While the goal of optometry school is to acquire a comprehensive education in both the clinical and non-clinical aspects of eyecare, it is only natural that students will find certain portions of the curriculum more appealing and discover they are naturally more adept at some skills than others.
Finding your niche and establishing a practice in that specialty allows you to lean into your innate talents and focus on the area of optometry where your deepest interest lies.
When choosing not to pursue a niche modality of practice, primary care optometry can also be equally rewarding and challenging. Most new grad optometrists tend to enter this space upon graduation.1
This article and the accompanying quiz will help guide you in identifying your niche while in optometry school.
What is a niche?
A niche is simply a specialized market, product, or service. In optometry, this means identifying the specific disease states, segment of the eye, practice modality, or demographic that you feel most drawn to and then linking those preferences to a specialty/subspecialty.2
When looking at healthcare as a whole, it is suggested that finding a niche may be a useful tool in reducing burnout and stress while allowing practitioners to feel more empowered, more connected, and confident. This is related to a heightened level of exclusive interest and expertise.3
According to a 2023 study, respondents who were classified as optometry students and/or new grad ODs (those who have practiced less than 5 years) overwhelmingly believed (82.4%) that there should be subspecialties in optometry.4
Take the optometry niche quiz here
Top optometry niches
Below is a list of the top optometry specialties/subspecialties ordered alphabetically.5,6
Aesthetics
Ocular aesthetics is a relatively new specialty focused on improving the appearance of the eyes and surrounding areas by administering cosmetic treatments.
These include dermal fillers, radiofrequency, neurotoxin injection (BOTOX), advanced laser procedures, intense pulsed light (IPL) therapy, and skincare/makeup recommendations.4,7
Advocacy
Advocacy may be the ideal niche for those who are politically inclined, good communicators, and interested in protecting and/or changing the policies that guide and guard the field of optometry.
In this specialty, the optometrist lobbies for changes and improvements in the optometric scope of practice by meeting with fellow optometrists to establish their wants and needs, speaking as an eyecare expert before committees, and testifying on behalf of desired bills.5,8
Anterior segment
This specialty centers around the diagnosis, treatment, and management of diseases and conditions of the anterior segment, such as dry eye, conjunctivitis, refractive errors, corneal ulcers, cataracts, keratoconus, ocular trauma, etc.6
Community health
Those who choose community health should have a deep interest in public health, healthcare systems, cultural issues, and disparities in eyecare with a focus on affordability, accessibility, and providing primary and preventative care to all ages of underserved patient populations.9,10
Cornea/Contact lens
To some degree, cornea/contact lens intersects with anterior segment, in that it deals with the diagnosis and treatment of anterior segment disease.
Optometrists in this specialty are also dedicated to furthering their expertise in corneal conditions and advanced contact lens care.6,11
Specialty contact lens
This is a subspecialty within the cornea/contact lens space that takes it a step beyond soft contact lenses into the realm of prescribing, fitting, and troubleshooting specialty contacts. These include scleral, rigid gas permeable (RGP), hybrid, and orthokeratology (ortho-K) lenses.12
Dry eye
With ever-increasing digital device usage, environmental factors, and longer life spans, dry eye disease is rampant and offers an excellent opportunity as a niche practice modality.
A dry eye specialist focuses on optimizing the ocular surface and treating the underlying causes of dry eye disease, such as meibomian gland dysfunction (MGD), blepharitis, autoimmune disorders, and lifestyle.
In this specialty, you will bring the latest diagnostic tools and treatment technologies—lid debridement, punctal plugs, IPL therapy, radiofrequency—to your patients.13
Geriatrics
In this specialty, clinicians are dedicated to the diagnosis, assessment, treatment, and management of the ocular diseases, systemic conditions, and vision impairments within the geriatric population. This demographic is commonly defined as patients aged 65 and older.6
Glaucoma
Worldwide, glaucoma persists as the second-leading cause of blindness.14 In the US alone, 3 million people are diagnosed with some form, which emphasizes the need for specialization of this disease state.15
This niche centers around the diagnosis, management, and treatment of the different types of glaucomas, including open-angle glaucoma, angle-closure glaucoma, congenital glaucoma, and secondary glaucoma.6
Low vision
Low vision can affect patients of all ages, though the majority are often older patients with age-related macular degeneration, glaucoma, and/or diabetic retinopathy. As visual impairment can drastically decrease quality of life, this specialty can prove quite rewarding.
The goal of a low vision specialist is to utilize rehabilitation techniques and technologies to maximize a patient’s remaining vision and enhance their ability to perform their daily activities.16
Myopia control
Myopia is occurring in epidemic proportions, leading to a need for more specialization around the condition to prevent the long-term ocular sequelae associated with unmanaged myopia.
Optometrists in this niche aim to properly assess myopia in patients, accurately predict progression, and then prescribe leading-edge treatment to manage the current condition and slow the progression. Naturally, a large number of myopia patients will be children, so there is an overlap with pediatric optometry.5,17
Neuro-optometry
Within the specialty of neuro-optometry, there are subspecialties, including brain injury rehabilitation, vision rehabilitation, and vision therapy.5,6,18
Brain injury rehabilitation
This niche uses therapy, devices, and procedures to restore function and offer solutions to individuals with either a traumatic or acquired brain injury with the mission of restoring function and promoting independence.6,18
Vision rehabilitation
In addition to providing rehabilitation to individuals with brain injuries, general vision rehabilitation also assesses and manages patients with neurologic conditions or other physical disabilities that affect their vision and function—using many of the same therapies and devices and working toward the same goals for patients with brain injuries.6
Vision therapy
Vision therapy (VT) is a specialty within optometry that primarily treats developmental eye issues. It requires a thorough understanding of the patient’s visual system and how dysfunction can impact binocular and perceptual systems, eye movements, visual acuity, and visual fields.
Common conditions managed in this specialty include convergence insufficiency, strabismus, amblyopia, and binocular and/or oculomotor dysfunction.5,6,18,19
Ocular diseases
As the name implies, this specialty is committed to the diagnosis, management, and treatment of ocular disease.6
Practitioners must have a thorough understanding of the myriad ocular sequelae that can manifest from undiagnosed/uncontrolled chronic diseases (e.g., diabetes, metabolic syndrome, hypertension, autoimmune disease).
Pediatrics
Those drawn to improving vision for the youngest segment of our population may find their niche in pediatric optometry.
This practice modality deals with the assessment and treatment of children and involves performing pediatric exams and providing glasses and contacts as well as diagnosing and treating the myriad of conditions and diseases that affect young patients.5,6
Refractive surgery
This niche is for optometrists whose main interest is in co-managing patients prior to and after refractive/cataract surgery, alongside an ophthalmologist, and are drawn to an MD-OD practice type.5,6
Retina
A retina specialist’s interest lies in the diagnosis, management, and treatment of diseases of the posterior segment, including but not limited to:6
- Age-related macular degeneration (AMD)
- Geographic atrophy (GA)
- Diabetic retinopathy (DR)
- Retinal vein occlusion (RVO)
- Macular holes
Sports vision training
For optometry students who have been athletes or have a love of sports, the area of sports vision training may be appealing.
Sports vision has come to comprise the examination, care, and treatment of the ocular health—and very specific visual demands—of athletes across the sports spectrum.20
Click here to go back to the optometry niche quiz
Questions to ask to find your niche
There are a range of questions—both personal and professional—that you should answer for yourself when determining the optometry specialty that is best suited to your predilections and goals.
The personal questions gauge your aptitudes, likes/dislikes, and personality traits and are broken into general and optometry school-based inquiries. The professional section looks at factors that will influence your success in a niche, including modality, location, and logistics to determine viability.21,22
Personal questions to determine your optometry niche21,22
General questions to find your optometry niche:
- Are you naturally more introverted or extroverted?
- Do you prefer variety or diving deep into a single subject?
- Do you love keeping up with the latest technology?
- What age group do you enjoy spending time with most?
- What do you enjoy doing in your spare time?
- Have you been involved in politics/policy in other areas of your life?
- Do you enjoy playing or watching sports?
- Do you have an interest in cosmetics?
- Are you invested in the role of nutrition and lifestyle in optimizing health?
- Would you classify yourself as someone who can sell either a product or an idea?
- Have you volunteered? If so, did you find it a rewarding experience?
- Are you a natural teacher/educator?
- Do you speak a second (or third) language?
Optometry school-focused questions to determine your optometry niche
- What were your goals when you chose to become an optometrist?
- What gets you excited about optometry?
- Which course have you most enjoyed?
- Which of the skills you’ve learned thus far have come most natural?
- Are you passionate about alternative or complementary medicine?
- Is research something you look forward to or dread?
- Which rotation have you found most rewarding?
- Does refraction come easily to you?
- Did you find the anterior or posterior segment more fascinating?
- Do you enjoy working with imaging technology?
- Are you interested in pursuing a residency?
Professional questions to determine your optometry niche21,22
- Is your goal to practice full-scope optometry?
- Is there a particular geographic location in which you want to practice?
- Do you prefer rural or urban practice settings/patient populations?
- Do you thrive in a fast-paced environment?
- How much money do you expect to make as a new OD?
- How saturated is the market for the niche/geographical area you are considering?
- Is there a large enough patient population in general to support this specialty in your preferred locale?
- Is having surgical privileges important to you?
- Do you feel strongly about community health?
- Are you comfortable with marketing?
- Do you see yourself as a practice owner with all of its associated responsibilities?
I found my optometry niche, now what?
Once you have asked yourself the important questions, analyzed the feasibility, taken our quiz, and decided which niche is best suited to you, there are steps you can take to prepare yourself for specialty practice.
1. Pursue a residency
In 2024, there are nearly 300 accredited optometric residency programs offering 496 approved positions. There are also non-accredited programs available.23
The Eyes On Eyecare 2023 Student Optometry Report revealed that 30.8% of respondents planned to pursue an optometry residency, with the majority going into ocular disease (32.6%) or cornea and contact lens (25.2%).24
A residency in your specialty offers numerous advantages, which include:25
- Honing the clinical skills required for your specialty
- Interacting with a specific patient population
- Improving critical thinking and focused diagnostic skills
- Learning the latest treatment technologies in a safe environment
- Collaborating with like-minded ODs
2. Intern at a specialty clinic
Look on optometry job boards for intern opportunities in the niche you have chosen. Interning at a specialty clinic offers many of the benefits of a residency but also offers first-hand experience in seeing how a clinic is run from a practice management perspective. In addition, you can build valuable student-mentor relationships with optometrists who are already succeeding in the specialty you have considered.
Applying to an internship requires the same paperwork and interview process as applying to any job, so be prepared. As part of your optometry school application, you most likely created a resume/curriculum vitae (CV) containing your educational and work history, research projects, achievements, honors, and awards.
Update this document at the end of each semester to reflect any additional clinical experience/accomplishments.25
3. Subscribe to journals/publications in your niche
There are online resources dedicated to a wide range of specialties, from ocular surface to retina to contact lens and even practice management. These offer the latest information in research, disease staging, diagnostic technology, treatment options, and products.
Subscribe and read regularly to stay up on innovations and learn from the key opinion leaders in your optometric niche.
Conclusion
It should be stated that there will always be a place for well-trained and dedicated primary care optometrists.
Being a generalist allows you to practice to the fullest scope of practice you worked so hard to master throughout optometry school. Primary care optometry offers day-to-day variety in both patient population and conditions, and garners flexibility when choosing where to practice.27
However, there is much to be said for specialization, which provides you the opportunity to capitalize on your strengths, pursue your true passion, and build a rewarding career where you utilize your unique talents to improve the lives of patients and elevate the field of optometry.
