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Tales so bizarre we couldn’t make them up ... Not that we’d want to.

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WE DARED ECPs to share their most astonishing, their weirdest — and their downright yuckiest — customer encounters. Boy did they come through! In the following pages you’ll read stories that will make you chuckle, cringe, and squirm in discomfort. Mostly, you’ll just count your lucky stars it didn’t happen to you.


1. Out of Africa… and Straight to The Optical

Duke Dye, OD | Riverside Eye Center | Columbus, OH

Once we had a patient scramble in to buy another pair of Maui Jims.

The transaction was so fast we had to ask why, since it had been less than a month since he’d purchased his last pair.

Turns out that the guy lost the original pair because he had to jump into a river to save himself from a swarm of killer bees while traveling in Africa! Yikes!

2. But Why Did He Have So Much Free Time?

Jeff Grosekemper | Casa de Oro Eyecare | Spring Valley, CA

I used to work for a doctor who always spied on us. He used the glass in picture frames hanging in the hallway to watch us from around the corner. He thought he was sly but we could see his reflection as well. Also we could see the tips of his shoes sticking out of the doorway when we walked to the other side of the dispensary. He listened in on our phone calls not knowing a little red light would come on when somebody else picked up a phone. Always be one step ahead.

3. Cradle to Grave

Christine Howard | Attleboro Vision Care | Attleboro, MA

I had to make glasses for a deceased patient. Their glasses broke, and although they could have been repaired enough to function well during the viewing, the patient’s daughter insisted on making a whole new pair, Rx and all.

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4. That Isn’t A Real Thing

Angel Miller | Cynthiana Vision Center | Cynthiana, KY

We had someone who wasn’t a patient come in and ask if we had those colored contacts made of paper that dissolve in the eye. We told them there was no such thing. He then asked whether, since we didn’t have them (because they don’t exist), we would let him have them shipped to our address if he ordered them elsewhere. Weirdo.

5. What They Don’t Teach You At School

Frances Ann Layton | Eye Associates of South GA | Valdosta, GA

I don’t recall my teachers telling me about the disgusting side of opticianry. My favorite story to tell newbies is about a man who brought his semi-rimless glasses in with one of the lenses out. He puts them in my hands and then tells me “they fell off my head into the manure mound and the lens popped out. Could you fix that and clean them up for me?”

6. Tastes Like Chicken

Kim Riggs, OD | Kimberly Riggs OD | Ligonier, PA

I had a patient who admitted that he was too lazy to get up off the couch one evening to throw away his daily disposable contacts, so he ate them after he took them out.

7. Maybe She Just Likes Standing in the Rain

Nytarsha Thomas, OD, Visionelle Eyecare Zionsville, In

We hired an optician who was really nice and said her best quality was attention to detail. One day, after she had been there about a month, she was the first to arrive at work. She opened the door and instead of putting in her unique alarm code, she entered the address of the business. (Why would we ever make the most visible number on the building the code to the alarm system?) When that triggered the alarm, she thought if she left the building and closed the door, it would stop. When I arrived, the alarm was blaring, a police officer was knocking on the front door, and she had been standing outside the back door in the rain for 10 minutes despite her car being inches away. Just a one-off incident, you may be thinking. But the next day, she was standing in the rain again, saying her key (the one she used the day before) didn’t work. I immediately used it to open the door. The following weekend, she forgot to lock the front door when she closed and a patient walked in over the weekend setting off the alarm and alerting the police again. Needless to say, she didn’t last very long.

8. We’ve Always Wondered What’s under Those Lab Coats

Mark Perry, OD | Vision Health Institute | Orlando, FL

Years ago, I had to stop by the office for something on my day off. When I walked in, one of the technicians standing at the front desk spoke up and said, “It’s nice to see you with your clothes on.” (She’d meant to say with my casual clothes on. We all had a good laugh.)

9. If You Don’t Have Anything Nice to Say …

Kevin Proctor Springer | KP, Brooklyn Center, MN

Customer comes in and says: “Where’s that other guy? He was so nice and could really help me pick out new looks for myself. Darn, I don’t see him … I really don’t want you to help me. Where is he?” I finally said, “Margaret it’s me! I just got a haircut and gained some weight.” She smiled and said, “Well, you looked better before.”

10. There Are No Stupid Questions … Wait

Martha Downing | Advanced Ophthalmology Associates | Clawson, MI

I once had a patient call to say she had a stupid question. Our office response was always that there are no stupid questions … her response was, “Well, I think I put superglue in my eye. Is that a bad thing? It kind of hurts.” I told her to come in, the doctor would see her right away. She showed up an hour later, after getting her manicure fixed (the glue got on her fingers as well). Apparently, she kept both a bottle of eye drops and a bottle of superglue in her car for emergency use. While stopped at an intersection in LA, she picked up the wrong bottle and dropped it in her eyes. What saved her was her contacts, as most of the glue landed on them. She did end up suffering a corneal ulcer from the episode and couldn’t wear contacts anymore. She removed the superglue from her car.

 
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11. That’s Awkward

Cynthia Sayers, OD | EyeShop Optical Center Lewis Center, OH

One of my employees was pretesting a teenage girl. We always come out and discuss the retinal photo screening option with the parents. The employee came out and asked the man who was with the girl if he wanted her to get the retinal photo. He said, “Sure.” I was witnessing this and couldn’t stop laughing. My employee had just asked the teenager’s boyfriend if she should get the retinal photo! In the employee’s defense, he did look very mature for his age, but not old enough to be the girl’s father!

12. That’s Not How It Works

Sarah Jerome, OD | Look+See Eye Care | Minneapolis, MN

I had a patient who, like many of our patients at the conclusion of the exam, asked about how her prescription had changed. She followed that by asking if her right eye needed a different prescription from her left eye. I explained that it is very common for the two eyes to be unequal, and that, yes, she had a slight difference in the strength of her prescription. I was a bit taken aback by the patient’s follow-up question: “Could this be why my left breast is slightly smaller than my right breast?”

13. Grossest. Thing. Ever.

Annie Corvo Poston | Gig Harbor, WA

A woman with open wounds/sores all over her forearms came in and left my counters covered in blood and ooze. She tried on a bunch of glasses and left. I sanitized 378 frames. I’m pretty sure she grabbed a piece of her own skin off the counter and put it in her mouth.

14. Be Careful What You Say

Kristy Smith, Eyeglass Wearhouse Reynoldsburg, OH

Patient came in to get an adjustment on his new pair and inquired as to why his glasses kept smearing on the top of the lens. He was told it was from the lenses touching his eyebrows (bushy). He asked if there was a way to make it stop? Jokingly, my optician said, “Shave them off!” A week later, he came back in for another adjustment — minus the eyebrows!

15. Fashion Over Function

Jocelyn Mylott | D’Ambrosio Eye Care | Lancaster, MA

We had a patient ask us to frost his other lens. One was already frosted for medical reasons as he isn’t using that eye and he wanted them to look even cosmetically … but if we’d frosted the other one he wouldn’t have been able to see with his good eye!

16. Maybe He Wanted To Sell You A Policy?

Heather Kaikuana | Eye Care Hawaii | Hilo, HI

On a Saturday back in January we had a green visitor … a lizard … in our office. He was crawling everywhere and the staff was all screaming, so one of our patients who had just finished her appointment whacked the lizard out with her slipper. It was just so funny the way the staff reacted and how calm our patient was. She is our Lizard Hero for sure!

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17. And on the Seventh Day …

Paula Hornbeck | Eye Candy & Eye Candy Kids | Delafield, WI

We had a couple come in six Saturdays in a row and stay for two-plus hours looking at frames. We started referring to them as the “Saturday people.” All of my opticians, as well as myself, took their turn at helping them find what they were looking for. I finally got them to pull the trigger on the sixth Saturday. They bought frames only — one for her, two for him. The seventh Saturday they came back to return hers and one of his. Good Lord! We don’t do refunds, so then the credit sat there just waiting for it to start all over again. Sheesh!

18. Talk About Visual Learning

CHRIS CLARK | MULLIS EYE INSTITUTE | PANAMA CITY, FL

One day a mom came in and said her son was the most destructive person she knew. I showed them the Flexon frames and how they seem pretty indestructible. When we turned around there were eight to 10 frames lying broken on the frame counters. I don’t do that anymore.

19. Time Can Be Tricky like That

Fred Sirotkin, OD | Eagle Eye Care | Columbia, MD

Chief complaint recently from a patient was that her two-week contact lenses only lasted two weeks …

20. Think about the Children

Pablo E Mercado | The Eye Gallery | Woodstock, GA

A woman asked our doctor if having crossed eyes was genetic, because her son was dating a girl who had crossed eyes in the past, and she “did not want any cross-eyed grandchildren.”

21. Find What Motivates

Paul Londraville | In Focus Eyewear | Greensboro, NC

Once upon a time my old boss decided we would do a community eyewear drive to gather used glasses to send overseas. The response was tremendous and it took a lot of work to clean, sort and neutralize them all. A co-worker, famously penurious, considered the task beneath him and was not contributing to the project. Our lab guy said, “I’ll fix it.” He took a fiver out of his wallet and hid it in a case in the huge pile of old glasses to be gone through. When he knew the other optician was watching, he took that pair out of the pile and pretended to discover the fiver in the old case, snapping it briskly and saying he was getting a cheeseburger for lunch. The other optician’s eyes were bugging out as he watched the lab guy put the bill in his wallet with a flourish. You have never seen a quicker change of attitude in your life. Instead of shirking the onerous task, this guy became a paragon of industry and selfless dedication to charity. He plowed through the rest of the pile nearly single-handedly in the vain hope of another stray fiver.

22. And This Is Why We Have Yelp

Kevin Count | Prentice Lab | Glenview, IL

I once worked for an ophthalmologist in the early days of my career. He was known to be a bit of a hot head and the staff always treated him with kid gloves. A patient came in one day, complaining about his glasses for the umpteenth time. The doctor happened to be at the front desk as the patient railed at the receptionist. The doctor then calmly walked over, addressed the patient and asked to see the glasses. When the patient handed them over, the doctor carefully turned them over and over in his hands, then chuckled and said, “I see the problem.” Then he promptly threw them on the floor and stomped on them. We were all silent in disbelief as the doctor calmly walked to the manager’s desk and grumbled, “Write ’em a check and get them out of here,” as he went to his next patient.

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23. Sounds Like She Needs a Referral

Ted McElroy, OD | Vision Source Tifton | Tifton, GA

When I was an optometry student at SCO (way before HIPAA issues, of course) we would all try to get a little bit ahead on the history of the patient by starting it on the way from reception to the exam room. So I would always ask, “So, what brings you in to see us today?” The response I got from one patient was, “I hear voices in my head.” All I could respond with was, “Is that with your glasses on or off?” My exam partner immediately stops, turns in the other direction and holds his laughter as long as possible. As I turned the corner I could still see him losing it in the hallway.

24. It’s a Trifecta!

Candy Crone | Wayne Optical, York, PA

It might be the woman who insisted Transitions gave her diarrhea — and made me call Transitions to discuss it with her. Or the woman who insisted the Rx fell out of her semi-rimless frame and she could no longer see out of her glasses, so she wanted a frame that went all the way around so it didn’t happen again. Then again it may be the woman whose glasses I scrubbed tons of hairspray and dirt off of while fixing them and she insisted I changed her frame. She swore she had never worn the frame I brought back to her.

25. ‘Oh, Magoo…!’

Jerry Ellis | BJ’s Optical | Framingham, MA

An elderly lady came in to buy glasses. She purchased a pair then left. She called me half an hour later and said I’d switched her old glasses with someone else’s. She came right down with her driver. I looked at her glasses and sure enough they were not hers. I explained to them that I had no idea what happened because I never left the table with them. The driver then said, “Wait” — and switches her glasses with the patient’s. “That’s better.” I was miffed she drove the patient home and back wearing the elderly lady’s glasses!

26. The Stuff of Nightmares

Cindy Henderson | Eyear Optical | Hixson, TN

Once when I first started working, I had a sweet old man come into our small dispensary and ask me to repair his glasses. The optician had stepped out to get coffee so I was by myself. He took off his glasses and his plastic artificial eye came with the frame. There was a large space where everything had been removed … with only gauze in the socket. The plastic “eye” which included the “skin” that covered the socket was coming loose from the frame and needed to be reattached. I got it done … I’ve been doing this for 40 years and I’ve never seen anything else like it.

27. What’s That Sound?

Susan Frick | Premier Eye Care of Eastern Idaho | Idaho Falls, ID

Once, I was trying to provide an explanation of benefits to a post-cataract eyeglass patient. He was very upset about what Medicare didn’t pay and I suddenly started hearing a clicking sound. It got even louder as he was explaining his disgust over the reimbursement, when suddenly his top teeth flew out and rolled across the floor. He didn’t miss a beat though … he retrieved his false teeth from the floor, put them back in his mouth and continued on with his rant about reimbursement.

28. Splitting the Cost

Steve Whitaker | Whitaker Eye Works | Wayne, PA

Patient: “My contacts are larger than my pupils. I’m the same in both eyes; can I tear them in half and have twice as many for the same price?”

29. She Worked Hard For Her Money

Tanya Rogers | Mountain Eye Clinic | Dahlonega, GA

I once worked at a clinic where a patient came in with an abrasion that just would not heal. By the fourth visit the doctor asked what had caused it (the young man would not say before). He finally admitted what had happened — he got a little too close to a high heel at a gentleman’s club!

30. Hair-Raising

Sherry Berry | Pascarella Eye Care and Contact Lenses | Newtown, PA

As I was dispensing eyewear, I accidentally knocked my client’s wig off. I was mortified but she just couldn’t stop laughing about it.

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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Cover Stories

Endings: Owners Share How and Why They Closed the Curtain on Their Eyecare Businesses

No two exit strategies are exactly the same.

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They say all good things must come to an end. In this industry, we often focus on the numbers when it comes to the sale or closing of a business… What sort of revenue did they have? What kind of deal did the owners get? How much did they sell for? But for business owners, there is an entire emotional and psychological journey when they are exiting the businesses they have poured money, sweat, and often, tears into.

No two exit strategies are exactly the same, and in the following pages we profile four business owners who have transitioned, or are looking to transition, out of ownership. What was their motivation? What did the process look like for them? How did they communicate their exit to their patients and staff? How did leaving their business make them feel? And what do their lives look like post-ownership?

LIFE SOMETIMES HAPPENS

Bryan Finley, LDO | Island Opticians, Palm Beach, FL | DATE CLOSED: May 2016

Bryan and Amie Finley

The original founder of the business, Stuart Villars, worked at Lugene Opticians on Worth Avenue, the luxury-shopping destination in Palm Beach, until they closed unexpectedly. Shortly after, he opened Villars Opticians on Peruvian Avenue, one block north of Worth. The business moved twice, but always stayed on Peruvian. In 2010, Mr. Villars decided it was time to relax a bit, and listed the business for sale. I was living in Oklahoma but saw the listing at a continuing education event I attended for licensing requirements in preparation for a move to Florida. I contacted Mr. Villars about purchasing it but, unfortunately, my then wife wasn’t interested in moving to Palm Beach, even though it was a tremendous opportunity. Mr. Villars sold the business to Christopher Moné, who renamed it Moné Optical Gallery.

After a short time in Florida, my marriage ended and I moved back to Oklahoma. I met Amie and we married. Again, I was looking for work opportunities in Florida when I saw a listing for a Moné Optical Gallery in Palm Beach. I told her: “No way, surely not!” She was excited about the prospect of owning our own business, so we contacted Chris Moné and struck a deal. We took over ownership and re-opened as Island Opticians on our first wedding anniversary, providing independent eyewear to the people of Palm Beach.

Although a bit stressful due to seasonality (Palm Beach has about 2,000 year-round residents but swells to 9,000 in winter), we loved our little 300 sq. ft boutique … But then life started to happen. Three months after opening, one of our daughters told us she was going to have a baby. Then, four months after that, another daughter called with the same news! Suddenly, we were going to have grandkids 1,500 miles away. Not long after the grandkids were born, our parents started having some medical issues. We tried traveling back to Oklahoma frequently to see the kids, grandkids and parents, but eventually we decided it was important and necessary to be near our family on a regular basis, so we made the difficult decision to sell the business after only two years.

We listed the business for sale on several optical forums and sites. After several inquiries, we reached an agreement in principle to sell to an optician, so we finalized all of our moving plans. One month before the sale was to be finalized, our buyer and her financier went in a different direction. Suddenly we had no buyer and no backup plan. With no time left to find a new buyer, we went into liquidation mode. We quickly had mailers printed to send to all of our clients and potential customers, with an aggressive going-out-of-business campaign. Everybody loves a good deal, even affluent people, so we were able to sell the majority of our product in one month. I ended up staying in Palm Beach a few weeks longer than Amie; she had already committed to a start date on a new job.

Since we were an LLC, the transition was fairly simple. We just had to notify the state that we were ceasing operations. As for communicating our plans to employees — no employees, so that was easy!

The first lesson we learned was: Have a good long-term plan and plenty of capital! Realize that starting or selling a business, should the need arise, doesn’t happen quickly; have patience. Be flexible. At the end of the day, integrity is the most important thing you offer as a proprietor.

Our advice for others is to have a Plan A, Plan B and Plan C!

QUICK Q&A

What was your greatest concern about giving up ownership?
Would we recover our investment? Would we ever have such a unique ownership opportunity again? After being owners, could we be happy working for someone else? Can we trust someone else to take care of our long-time clients?

Is there a patient encounter that stands out when they found out?
Many clients called in that last month to express their disappointment. Tears were shed. Mr. Villars, upon hearing the news, called to express how crazy he thought we were, but I think he was mostly sad to see the business close. One client offered to buy the business if we’d stay!

How would you describe the emotions you went through?
It was a bit heartbreaking. I felt like I was letting Mr. Villars down, and I was sad that my “retirement plan” wasn’t going to come to fruition. But we were both excited to spend more time with family.

Would you do anything differently?
I wouldn’t have been in such a hurry to sell.

What did you do to help overcome doubt?
We just reminded ourselves of the importance of family, and that things don’t create happiness.

How do you feel about the outcome?
We’re okay with how things have turned out, and plan to return to Florida, but as retirees instead of owners! We miss owning Island Opticians, but there is a certain level of anxiety that comes with ownership that we don’t miss.

Now what?
We tried working in private practice again, but just couldn’t get past knowing how to get things done better than our employers, because we’d been both opticians and owners. So, we decided to become brand ambassadors for some of our favorite independent lines. We still work together and are able to plan our travel schedule around our family activities. We do things a lot differently than most frame reps; we bought an RV that we live and travel our six-state territory in. This way, we’re “home” every night. We’re still technically owners as independent contractors, but have a little less anxiety now!

 

HANDING OVER YOUR BABY

Shimul Shah, OD | Marysville Family Vision, Marysville, OH | DATE SOLD: September 2018

The practice began as an ophthalmology practice. I purchased it in 2012. I practice general optometry and the patient base is very family oriented.

Accepting it was time to end ownership was a slow, painful realization that finally took a friend telling me that I would be just signing up for years of being unhappy and financially unsettled if I didn’t. It took a lot of introspection to realize I wasn’t able to accomplish what I wanted. I am very risk averse when it comes to money, and the one thing you need in growing a business is the ability to invest in it financially.

I had started asking around a little but was not actively looking for an exit strategy. When two different people gave me the same name to reach out to, I thought I should give it a try. I was hesitant to make promises and was willing to hold off until I knew that the practice, patients and my staff would all be treated with care.

A lawyer generated a Memor­andum of Understanding to get my intentions on paper and list what I wanted and was not willing to budge on. An accountant helped come up with a price and negotiate the sale. The biggest help was my family, who served as my sounding board.

Shimul Shah, OD

When it came time to communicate the change, I spoke with each employee and made sure they knew that a part of my agreement with the new owner was their position, the hours they would be working and the pay. I needed them to know it was something I had to do for myself and that I had made every effort to make sure they were taken care of.

We sent emails to all patients letting them know the business was turning a page but the doctor, staff, products and service were not changing. They seem accepting of what has occurred.

One surprise is that I find myself slightly disconnected from the profession at the moment. I went to a conference recently where I found myself wanting to attend and listen to practice management talks but didn’t know how I could implement anything now that it wasn’t my position to worry about those things anymore. I want to refocus on patient care, but changing gears has been challenging.

The process of deciding to give away ownership of something is a grueling one. I had to really think about my life and what I wanted out of it, and whether the good outweighed the bad. I learned on a deeper level what my strengths and weaknesses were and how each contributed to the conversation, and the ultimate decision, to start placing my efforts elsewhere and to pass the practice on to more willing and able hands.

My advice to others is to have good advisers in your corner. Be specific and diligent about what you want, but know that without compromise you will probably never find anyone that’s good enough to take over your “baby.”

QUICK Q&A

What was your greatest concern about giving up ownership?
Being an employee in a space where I’m used to being in charge. Secondly, I was nervous I would lose the passion I’d had for the practice’s success.

Is there a patient encounter that stands out when they found out?
Every encounter I’ve had has been positive and supportive! I don’t think patients care so much about the behind-the-scenes stuff as long as there is continuity of services.

How would you describe the emotions you went through?
I felt a myriad of emotions ranging from failure to anxiety, sadness, and excitement. At times, I felt I was abandoning my patients, staff and Marysville. At others, I felt like I was letting down all the people that had so much faith in me. Now that it’s over, I feel peace, stability and anticipation for the future.

Would you do anything differently? No.

What did you do to help overcome doubt?
I reminded myself that the current situation was unsustainable. I could potentially keep going for another six months, maybe even a year, but ultimately that would just be delaying the peace of mind I was so desperate for.

Are you happy with the outcome? Yes

Now what?
My plans include making more time for traveling, cooking, reading, and spending time with friends and family. I may get involved in the political and legislative branches of optometry and see how I can use my talents to help optometry grow in a different context.

 

PRIVATE PRACTICE TO PRIVATE EQUITY

Carol Record, OD | Drs. Record & Record | Charlottesville, VA | DATE SOLD: February 2016

Steve Record and I graduated from SUNY Optometry in 1982. It was the heyday of extended wear contact lenses and retail optometry was just beginning to advertise for eye exams, eyeglasses and contact lenses. We moved to upstate New York and worked retail optometry as our first jobs. We saw many patients and fit lots of contact lenses. We wanted to work in private practice and eventually own a practice, but not in upstate New York. The population was not growing. We felt we needed to move south to a town that was experiencing growth; preferably a college town.

After exploring established practice opportunities in Virginia, none seemed quite right. Once we accumulated enough capital to open a practice we moved to Charlottesville and opened cold. We opened in August 1983 and were the first in town to advertise our services for eye exams and contact lenses. Looking back, it is hard to believe we survived and actually made enough to pay our bills. Fortunately, we were able to live off the income we made from optometric employment and both had part time jobs working one hour away. Within five years we gave up all outside employment.

Our practice grew from zero patients, to two offices, four doctors, and over twenty employees. We embraced medical eyecare, added new equipment each year, and were fortunate to experience growth every year we were in practice.

Before we knew it, our children graduated college and we were advised that we had enough money saved to retire whenever we wanted. We were in our late 50s. I still had the mindset of growing the practice, perhaps adding an additional location, but Steve wanted to retire and I did not want to do it alone. We sought the advice of Al Cleinman of Cleinman Performance Partners to map out our options. We learned there were fewer buyers able to purchase a large practice as a whole. The better option was to sell each location. We were also informed it usually takes a few years to sell, so we retained him to help us transition our practice.

Selling a practice takes time and there are lots of facets to it. Finding a buyer willing to provide a fair deal is perhaps the hardest part. Legal and accounting documents will be needed. Will you work for the new owner? For how long? What will your employment contract look like? What will you do with the real estate? We were lucky to have an unsolicited offer from MyEyeDr that we could not walk away from. Cleinman, having brokered many practice sales, knows a good offer from a bad one and advised us as such. He also walked us through the details, along with our attorney, financial planner and accountant. From the time we decided to look for a buyer to the time we actually sold took about 2.5 years and MyEyeDr purchased all the assets.

We have many colleagues who are transitioning their practice. In all cases, the employees are informed of the sale of the practice once it is definite that the deal will go through. In our case, we informed our employees one month prior to closing. Since Steve and I were employed by MyEyeDr, MyEyeDr informed our patients of our new affiliation. As it came closer to the time when I would retire, I thanked my patients, hugged them and told them it would be the last time I saw them professionally. Often it was my retired patients who said “You can’t retire. Who am I going to see for eyecare?” Most patients thanked me for their care and congratulated me.

I consult with doctors at least once a month about practice transitions. The first thing I tell them is “no matter who you sell your practice to, your practice will change.” Second, I inform them that “the best deal for your practice is the deal that is best for you.” Everybody’s situation is different. The longer you work in the practice after the sale, the more valuable the practice is.

For the doctor who is unsure they should sell their practice I’d ask first, “What do you plan to do after? Will you continue to work? Will you change careers?” If you plan to retire I can assure you, you will be surprised at how busy you will be. Volunteer opportunities abound. New hobbies and games are ready for you to explore. New friendships will form, and the extra free time you now have will let you experience life’s moments with greater joy and enthusiasm.

QUICK Q&A

How would you describe the emotions you went through during the process?
I was consumed by worry about giving up control… but I found it quite liberating to see patients and go home. Once I left the office, work was behind me.

Would you have done anything differently?
I speak at Cleinman’s Practice Transitions Conference and have learned a lot about transitioning a practice. There are various options you and your new owner may have that I was unaware of. This type of meeting did not exist when I sold. I wished it had. The transition will go a lot smoother if you allow someone who has experience in practice transitions help you.

What did you do to help overcome doubt?
I reminded myself that the business of health care was changing and eyecare was no exception. Colleagues I respected and considered good businessmen were also selling their practices to private equity. Health care professionals may not think of their practices as businesses, but they are and business models change.

Are you happy with the outcome?
If you are anything like me, your practice is something you are very proud of. It is very emotional to give up what you have taken years to build, you want to be sure your patients will be cared for the way they need to be taken care of. Fortunately, the next generation of optometrists are very bright and take very good care of patients. Throughout the sale process, even up until the last week, I wondered if I was making the right decision. My husband encouraged me it was the right thing to do. Now, I am so happy I sold.

How are you spending your time post-ownership?
I have been fortunate to continue my optometric affiliations by serving as secretary treasurer of AOA’s Optometry Cares Board, co-chairing the HEHC community grant program, speaking on optometry topics, and up until last fall, serving on the disbanded Essilor Advisory Board. Not a day goes by however, where I don’t think about starting a venture to bring new optometric services to the members of my community.

 

LEAVING A LEGACY

Michael Cohen, OD | Four County Family Eye Care Center, Winslow Township, NJ | Sold business: TBD

our County Family Eye Care Center opened on Sept. 11, 1973 in the Winslow Professional Center of Tansboro/ Berlin/ Winslow Township, NJ, three months after I graduated from Pennsylvania College of Optometry. My father, Dr. Philip Cohen, learned about the center from a patient of his who was friendly with the building’s owner. We decided it looked like a good place to open a new optometric practice, signed a lease, and began planning to lay out and equip the office.

My wife and I made address labels on a typewriter and had announcement cards printed. We mailed out thousands of cards and on the day we opened, I prayed for good business. In those days, if I saw one or two patients a day, I considered myself lucky. I spent most of my time watching General Hospital and writing a digest for my wife, who was keeping us afloat teaching at a local school. I grossed $33,000 that first year. No insurance. No credit cards. Cash only. I made patients’ glasses by hand in my optical lab.

A couple years later, the owner lost the building in a bankruptcy. I decided to look for real estate to purchase and build a new office on. A patient and local realtor, Ursula Christinzio, found me a location nearby; a vintage 1850s farm house sitting on 1.5 acres on the highway at an intersection with a county road. I opened Four County Family Eye Care Center on June 1, 1979.

I’ve been in optometric practice in Winslow Township for 45 years offering comprehensive eye exams, diagnosis and treatment, and contact lens and eyeglass fitting. We counsel patients about LASIK and do the follow-up care, treat glaucoma, and make referrals to many ophthalmic sub-specialists in the region. I have three full-time staff and three part-time. My office manager started working for me at 17 years old; she is now 47. People tend to stay on for years; it is better to pamper your staff and keep them happy, than it is to abuse them, lose them, and train new people!

Michael Cohen, OD

I realized it was time to think about ending my ownership and retiring when my wife informed me that she hates the cold and would like to spend winters in a warmer clime. Also, I noticed that most of my patients my age are now retired and very few of my peers were alive and well and still running their own practices.

My ideal exit strategy would be to find an honest, talented, skilled, clever, caring, and compassionate OD who would be willing to purchase both the real estate and my practice and allow me the luxury of still seeing patients.

I worry that, if my staff get wind that I am thinking about retiring, they will look for employment elsewhere. Hiring and training staff is costly, time-consuming, and fraught with peril. Also, is it fair to hire someone when you are planning on leaving? When I have confirmation I am throwing in the towel, I’ll meet with my employees and lay my cards on the table.

I lead a very busy life now. Selling my property, as well as my practice, is time-consuming. I’ve spoken to a number of professional practice brokers, all of whom concur my gross revenue does not justify them getting involved. They all said I should sell it myself and I would like to continue seeing patients for two more years, provided my health holds up.

Every day, my long-time patients query me about my plans. I’ve been honest with them. I’d love to slow down but I don’t see any way out. Everyone encourages me to stay on … then they tell me how much they enjoy their retirement. My advice to other ODs looking to transition out of ownership is to try and build a business that has sufficient gross revenue to justify a professional broker skilled at doing all of the things that I must now do myself.

QUICK Q&A

How would you describe the emotions you are experiencing as you begin this process?
I am feeling quite inadequate to meet this challenge. I have a fear of failure.

Is there anything you wish you had done differently to prepare for this?
I did it my way! I have always been true to myself, my family, my staff, my patients/friends. If I have to turn off the lights, lock the doors, and not look back, I really have no regrets. I’ve helped a great many people over the years.

What do you do to help overcome doubt?
I talk to friends who are older than I am and find out how they were able to live so long and so well. I attend religious services weekly to meditate through prayer. I’ve discovered that Tai Chi and Quigong help me divest myself of my monkey brain. I call this my standing meditation. I occasionally use a therapist friend to bounce ideas off, when I cannot seem to move a big rock that is blocking my progress.

What would make you happiest with the final outcome?
I would love to see someone take the baton and run with it after I am gone.

How do you plan on spending your retirement?
Workout at the gym ten hours a week, travel to new places, spend time with my children and grandchildren and maybe spoil them a bit. Find people less fortunate and extend a helping hand. Go to synagogue on Saturday mornings, read the classics, watch great shows, eat great food at the best restaurants, and take in some Broadway shows now and then.

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Cover Stories

Escape From Insurance: Words of Wisdom From Eyecare Practices That Made the Leap

They left managed care and went to private pay.

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If you feel you’ve reached a point in your practice where you no longer want to be held captive by the low-margin traffic generated by insurers, you may be wondering how to break free. We reached out to eyecare businesses to find out what steps they took to throw off the shackles of dependency on vision plans. None of these tips will work unless you’re able to engender patient loyalty — and you don’t need us to tell you where that comes from ­— but here are eight tips to help you plot your escape from insurance.

1 Secure sources of self-pay patients that continue to deliver. Buena Vista Optical in Chicago, IL, is taking what co-owner Diana Canto-Sims calls “pro-active baby steps to transition away from vision plans.” After they run quarterly reports of the vision plans with the lowest reimbursement, they’re on the way to finding self-pay patients to replace those patients the next quarter. Among the places they have found them are career days at local schools — they send every student home with information including a package of exam and glasses for first-time patients with no vision plan — and collaborations with organizations that reach out to the uninsured, such as the consulates of Latin American countries. (Buena Vista has a fully bilingual staff). “These organizations are very appreciative that we collaborate with them and they send us self-pay patients weekly,” she says.

2 Brace for a pre-cutoff influx; remind patients to check their medical coverage. Whelan Eye Care in Bemidji, MN, quit taking VSP almost two years ago. Bridgett Fredrickson warns ECPs that there will be patients that get upset. “We are honest and tell them to check with their medical insurance as it may cover their exam as well, or they are always welcome to self-pay and we give them a 20% discount for same-day payment. Remember, she says, that you will need to send all of the current households a letter letting them know that you are no longer going to be accepting their insurance with an effective date and they need to receive the letter at least 30 days before that effective date. “With this, expect an influx of patients that want to get in before that date,” she says.

3 Phase your plans out. Dr. Robert Easton Jr. has had a solo practice in Oakland Park, FL, for 37 years. One year his CPA told him “that since I was providing comprehensive eyecare, my vision plan base was increasing faster than my major medical, PPO and Medicare patient base. We were concerned that vision plans were taking over my practice, which could eventually put me out of business.” After careful analysis, Easton eliminated the three lowest-paying plans first and kept the other two as a cushion. As the other two continue to become more corporate in nature and their low reimbursements fail to meet his cost of doing business, Easton plans to eliminate those one at a time.

4 Get your team up to speed. Jenna Gilbertson says dropping VSP was the best decision McCulley Optix Gallery in Fargo, ND, ever made. However, she cautions, “Before you ever send the termination letter to the insurance company, have a plan in place. Make sure all staff is on board. Have scripts for what to say. And have a plan for your patients. Be over-prepared for every situation. We ran role-plays with our staff, and had them think of all the questions a patient might ask.” They marked everyone who was pre-appointed on the schedule. They then went through each of those patients to see who had a calendar year plan, and called those patients, explained the situation, and rescheduled them for before our termination date. Yes, it meant the doctor had to work extra days and times, “but it was totally worth it to make those patients happy,” she says.

5 Keep a list of complaints about the plan you’re dropping. Last year Focus Eye Care in Hackensack, NJ, made the decision to jettison Davis Vision. Prior to this, the largest employer in the area had switched from VSP to Davis, while a big-box retail chain associated with the latter began advertising discounts. Before Focus could make the split it endured a period in which patients had a long list of complaints about jobs that were now going through Davis. Managing licensed optician Vlad Cordero took notes: “We used the list of complaints to train our front desk and optical staff on how to handle objections when Davis members call in to schedule an appointment or inquire about eyewear.”

6 Find a niche, or team up with an OD who has one. “The most important key to dropping insurance is having a niche,” says Dr. Pauline Buck, a vision therapy specialist at Behavioral and Developmental Optometrists in Miami, FL. “I was building that practice up while slowly dropping off insurance panels.” Next is the hard part. “You really need to get out into the community and speak about your specialty. I host quarterly lectures with dinner in my office for other professionals… The cost of the dinner is offset by a single referral.” Finally, “for non-optometric professionals who would like to break the bonds of insurance I highly recommend approaching specialists and seeing how your services can help them… I refer out 80 percent of my glasses prescriptions,” she says.

7 Help patients collect out-of-network benefits. The Visionary in Allen Park, MI, took a long look at their profit margin with EyeMed and decided it was time to split. They knew they had patient loyalty on their side. And, says Annette Prevaux, “We make it easy for patients to get their OON reimbursements by having the forms ready when they come in.” She expects to keep about 60 percent of her EyeMed patients.

8 Switch to independent brands; consider an OON service. Krystal Vision in Logan, UT, is in the process of dropping most vision plans. According to Travis LeFevre, being insurance-free goes hand-in-hand with carrying independent brands. “It’s an easy jump to make once you look at your margins while taking insurance compared to cash pay and filing a simple claim for the patient out of network,” he says. He cautions that “creative marketing is a must to stay relevant after dropping managed plans.” And after initially being unimpressed, Krystal Vision now uses Patch, an “online insurance assistant” that helps ECPs and patients negotiate out-of-network benefits and claim them digitally. LeFevre says Patch is now offering a better product than it did three or four years ago. “It allows us to know the exact amount of a customer’s OON benefits for their vision insurance. It gives us a breakdown … depending on the plan and insurer. Another useful part of Patch is the ability to accept payment for VSP and Cigna claims; this allows us to give the patient the reimbursement savings up front rather than making them wait [for the] check in the mail.”

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Cover Stories

How to Improve Your Kids Business

6 experts explain how to win them over early.

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Transforming the medical side of your practice is obviously not a step to be taken lightly, particularly if you’re looking at expanding your treatment of children. The challenges are many, but the rewards can be great, personally and financially. To help those of you thinking of boosting your optometric offerings for kids but wanting to know what that could entail, we assembled an impressive panel of experts in pediatric eyecare, and its related specialties, for a rundown of the main areas you should be looking at. If children are the future, and the future is now, what are you waiting for?

Specialty
PEDIATRICS

EXPERTS:
Dr. Dominick M. Maino, professor, Illinois College of Optometry/Illinois Eye Institute, associate, Lyons Family Eye Care, Chicago, Il; and Dr. Nathan Bonilla-Warford, OD, Bright Eyes Family Vision Care, Tampa, FL

ASSOCIATIONS OR GROUPS AVAILABLE:
College of Optometrists in Vision Development (covd.org); Optometric Extension Program Foundation (oepf.org), Binocular Vision, Perception, & Pediatric Optometry (BVPPO) Section of the American Academy of Optometry; Optometric Extension Program (OEP) Foundation

Dr. Don Teig

TRAINING OR CERTIFICATION NEEDED?
Dr. Maino:Not necessarily needed but a residency in pediatrics/binocular vision would make you stand out from the crowd. A Fellowship in COVD would do the same thing.

Dr. Bonilla-Warford:Generally, yes, additional training is beneficial outside of typical optometry training. A one-year optometric residency in pediatric vision care is an excellent way to become specialized. Beyond that OEP offer courses that cover the clinical care of infants and children as well as the practice management of the specialty.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED?
Dr. Maino: Yes, but most ODs have much of what they need already.

Dr. Bonilla-Warford: The retinoscope is standard equipment, but many optometrists are not comfortable with it. Practice! Also, the pediatric-sized trial for refraction and probing refractive error without a phoroptor. A digital randomized visual acuity chart with movies for fixation and pediatric option acuity symbols. The Lang stereo test is a simple tool for assessing stereopsis without polarized glasses. Prism bars and loose prisms for binocular testing. And toys, finger puppets for entertaining little ones. They make a little booster for exam chairs that are perfect for kids who are independent enough to not sit on a parent’s lap but are still small.

Matt Oerding

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY?
Dr. Maino: Not unless you are doing developmental vision/vision perception testing and in office VT.

Dr. Bonilla-Warford: Not necessary. It is common to have one exam room that does have a few extra items for kids, but it can be used for adults as well, so it doesn’t really require extra space.

ADDITIONAL MARKETING REQUIRED?
Dr. Maino: Definitely. You need to get the word out about your expertise in this area. Use social media.

Dr. Bonilla-Warford: Very smart [if you do]. Add children’s specialty services with info and descriptions on your webpage so patients can find and learn about them. Informative displays about children’s vision are an inexpensive and easy way to raise awareness. Networking with referral services is very effective.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT?
Dr. Maino: Yes. You often need to not only do a comprehensive examination but also a sensorimotor assessment and other testing as well. Frequent follow up appointments are often necessary.

Dr. Bonilla-Warford: For typical children’s primary care, the reimbursement is somewhat lower because they often do not need glasses or contacts. However, specialty services such as myopia control and vision therapy are significantly more because they are often higher-end self-pay services.

Dr. Dominick M. Maino

IN SHORT:
Dr. Maino: When I work with my optometry students, I always tell them that a smile is the best piece of equipment you could have. You must be genuine. You should keep up on the current research in this area and be ready to take that extra step. You are not just working with a pair of eyeballs, but also with the child and the whole family. It is fun, challenging and fiscally rewarding.

Dr. Bonilla-Warford: Working with children is so fun. It is very rewarding to see them grow and develop and to know that you are helping them reach their goals, whether it is in school, sports, or overcoming symptoms. However, it can be challenging. You have to be honest with them in a way that they can understand. Children will not hesitate to tell you “I don’t like you! I am never coming here again!” If staff sets the tone so the child can feel that you are on their side, you will be amazed how much clinical information you can get from them at very young ages. Knowing when to stop or change a particular test or activity is essential. Most importantly, have fun! And get good at retinoscopy.

Specialty
MYOPIA MANAGEMENT

EXPERT:
Matt Oerding, co-founder/CEO, Treehouse Eyes, Bethesda, MD and Tysons, VA

ASSOCIATIONS OR GROUPS AVAILABLE:
“The International Myopia Institute provides evidence-based treatment guidelines for this specialty; American Academy of Orthokeratology and Myopia Control (aaomc.site-ym.com)

TRAINING OR CERTIFICATION NEEDED:
No. Any optometrist can technically perform pediatric myopia management. However, specific CE/education is required to become proficient at the various treatments proven effective. These are currently orthokeratology lenses, multifocal soft contact lenses and atropine.

Dr. Charlene Henderson

SPECIALTY EQUIPMENT OR TOOLS REQUIRED:
Yes. A practice must have a good topographer as a highly accurate map of the cornea is critical to success. Additionally, a device to measure axial length is highly recommended.

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY:
No. This can be done within an existing exam lane or space.

ADDITIONAL MARKETING REQUIRED:
Yes. Currently pediatric myopia management is not covered by vision plans, so it is a private pay procedure. Due to lack of parental awareness of the risks of progressive myopia and the availability of treatments, marketing is critical to generate interest. At a minimum marketing to existing primary care patients via email, newsletter and in-office marketing is required. To gain new patients for pediatric myopia management, social media, PPC and PR are all proven techniques.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT:
Yes. Because this is a private pay procedure and children are likely to be in treatment for several years, the revenue per patient is significantly higher than a typical optometry patient. Fees vary widely, but typical is $2,000-3,000 for the first year of treatment.

Dr. Pauline Buck

IN SHORT:
Pediatric myopia management can be an incredibly fulfilling specialty when done correctly, as you are helping a child see better today and reducing their long-term risk of serious eye diseases associated with progressive myopia. Offering these services can generate significant patient/family loyalty to the practice, as treatment typically lasts several years and successful patients are proven to be great referral sources to others in the community.”

Specialty
VISION THERAPY

EXPERT:
Dr. Pauline Buck, Behavioral and Developmental Optometrists, Miami, FL

ASSOCIATIONS OR GROUPS AVAILABLE:
The College of Optometrists in Vision Development (COVD); Neuro-optometric Rehabilitative Association (NORA); Optometric Extension Program (OEP); College of Syntonic Optometry (CSO).

TRAINING OR CERTIFICATION NEEDED:
Post-graduate training is very much needed. A new graduate from optometry school has the basics to begin a vision therapy program. Yet a successful vision therapy doctor will stand on the shoulders of their predecessors by learning what has already been learned. COVD and OEP provide training. OEP has regional seminars. COVD has state study groups and their annual meeting. Mentors are provided to assist when there are questions.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED:
Yes and no. Bernell is a great resource of vision therapy equipment. There are many computer-based programs as well. However, I know many experienced doctors who have used something as simple as a stick and a straw to illicit a change in their patient’s visual system. This ability comes back to the training. When you really understand the system, you can make changes using just about anything.

Dr. Nathan Bonilla-Warford

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY:
Again, yes and no. Yes — the functional vision evaluation is done in the exam room using the phoropter and equipment that is standard to the profession. No — I have an entire room, ‘the play room,’ dedicated to the testing of physical performance. How do the eyes affect a person’s ability to perform an everyday task? I also have another room for the testing of classroom skills, which contains a desk, slant board, and a lot of paperwork.

ADDITIONAL MARKETING REQUIRED:
Yes. ‘If you build it, they will come’ doesn’t work. I have gone out in the community and lectured about vision therapy. I have spoken to therapists, doctors, teachers, parents and other professionals about the visual system and how it can affect performance. Those individuals eventually become referral sources. I am constantly practicing my elevator [pitch] of what I do.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT:
Yes. Most optometrists will see a patient once a year for their annual or several times throughout the year for care of ocular disease. When a patient is doing vision therapy I see them for their annual, their progress evaluations every 10 weeks, and weekly for the therapy sessions.

IN SHORT:
Vision therapy is understanding the nuances of the development of the visual system, how it can change behavior, and how it can alter a person’s performance. It can benefit children and adults with brain injury, children with difficulties in the classroom, individuals with autism and down syndrome. When all other professionals have told a person that there is nothing else to do for their condition and they come to me for a glimmer of hope, I offer the potential for change. When their symptoms decrease and their performance improves, those are the moments of my greatest job satisfaction and I am thankful that I have a ‘tool box’ large enough to have made that possible.

Specialty
SPORTS VISION or VISUAL NEURO-COGNITIVE TRAINING

EXPERTS:
Dr. Don Teig, founder/CEO, “The A Team” High Performance Vision Associates, Hollywood, FL; and Dr. Charlene Henderson, Blink Eyecare and Eyewear, Charlotte, NC

ASSOCIATIONS OR GROUPS AVAILABLE:
Dr. Teig: This niche or specialty has always been referred to as “sports vision” but more recently as ‘visual neuro-cognitive training’ given the attention to the impact concussions and chronic traumatic encephalopathy (CTE) has had on sports. I also often refer to it as ‘high performance vision.’ I am the founder and executive director of ‘The A Team’, High Performance Vision Associates (highperformancevisionassociates.com), there is also ISVA (International Sports Vision Association, sportsvision.pro).

Dr. Henderson: High Performance Vision Associates and the AOA.

TRAINING OR CERTIFICATION NEEDED?
Dr. Teig: Yes. I provide a 16-hour course with certification (ultimateevents.com.) I also travel to provide this training. ISVA is working in conjunction with me to develop a certification program.

Dr. Henderson: It is necessary to understand the sports you are working with and how vision plays a role in success. Sports vision training by people who have pioneered the concept is invaluable. We went to Don Teig’s Sports Vision training weekend, and Fred Edmunds Xtreme Sight sports Vision training weekend. They are both excellent. We also did several Sports Vision AOA courses and read all the books out there.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED?
Dr. Teig: Yes. The A.M.P. System (Achieving Maximum Potential), an immersive virtual reality technology; Senaptec, a digital testing and training instrument; NeuroTracker, a multi-object awareness trainer; FitLight motion and light sensors; and Quick Board, an eye to foot training tool.

Dr. Henderson: Yes. When we built our new building, we added lots of exciting equipment like Vision Coach, Fit Light, Senaptec, and the Bassin anticipation timer among others. We still use traditional VT equipment like Marsden balls and flippers and balance boards. The athletes like the bells and whistles of the digital devices.

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY?
Dr. Teig: Yes. At the very least a room that is 10′ x 12′ is a must.

Dr. Henderson: Yes, for testing space. You need room to swing or jump or dribble a basketball, for example.

ADDITIONAL MARKETING REQUIRED?
Dr. Teig: Yes, by all means! Internal marketing with videos, pamphlets, etc., in your office and external marketing through social media, TV, radio and print.

Dr. Henderson: Yes. Internally tell all your sports-minded patients. All our patients walk by our sports vision room. You should reach out to teams and clubs and let them know what you do.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT?
Dr. Teig: Yes! A typical Sports Vision patient can generate revenues of up to $3,000 each if they complete an eye exam, a Sports Vision Workup, a Sports Vision Training program of 12 weeks minimum; specialty contact lenses or sports eyewear and goggles.

Dr. Henderson: Yes. Sports vision training is an additional service not covered by insurance. So, it is up to you to set the fees you think are fair for your time for the evaluation and then training sessions.

IN SHORT:
Dr. Teig: Having been a pioneer in this field for almost 40 years, I can confidently say that sports vision is both emotionally and financially rewarding beyond belief. However, it doesn’t happen overnight and requires continual hard work. That being said, if you love sports like I do, it’s well worth the ride.

Dr. Henderson: It can be really rewarding if you have a passion for sports and working with highly competitive people. The niche does require training, equipment, space and active marketing. So, it will not just fall in your lap. But it is a great way to help people achieve their goals and use our skills as vision experts.

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