Let's TalkLet's TalkTwo businesses share one waiting room - low-margin insured exams and high-margin optical and specialty care. Marketing the first and hoping for the second is why most practices feel busy and unprofitable.
Most optometry practices market for exam volume and cannot say what an exam produces once optical capture and specialty conversion are counted. Send us 12 months of exam counts against optical and specialty revenue and we will show you revenue per exam, and which patient types are worth acquiring at all.
Four failures we see repeatedly in this vertical, and what each one actually costs.
An insured routine exam is close to a loss-leader once chair time is costed, and it is what nearly every optometry campaign sells. The margin is in optical capture, specialty contact lenses, dry eye and myopia management. A campaign that fills the diary with vision-plan exams can grow appointments and shrink profit at the same time.
Rollups have been buying independent practices for years, and they compete on convenience, hours and brand spend rather than on clinical depth. An independent trying to out-advertise that on the same message loses. The defensible position is the specialty work a corporate chain does not staff for, and almost no independent markets it.
When plan reimbursement decides the exam fee, the only levers left are volume and what happens after the exam. Practices that treat the plan as the business end up advertising to fill slots they barely profit from. The ones that grow treat the exam as the entry point to something the plan does not cover.
Refractive surgery is a high-ticket elective cash-pay decision made over months. A routine exam is a low-ticket insured appointment booked this week. Shared campaigns optimise toward the cheap conversion, which is the exam, and the refractive pipeline quietly never fills.
Business outcomes rather than dashboard metrics. None of these is a guaranteed number - where we do guarantee something, it is written into the offer above.
The real deliverables, not a list written to make a proposal look thicker.
Not the general agency pitch. The reasons that only apply to this kind of business.
Eyewear is partly fashion, and many independents carry collections the chains do not. Treating the optical as a retail business - new arrivals, styling, the brands you stock - gives patients a reason to buy in the practice rather than online, and gives the practice something to talk about between exams.
Patients increasingly take their prescription to online retailers. Guilt does not keep them; a better reason does - proper fitting, adjustments, warranty and a clear price at the point of the exam. We build that case into the patient journey, because the optical sale is usually decided before the patient leaves the chair.
Children's myopia management is a long-term commitment decided by parents, often in response to worry about a child's worsening eyesight. It needs different channels, different timing and a different explanation from adult care - and done well it creates a relationship with a family that lasts for years.
Twelve months of exam counts against optical and specialty revenue, so the affordable cost per new patient comes from your numbers rather than a benchmark. Everything downstream is priced off this.
Routine, specialty and refractive separated with their own conversions and reports. Until this exists, the specialty and refractive pipelines are invisible inside the exam numbers.
Dry eye, myopia management and specialty lenses are what a corporate chain does not compete on and what carries real margin. This is usually the largest available change to the mix.
Vision care recurs annually by nature, which makes the existing patient list the cheapest appointment in the practice. Most practices have a recall system nobody has reviewed in years.
Budget follows revenue per patient by entry type. That is how a practice can afford to bid for the patients worth having rather than the cheapest exam bookings available.
The parts of this that come from having run it in this industry before rather than from running it well in general.
Children's eye exams cluster around the start of the school year, and a child struggling to see the board is often the trigger. Campaigns and reminders timed to that calendar reach parents when the concern is front of mind rather than competing for attention at random points in the year.
Offering a full year's supply at the exam, with clear pricing against online retailers, keeps contact lens wearers connected to the practice between visits. It is recurring revenue, it reduces the pull toward online retailers, and it makes the next annual exam a natural return rather than an optional one.
People with dry eye have often tried drops for years without real improvement. Pages that explain what a dry eye assessment involves and the treatments the practice offers reach them at the point they are ready to try something more - a far stronger position than competing on the routine exam.
Seeing the same optometrist year after year, who knows the patient's history, is something corporate practices with rotating staff find hard to match. Making that continuity visible - and scheduling to protect it - turns a structural advantage into a reason patients choose and stay.
No vision practice in our case studies, and we will not pretend otherwise. What this multi-state clinic group demonstrates is the mechanic that matters most here: demand split by service line rather than run as one campaign, and the conversion moved off the form fill. That cut cost per lead 57% in two weeks and funded expansion from three states to twelve. For an optometry practice the equivalent split is routine against specialty against refractive - three businesses that should never share a report.
Read the full case studyRevenue per exam was the number nobody had ever shown me. Half the appointments we were advertising for barely covered the chair.
Marketing the dry eye clinic separately changed the business. The corporate place down the road does not offer it.
We had been running LASIK and routine exams in one account for two years. Splitting them was the first time either number meant anything.
Because an insured routine exam is close to a loss-leader once chair time is costed, and it is what most optometry campaigns sell. The margin sits in optical capture and specialty services. Filling the diary with vision-plan exams can raise appointment counts and lower profit simultaneously, which is why revenue per exam matters more than cost per appointment. Routine care still has a role - as the entry point to something the plan does not cover, not as the thing being sold.
Not on convenience, hours or brand spend, which is where the rollups are strong and an independent cannot outspend them. The defensible ground is clinical depth in services a corporate chain does not staff for - dry eye management, myopia management, scleral and specialty lenses, complex fits. These have real demand, are searched specifically, and almost no independent markets them deliberately. It is a positioning problem before it is a media problem.
They can, and they should not. Refractive surgery is a high-ticket cash-pay elective decided over months; a routine exam is a low-ticket insured appointment booked this week. A shared campaign optimises toward the cheaper conversion, so the exam wins and the refractive pipeline never fills while the account looks efficient. Separate campaigns, separate conversion events, separate reports - and a nurture sequence on the refractive side measured in months.
The share of patients who buy eyewear from you after their exam rather than taking the prescription elsewhere. It is the single biggest determinant of what an exam is worth, and most practices estimate it rather than measure it. A practice capturing a high share can afford to acquire patients at a multiple of what a low-capture practice can, and that number - not a benchmark - should set the budget.
Yes, and it is the Texas Optometry Board or your state's equivalent rather than the medical board - a separate body with its own rules on claims, credentials and how services may be described. Advertising that names specific outcomes, or that describes a practitioner's qualifications loosely, is where problems arise. We check your board's current rules before creative is produced, and the review is a marketing one rather than legal advice.
It is usually the cheapest revenue available, because vision care recurs annually by nature. The patient already chose you, and reactivating them costs a fraction of acquiring someone new. Most practices have a recall system that was configured once and has not been examined since, and a meaningful share of the list is overdue. We rebuild it alongside acquisition rather than after, because running paid traffic to fill a diary that recall should be filling is paying twice.
The board that governs your advertising depends on the licence you hold and the region you hold it in. These are the states we have written up.
Written for owners weighing this up, whether or not they work with us.
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