Dry Eye And Aesthetics

Rebuilding a Practice Around Dry Eye Care

Photo Credit: Getty Images. There is opportunity to grow your practice and help dry eye sufferers.

Embrace a medical optometric model including dry eye care to enhance your financial stability

By Jeffrey S. Williams Jr., OD, Dipl ABO

Jan. 27, 2026

When I joined my father’s optometry practice, it looked a lot like most others: a mix of primary eye care, refractions and the occasional medical billing opportunity. Today, our practice is about 90% dry eye care and 10% primary and specialty care. Our transformation didn’t happen overnight. It didn’t happen by accident. It’s been a journey driven by patient need and strategic investments, including a personal investment in becoming a better communicator.

I believe more optometrists can find professional satisfaction and financial stability by embracing medical optometry, specifically dry eye. Making a lot of smart moves, and a few questionable ones, too, has taught me that growing a specialty practice is just as much about how you talk to patients as it is about what tools you buy.

EARLY INTEREST AND INVESTMENTS

My interest in dry eye began in optometry school, studying under Kelly K. Nichols, OD, MPH, PhD, FAAO. At the time, she was doing groundbreaking work linking dry eye and hormonal changes in women.¹ Another mentor taught me that women over the age of 40 tend to be the primary healthcare decision-makers in their households.² I started to think, “If we can help ‘mom’ and gain her trust, we will win the loyalty of her entire family.” Providing her a new pair of progressive readers or multifocal contact lenses didn’t feel like I was solving her problem. Treating her persistent, often invisible symptoms like dryness, irritation and fluctuating vision, however, could make a real and lasting impact. And it also could help grow our practice organically.

When I first started treating dry eye, I didn’t own any fancy equipment. I used fluorescein strips and listened to my patients’ complaints. I practice in New York, and I couldn’t even bill for matrix metalloproteinase-9 and thermal pulsation. Still, patients appreciated being heard and being offered something beyond artificial tears. Eventually, I made large capital investments in both an intense pulsed light and a radio frequency device. Both had price tags in the six-figure range, but I had high hopes from both a clinical standpoint and a business perspective. Although I still use these devices and some patients find symptomatic relief, neither truly matches our patient population or clinical goals. What I learned was that I didn’t need expensive equipment to start a dry eye clinic, I just needed a plan—and a way to communicate my value.

THE BEST INVESTMENT I EVER MADE

This may sound odd for a medical professional, but the best investment I made was learning how to be a persuasive communicator. Optometrists are incredible diagnosticians, but if you can’t explain a diagnosis in a way that makes your patient understand it, act on it and stick with a treatment plan, then what good is it?

I read everything I could get my hands on about neurolinguistic programming and sales psychology. What I learned is patients need to want to get better. They need to believe their condition is real and that your treatment is the answer.

When I talk to patients about dry eye, I help them visualize what’s happening with their tear film and meibomian glands. Sometimes, I show them images of their own ocular surface. What matters is that I connect with them—and because of that, I’ve built a loyal base of highly compliant patients.

Meibography images are helpful to show patients they have gland dropout and motivate them to stick with therapy. In terms of reimbursement or driving practice growth, however, the return of investment isn’t huge.

MEDICATIONS THAT MOVE THE NEEDLE IN DRY EYE CARE

My dry eye formulary has grown significantly over the years. When I graduated in 2006, cyclosporine ophthalmic emulsion 0.05% (Restasis; AbbVie) was the only available treatment, followed by lifitegrast ophthalmic solution 5% (Xiidra; Bausch + Lomb and cyclosporine ophthalmic solution 0.09% (Cequa; Sun Ophthalmics). Today, we have more arrows in our quiver, including cyclosporine ophthalmic solution 0.1% dissolved in perfluorobutylpentane (Vevye; Harrow), perfluorohexyloctane (Miebo; Bausch + Lomb) and varenicline solution 0.03% (Tyrvaya; Viatris). Lotilaner ophthalmic solution 0.25% (Xdemvy; Tarsus Pharmaceuticals) is approved for the treatment of Demodex blepharitis.

Each medication plays a role in how I tailor care. Vevye, for example, is among my most prescribed treatments because it doesn’t cause burning or irritation, spreads evenly over the ocular surface,³ works quickly and is comfortable on instillation, which is especially helpful for patients with very sensitive eyes. It has a longer residual time of up to 8 hours and a 22 times higher penetration of cyclosporine compared to cyclosporine ophthalmic emulsion 0.05%.³ According to the DEWS III guidelines, it may play a role in preventing tear evaporation.⁴

BUILDING REFERRAL NETWORKS AND WELCOMING NEW COMMUNITIES

One simple and effective way I’ve built my practice is through primary care referrals. After each visit, a fax is sent to the patient’s family doctor. Over time, physicians start to trust you and send more patients your way.

If your clinic is welcoming to new populations, word-of-mouth will do the rest. One key strategy has been building relationships with the Spanish-speaking community. I can perform most of an eye exam in Spanish now, and I’ve hired staff who are fully bilingual. Additionally, we see more kids with dry eye than ever before. Between 70% and 80% of the school-age children I see show symptoms, which is largely driven by increased screen use.⁵ I often prescribe cyclosporine for kids, particularly for those with vernal conjunctivitis. There’s an FDA-approved formulation for children as young as 2 years old, and I’ve had excellent success with it. Dry eye is no longer just an “over-40” issue.

THE BOTTOM LINE

Dry eye care can be profitable. Our practice has increased its revenue substantially without seeing more patients, relying on high-volume refractions, or investing in every new device that hits the market (see below about the ROI in building a dry eye practice). Success in dry eye management begins with asking the right questions during the exam, identifying signs and symptoms early and educating patients on the chronic nature of the condition. Treatment often involves prescription therapeutics initiated chairside with scheduled follow-ups every 3 months to monitor progress and adjust care plans.

Ultimately, if the clinician does not approach DED with the same seriousness as chronic conditions like glaucoma, patient perception and compliance will diminish. A systematic, committed approach not only elevates patient outcomes but also supports a sustainable and profitable clinical model. Even more importantly, helping patients find relief from their dry eyes is satisfying. I get to solve their problem, build lasting relationships and practice the kind of eye care that made me want to be a doctor in the first place.

You don’t need a $50,000 piece of equipment to start. You need empathy, a plan and a willingness to learn how to lead your patients to better eye health.

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ROI in Building a Dry Eye Practice: A Low-Cost, High-Impact Approach

Establishing a dry eye treatment protocol in clinical practice does not require substantial capital investment. With minimal resources such as a box of fluorescein strips and a yellow filter, clinicians can begin diagnosing and managing dry eye disease effectively and profitably.

A box of 100 fluorescein strips typically costs approximately $15. The addition of a Tiffen Yellow 12 filter, which can be adapted for use with a slit lamp to enhance the cobalt blue filter effect during fluorescein staining, costs roughly $25. This total initial investment of $35 is sufficient to evaluate 100 patients for an outlay of $0.35 per patient.

From a billing standpoint, a typical dry eye evaluation might be coded with 92012 (intermediate eye exam, reimbursed at approximately $77.65) and 92285 (external ocular photography, reimbursed at approximately $27.66) in New York’s Long Island region. This represents a potential reimbursement of $105.31 per patient, or $10,531 for 100 patients.

Amount invested: $35	Revenue generated: $10,531
Net gain: $10,496	Return on investment: 29,988.57%

This remarkable return on investment (ROI) illustrates that initiating a dry eye care protocol is not only clinically valuable but also financially strategic. Contrary to the belief that building a dry eye practice necessitates expensive diagnostic platforms or devices, the most critical components are clinical diligence, patient education and consistent follow-up.

This article was submitted by the doctor, reflecting his experience.

References

Nichols KK. Dry eye in postmenopause. Accessed June 1, 2025. https://grantome.com/index.php/grant/NIH/R01-EY015519-01A2
US Department of Labor. General facts on women and job based health. Accessed June 1, 2025. www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/women-health-care-jobs-fact-sheet.pdf
Agarwal P, Korward J, Krösser S, Rupenthal ID. Preclinical characterization of water-free cyclosporine eye drops – factors impacting ocular penetration ex vivo and in vivo. Eur J Pharm Biopharm. 2023;188:100-107.
Stapleton F, Argüeso P, Asbell P, et al. TFOS DEWS III digest report. Am J Ophthalmol. In press. June 3, 2025. doi.org/10.1016/j.ajo.2025.05.040
Al-Mohtaseb Z, Schachter S, Shen Lee B, Garlich J, Trattler W. The relationship between dry eye disease and digital screen use. Clin Ophthalmol. 2021;15:3811-3820.