When I made the decision to step away from routine eyecare and fully commit to dry eye disease, it was not simply a change in clinical focus. It was a complete redefinition of how I wanted to practice. In late October of 2025, I purchased an existing practice with the goal of transforming it into a fully dedicated dry eye center. By December 1st of that same year, that vision became reality when we officially opened our doors.
What followed was a period of rapid growth, constant learning, and countless decisions that challenged the way I thought about both medicine and business. This guide is a reflection of that journey. It is not meant to be a perfect blueprint. It is a collection of practical strategies, lessons learned, mistakes made, and decisions that come with building and scaling a dry eye-focused practice from the ground up.
Whether you are acquiring an existing dry eye clinic, adding dry eye services to an established practice, or starting a new dry eye center from scratch, the principles in this guide are designed to apply broadly.
The business of dry eye disease
Let’s get down to the numbers. Dry eye disease (DED) is one of the most common ocular conditions in the United States, with studies estimating that more than 16 million Americans have been formally diagnosed with DED, while the true number of symptomatic patients may exceed 30 to 38 million due to underdiagnosis.1,2
The economic burden of dry eye is also substantial. A landmark US analysis estimated that direct healthcare costs related to the diagnosis and treatment of dry eye total approximately $3.84 billion annually, while the overall societal burden, including reduced productivity and quality-of-life impairment, exceeds $55 billion per year.3
As awareness of ocular surface disease continues to grow, there has been a rapid expansion of specialty dry eye clinics and practices dedicated specifically to ocular surface disease management across the country. Based on recent surveys, estimates show 15.5% of doctors are primarily focused on dry eye, an increase from 14.3% just last year. This was the second highest practice focus, preceded only by primary care.4
Preparation and planning
Every successful dry eye practice starts long before the first patient walks through the door. It starts with clarity: clarity of vision, clarity of brand, and clarity of numbers.
The name game
The first step is building a brand that people immediately understand. That means choosing a name, designing a logo, and defining your identity. Your name should be simple, direct, and memorable. Ideally, it should clearly communicate what you do.
For example, my practice, The Dry Eye Center of Arizona, leaves very little room for confusion. Patients know exactly what we specialize in before they even visit our website. That clarity has also proven to be extremely valuable for search engine optimization, or SEO, which is something every modern practice owner should at least understand on a basic level. When your name aligns with what patients are already searching for, you give yourself a real advantage from day one.
Another form of online presence, which seems to be more prevalent day after day, is the utilization of artificial intelligence (AI). In just 5 months of my practice opening, I have had multiple patients report that they found us using tools such as ChatGPT. Keep in mind, these programs are likely making their recommendations based on Google reviews, which means you’ll want to set up your Google Business account early.
Before you get too attached to a name, make sure it is actually available, both legally and digitally. Check business registrations, domain availability, and social media handles. States often offer their own business entity search to allow for easy inquiries of names that may already be taken. For example, here in Arizona I used the website linked here.
Once that is squared away, logo design becomes the next step. You do not need to overcomplicate this. There are plenty of cost-effective resources, such as Fiverr, where talented designers can help bring your vision to life.
From there, the real work begins: planning.
Putting a plan in place
Start putting numbers on paper as early as possible. Whether you prefer Microsoft Excel or Google Sheets, the goal is the same. You need one centralized place where you can map out every financial aspect of your business. For me, Google Drive became indispensable. The ability to organize folders, access documents anywhere, and keep everything in one ecosystem made the entire process much more manageable.
I created a spreadsheet titled “Dry Eye Center of Arizona Master Sheet,” and to this day, it remains one of the most important tools I have used in building my practice. This document was tracking my projected costs, as well as projected revenue.
While it may be early to think about how much you may bring in, this can help set the stage of what may or may not be achievable in your expenses from day one. Make sure to set realistic goals to avoid over-spending on non-essentials before getting up and running.
In the early stages, I focused on two main categories.
- One-time startup costs: This included everything required to get the doors open: exam lanes, diagnostic equipment, treatment devices, buildout costs, furniture, computers, and more. The goal here is simple. You need to determine how much capital you need just to exist. If you are purchasing a practice, make sure to include that cost as well.
- Monthly operating expenses: This is where things become more sobering. Payroll, EHR systems, malpractice insurance, rent, internet, utilities, health insurance, loan repayment if needed, and other recurring expenses add up quickly. These are the numbers that determine your survival.
Once you have mapped these out, you are left with two critical questions:
- What size loan, if any, do I need?
- How much revenue do I need each month to stay afloat?
One of the most important decisions I made was to build in a financial safety net. From day one, I made sure I had 6 months of payroll, rent, and loan repayment sitting in the bank through the loan I took out. That cushion allowed me to focus on growth without making decisions from a place of panic.
As your planning evolves, your spreadsheet should evolve with it. Mine eventually expanded beyond expenses and into operational modeling.
I started creating hypothetical schedules and asking questions like:
- What does my lightest day look like when I first open?
- How do I realistically grow over the first month?
- What should my schedule look like in 6 months? What about 1 year?
This kind of forward thinking turns your plan from a static document into a living roadmap.
Already have a practice and looking for tips on budgeting? Check out the article How to Reduce Monthly Costs in Your Optometry Practice!
Location, location, location
Where you choose to build your practice can be just as important as how you build it.
Many doctors choose to work with a broker, but it is not required. I personally used LoopNet to search for available medical spaces, both for lease and for purchase. It gave me the flexibility to explore options on my own terms and move quickly when I found the right fit.
On the other hand, one advantage of working with a broker would be the exposure to spaces that have not yet formally hit the market. This can be incredibly beneficial if you find yourself having trouble finding the perfect space on your own.
Before you begin touring spaces, define your non-negotiables. These are the features your practice must have. For me, they were:
- Ground-floor access
- Easy parking
- Proximity to other healthcare providers
- Central location with strong accessibility
Ground-floor access
Dry eye patients often skew older, and accessibility matters. A first-floor location removes friction, improves the patient experience, and reduces barriers to care. Since opening, I have had several patients specifically thank me for having a space on the ground level.
Easy parking
Whether it is a garage or a dedicated lot, parking should never be a pain point. Few things sour a patient experience faster than struggling to find a spot before an appointment. If patients are telling you that parking was a nightmare, it becomes part of your brand, and not in a good way.
Proximity to other healthcare providers
This is one of the most overlooked growth accelerators. Being surrounded by other medical professionals creates natural referral opportunities. This also opens the door for higher quality of care, especially when coordinating care with local primary care physicians.5
In my case, my office is located within a healthcare plaza. I made a point to introduce myself to a family medicine practice in the same building, drop off business cards, and explain what I do. Within a week, they had already referred three patients. Each had different complaints that ultimately tied back to ocular surface disease. That kind of early traction is invaluable.
Central location with strong accessibility
Being centrally located, especially near major highways, allows you to draw from a wider geographic area. My location in downtown Scottsdale gives me access to patients across the greater Phoenix region, which has been a major contributor to early growth.
These details may seem small on their own, but together they shape the patient experience and directly impact your ability to grow. A great location does not guarantee success, but a poor one can absolutely limit it.
Download the checklist here!
Comprehensive Checklist for Opening a Dry Eye Practice
Use this checklist to help guide the process of opening a scalable and efficient dry eye practice for long-term practice growth and profitability.
Hiring for heart: Building your first team
Staffing a new practice is a balancing act between ambition and reality. In the early stages, you should be prepared to run lean. That might mean wearing multiple hats, including technician, receptionist, and even IT support at times. If your schedule allows it, stepping into these roles early can significantly reduce payroll expenses while giving you a deeper understanding of your workflow.
I was fortunate to bring over a technician from a previous role and hire a front desk team member early on. Not every doctor will have that luxury, and that is okay.
If there is one principle I would strongly emphasize when interviewing candidates, it is this: hire for personality, not experience. Technical skills can be taught, personality cannot.6 My front-desk hire had no prior experience in eyecare or even healthcare, but she was prepared, articulate, and most importantly, genuinely kind. That matters more than any line on a resume.
Your front desk creates the first impression of your practice. They set the tone for every patient interaction, from the initial phone call to the moment the patient walks through the door. A warm, friendly, and organized presence at the front desk can elevate the entire patient experience.7
There are also strategic advantages to hiring early, even if your schedule is not full yet. It gives you time to train properly without the pressure of a packed clinic. It also gives your staff early exposure to your systems and workflow, allowing them to grow with the practice.
By the time your schedule begins to fill, your team will not just be functional. They will be confident and efficient. That is when things really start to scale.
Click here to learn more about adopting a lean operations framework to build a scalable, patient-focused, and efficient eyecare practice!
Getting your name out there: Building a referral engine
You can build the most beautiful clinic, invest in the best equipment, and design the perfect workflow, but none of it matters if patients do not know you exist. In the early stages of a dry eye practice, your growth is heavily dependent on one thing: relationships.
One of the best places to start is by getting involved with your state optometric association. For me, that is the Arizona Optometric Association. These organizations often host annual or semiannual conferences.
In Arizona’s case, that includes Spring and Fall meetings. These events provide invaluable opportunities to connect with other doctors in your area. They are not just about continuing education, they are about visibility.
When you attend consistently, introduce yourself, and talk about what you do, people start to remember you. When they encounter a patient they do not feel comfortable managing or would prefer to refer out for care, you want your name to be the first one that comes to mind.
Leveraging local industry events and rep relationships
The same applies to local lectures and industry-sponsored dinners. Pharmaceutical and device representatives often host dinner lectures, given by doctors, focused on dry eye therapies, emerging treatments, and clinical strategies.
Make it a point to attend these. They help you stay current on the medications and technologies you may rely on, while also putting you in a room with other doctors in your community in a much more relaxed setting.
Equally important, get to know your reps. Your reps are not just salespeople. They are connectors. They know which doctors are interested in dry eye, which practices are overwhelmed with certain types of patients, and where referral opportunities may exist. A thriving dry eye clinic is incredibly valuable to them, so they are often highly motivated to help you grow.
Ask them:
- When is the next dinner lecture?
- Who else in the area is active in dry eye?
- Are there opportunities to collaborate or present?
You may be surprised how many doors that can open.
Connecting with local eyecare practices
Beyond organized events, one of the most impactful things you can do is take a more direct approach. Early in my practice, I made a deliberate effort to identify local eyecare offices, both MD and OD, that did not advertise dry eye treatment on their websites. These practices were often seeing dry eye patients, but did not necessarily want to manage more complex or time-intensive cases.
I created a simple single-sheet handout that clearly outlined:
- The types of patients I focus on
- The conditions I treat
- The services and technologies I offer
Then I went door-to-door. I introduced myself, dropped off materials, and made it clear that I was available as a resource, not a competitor. The results were immediate and meaningful.
I now have a local glaucoma specialist who regularly refers patients with neurotrophic keratitis, general optometrists who send patients specifically for chalazion management with intense pulsed light (IPL), and so much more. These are cases that many practices would prefer to co-manage or refer out. That is exactly where a dedicated dry eye clinic becomes indispensable.
The reality is most doctors are not looking to hold onto complex dry eye patients. These cases are time-consuming, often frustrating, and require a level of specialization that many practices are not built around. But for a dry eye-focused clinic, those patients are exactly where you thrive.
Tip: If you position yourself correctly as visible, approachable, and clearly specialized, you become the natural endpoint for those referrals. Once that referral network starts to build, it becomes one of the most powerful and sustainable growth drivers your practice can have.8
Looking for actionable steps to integrate dry eye care into your practice? Download the Comprehensive Checklist for Opening a Dry Eye Practice!
Start smart: Building your diagnostic foundation
When it comes to equipment, this is where a lot of doctors can get overwhelmed or sidetracked. You are going to see the “shiny toys.” The high-ticket treatment devices. The ones that promise strong cash flow and practice growth.
Those devices absolutely have a place in a dry eye clinic, but the reality is that you likely will not have the capital to do everything on day one, that is okay. Trying to do too much too early can put unnecessary financial pressure on your practice before you have had a chance to build momentum.
Instead, start with what truly matters: diagnostics. If you do not understand the problem, you cannot effectively treat it. More importantly, you cannot convincingly explain it to your patient.
For me, the cornerstone of my diagnostic setup is the Bruder Ocular Surface Analyzer (BOSA). At first glance, devices like this can be easy to overlook. They do not carry the same immediate “revenue-generating” appeal as treatment devices, which can make them seem less urgent when you are budgeting your startup costs.
However, that thinking is short-sighted. A high-quality diagnostic platform is not just a clinical tool. It is a communication facilitator, a trust-building tool, and ultimately, a revenue driver in its own right.9
Think about the types of testing you want to offer your patients. For me, that included:
- Meibography, for imaging of the meibomian glands
- Interferometry, for assessing lipid layer thickness and quality
- Tear meniscus height, for evaluating tear production
- Blink analysis, for identifying incomplete or partial blinks
- Tear breakup time, for measuring tear film stability
- Anterior segment photography, for documenting lid erythema, chalazia, Demodex blepharitis, and more
This is your foundation. Dry eye is not a condition you can manage effectively based on symptoms alone. It is a disease that requires objective data, both for diagnosis and for tracking progress over time.9 Just as importantly, patient education is everything.
Utilizing data to educate patients
When a patient can see their gland dropout, tear instability, or lid inflammation, the conversation changes. You are no longer asking them to just trust what you’re saying. You are showing them exactly what is happening. This becomes even more powerful once treatment begins.
You can pull up baseline images and compare them to follow-up visits. You can demonstrate improvement in gland function, tear stability, or lid health. That visual proof plays a major role in reinforcing compliance and confidence in your treatment plan. The truth is dry eye is as much psychological as it is physical.
Something that Drs. Arthur Epstein, Cory Lappin, and I have discussed many times is how difficult it can be to convince a patient they are improving, especially when symptoms fluctuate. Dr. Epstein often referred to this concept as “eye-chiatry.”
It is the idea that part of your role is guiding patients through their own perception of disease and helping them understand where they started, where they are now, and the progress they have made. Without objective data, that becomes exponentially harder. With it, everything becomes much clearer.
Check out The Psychology of Dry Eye, which was written by Drs. Epstein and Lappin, for a deeper dive into this topic.
Don’t overlook corneal sensitivity
Another critical, but often underutilized, component of your diagnostic process is corneal sensitivity testing. Conditions like neurotrophic keratitis can be easily missed if you are not actively looking for them. These patients often require extensive education and specialized management, and identifying them early can significantly impact outcomes.
The good news is that testing does not have to be complicated. You can start simple by using the tip of a cotton swab or a piece of unflavored dental floss. These low-cost methods can give you meaningful clinical insight. If and when you have more capital to work with, you can invest in a device like the Brill Esthesiometer, which allows for more standardized and repeatable measurements. Regardless of the method, the key is consistency.
Tip: Make corneal sensitivity part of your routine evaluation, especially in patients with severe staining, poor symptom correlation, or suspected neurotrophic disease. It is a diagnosis that is frequently under-recognized, and in a dry eye-focused clinic, it can quickly become a meaningful part of your patient population.
Quantifying symptoms: Don’t skip the questionnaires
While objective testing is the backbone of your diagnostic process, subjective data still plays an important role, you just need to quantify it.
One of the easiest ways to do this is by incorporating validated dry eye questionnaires into your workflow. Tools such as the Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of Eye Dryness (SPEED), and Symptom Assessment in Dry Eye (SANDE) allow you to track symptom severity in a structured, reproducible way.
These tools have been shown to be consistent in assessing the subjective perception of a patient’s own dry eye symptoms, and give you a numerical baseline on day one and make it significantly easier to monitor trends over time.10
When paired with your imaging and diagnostic data, they help paint a more complete picture of the patient’s condition. They also serve another important purpose, which is validation.
Even when objective findings improve, patients do not always feel dramatically better right away. Having a documented symptom score that trends in the right direction can help reinforce progress and keep patients engaged in their treatment plan.
Education doesn’t stop at diagnosis
One of the biggest mistakes you can make is thinking that patient education ends after showing diagnostic images. That is only the beginning.
Patients want to understand:
- What condition they have
- Why they have it
- How you are going to treat it
When you explain not just what you are prescribing, but how it works and why it matters, something shifts. Patients stop feeling like they are being given a generic solution. They start feeling like they are receiving personalized care, and that builds trust. A patient who understands their doctor is a patient who trusts their doctor.
The revenue drivers: Building your treatment portfolio
This is the section everyone is waiting for: the high-ticket, cash-generating treatment devices.
Before diving in, it is important to understand a fundamental truth about dry eye care. Most in-office treatments are cash-pay. These services are typically not covered by insurance, which means pricing is largely up to you.
Your fees should reflect your cost of entry, your overhead, and the margin you need to make the treatment sustainable within your practice. There are several complexities to setting the price of your cash-pay services, should you choose to offer them. The Medical Group Management Association has tremendous resources to help understand value if this is your first experience with setting up a system such as this.11
That flexibility is part of what makes dry eye such a powerful niche. It also means you need to be thoughtful in how you build your treatment portfolio. The relationship between diagnostics and in-office treatments can be the secret sauce to what sets a dry eye practice on to the path of success.
Start simple: Low-cost, high-value treatments
Before jumping into six-figure devices, there are several effective treatments you can implement with a relatively low cost of entry.
One of the easiest places to start is microblepharoexfoliation. Devices like NuLids Pro, or similar technologies, offer a simple in-office solution for mechanically cleaning the lids and lashes. These treatments help remove biofilm, debris, and Demodex-related buildup, all of which are often at the root of chronic irritation.12
Another strong option is ocular surface lavage, such as RINSADA. This approach stands out because it often provides immediate symptomatic relief following treatment. That is incredibly valuable, especially for patients who are coming in frustrated and looking for fast improvement. It is also particularly useful during allergy season, when patients are dealing with increased inflammation and debris on the ocular surface.13
These treatments come with several advantages:
- Small footprint, which is helpful if you are tight on space
- Lower upfront investment
- Affordable entry point for patients
These types of treatments help you generate revenue early, build patient trust through quick wins, and expand your service offerings without major financial risk.
The heavy hitters: High investment, high return
Once your foundation is in place, you can begin looking at the larger, more capital-intensive devices:
- Intense pulsed light
- Radiofrequency
- Dynamic muscle stimulation
These come with a higher cost of entry, but they can also provide significantly higher long-term return on investment when implemented correctly. While it is ideal to eventually offer a full spectrum of treatments, it is very common and completely acceptable to start with just one.
IPL: The cornerstone treatment
If you are choosing a single device to anchor your treatment offerings, intense pulsed light is often the best place to start. In our practice, IPL has become one of our highest revenue-generating services.
Devices like OptiLIGHT from Lumenis have set the standard as the only FDA-approved IPL specifically for the treatment of dry eye. But there is an important caveat: IPL is not appropriate for every patient.14
One of the biggest mistakes I see is doctors investing in IPL and then feeling immediate pressure to make it work financially. That pressure can lead to offering IPL to patients who are not ideal candidates, which ultimately leads to poor outcomes, dissatisfied patients, and damage to your reputation.
Instead, focus on patient selection. IPL works best in patients with:
This is where your diagnostics come back into play. Show patients their meibomian gland structure, oil quality, and lid inflammation. When patients understand why you are recommending IPL, case acceptance becomes significantly easier.
Just as importantly, you can show results. After completing a treatment series, repeat your diagnostic testing and walk them through their improvement. This closes the loop and reinforces both clinical success and patient confidence.
It is also worth noting that patients are doing their research. I have had numerous patients specifically seek out our practice because they were looking for a clinic that offered IPL using the OptiLIGHT device. That level of awareness is only increasing, so the technology you offer can absolutely influence patient decisions.
RF and DMSt: Expanding your impact
Once your practice is established and generating consistent revenue, adding complementary treatments like RF and DMSt can take your outcomes to the next level:
- Radiofrequency helps heat and liquefy meibomian gland secretions, improving oil flow and gland function.
- Dynamic muscle stimulation can address issues like lower lid laxity and incomplete or partial blinking.
Systems like OptiPLUS and OptiLIFT expand your ability to treat different aspects of dry eye disease.15,16 These modalities work extremely well as adjunctive treatments. They can enhance the results of IPL and broaden the range of patients you can help.
That said, they are best viewed as growth-phase investments. If you are early in your practice and looking for a reliable, foundational revenue driver, IPL is typically the priority.
At the end of the day, your treatment portfolio should evolve with your practice. Start with what you can afford. Master it. Build demand. Then expand strategically. That is how you create a system that is not only profitable, but sustainable.
Other treatment modalities to consider
Beyond the treatments mentioned above, there are several additional therapies that I have not personally implemented, but that are being used successfully in other dry eye practices. These include modalities like low-level light therapy (LLLT) and LACRIFILL (canalicular gel 20mg/mL, Nordic Pharma), among others.
Each of these treatments offers a different approach to managing dry eye, whether through inflammation control, tear film stabilization, gland support, or other mechanisms. Many practices have built effective models around these technologies, often integrating them as standalone options or combining them with other treatments.17,18
The key takeaway is that you do not need to offer everything. There are multiple ways to build a successful dry eye practice. Start with a focused set of treatments, master them, and expand only when it makes sense for your patient population and growth strategy.
Short on time? Download the Comprehensive Checklist for Opening a Dry Eye Practice!
Staying current: The evolving world of DED pharma
If there is one area of dry eye that refuses to stand still, it is the pharmaceutical space.
New medications are being developed, approved, and refined at a rapid pace. Because of that, I will not dive too deeply into specific drugs here. What is relevant today may be outdated in just a few years. Instead, the focus should be on something far more important: your mindset and depth of knowledge.
If a patient comes to a dry eye specialty clinic and leaves with nothing more than artificial tears and generic cyclosporine, there is a good chance they will walk away disappointed. Not because those treatments do not have value, but because they expected more from a focused dry eye practice.19
Your role is to go beyond the basics. Understand the mechanisms behind the medications you prescribe. Know how they work, when to use them, and how they fit into a broader treatment strategy. Dry eye is multifactorial, and your pharmaceutical approach should reflect that.
Just as importantly, become comfortable navigating the prior authorization process. Many of the more advanced or targeted therapies require additional steps for approval. While this can feel like a burden early on, it quickly becomes a differentiator. When other doctors know that you are willing and able to handle these complexities, it makes referring patients to you an easier decision.
This ties directly back into building your referral network. A general optometrist or ophthalmologist may not want to spend time fighting with insurance or staying up to date on every emerging therapy. But if they know you do, and they know their patients will receive thoughtful, comprehensive care, you become an invaluable resource.
Lean into the community
One of the most underrated aspects of dry eye care is the community behind it. This is not a field where doctors operate in isolation. In fact, it is quite the opposite.
Attend dinner lectures. Stay connected with your pharmaceutical and device reps. Reach out to other dry eye-focused doctors, both locally and nationally.
You will find that many are more than willing to share insights, discuss cases, and talk through treatment strategies. Whether it is a quick phone call or a longer conversation about protocols, these interactions can accelerate your growth in ways that textbooks simply cannot.
Dry eye is constantly evolving, but you do not have to keep up with it alone. Facebook groups such as OSDocs, and conferences/CE opportunities such as Dry Eye in the Desert offer companionship and resources for doctors seeking information or guidance.
Beyond prescriptions: OTC solutions and in-office retail
While prescription medications play an important role in dry eye management, they are only one piece of the puzzle. There is an entire category of over-the-counter therapies that can significantly improve patient outcomes while also creating an additional, often overlooked, revenue stream for your practice.
These include:
- Omega-3 supplements
- Lid hygiene products, such as hypochlorous acid lid spray
- Heat masks and warm compress systems
Individually, these may seem like small-ticket items. Collectively, they can have a meaningful impact, both clinically and financially.
From a patient care perspective, these products reinforce your treatment plan. They give patients actionable steps they can take at home and help maintain the progress you have initiated in-office. From a business perspective, they create consistent, recurring revenue. Perhaps most importantly, they add convenience.
When a patient can leave your exam room, walk to the front desk, and pick up exactly what you recommended, you remove friction. There is no guessing, no searching online, and no risk of buying the wrong product. That convenience leads to better compliance. Better compliance leads to better outcomes. Better outcomes lead to stronger patient loyalty.
It is easy to underestimate the financial impact of retail products. But over time, these small purchases add up, especially as your patient base grows. A well-curated selection of over-the-counter products can quietly become a reliable contributor to your overall revenue.
The key is to be intentional. Only stock products you genuinely believe in. Use them yourself if possible. Recommend them confidently. Patients can tell the difference between a thoughtful recommendation and a generic upsell.
Expanding into aesthetic and cosmetic offerings
As your dry eye practice grows, there is also an opportunity to expand into eye-adjacent cosmetic products. One of the most common questions I get in my practice is regarding which products I recommend for a patient’s cosmetic needs. This makes products like eye-safe lash serums, under-eye patches, and periocular creams a natural extension of your offerings.
Companies such as Eye Derm or Twenty / Twenty Beauty become valuable resources when you’re able to give patients these alternatives to some more common beauty brands that may not take into consideration the health of the ocular surface.20,21
There are different approaches, whether you look to carry products such as this in your office that you obtain through wholesale, or simply offer them as recommendations to patients. Starting with simply mentioning these brands to patients will give you more comfort and familiarity with them, while also decreasing your overhead and start up costs.
Not only do these products align with your patient demographic, but they also help position your practice as a comprehensive destination for both ocular surface health and periocular care. While leaning into the aesthetics component of dry eye, make sure to reach out to your local state board to understand what is and is not within scope of practice, especially if you’re going to start getting your in-office treatments involved.
Insurance vs. cash-pay: Choosing your practice model
One of the biggest decisions you will make when building your dry eye practice is whether to accept insurance or operate entirely on a cash-pay basis. There is no universal right answer.
Both models can be successful. What matters most is choosing the one that aligns with your goals, your patient demographic, and how you want your practice to function day to day.22
The insurance route: Accessibility and volume
Getting credentialed with insurance plans can be a challenge. There is no single way around that. The process can be time-consuming, detail-oriented, and at times frustrating. You can choose to go through credentialing services to streamline the process, or you can take it on yourself if you are willing to put in the time.
The main advantage of accepting insurance is accessibility. For many patients, knowing that their exam will be covered or partially covered lowers the barrier to entry. It makes it easier for them to walk through your door and say yes to being evaluated.
In my practice, we have elements of both approaches. We accept most major insurance plans for covered services, such as exam fees, and certain covered treatments like amniotic membranes. However, many of our in-office treatments, like IPL, which are not covered by insurance, remain cash-pay.
This model allows patients to use their benefits where applicable, while still giving us the flexibility to offer advanced treatments that are not insurance-based.
The cash-pay model: Simplicity and transparency
On the other end of the spectrum is the fully cash-pay model. There is a lot to like about this approach because everything is straightforward:
- There are no deductibles to explain.
- There is no confusion about in-network versus out-of-network status.
- There are no prior authorizations for visits.
Patients know exactly what they are getting and exactly what it costs. From a business standpoint, this can lead to higher revenue per patient and more predictable cash flow.
But there is a tradeoff. Higher upfront costs can reduce patient volume, especially in the early stages of your practice. Some patients may hesitate to move forward without the involvement of their insurance, even if the care you provide is more specialized. In certain cases, patients can submit their costs to their insurance providers for reimbursement, however reimbursement is never guaranteed and this does require additional work.
How this impacts treatment strategy
Your decision can also influence how you approach certain treatments. For example, therapies like amniotic membranes can be costly to provide but offer high reimbursement through insurance.
If you are in-network, these can become valuable tools both clinically and financially. In a fully cash-pay model, however, they may be less practical depending on your patient population and pricing structure.
This is where your business model and clinical approach intersect.
There’s no right answer, only the right fit
At the end of the day, choosing between insurance and cash-pay comes down to preference.
Ask yourself:
- Do I want higher volume with lower per-visit revenue?
- Do I want lower volume with higher per-visit revenue?
- How important is simplicity versus accessibility in my workflow?
Some doctors thrive in a fully cash-based environment, while others prefer the balance of a hybrid model. Both can work, but the key is to be intentional. Design your practice in a way that supports your long-term goals and allows you to deliver the level of care you set out to provide.
The patient experience: Where everything comes together
At the end of the day, everything you have built comes down to the patient sitting in your chair. Your brand, location, diagnostics, and treatments all matter, but the patient experience is where everything comes together.
Early on in your practice, you will have something incredibly valuable: time. Use it. Spend time with your patients. Go out of your way to explain what you are seeing, what it means, and how you are going to approach it.
For many patients, this will be a completely different experience from what they are used to. While they may be used to the typical 10-minute, in-and-out exam, several studies show a correlation between the quality of physician-patient communication and the health outcomes of patient care.23 Taking your time alone can set you apart.
To enhance the patient experience, incorporate the following principles:
Listen first, then examine
Before you touch a slit lamp or run a single test, listen. Patients will tell you more than you think if you give them the space to do so. Their symptoms, frustrations, and treatment history can often help you start forming a differential diagnosis before the exam even begins.
That level of attentiveness improves your clinical decision-making and builds immediate trust.
Be thorough…every time
Dry eye patients do not come to a specialty clinic for a surface-level evaluation. They are looking for answers, so be thorough.
- Do not assume there is no corneal staining. Check.
- Do not assume the palpebral conjunctiva is normal. Flip the lids.
- Look at everything, document everything, and connect the dots.
Attention to detail is what defines a specialty practice.
Connect on a human level
Dry eye is not just a physical condition. It is also an emotional one. These patients are often frustrated, discouraged, and tired of trying treatments that have not worked. If you want to truly help them, you have to meet them where they are.
Make it clear that this is a collaborative effort. You want them to feel better just as much as they do. When patients feel that alignment, they become more engaged, more compliant, and more trusting of your recommendations.
Turn great experiences into practice growth
One of the most powerful marketing tools you have is sitting right in front of you: a happy patient. If you have just completed a thorough exam and built a strong connection, do not be afraid to ask for a review. It does not have to feel forced. It can be simple and genuine.
I have also trained my staff to recognize key moments. When a patient says something like, “I’ve never had such a thorough exam,” or “No one has ever explained this to me so clearly,” that is the opportunity. A simple follow-up such as, “It would mean a lot to the doctor if you could leave a review online,” can go a long way.
Over time, these reviews build credibility, improve your visibility, and become a major driver of new patient growth. Don’t be afraid to drive full force into the modern age of social media, either. Studies have shown that 41% of patients agree that social media presence positively impacted their decision to visit a doctor, while only 9% favored no social media presence.24
Final thoughts
If you are considering building a dry eye practice, it is not a decision you made lightly. You understand the commitment. You understand the challenges, and you likely understand what you are signing up for.
The truth is this: this practice becomes your life, so treat it that way. Nourish it. Invest in it. Take care of it. If you do, it has the potential to become not just a successful business, but an incredibly rewarding way to practice.
