Growth strategies are often counterintuitive. For many optometrists, throwing a wide net to catch as many patients as possible may seem like the wisest idea, but there are plenty of specialized practices today that beg to differ.

More and more practices now strive to be the “big fish in a small pond” through specialization. By narrowing their focus and honing their niche, doctors are doing more than setting themselves up for impressive growth—they’re also doing work they are passionate about.

Five optometrists shared their stories and how specializing has been key to practice expansion, patient base growth, heightened revenue and personal fulfillment.

Optometrists that specialize in ocular aesthetics focus on treatment options that protect and improve the appearance of the eyes and surrounding skin. Treatments include eyecare safe products and in-office skin care procedures.

Helping People Look and Feel Better While Tripling Revenue per Patient
Margaret Foley, OD
Owner, Foley Vision Center
Eugene, Oregon

Other Specialties: Dry Eye

Dr. Foley’s path to practice specialization started early. “I got out of school immediately knowing that I didn’t want to do plain optometry and move dials all day—the disease aspect was always more challenging and interesting to me,” she said.

When she launched her career, Dr. Foley started in neuro rehabiltation, which led her to a specialization in Ocular Surface Disease (OSD). As she got deeper into OSD treatments, she quickly learned the limitations of pharmaceuticals and gravitated to energy treatments. After acquiring a radio frequency platform, Dr. Foley was very impressed by the treatment’s multi-faceted benefits, which sparked a whole new business trajectory.

“The upside of radio frequency treatments is profound—not only do people feel better, they also start looking better because we’re improving the collagen and elastin around the eyes,” she explained. “Once I saw that patients kept coming back for these treatments, the light bulb went on. I realized that this is the future.”

Dr. Foley started doing research and attending aesthetic-only meetings, where she was the only eye doctor in the room for at least six years. “I realized that this was an untapped market that could really benefit our long-term strategy.”

Once the decision was made, finding patients proved easy.

A patient receives IPL to treat OSD and improve cosmesis.

“We’ve been in this location for 18 years and have a very loyal following of OSD patients,” said Dr. Foley. “We focus on female heads of household and when I prescribe OSD treatments, I mention that they will also see a reduction in fine lines and wrinkles, along with improvement in collagen and elastin, which makes many people excited to learn more. Then we talk about their cosmetics and skin care, and we guide them to things that are healthier and safer than injections. That leads naturally into conversations about aesthetic treatments.”

For additional marketing, the practice hosts monthly lunch-time webinars, covering different topics of eye beauty. Those webinars have grown to be well attended. Plus, they post regular content on Facebook, Instagram and Tik Tok.

This strategy has proven very effective. “Before we brought on aesthetics, our average revenue per patient was around $400, but now it’s between $1,200 and $2,000 per patient,” she said. “Many patients also buy treatment packages ranging anywhere from $1,500 to $7,000, which is impressive considering it’s all private-pay.”

Another perk is limited competition. No other local ODs have the same instruments—only one plastic surgeon has something similar, but he uses it for a different purpose. Therefore, Dr. Foley often gets referrals from other MDs and ODs in the area.

Today, Foley Vision Center is proud to specialize in both OSD and aesthetics/beauty, with services including radio frequency, micro needling, Platelet-Rich Plasma (PRP), Intense Pulsed Light (IPL) and fractional laser treatments. The practice also has its own skin care line and cosmetics—providing a one-stop-shop for patients who want to look and feel their best.

Dry Eye
Optometrists who specialize in Ocular Surface Disease (or dry eye) focus on managing the symptoms associated with one of the most common ocular diseases—the inability to produce sufficient quality tears to maintain proper ocular surface lubrication. This condition may be caused by allergies, contact lens wear, systemic conditions and the presence of contributory ocular diseases.

Bringing Professional Fulfillment and Financial Rewards
Shane Swatts, OD
Co-owner, Eastern Virginia Eye Associates
Chesapeake, Virginia

Other Specialties: Facial Aesthetics

(Top to Bottom) Dr. Swatts performs Radiofrequency (RF) treatment. Dr. Swatts with his team. Intense Pulsed Light (IPL) treatment.

Although Dr. Swatts has always considered his practice to be a dry eye practice, he and co-owner Dr. Leah Ramos officially opened their Dry Eye Specialty Clinic just two and a half years ago. Their practice is broken down into two sections—one for primary care and medical eyecare, and the other being a MedSpa where they provide advanced treatment of Ocular Surface Disease (OSD) and wellness aesthetics.

According to Dr. Swatts, they don’t need to look far to find patients—they are already sitting in their chairs. With an estimate 49 million Americans suffering with dry eye disease, there’s no lack of patients in need of care.

“Initially, we were concerned that there may be some pushback from other healthcare professionals providing similar services, such as ophthalmology, dermatology and aesthetic practices,” he said. “However, rather than push back, we have developed a collaborative relationship with these providers. Surprisingly, these have become primary referral sources for our Dry Eye Specialty Clinic. Optometrists have taken the lead and are now seen as the ‘go-to’ providers for dry eye disease.”

Since specializing, profitability has also seen a hike. “We’re all aware of the frustrations involved with managed care and vision care plans,” he said. “Introducing a cash-based model into our dry eye clinic has resulted in significant financial growth. While the treatments themselves are financially rewarding, it’s the packaging of those treatments and structuring ongoing maintenance models that have yielded the greatest financial rewards and elevated patient outcomes.”

Dr. Swatts has found specialization highly satisfying, too. After 15 years in primary care optometry, he started to feel burned out—he felt like he wasn’t truly making a difference. After taking some time to step back, he decided to narrow his focus and specialize in one area. Focusing on OSD became not only personally and professionally fulfilling, but with ongoing innovations in treatments, an exciting option as well.

After bringing in one of the first IPL units in the region, the practice hit ROI in approximately five months. Since then, they’ve never looked back.

“Bringing in this advanced technology not only invigorated and energized our team, but truly transformed our practice,” said Dr. Swatts. “Once we started doing procedures that also provide aesthetic benefits, patients quickly realized the benefits and began asking, ‘What else do you offer?’ This was the impetus for us adding treatments such as hydrafacial, oxygeneo, neurotoxins and dermal fillers, which have provided revenue streams that we never imagined.”

Sports Vision
Sports vision optometry is the practice of examining a patient’s visual system and ensuring that it is maximized for performance in the athletic arena. This includes advising athletes on the most appropriate method of refractive correction for their sports, discussing ocular health and safety, and measuring ocular strengths and weaknesses in the context of the sports they play (such as visual reaction time) and prescribing training to improve on any weaknesses in visual skills.

Specialization Helps Take Business to the Next Level
Jarrod Davies, OD, FCOVD
Owner, Utah Vision Development Center
Riverton, Utah

Specializations: Vision Therapy, Neuro-Optometric Rehabilitation and Sports Vision

Over the past 10 years, Dr. Davies’ practice scope has expanded greatly due to specialization. It’s grown in the area of rehabilitation and training, as the optometric community becomes more involved in concussion and brain injury treatment. It’s also provided more opportunities to work with professional athletes to help them understand the unique visual demands of sports.

That growth has only escalated as more people began to recognize the practice’s expertise and unique offerings. Today, Dr. Davies gets a lot of referrals from concussion specialists to perform vision rehabilitation services. And he’s also worked with a wide range of athletes—from professional shooters, badminton professionals, pickleball professionals, the U.S. Ski Team, Major League Baseball, athletes from the NFL, hockey and countless other sports.

(Top) Dr. Davies with Team USA Para Hockey goalie (and patient), who brought in her gold medal to show and share with the team. (Bottom) Member of the U.S. ski  team working on a peripheral vision task to speed decisions and response time.

“We offer so many services that others don’t have,” explained Dr. Davies. “By practicing in this specialty, we’ve become known for our expertise and unique approach to vision.”

“I’ve had opportunities to work with professional athletes, assess vision for the U.S. Ski Team, travel to spring training for Major League Baseball teams, and be on the golf course discussing vision and putting with very talented golfers. I’ve also had the great privilege of helping individuals with brain trauma or stroke to recover visual function and return to normal activities. This has opened opportunities to travel internationally—to date, I’ve now lectured in seven different countries.”

To grow the practice even more, Dr. Davies does web-based marketing and social media, and he regularly approaches teams and local schools to give seminars on sports vision. He also educates his referral sources by giving in-service trainings to other professionals and their office staff.

Not surprisingly, his practice has experienced exciting revenue growth. “Because we offer services that enhance vision, it has greatly grown our private pay services,” he said. “We’ve also grown in medical billing due to offering rehabilitation that’s covered by some medical insurance. The growth has allowed us to expand twice in the last seven years. We recently moved to a much larger location to be able to provide these services.”


The Neuro-Optometric Rehabilitation Association (NORA) defines neuro-optometry as a customized treatment regimen for patients with visual deficits caused by physical disabilities, traumatic brain injury (TBI) and other neurological problems. It’s a part of the rehabilitation process for visual/perceptual/motor disorders like acquired strabismus, diplopia, binocular dysfunction, convergence and/or accommodation paresis/paralysis, oculomotor dysfunction, visual-spatial dysfunction, visual perceptual and cognitive deficits, and traumatic visual acuity loss.

Accelerating Growth from Vision Rehabilitation and Binocular Vision Care
Amy Pruszenski, OD, FCOVD
Visual Victory Training
Portsmouth, New Hampshire

As a child, Dr. Pruszenski had exotropia with severe strabismic amblyopia, and she suffered horribly with 24/7 patching. Fortunately, her optometrist knew about vision therapy and taught her mom how to get her eyes working together after the visual acuity had improved through patching. She was motivated to learn everything she could about the eye-brain connection and how vision occurs and develops.

Dr. Pruszenski earned her bachelor’s degree in Brain and Cognitive Science, which sparked her love of the eye-brain connection. Rather than pursuing a PhD in Cognitive Science, she chose to get her Doctor of Optometry degree because it was more flexible—allowing her to teach, see patients and/or do research.

Dr. Pruszenski (right) performs a trial of therapeutic lenses to move light on the retina for better spatial localization and reduction of headache and light sensitivity.

After feeling constrained by primary eyecare in corporate practice (at Sears and LensCrafters), Dr. Pruszenski was excited to offer binocular vision care services in her first private practice, Harbor Eyecare Center, which opened in 1998. Happily, many people showed great improvements and her practice was built mostly by word-of-mouth recommendations.

“I felt the need to marry my vision science background with my optometric education as a way to ‘pay it forward’ and help others get their visual systems working better, too,” she said. “Once my first practice was up and running, the reputation of ‘Dr. Amy’ or ‘The Eyeball Coach’ grew as we got increasingly better results for children with learning-related vision issues.”

As the vision therapy aspect of her practice grew and hit critical mass, it was clear there weren’t enough doctors in the area who were doing this kind of work. Dr. Pruszenski decided to split the vision therapy part of Harbor Eyecare Center off from the primary care aspect of the practice, partially because of the lack of coverage by third-party payors. Due to these issues, her vision therapy practice, Visual Victory Training, is self-pay only.

“There are so few optometrists doing neuro-developmental optometry in my area of the country,” she said. “It’s hard to stay on top of the research in every area of optometry, and many colleagues are happy that I have a passion for this work. They often continue to provide their patients’ eye health maintenance, while I address their functional issues.”

Today, Dr. Pruszenski proudly offers tertiary care for developmental and learning-related vision issues (including binocular vision care services) and applies neuroscience and vision rehabilitation to aid recovery after brain injury.

“Nothing makes me happier than helping a person of any age seek their highest potential because their vision issues no longer hold them back,” she said.

Pediatric Myopia
Optometrists that specialize in myopia management prescribe proven ways to slow down the progression of nearsightedness in children. Addressing myopia in children is a specialty area that’s gaining popularity because of the tight correlation between vision and learning. According to the Centers for Disease Control and Prevention, fewer than 15 percent of preschool children receive an eye exam by a professional, making this specialty an exciting and ripe place for growth.

Finding the Niche that Helped One Practice Double in Size
Brianna Rhue, OD, FAAO, FSLS
Owner, West Broward Eyecare Associates,
Co-founder, Dr. Contact Lens
Tamarac, Florida

Other Specialties: Contact Lenses

For Dr. Rhue, the seeds toward specialization were planted in school, where she was taught to find her niche and discover the kind of patients she loves to see. Only then would her practice and herself truly thrive.

After starting her career at West Broward Eyecare Associates in 2010, after completing her residency, she hadn’t yet found her niche. That changed in 2015 when she attended the Vision By Design Conference and learned how far behind the U.S. was compared to the rest of the world when it came to managing childhood myopia.

“As I was building the clinic, I knew that I loved seeing kids; I’m good at talking to parents; and after becoming a mom myself, I realized that a pediatric myopia management specialty was right for me,” she said. “I also liked the idea of getting paid for my unique expertise.”

Dr. Rhue measuring her son’s axial length.

The practice was originally focused on primary care and specialty contact lenses. Since adding myopia management as another specialization in 2015, Dr. Rhue said her practice changed in exciting ways for her, her team and her patients.

“We are seeing fewer patients, but are more profitable because we’re making more per patient and we’re seeing more of the patients we want to see,” she said. “We still have a large primary care base—that’s what feeds the clinic—but we no longer have to jam our schedule so full. Seventy percent of our patients are already myopic, so we can carve out more time for myopia management. And over time, we’re starting to get a lot of referrals for kids from parents looking into this for their own children as major companies get FDA approval for their treatments.”

Since 2015, the practice has doubled in size, increased revenue by about 20 percent and has become more profitable since myopia management patients are all private pay and refer their friends.

“Specializing has enabled our practice to flourish, and it only required about $30,000 in new technology—a relatively small investment,” said Dr. Rhue. “Throughout optometry, we’ve all seen a huge race to the bottom, but I’m not on that train. I want to be a destination practice where people feel cared for, where they invest in us, and we invest in them.”