Dr. Vittorio Mena, OD, MS, in his exam room. Dr. Mena offers tips for making the crucial decision on whether to sell to a private equity-backed buyer.
Private equity
By Vittorio Mena, OD, MS
April 23, 2025
Like nearly every life decision, the answer to whether you should sell your practice to a private equity-backed buyer is often, “it depends!”
There are currently over 30 private equity firms acquiring optometry and ophthalmology practices. The top five firms in our space—AEG Vision, EyeCare Partners, U.S. VisionMed Partners, MyEyeDr. and Retina Consultants of America—are changing the dynamics of the industry.
Seemingly, their main goal is to make the practice as lucrative as possible and then resell it at a higher rate within the next three to seven years.
The Financial Landscape
In recent financial news, firms like Blackstone and TPG are planning to bid to acquire Bausch + Lomb for $11.5 billion.1
According to Preqin data2, there have been 313 deals completed worldwide with a combined value of $17.0 billion since 2019. However, in 2023, investments in optometry companies fell from a peak of 81 deals worth $5.2 billion in 2021 to just 29 deals valued at $718.4 million.
Additionally, it was reported that 460 U.S. hospitals are owned by private equity firms, representing 8% of all private hospitals and 22% of all for-profit hospitals, with Texas having the most.3
Why Optometry and Ophthalmology?
What makes optometry and ophthalmology so enticing? There are about 19,000 optometry practices in the U.S., and vision is the number one sense we all have. Everyone needs some form of eyewear, whether prescription or plano sunglasses or contact lenses. And, at some point in their lives, many may require eye surgery. Because of this, the health care industry can be considered recession-proof.
According to The Vision Council, 92% of adults in the U.S. wear some type of eyewear, and in 2024, the U.S. optical industry hit $68.3 billion, growing 2.7% from 2023.4 Prescription lenses in glasses accounted for $17.2 billion, plano sunglasses for $17.8 billion and contact lenses for $11.8 billion. The average optometry practice has a single location with eight employees and about $947,000 in annual revenue. This makes our industry very beneficial for equity firms looking to buy.
To Sell or Not to Sell?
Now, if you own a private practice, you might be wondering whether to sell to private equity or stand strong.
Being a business owner is tough, and sometimes owners have had enough of the everyday ups and downs—hiring and firing, misplaced orders, insurance reimbursements and so on. It’s easy to consider calling it quits sooner than expected.
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Ultimately, it comes down to culture. Do these firms align with your vision for the practice? Are they interested in growing it exponentially, or do they only care about their bottom line? Can you see yourself working as an employee for the first time all over again, no longer calling the shots? Age is another factor; if you’re nearing retirement, your exit strategy will likely focus more on whether the price is right to close the deal.
Understanding Your Practice’s Value
To determine if selling to private equity is the right move, you need to calculate the value of your practice. You don’t want to get low-balled.
A crucial metric to know is your EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortization), as this is what firms will use as a multiple. Optometry practices typically average a multiple of around 3-6x EBITDA, and most private equity firms want to see margins of 25-30% or higher to ensure it’s a good investment.
Consider hiring a medical practice appraiser or a financial advisor who understands both the financial aspects of your practice and the overall team and systems you have in place. The biggest advantage of selling to private equity is, of course, the financial gain. Other benefits include access to better technology and equipment, which can enhance patient care, and the potential for a broader network of doctors and experts.
The Downsides to Consider
However, there are downsides to selling. You may lose control over your schedule, leading to longer hours and potentially poorer patient satisfaction. You won’t be calling the shots anymore, which can be an adjustment. Additionally, you might not like the culture that develops post-sale, and there could be conflicts of interest regarding patient care or increased costs for patients.
Timing and Financial Planning
In the end, it has to make financial sense for you to sell to private equity, and timing is everything. If you decide to sell, it’s crucial to figure out how to manage that money to make it last. Knowing what financial moves to make before you receive that cash is just as important as closing the deal.
It all comes down to having a game plan and “winning” the race financially.
Resources
- https://economictimes.indiatimes.com/news/international/business/tpg-blackstone-bid-for-bausch-lomb-in-potential-14-billion-deal/articleshow/114212563.cms?from=mdr
- https://www.preqin.com/news/optometry-in-the-spotlight-as-private-equity-firms-eye-usd11-5bn-bausch-lomb
- https://hsph.harvard.edu/news/private-equitys-appetite-for-hospitals-may-put-patients-at-risk/#:~:text=Nonprofit%20watchdog%20the%20Private%20Equity,owned%20by%20private%20equity%20firms.
- https://thevisioncouncil.org/blog/us-optical-industry-grows-683-billion-according-vision-councils-new-market-insights-report
- https://verticaliq.com/product/optometry-practices/#:~:text=Industry%20size%20&%20Structure,of%20optometry%20in%20the%20US.
Vittorio Mena OD, MS, is the sports vision director with Optical Academy. Dr. Mena is also an Optometric Financial Coach, with Series 6 and 63 investment licenses and Series 2-14 life and variable annuity licenses. To contact him: menavitt@gmail.com
