnover isn’t just frustrating, it costs time and money in lost training and momentum.
After years of feeling pressured to fill empty seats quickly just to keep up with patient flow, I learned the hard way that rushing the hiring process almost never pays off.
Now, instead of hiring in a panic, I put a stricter process in place: a phone interview, followed by an interview with our team then a final meeting with me. It sounds like a lot but candidates who are truly interested stick with it.
We also lean into hiring motivated students who are interested in optometry—they’re available during busy periods and bring authentic enthusiasm to the practice.
What’s worked best for us is a part-time staffing model. With 11 part-time support staff, I’m not scrambling if someone’s class schedule changes or they go on vacation. I get better coverage and less burnout all around.
One thing I changed is the way I stay in touch with my team. Big group meetings don’t tell me who’s truly engaged so instead I do quarterly one-on-one check-ins with each employee. I listen to their feedback—what they like, what they want to do more or less of, where they see themselves growing.
When someone at the front desk wants to train in glasses measurements or optical work, we give them that opportunity. The result? My staff feels more valued and engaged. Employee feedback is my number one retention tool and internal culture metric.
As for loyalty, nearly my entire staff followed me from my previous location. With part-time roles, new technology and bonus opportunities, staff who used to feel stretched now see their work as rewarding—often earning more in bonuses from supporting me in delivering specialized services, like dry eye treatment, than from hourly wages.
While our new office has only been open seven months, nearly all my staff have been with me for years—most for two to six years, even through big practice changes.
I believe that’s because our revenue per patient is up, patient volume is down and every team member feels they play a unique role.
Leaning Into Cash Pay Procedures to Boost Average Revenue Per Patient
My second biggest challenge as an independent OD is stagnant insurance reimbursement—especially for vision care. Overhead keeps rising but vision plan payments haven’t changed in 40 years. When I realized I couldn’t change the insurance system, I focused on increasing my cash-pay services.
During COVID, I hit a wall and had to rethink everything. I added procedures like radiofrequency and intense pulsed light (IPL) for dry eye. It was a total game changer. Instead of racing through 40 low-reimbursement exams a day, I invested more time per patient and built up our dry eye niche.
Here’s the core profitability metric I track now: average revenue per patient. For dry eye, our average is $2,500 to $3,000 per patient. That’s a world away from the $40 per patient days when I was a sublease OD sending patients elsewhere for glasses.
Even our routine exams are more profitable now—typically $250 to $500 per patient—since we prioritize medical billing and have a thriving optical.
If you’re struggling with insurance plans, my advice is get credentialed on every medical plan you can. Medical visits usually reimburse three to four times more than vision and you can offer a more comprehensive exam—with medical plans often covering tests like Optomap or visual field.
Standing Out: The Power of Niches and Exceptional Office Experience
The third challenge I see across our field is standing out in a saturated market. I talk with colleagues who have six ODs within a mile. My answer: you need a niche. It could be dry eye, myopia management, scleral lenses or another area but you must become known for something relatively unique.
For me, dry eye is our specialty and we’re also building up myopia management—something most parents will pay for without hesitation if it benefits their child’s vision and long-term eye health. I encourage all ODs to consider what excites them and lean into it.
No matter your specialty, make sure your entire staff can answer basic patient questions—like, “What is IPL?”—when the phone rings. I bonus my staff on dry eye treatment conversion rates and at-home treatment product sales and when they’re invested in our mission, patients see and feel the difference.
Ongoing doctor and support-staff education, direct patient consultations (sometimes 45 minutes per appointment) and adopting the latest technology keep our experience at the highest level.
Closing Thought: Reignite Your Passion—And Watch Your Numbers Rise
If I have one closing thought for my peers, it’s this: don’t let the day-to-day grind and stresses steal your passion.
Independent optometry gives us immense freedom to evolve. Take a step back, ask yourself what you love and do more of that in your practice. When you’re passionate, patients feel it—and yes, profitability follows.
Read another article by Dr. Mehdiratta here.
Nishi Mehdiratta, OD, is the owner of Luxe Eye Care in Houston, Texas. To contact her: nishi.mehdiratta@gmail.com
