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Beginnings

New owners weigh in on the hardest part of their business … starting it.

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They say that starting is the hardest part. If that is true, then these ECPs—whom we asked to share their businesses’ origin stories while they are basically still happening—should have it pretty easy from here on out, right?

Kidding aside, if you’re curious about what happens in that space between idea and execution, we’ve got the perspectives of four new business owners who implemented different models and priorities as they got off the ground. From business plans to securing financing, from what they’d do differently to advice for others looking to branch out on their own, read on for all the fascinating details.

A FAMILY AFFAIR

Julia Laval and Anissa Laval
Cutting Edge Optics, Berkeley, CA
Opened: November 2018

We are a mother/daughter optician duo and opened Cutting Edge Optics in November 2018 located in the charming Elmwood community on one of Berkeley’s busiest streets, College Ave.

Julia also owns Montclair Optical in Oakland. Montclair Optical boasts a long history; it has been in business for 42 years and passed down through several generations of opticians in our family for the last 35. Montclair Village has its own lab and Julia has been the technician in charge of cutting all lenses for the last few years.

I have been an optician for the last nine years. I learned my skills from my mother; observing the techniques needed to succeed in the business. If not for having seen first-hand how to correctly understand lenses, prescriptions and frames, my climb into the business would have been much steeper. I’ve worked under enough doctors to understand how not to run a business, enough that I knew I was ready for this adventure.

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We opened Cutting Edge Optics because of our passion for opticianry. We are bringing true optical knowledge, new techniques, and unique, fresh brands to Berkeley. As two opticians with genuine love for this profession, excellent service comes naturally to us. We take our time, offering personal attention to every customer, and supplying a broad yet original selection of glasses to guarantee the perfect fit, customized in every way: from color and lens shape, to the glasses-buying experience itself.  

The shop was previously owned by an optician who was ready to move on. The decor was entirely white. Our aesthetic is based on a New York studio loft. When we took over, we painted and put up a gorgeous plant wall as the focal point. It pulls in the green, sustainable and eco-friendly aspect of the neighborhood, fitting these values into our urban aesthetic. The large windows create an airy, inviting feeling. We play music from all over the world, including Africa and Central and South America. We even mix in a little French rap.

This store has an extensive business plan. After more than 30 years of success in Montclair, it was natural to apply those guidelines to Cutting Edge. We are very serious about the buying process and making sure we don’t overspend on frames. Optical businesses fail in one category: how big their eyes get when a rep walks in verses how much they have in their bank account. It should never be a race to rush patients in the door just to cover your costs month to month.

Julia knew from experience what was needed to financially support the business and get it off the ground, and Anissa knew how to deploy social media and advertising to generate a buzz before the doors even opened. Before Day 1 our Instagram had over 700 followers and we gave hour to hour updates and sneak peeks. Business has been busy from the first day.

We constantly push ourselves to keep our patients informed about what we’re doing next. Social media gives us a platform to align brands with specific people. Every brand introduction and major event is published online. Photographer Dione Green (@Dione.Green), who took our photos, is key. We also advertise a lot with the Elmwood community newsletters.

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Business, especially starting cold, can be a waiting game. When you revamp an established business, you’re going to deal with customers who are accustomed to the old way, the old prices, and the old frame selection; these loyal customers can take a while to warm up to changes. One of the most important lessons we’ve learned is not swaying to please everyone.

Annisa (l) and Julia Laval have brought true optical knowledge, new techniques and unique, fresh brands to Berkeley, CA, with Cutting Edge.

In terms of advice, make a detailed guideline to how you want to financially run your business and stick to it. Our way is to make a frame board. Our frame board details how many frames can fit into a section and how much money we are willing to spend on that section. You may think more is better but picking the right frames for customers is smarter than having as many as possible. Listen to your gut, not the rep! For example, if I’m buying 60 pieces of Garrett Leight, I need to ask myself how much I’m spending and how far they will get me before I have to repurchase. Then I need to consider what happens if 35 percent of those frames don’t move. I cannot purchase Caroline Abram just for its beauty, I have to consider who is going to buy these frames and is it worth having the same frame in three colors.

Also, have a social media advisor. Social media is the new Yelp. Without a visual aid to generate intrigue for customers, you’re doing your business a disservice and damaging its ability to grow and make profit. Social media is a digital lasso for new customers.

QUICK Q & A

What was the first major milestone you celebrated?
We wanted to open as dramatically as we could. Our doors and windows were covered then we did a large reveal online and on the Elmwood community site. We were met with overwhelming support.
Have you already had to break up with a patient/customer or vendor?
We have had to break up with many vendors and bring in new brands.
Has the business made you cry?
Of course! If a business doesn’t make you cry, you’re not working hard enough.
Would you have done anything differently?
No.
What’s been your most empowering moment?
A customer who had been looking for frames for over three years left with six. She later came back with three friends who all purchased.
How long did it take until you felt like were gonna make it?
Instantly. Business grows if you control money flow. Everything else comes easy.
Do you ever feel like you’ve made a terrible mistake?
Never. You have to be confident in your ability to succeed.
What do you do to help overcome doubt?
We sit in the office every time we feel overwhelmed and say: “There’s no way we are going to fail.”

 

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GOING HOME AGAIN

Erika E. Mabus, OD 
Muncy and Laporte, PA
Opened: September 2018

I established my corporation on July 26, 2018 and officially signed closing documents on Sept. 6, 2018. I purchased it from an optometrist who had been practicing in the same location for the last 20 odd years. It’s 12 miles north of where I grew up and 25 miles south of where I live now. It was well-established, privately-owned, and one of very few independent offices in my area. I believe in private practice optometry and I am excited to officially be practicing in that capacity. 

I’d been contemplating my own practice since graduating from optometry school in 2013, and the timing just felt right. The optometrist had plans to retire soon, so it’s been a nice way for us to transition patients and give me time to pick his brain on the business aspects. 

I spent months going over the financials with an accountant and business advisor, as well as a lawyer with expertise in accounting and business acquisitions. I was surprised at how long it took for lawyers to go back and forth to on the contract’s terms. The retiring doctor and I began the process in April 2018 and finalized it September.

I secured financing through PNC Healthcare Business Banking and have been extremely happy with the help I received before, during, and after the purchase. I contacted a few smaller local banks, but they asked for high down payments or collateral; PNC made it simple and easy. 

I made a business plan, but just as everything in the world evolves, so has my idea of how my practice should run. I am happy with what I have accomplished in the last seven months of ownership, but I am always striving to do better. Currently, I am considering a consultant for more accountability and to keep myself on track, but also to help me achieve my future goal: comfort with the cost of new technology to set my office apart. 

Part of the appeal of private practice in a rural area is that patients feel at home. My team greets every patient by name and in the exam room I always try to make at least one personal connection. I recently saw an older patient I thought may have patronized my grandfather’s business years ago. We reminisced about the time he and his father spent in my grandfather’s hardware store. 

Taking over from an established OD where she grew up was Dr. Mabus’ way to ownership.

The retiring doctor and I put up a photo in the waiting area with a note welcoming me to the practice. I advertised with local high school sports teams and drama club programs and T-shirts. I also contacted the local newspaper for a “spotlight on business” article which brought a lot of business to my new location without any cost to me. 

The day we signed the agreement there was a full book of patients and it’s been that way ever since. Keeping the same staff with the retiring doctor still seeing patients has been a huge help. Patients are getting used to the idea of another doctor and they get one final visit with their previous optometrist. I opened a second location cold in January and I am just now starting to have a full day of patients there after a few weeks of one to five patients a day. 

I am happy with the quality of medical eyecare I provide, but I’d love to incorporate more advanced dry eye treatments. It is one of my personal passions, since I experience it myself. I also hope to become more skilled at specialty contact lens fittings to differentiate myself and complement my dry eye treatments. I thought I would be ready to jump in and purchase more equipment the first year, but now I hope to do so in year two. 

If anyone else is thinking of purchasing or starting their own practice, I would recommend getting an excellent set of advisors: a good lawyer, a competent accountant, and a business advisor. Having people to help is huge. My other advice is to integrate yourself into your community. Patients love to make connections with you, and that’s easier if you go to the same restaurants, know the schools, join the same gym, or shop in the same places.  

QUICK Q & A

What was the first major milestone you celebrated?
I brought in two new independent frame lines that focus on sustainability — TOC lunettes Monkey Glasses and David Green Eyewear
Have you had to break up with a patient/customer or vendor?
Not yet, thankfully. Has the business made you cry? e Not yet! But I have had a few sleepless nights since September
Would you have done anything differently?
I would have set up my website sooner, which is still not complete.
What’s been your most empowering moment?
I still see patients at two other retail locations on evenings and weekends. When I tell them I have two private practices, they tell me that they are excited to see me there next year.   
 
How long did it take until you felt like you had it under control?
About three months, although there are still times when I feel like I’m lost with the business aspects. 
Do you ever feel like you’ve made a terrible mistake?
Not yet. Even when I am working seven days a week because I know in the end all the hard work will directly benefit me, not someone else.
What do you do to overcome doubt?
I breathe. I meditate. I trust that I am enough. I work hard, so I know that I’ve done everything I can. 

 

FROM BIG BOX TO BOUTIQUE

Mitch Peterson and Kelsey Keltgen, OD
SEEK Eyecare / Victoria, MN
Opened: February 2017 (Soft), April 2017 (Grand)

My wife, Dr. Kelsey Keltgen, and I cold-opened our practice in early 2017. We chose a new building in downtown Victoria, MN. We were the first and are still the only practice in Victoria.  

My wife, and high school sweetheart, had been practicing for about six years prior to opening SEEK. She worked as a paid hourly doctor right out of school and filled in at other practices on the side. After that she was a lease-holding doctor at a big box optical. I have a diverse background, from working on my family farm to starting a few successful businesses. I was even a bouncer and drove semi-trucks in college. Our unique backgrounds make us a great team. She is one of the most passionate ODs out there.

We both worked six to seven days a week to pay off our personal debt. So, when we were ready to open our dream store we were financially able to do so. We wanted to open our own practice because no one was doing what we wanted to do: offer a state-of-the-art practice that provided comprehensive exams with an approachable retail space. My wife wanted to be able to take a preventative approach that would be more beneficial to patients.

We did a ton of research. We used our experience to develop a patient experience that picked up where a lot of practices fall short. We had to figure everything out from scratch. None of us knew how or where to purchase frames … What lenses or lab to use.

We developed a very in-depth business plan with multiple options to pivot with if things didn’t pan out. We have adhered to the majority of it. The only major change is that we had to adapt due to how fast we are growing. We are hitting our goals for years four and five in year two.

We secured a build-out loan fairly easily due to our favorable debt-to-income ratio and self-financed the operating side. The most surprising challenge we encountered was that construction was always four months behind schedule due to more than 35 inches of rain the day we broke ground. We had to meet frame reps at a coffee shop.

Insurance credentialing was a huge project that my rock star wife handled. Start working on that the second you can. We are involved in the community, volunteering and sponsoring events. I’ve used unique marketing avenues to get our brand out. Constant logo use and branding is important to my marketing plan. Since we previously leased at a corporate big box practice, the patient base was ours. We posted on social media each step of the build-out.

Business was crazy when we opened. We had so much local support and we both have large families; they were some of our first patients. The support from our friends and family has been amazing.

Over time, we have gotten very precise in how we operate. We have brought in more high-end eyewear than we initially planned. The biggest learning curves have been on the optical side: we’re more particular with our frame purchases; we make sure the product is great and the rep is even better; if they aren’t, we get rid of them.

Our advice is don’t over-extend yourself. If you aren’t financially and mentally prepared to do everything yourself, wait a few years. Write up your dream business model and find the patient base that fits it. Don’t let anyone or anything push you to start cold. You have to be all-in. We have zero regrets and love working as a wife and husband duo.

QUICK Q & A

What was the first major milestone you celebrated?
The night before we turned the OPEN sign on, we sat and had a beer in the front office after a month of 100 hour work weeks.
Have you already had to break up with a patient/customer or vendor?
We are break-up free on the patient side. We have had to let a vendor or two go.
Has the business made you cry?
It has been an emotional rollercoaster but I think the only tears have been tears of joy.
Would you have done anything differently?
e Nope.
What’s been your most empowering moment?
When publications like INVISION contact us to share our story. It reassures us that we must be doing something right.
 
 
How long did it take until you felt like you were gonna make it?
Once the first patient came in the door I knew we had created something special.
Do you ever feel like you’ve made a terrible mistake?
e No success comes without mistakes. It is how you move forward and learn from them.
What do you do to help overcome doubt?
We work through everything as a team. If there is any doubt we talk it through between the doctor, Rachel and myself. Keeping each other in check keeps confidence high.

 

CROWDSOURCING SUCCESS

Jason M. Klepfisz, OD
Urban Eyecare, Phoenix, AZ
Opened: August 2017

We opened Urban Eyecare in August of 2017 to bring comprehensive care and independent eyewear and specialty contacts to an underserved area, and also hoping that bringing these services would springboard future growth.

I spent the better part of three years jotting down notes on all the little aspects of private practice and optical that resonated with myself. I wish I could say it was all fun and games, but there was a lot of monotony: Which slit lamp has the best optics? Manual vs. automated phoropter? White-gray flooring or gray-white? Pricing out the optical. The best advice came from those that have gone down this road before, those that are currently practicing, and those looking to hang up their own shingle.

I come from an Indian Health Services background, having completed residency in a rural community. This continued in a geriatric setting for years when I returned to Phoenix before deciding to open my own office. The biggest challenge we faced when opening, and one that changed our overall goal, was getting credentialed on medical insurance panels. We pivoted to focus on our retail experience, seeking harmony between a medically and optically oriented office. What I didn’t expect was to fall in love with the materials and craftsmanship as much as I have.

To make ourselves stand out, we push brand-awareness social media campaigns and provide adjustments and free cleaner to anybody who walks in. We exhibit local artists in our office.

We got the word out through trial and error. We started with our online presence. I also hand delivered letters to about 250 local businesses on a 100-degree spring day. We called local businesses and found ones who allowed us to deliver gift bags to their employees. We took every health fair opportunity available. Every bulletin board, coffee shop and college building we could leave flyers, we did, even handed them out on the street.

Business was great when we opened. The problem was we lost our optician just a few days before opening. I had no previous experience with optical and my staff were untrained in the area. In our first week, we slowly built up a pile of lab orders ready to be placed but nobody to place them. Fortunately, by the end of that week we found a wonderful replacement who has been our rock star ever since!

The main lessons we’ve learned are, firstly, to check out eyewear in person before buying. With our limited window to purchase frames while opening, we carried some brands we were less than thrilled with over the course of the year. We shed about half of the brands we started with and are much more careful in our choices now.

Lastly, my advice is to follow your dream! Don’t feel the need to take over somebody else’s problem office because starting cold is too difficult. Create something unique, a place that patients want to go, rather than a place they reluctantly need to go. Create an experience that makes people want to come back.

QUICK Q & A

What was the first major milestone you celebrated?
Adding a fourth doctor day per week. It was wonderful to spend another day in my practice rather than working for somebody else. 
Have you already had to break up with a patient/customer or vendor?
We have unfortunately had to drop a few vendors. The beauty of ownership is we can choose to work with brands that complement us and our mission, to grow together.
Would you have done anything differently?
I would make design changes for our next office. A doctor who owns a large chain once told me that you always like your first office the least, but each one after gets a little better.
How long did it take until you felt like you were gonna make it?
It’s still day by day, even though we are turning a profit. The days with 16 patients make me feel like the king of the world, while slow days make me feel like tomorrow is never going to come. I don’t think I’ll feel like it’s completely under control for a couple more years.
Do you ever feel like you’ve made a terrible mistake?
Never!
What do you do to help overcome doubt?
Wake up happy every day and excited to go do my dream job at my dream office!

Since launching in 2014, INVISION has won 23 international journalism awards for its publication and website. Contact INVISION's editors at editor@invisionmag.com.

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2020 Vision

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The coming year has “eyecare” written all over it. But what changes can we expect to see in eyecare and eyewear as we enter a new year and a new decade? We asked more than 20 industry experts which major trends they expect to make themselves felt in the coming year and beyond. Their responses can make for scary reading at times — few independent ECPs leap for joy when they hear talk of “retail homogenization,” “online refraction” and “eroding margins.” But the way we see it, the real takeaway here is about silver linings and crises turned into opportunities. They say to be forewarned is to be forearmed. Check out the eight currents in the optical and optometric industry discussed in the following pages, and arm yourself for a new year—and a new era—in eyecare.

1. VERTICAL INTEGRATION

Among the industry experts INVISION spoke to for this article, the consensus is clear; the vertical integration that has been evident at all levels of the optical and optometry industry in recent years, from the Essilor/Luxottica merger to the private equity-fueled acquisition of independent practices, will only accelerate in 2020.

According to Evan Engel, vice president for sales and marketing at EyeCarePro, a digital marketing firm for eyecare businesses, “The financial incentive for the Essilors and VSPs of the world to own practices and push their products through their own practices will change the landscape, much like private pharmacies are virtually gone, replaced with CVS/Walgreens.” Mark Hinton, founder of advisory firm eYeFacilitate, puts a hard figure on the financial incentive described above by Engel, saying acquisitions can only grow as “venture capital execs will continue to show investors a 20-plus-percent gain” on acquisitions of eyecare practices.

Matt DiBlasi, president of Abyde, a HIPAA-compliance software provider, named the emergence of private equity within optometry as his top trend to watch. “It’s here and it’s here to stay,” he told us. “Will the independent OD thrive or eventually cave to the more recent trend of offloading business functions through the process of acquisition?”
The most obvious effect of this process is homogenization; as small businesses sell out to join large groups, eyecare is at risk of looking the same everywhere, something that, according to Jennifer Lyerly, OD, co-founder of Defocus Media, “weakens our chance to personally connect optometry’s message with patients.” As the current generation of eyecare’s most prominent leaders sells to private equity, she says, “We need to find and embrace new leaders in the profession who are innovating independent paths forward.”

According to business development expert Michael Karlsrud of the Karlsrud Company, the consolidation of the private ECP market will be focused on larger population areas, or where multiple office locations exist. This is significant, he says, as many frame and lens companies, along with their sales teams, are going to be at risk as decision-making and purchasing will become centralized to maximize purchasing power. “We may experience a loss of jobs in the overall market, and organizations will certainly have to regroup as their ‘A’ accounts are picked off.”

Other eyecare pundits are drawing similarly interesting conclusions. Richard Frankel, OD, of Atlantic Cape Eyecare in Wildwood, NJ, and founder of #emergingtrends on ODs on Facebook, says the acquisitions of VisionWorks by VSP, and FourEyes by Luxottica, point to “the growing segment of the eyecare market in the value-based segment as pioneered by America’s Best.” In addition, he says, “expect the VCPs [vision care plans] owned by those corporations to funnel more of their beneficiaries to them for added synergy.”

Louis Fullagar, creative director at SpexAddict, a digital marketing firm specializing in the eyewear industry, and founder of the online magazine Luxury Eyewear Forum, sees a lot of retirements on the horizon. This will in turn create a real opportunity for independents to separate themselves from the herd, he says. “I see growth in the area happening already but I think there will be more pressure to differentiate in the changing market profile over the next year. It will be ‘decision time’ for many owners to either sellout or step it up!”

Echoing this is Bart Foster, managing director of Colorado-based Sanitas Advisors, who says that while, sure, it can be a scary thing to see, the continued vertical integration of the industry can be an opportunity for those ECPs who recognize it, helping to open up space for smaller companies and niche brands.

James Armstrong of Alberta Eyecare in Portland, OR, made this bold call on an acquisition that’s barely three months old: “VSP abandons VisionWorks after massive revenue losses.”

2. TELE-OPTOMETRY HAS LANDED!

Industry observers have been warning for years that it’s just a matter of time until online refraction becomes something optometric practices will have to take seriously. Well, if our experts are to be believed, that time is upon us, with 2020, as Texas State Optical president John Marvin puts it, likely to be the year that “tele-optometry will go mainstream and be adopted by large groups.”

As far as telemedicine in general goes, Michael Kling, OD/owner at Invision Optometry in San Diego, CA, sees a familiar pattern. “It’s real and it’s coming. Not just to service the under-served, rural areas of the country, but also to meet the increasing demand for convenience and efficiency. Disruption occurs when a new market is created, first by appealing to a niche market, then by becoming mainstream. Just like we’ll soon be hailing driver-less automobiles to get to work, we’ll soon see a completely virtual healthcare delivery system emerge.” It’s an idea expressed succinctly by Peggy Gartin, founder/CEO of The Social Eye, a social media agency for optical businesses, who says that the pressure is on to make online exams a reality, “because some people just don’t want to go to the doctor.”

Foster of Sanitas Advisors not only agrees that the trend is real, he embraces it. “Telehealth — soon to be called just health — and online refractions will finally gain a foothold and enable eyecare providers to offer better access with fewer costs.

Karlsrud, while agreeing that acceptance of online exams is on the way, isn’t sold on the idea that 2020 will be the year US consumers fully buy in. “We are in the third inning of the ballgame. When online refraction becomes perfected and accepted overseas, it will be more accepted in the US. When that happens, look for the consumer to take more control of their healthcare and make decisions based on their own consumer ‘needs,’ i.e. fashion, flexibility, cost, utility measures, versus eye health and other benefits of a healthy eye exam.”

The question ECPs should be asking themselves, according to Lauretta Justin, OD, owner of Millennium Eye Center and founder of Optometry Divas in Orlando, FL, is no longer really about whether telemedicine is coming, or even how to incorporate it into their practices, but how to ensure it best serves eye health. “If we get involved and find ways to incorporate its use in our practices, I believe we can help steer it in the right direction,” she says. Lyerly takes a similar view. “We have to find a way to use it ethically or risk being left behind,” she says. “Primary care doctors are already using telemedicine to prescribe antibiotics for ‘pinkeye’ — even though we know most acute conjunctivitis is viral and doesn’t need antibiotics. Can we ethically employ telemedicine to meet the convenience our patients want, without sacrificing proper care and contributing to antibiotic resistances? If optometry can find the path forward that balances these concerns, our profession will be stronger for it. The pioneers that will bring us into the future are out there right now embracing the challenge.”

3. DECLINING ENROLLMENT, CORPORATE RECRUITMENT

One topic that our experts will be looking carefully at over the next year is the perhaps too-seldom discussed subject of the state of education for aspiring optometrists and opticians.

Sadly, Hinton expects opticianry colleges will continue to see a drop in enrollment as optical salaries present a lower income opportunity than other trades. As for ODs, graduates will flock towards corporate stores instead of private practice, says Karlsrud. “Their debt load will be very high and the risk too great not to seek the shelter of a larger organization — particularly in a market that is shifting rapidly,” he says, with the end result being less options for retiring doctors in smaller markets to have an exit strategy. “In the end, this could mean few choices for care in small markets, forcing the patients to drive to larger communities, or for the younger demographic to hit online options,” he adds.

EyeCoach’s Bell offered the glum prediction that schools and colleges of optometry “will continue to do a disservice to their students by not offering any classes in how to run/manage a profitable practice/business or making the following classes mandatory in undergraduate studies as a criteria in being accepted into optometry school: Entrepreneurship, Business Finance/Accounting, Sales & Marketing, Human Resources, Inventory Control, etc., etc., all the while as students accumulate crushing debt from their student loans which average around $200,000.” Because of this, he warns, independent optometry will see a further drop in capture rates and big box stores and online retailers will continue to see growth “as independent optometry continues its death knell.”

4. MYOPIA AND EYE HEALTH AWARENESS

An increase in myopia cases, heightened public awareness of the importance of eye exams, growing government regulations, gene therapy and more are all on our experts’ radar for 2020.

Look for eyecare practices to expand their scope of practice, predicts Foster, “speeding up new treatments and product opportunities — for example auditory, cognition, genetic testing and eye health.”

American Optometric Association president Barbara Horn, OD, says 2020 will be the year of the eye exam, thanks in no small part to AOA’s #2020EyeExam campaign to drive awareness of the importance of making a comprehensive eye exam part of every American’s annual health care routine. “We are reaching out to employers across the country, enlisting their support and commitment to foster awareness of the importance of eye health and vision care and the overall health benefits of in-person, comprehensive eye examinations,” she told INVISION.

Kristan Gross, global executive director of the Vision Impact Institute, agrees that vision health will become part of the wider public health conversation. With the release of two new reports on the state of vision around the world, the topic of vision is already being elevated to the public health stage, she says, citing the World Health Organization’s World Report on Vision, which highlights the magnitude of the problem of poor vision, and a study by Essilor International on the global scale of uncorrected poor vision. Gross also expects the link between children’s vision and learning to continue to be on the radar of policymakers, adding that in several states this conversation has already resulted in policy change when it comes to children’s vision exam policies. She predicts that more states will introduce legislation in 2020.
The topics of children’s vision and eyecare-related legislation are also on the mind of Armstrong at Alberta Eyecare, who expects the coming year to bring both growth in pediatric-specific optometry practices and new laws in almost all 50 states regulating online eye exams.

Frankel expects 2020 will show us even more evidence of optometry’s potential to integrate with mainstream medicine. “The future of optometry lies in providing professional services and integrating within the tapestry of medicine,” he says. “We are no longer going to be isolated but have the ability to coordinate with a patient’s total healthcare.”

Continuing the pediatric theme, Foster predicts that the massive increase in myopia, especially in children, will change the standard of care and open opportunities for new treatments and service models. He expects genetic testing and gene therapy will be used for early detection and diagnosis of eyecare diseases and, intriguingly, that contact lenses will be used for drug delivery.

Jaclyn Garlich, OD, founder of the 20/20 Glance weekly email for optometrists, is keeping her fingers crossed for possible FDA approval for myopia control. “Eyenovia is working on a drop called Micropine. If approved, Eyenovia will have the first microdosed treatment for progressive myopia in the US. Plus their eyedropper bottle is innovative and is designed to have better drug delivery to the eye. This could be the eyedropper of the future,” she says. Also on her radar are developments in meibography. “As the number of dry eye disease patients continues to increase, so do our diagnostic and treatment options. I think meibographers are going to become one piece of equipment primary care optometrists can’t live without,” she predicts.

 

OUR EXPERTS

 

5. THE RISE (AND RISE) OF MANAGED CARE

In a process inextricably linked to the vertical integration of the industry, managed care is taking over a large portion of the vision plan sector. None of our experts expects this to change any time soon.

You might be thinking this is one trend you can sit out as in independent. Not so, says Karlsrud. “Not only will [managed care] become closer to the consumer by completing the vertical integration of the supply chain, [it] will put pressure on independent ECPs to accept less reimbursements for customary charges and services,” he says. The result will be more patients being driven to corporate owned practices where benefits can be maximized, with the remaining independents forced to either change their business model, or move into a “cash only” practice. “Count on more direct marketing to patients to move them to online stores owned by the larger consolidators,” he says.

“The era of fee for service,” says Atlantic Cape Eyecare’s Frankel, “is drawing to a close.” With the Department of Health and Human Services having declared that 90 percent of Medicare beneficiaries be covered under programs that have quality based outcomes, MSSPs and Medicare Advantage programs are increasing in popularity. “ACOs will continue to become more popular with commercial carriers as a means to control costs. The panels that have been proven to reduce Medicare costs are being used for the commercial plans. Optometry cannot be closed out of providing medical eyecare as a result. Nor can routine eyecare be subcontracted out to VCPs.”

Foster warns ECPs that they should expect to see a dramatic shift in the control of managed vision care in the direction of employers and consumers.
Robert Bell, sales strategist and founder of EyeCoach, a sales and marketing practice, offers this frank assessment: “Optometrists will continue to bitch and moan about new policies of vision care plan companies that are only beneficial to these companies but not to the ODs who accept the plans. Yet, most ODs will not formulate any strategies to leave these plans and the profitability of their practices will continue to dwindle.”

6. THE SEARCH FOR A NEW BUSINESS MODEL GOES ON

Hand in glove with changing consumption patterns comes the eternal quest for the perfect business model. The complexity of the optical and optometric industry makes the challenge posed by online retail especially formidable for ECPs.

Louis Fullagar at SpexAddict, a social media, brand building and digital marketing company working in the eyewear industry, foresees a growth in practices getting their game on in terms of marketing, social media and branding in 2020. “There is a massive opportunity for every independent to at least take a step into that space,” he says. “We are now past the point of the blinkered approach to attracting customers. I am starting to see more practices and owners who are willing to at least try new ways and budget their marketing activity accordingly.”

The goal of such efforts, according to Kling, should be to reduce “retail friction”. “It’s important for businesses to challenge their processes of delivering goods and services, and to find ways to lessen any barrier to the consumer to complete the transaction. Any step in the purchasing process that requires cognitive hesitation creates doubt, and lessens the likelihood of the transaction being completed.” In other words, if you have to stop and think about a purchase, you’re less likely to follow through with it. “Poor customer service, delays in shipping/delivery, a poor shopping environment and poor reviews are all examples of retail friction.”

The most interesting emerging model, according to The Social Eye’s Gartin, is what she calls “DIY optical.” In her view, eyewear customers are unhappy with the price, complexity and restricted selection of the current buying experience. “This is why Warby Parker got so big. Customers are going to source their frames from wherever they can… As long as they bring those frames in to get their prescription lenses from an optometrist/optician, we should support this freedom to choose.”

Hinton at eYeFacilitate says capture from handoff to optical will continue to fall as consumers are influenced by advertised lower cost pricing. “The opportunity is to obtain lower cost, high quality progressive lenses from lab partners and stock SV lenses, both with AR included and frame included; the PAL with frame will cost the consumer between $350 and $389 depending on market saturation.” He advises ODs to write prescriptions for SV and PAL and send opticians to the low-cost providers to mystery shop the average cost of each.

In general, says Todd Berberian, owner of Todd Rogers Eyewear in Andover, MA — the winner of INVISION’s 2018 America’s Finest Optical Retailers competition — too many owners feel obliged to follow industry rules when, after all, “The rules don’t follow us. The only competition that exists should be within your practice’s own four walls; don’t worry about the choices being made by the practice across the street.”

7. CHANGING CONSUMER BEHAVIORS

What separates the future of optical retail from its past? Choice. The consumer/patient seemingly has a world of options available online. As prices stagnate and margins vanish, business owners need to adjust.

Explains Foster: “Online sales will continue to grow with new subscription models taking hold and improvements in virtual try-on technology.” The result? “Downward pressure on pricing will force margin erosion.” Karlsrud agrees, pointing out that there is already a perception in the consumer market that glasses cost as much as 10-15 times higher in a private practice versus online stores. “This will continue to drive the perception that glasses are commodities and can be bought anywhere for the price they want to pay,” he says. “We’ll see this more with the younger generations moving through our offices. The older generations will continue to pay for peace of mind and a relationship with their doctors. We’re all getting older, so now is the time to be preparing for the next generation’s expectations of price, value and convenience.”

Michael Vitale, ABOM, senior technical director at The Vision Council, stresses the opportunity this trend creates. For the discerning patient, he says, the interest you create online can be used to drive the consumer to a brick and mortar location.

“Retail bifurcation” is the term Kling from Invision Optometry uses. “We will continue to see a bifurcation in consumer behavior with, on one extreme, the low-cost-driven providers, and on the other, further expansion of luxury brands and a focus on delivering a unique experience. What will contract is the middle; that is, those that try to be all things to all people, delivering tired eyewear in uninspired environments.”

8. A WOMAN’S WORLD

Here’s an area where we at INVISION think we may even be a step ahead of our own experts. According to our “Big Survey” (check it out at invisionmag.com or in our November/December print issue) 56 percent of responding ODs were women. So while the trend of women gravitating to optometry is well and truly established, a number of the industry observers we spoke to singled it out as one that will continue to be felt in the coming years, with significant numbers of young women seeing a future for themselves in the industry.

In particular, Dr. Lauretta Justin told us to look out for an increase in the number of young women ODs going into private practice, not as solo owners but as partners or groups, which she said will increase the likelihood of success and work-life satisfaction for this new generation of ODs. She also expects an increase in the number of women ODs forming startups with innovative products, and founding companies and networks “to disrupt the status quo and usher in a new era in optometry.” Says Justin, “Many of my colleagues have already launched startup companies that are changing the way we practice. Their companies have various unique offerings such as competitive profitable frame lines, more efficient ways to order contact lenses and capital funding for optometrists by optometrists. It’s an exciting time.”

Marvin of Texas State Optical agrees: “Optometry, as a profession will grow in appeal to females who see practicing as an employment opportunity.”

MORE TRENDS TO LOOK OUT FOR…

• “Virtual reality visual field testing! A company called Virtual Field has a portable visual field tester with audio instructions in your patients’ native language. It’s a great option with a small footprint for patients that have trouble with conventional visual field testing.” Jaclyn Garlich, OD, founder 20/20Glance, Boston, MA
• “Women will continue to fight stigmas about glasses. In November, a story broke about the policies of some Japanese companies banning women from wearing glasses on the job. When poor vision and blindness affect a disproportionately larger portion of females this is clearly a problem. We predict more stories like this.” Kristan Gross, Global Executive Director, Vision Impact Institute, Dallas, TX
• “1. Metals, metals and metals. 2. Ingenuity. You don’t have to spend titanium prices to get first quality metal.” Todd Berberian, Todd Rogers, Andover, MA
• “Divas of an advanced age are starting to come into their own and they all wear glasses. Expect more silver sisters to push the boundaries of eyewear style.” Peggy Gartin, Founder & CEO The Social Eye, San Diego, CA
• “In lenses, the continued development of filters to block specific wavelengths. Be it for color blindness, HEV or enhanced color contrast. Also, developments in “freeform” designed lenses. Not just progressives but also to improve visual acuity for single vision wearers.” Michael Vitale, ABOM, Senior Technical Director & Lens Division Liaison, The Vision Council, Alexandria, VA
• “Private label contact lenses will become a sizable part of the market.” Bart Foster, Managing Director, Sanitas Advisors, Boulder, CO
• “Additive and micro manufacturing — specifically 3D printing of lenses and frames — will become mainstream. Bart Foster, Managing Director, Sanitas Advisors, Boulder, CO
• “Value-based care, a continued migration from pay-for-service to pay-for-outcomes.” Matt DiBlasi, president ABYDE, Clearwater, FL
• “Augmented and virtual reality powered smart glasses, change the way eyewear is used and worn.” Bart Foster, Managing Director, Sanitas Advisors, Boulder, CO
• “1. More gender fluidity. 2. Functional art pieces. 3. Flashbacks to fashions from popular eras.” Arian Fartash, OD, The GlamOptometrist, Orange County, CA
• “There’s a lot coming up for Think About Your Eyes. From new concepts to campaigns kicking off in conjunction with movie releases. Look out April 2020! It will be an exciting year.” Ashley Mills, CEO The Vision Council, Alexandria, VA
•  “Differentiate. Do everything different than your competition. In the optical, find frame lines that no one else has, offer speedy service or home delivery to set yourself apart. Dave Ziegler, OD, Ziegler Leffingwell Eyecare, New Berlin, WI

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Here’s How Eyecare Pros Are Spending Their Advertising Budgets

The pie is getting sliced ever more finely.

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IN INVISION’S FIRST annual Big Survey, we asked more than 500 ECPs which medium accounts for the biggest chunk of their ad and marketing spending. Print is still on top, but the marketing budget pie is getting sliced ever more finely — and nearly 1 in 5 ECPs claim to be passing on the plate all together.

Which gets the largest portion of your marketing budget?

Print
13%
Community events (including sponsorships)
12%
Direct mail
10%
Other social media marketing
8%
Paid search (PPC, Google Ads, etc.)
7%
Facebook
7%
Email marketing
7%
Radio
5%
SEO
5%
Television
2%
Billboards
2%
Other
3%
Don’t advertise
19%

 

Looking at the above results, it’s seems likely the 19 percent of ECPs who said they don’t advertise are relying on word of mouth to sustain their business. Still, it appears to pay to be more active: 25 percent of the ECPs who told the Big Survey the last two years had been their worst ever also don’t advertise. That compares to just 14 percent of those who said those years had been their best ever. Also worth considering: In a separate question, we asked ECPs to name the most significant thing they were doing to drive sales five years ago that they’ve stopped doing. The top answer? You guessed it—advertising in traditional media. Check out the survey to see how your spending fits in to this complex picture.

The 2019 Big Survey was conducted from August to October and attracted responses from more than 500 American ECPs. Look out for the full results in the November/December issue of INVISION.

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Best of Eyecare

The Big Survey 2019 – The Basics

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THE BIG SURVEY 2019

Who is the American ECP? How does he or she do business? What are the main challenges they face? Our inaugural Big Survey set out to find the answers and 505 owners and managers of American vision businesses answered our call. Here are the results.

The Basics

We find it’s always best to start at the beginning … the basic stuff that makes up so much of your business’ identity. The Who, What, How and Where are all here; we’ll get into the fun stuff — like how much and what’s selling ­— later on.

1. Need to swing on chandeliers? Head to Missouri: 60 percent of stores have these fixtures.
2. They don’t take kindly to strangers asking questions in South Dakota. It, along with Louisiana and New Mexico, were the only states not to be represented in our survey.
3. Michigan ECPs are some of the hardest working in the industry: 25 percent work more than 50 hours a week.
4. Eyewear trend capital? That might just be New York where 21 percent of ECPs thought of themselves as being primarily in the fashion business (as opposed to health or retail), the highest level in the land.
5. Move over Austin. Connecticut was tops for self-declared weirdness with ECPs there giving themselves an average score of 8.2 out of 10 on our oddball scale.
6. Ohio ECPs have been listening to our sales experts – 44 percent use role-playing in training staff.
7. Florida had the most male owners and managers in our survey at 76 percent. Washington state had the most female owners at 86 percent.
8. Is there something in the water in the Midwest? ECPs in a band of states from Illinois to Ohio to Missouri were the happiest vision professionals (along with their cousins in NJ), with half or more (50-57%) ranking themselves 9 or higher out of 10 for professional satisfaction.
9. North Carolina vision businesses have among the highest turnover rates in the country, with 72 percent saying their staff stay less than 4 years.
10. Californian ECPs were the least likely to own their places of business with 82 percent renting. Must have been those pesky legal limitations…
11. Kansans were most likely to be open on Sunday with one in four stores and practices open on this traditional “rest” day.

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1. How many locations does your business have?

One
74%
Two
13%
Three to five
8%
Six or more
5%

2. Please indicate the type of location that houses your store:

Free-standing building
43%
A strip mall
22%
Business park or office building
16%
Downtown storefront
9%
Lifestyle center
3%
In a hospital/medical wing/health center
3%
The Internet
1%
Mobile practice
1%
A mall
1%
Other
2%

3. Do you own or rent your business property?

Own
39%
Rent
62%
NA (For online and mobile only businesses)
2%
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4. How well are things going in your business this year?

COMMENT: As our heat map shows, there’s very little to be blue about for an ECP right now. Note that white indicates states with statistically invalid responses. Figures in parentheses represent the number of survey responses.

5. How would you describe the market where your store is located?

Large city
15%
Medium-sized city (250,000-1 million people)
24%
Small city (25,000 to 250,000)
29%
Country town (up to 25,000)
13%
Resort area
1%
Other
1%

6. How long has your business been in operation?

COMMENT: Businesses that have been in operation for 11-20 years seem to be this survey’s sweet spot. Not only did they slightly edge out other lengths of time in business, as seen above, but those in business for that long also reported the highest proportion of revenue between $500K-$1.5M (50%).
Wondering what the rest of this group’s demos looked like? Well, 59 percent classified themselves as a private practice with a strong focus on retail, 49 percent were in the South and 39 percent operated out of a freestanding building in a small city or suburb. Forty-five percent of owners in business for that long reported salaries over $100,000 and, best of all, the majority reported their satisfaction with their professional life at an 8 or higher (66%).

7. Which description of your business do you most closely identify with?

Hospital or VA setting
1%
Medical model private practice, no retail
1%
Medical model private practice, small dispensarybuilding
22%
Private practice, strong focus on retail
53%
Corporate optometry location
3%
Eyewear boutique, employed or leased OD
10%
Eyewear boutique, no OD
9%
Mobile optician
1%

8. How big is your (main) location?

Less than 500 sq. ft.
4%
500-999 sq. ft.
10%
1,000-1,499 sq. ft.
24%
1,500-1,999 sq. ft.
17%
2,000-2,499 sq. ft.
15%
2,500-2,999 sq. ft.
11%
3,000-3,999 sq. ft.
8%
4,000-5,000 sq. ft.
6%
More than 5,000 sq. ft.
5%

9. Check the paid services you offer:

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