Disclaimer: The views expressed in this video and article are those of Dr. Cai, who emphasized that there are many ways to be successful in launching a solo retina practice.
One of the most important career decisions ophthalmologists face is which practice setting would best serve their priorities, personality, and long-term goals. For some, academia is the answer. Others opt for a hospital or group setting. Then there are clinicians, like Louis Cai, MD who follow the path of solo practice ownership.
“I knew I didn't fit the mold that a lot of private practices and private equity practices offered me, so I decided to go on my own and try to do my own thing, primarily for control over my work-life balance.”
In this episode of Evidence Based Retina, Rishi Singh, MD, FASRS, learns the reasoning behind this decision and gleans practical advice on going solo.
Location, location, location
Choosing where to open a solo retina practice determines whether referring optometrists and comprehensive ophthalmologists send patients there at all.
National provider-distribution data show ophthalmology practice locations have expanded faster than the ophthalmologist workforce itself, narrowing the average distance between an optometrist's office and the nearest ophthalmology practice to 11 miles.1 A practice sited near a dense cluster of referring providers, and away from an established retina competitor, starts with a structural referral advantage instead of building one from scratch.
Location carries clinical weight too. A Cole Eye Institute cohort of 642 retinal detachment repairs found reattachment rates were statistically similar regardless of travel distance, but longer travel was tied to delays before surgery.2
Moreover, a 2022 American Academy of Ophthalmology review found comparable geographic and travel-related access gaps affecting outcomes in glaucoma, cataract, and diabetic retinopathy care, with exam adherence dropping once patients live roughly 80 miles or more from a facility.3 For a retina practice serving an older, sight-threatened population, minimizing that travel burden is part of the care plan.
To learn more about leading a retina practice, check out: Hurdles for Modern Retina Practices: Rural Eyecare, Private Equity, and Hiring!
Using AI to identify optimal practice locations
Cai's approach turns this into a repeatable process rather than a gut call. He builds a custom map of every retina specialist, optometrist, and comprehensive ophthalmologist in a target region—red, blue, and green pins, respectively—then uses artificial intelligence (AI) to identify the spot with the greatest concentration of comprehensive ophthalmologists and optometrists and the greatest distance from the nearest retina specialist.
Critically, he runs that analysis on driving distance rather than straight-line mileage, since a 10-mile radius means something very different in Massachusetts traffic than on a rural Florida highway. Once the target area is set, he shifts to commercial real estate listings to evaluate specific properties, aiming for at least 1,200 to 1,300 square feet at minimum, with room to grow if the practice adds an associate down the line.
For the office itself, Cai draws a clear line between must-haves and nice-to-haves: two exam lanes with a connecting flow between them, and a dedicated room for injections, are non-negotiable starting points for a new retina practice.
Establishing essential equipment
“There’s always a balance between what you know, what’s cheapest, and what’s best. What you buy is going to need to last ideally the life of your practice,” explained Dr. Cai. “While buying used for certain items makes sense, I’d encourage you to invest in things that can affect patient outcomes,” he added. When opening an ophthalmology practice, it is essential to prioritize which equipment is most necessary for success.
“Ultimately I want to be in a practice where I feel I have all the tools I need to do the best care.”
For Dr. Cai, priority was directly correlated with price. Therefore, he approached the decision by buying the more expensive equipment first: fundus cameras and optical coherence tomography (OCT). After the biggest ticket items, he turned his focus to purchasing a pattern laser for panretinal photocoagulation (PRP), for the treatment of diabetic retinopathy and retinal vein occlusions.
After researching the available options, he chose the battery-powered Norlase LYNX—the first and only pattern scanning laser indirect ophthalmoscope.4 "Norlase has the most modern viewing system, and it’s readily portable. Having the pattern feature makes it the only one of its kind, and I had to splurge," he explained.
Takeaways
- A retina practice requires a minimum of 1,200 to 1,300 square feet, two exam lanes, a dedicated injection room, and an OCT as non-negotiable equipment.
- Joining a group purchasing organization (GPO) allows independent retina specialists to negotiate better drug pricing than purchasing directly from distributors.
- EHR systems for a new ophthalmology practice range from $600 to $2,000 per month and typically bundle practice management, scheduling, and documentation software.
- Securing net-30, net-60, or net-90 repayment terms with drug suppliers is critical to managing cash flow while awaiting insurance reimbursement.
- AI tools like ChatGPT and Gemini are now being used by independent physicians to navigate administrative tasks, site selection, and practice logistics from day one.
Conclusion
Solo practice ownership demands tolerance for uncertainty and a willingness to wear every hat in the early phase—but Dr. Cai's experience shows the path is viable.
With deliberate site selection, disciplined equipment prioritization, GPO partnerships, and AI-assisted administrative workflows, an independent retina practice can be built on a manageable foundation.
For ophthalmologists evaluating referral relationships or their own career trajectory, understanding what goes into building a solo retina practice offers practical professional context.
