Photo courtesy of Dr. Cory Lappin, who shares insights he’s learning in the process of growing a new specialty practice.
Successfully launching a specialty practice
By Cory J. Lappin, OD, MS, FAAO
May 28, 2025
Opening a new optometry practice is an exciting endeavor, but the process can be daunting. While traditional practices typically incorporate comprehensive eye exams, optical sales, and general eyecare, specialty clinics focus on a more tailored approach.
My journey in planning the Dry Eye Center of Ohio has given me invaluable insight into the unique challenges and opportunities of launching a specialty optometry practice dedicated solely to dry eye and ocular surface disease.
Defining a Niche
Unlike a conventional optometry practice, my clinic will operate as a referral-based center for patients needing specialized dry eye and ocular surface disease care. Some optometrists and ophthalmologists may not enjoy managing dry eye or may feel limited in their ability to address it.
My clinic aims to bridge that gap, providing specialized care before returning patients to their referring providers for their routine eyecare needs.
This focused model necessitates a unique business strategy. Rather than relying on optical sales, our revenue streams will be derived from medical management, in-office procedures and advanced therapies. Understanding this distinction has been crucial in shaping the clinic’s operational and financial plans.
Planning and Development
I began seriously considering private practice a few years ago after working in a dedicated dry eye clinic at my previous practice.
Though online resources and books provided foundational knowledge about local markets, accounting principles, legal requirements and general business workings, the most valuable insights came from in-depth discussions with colleagues and friends who successfully built their own practices.
One of the most important decisions I made at the outset of my planning was to hire a consulting company, a commonly used tool when establishing a new optometry practice.
However, the unique needs of a specialty optometry practice require a consulting company that can tailor their services to a clinic that differs significantly from the traditional optical-centric practice.
I knew that choosing the right company and surrounding myself with experts in this area would be key to my success. Based on their expert advice, I projected a six- to eight-month preparation phase.
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Key Investments and Technology
The conventional wisdom for new practices is to start with basic equipment and add more advanced technology as the patient base expands. However, because my clinic is a referral-based practice dedicated to dry eye and ocular surface disease management, I need advanced diagnostic and therapeutic technologies on day one.
Approximately 20% of a cold-start’s budget is typically allocated to clinical equipment, but for my practice, this is closer to 30%.
However, I was able to reallocate the 7% to 10% of the budget that is usually dedicated to frame inventory and displays in an optical to equipment, ultimately keeping costs about the same.
Some of my primary investments have included advanced treatments like intense pulsed light (IPL), radio frequency (RF) and dynamic muscle stimulation (DMS) devices. Specialized imaging and diagnostic equipment, like anterior segment cameras and ocular surface analyzers, though they may have a less direct financial benefit than in-office procedures, also have immense clinical benefit and can indirectly create value.
Additionally, I always keep an in-office supply on hand of treatments that have the ability to quickly reduce the signs and symptoms of ocular surface disease while also providing high insurance reimbursement, such as cryopreserved amniotic membranes like Prokera .
Low-cost, in-office treatment options, such as the NuLids PRO eyelid hygiene device and rinsada irrigating lid retractor, are also dependable tools for building my practice and strengthening the bottom line.
Financial Considerations and Return on Investments
Understanding return on investment (ROI) is vital to any specialty practice. My financial projections factor in expected patient volume, the percentage of patients undergoing procedures and revenue per visit.
Because I previously worked in a dry eye specialty clinic, I have a strong grasp of patient flow and the relative demand for various procedures available to patients with dry eye and ocular surface disease.
This experience also gave me an understanding of the ROI for each type of treatment.
For example, I expect 80% of my patients to elect to undergo in-office treatments, so I aim to recover the investment cost of these advanced treatment devices within six to 12 months.
For in-office hygiene-based treatments and surface therapies, the cost is covered within weeks or even with just one treatment. After the cost of the device has been recovered, these treatments carry very little expense in the form of consumables, resulting in significant revenue per treatment.
Compared to a traditional optical-centric practice, which requires a significant investment in frame inventory, there is a relatively low inventory cost associated with a dry eye-only clinic. Because money is not as tied up in cost of goods, cash flow becomes less of an issue. Additionally, the vast majority of in-office dry eye treatments are self-pay so there is no waiting on insurance reimbursement, which also opens up cash flow.
Measuring Success
As a specialty clinic, my focus is not on high patient volume, but rather, on high-value care. Key performance indicators include:
- Net revenue per patient visit: Because many dry eye treatments are self-pay, this metric is crucial
- Revenue per optometrist hour: This provides a more nuanced way to assess productivity, as dry eye care requires a heavier time investment than routine care
- Treatment conversion rates: Tracking how many patients proceed with in-office procedures
- Referral volume: Evaluating the consistency and growth of referrals from other providers
However, success is not solely measured in financial gain but also in patient outcomes and satisfaction. Ensuring that my patients receive optimal care while maintaining a sustainable business model remains my top priority.
Advice for Future Practice Owners
I am so pleased with how the advice of friends, colleagues, my consulting company and other industry experts has shaped the plans for my specialty dry eye practice. No one can master every aspect of running a business alone, so their guidance has been invaluable.
For those considering private practice, my best advice is to follow your passion. Specialty practices thrive if they are built around genuine expertise and dedication. There is no single, correct way to run a practice—the key is aligning your business strategy with your clinical strengths and long-term vision.
Opening a specialty optometry practice requires careful planning, strategic investments and a thorough understanding of patient needs and business dynamics. Challenges will invariably arise, but practice ownership is a deeply rewarding journey.
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Cory Lappin, OD, MS, FAAO, previously practiced at Phoenix Eye Care and has opened The Dry Eye Center of Ohio, a dedicated dry eye and ocular surface disease clinic in Cincinnati, OH. He serves as the Clinical Section Editor for Dry Eye at Eyes On Eyecare and is the Chief Medical Editor of Optometric Physician. To contact him: coryjlappinod@gmail.com
