Adding an area of expertise can re-energize a practice by making it more profitable and avoiding burnout. These include myopia management, dry eye, neuro and retina—all lucrative and exciting opportunities that provide a boost to your practice.

Areas of Growth

Knowing where the puck is going, as Wayne Gretzky once stated, is more important than where it is. This applies to significant areas of future growth such as myopia management, which accounts for about 30 million children in the United States.¹ With children spending far more time on digital devices and less time outdoors, not only is this category expected to increase by more than 3% per year, but the high myopia category is expected to accelerate even further.² It’s worth mentioning that high myopia has increased by almost 200% since 1966.³  

Dry eye affects 13.5% of the population or 44 million people in the US, with estimates of 75 million having significant dry eye symptoms. And it’s a highly underserved market with less than three million people on prescription medications.

What makes both these areas so profitable beyond the underserved need is that they are paid by insurance where applicable, and direct patient pay when not covered. For example, technologies like intense pulsed light (IPL), low-light level therapy (LLLT), BlephEx or thermal pulsation are not currently covered by insurance, but medical eye examinations, punctal plugs, amniotic membrane, etc. are covered. For myopia management, the examinations, fundus photography, axial length measurements, and topography, are covered, but spectacles and contact lenses or orthokeratology are patient pay. 

Myopia Management

If you need help incorporating myopia management, it can be franchised through entities like TreeHouse Eyes to ease the transition. It involves creating awareness by providing proper education about why parents should protect their children from becoming highly myopic. Statistics help, as patients with myopia above 6.00D have a 14-times higher risk of glaucoma, 22-times greater risk of retinal detachment and 41-times higher risk of myopic maculopathy, all which can result in blindness.⁴

A new prescription atropine by Sydnexis has the potential to be approved by the FDA in 2025 and is stable to a three-year shelf life, near neutral in pH and has superior tolerability and bioavailability. Having multiple treatment options also helps customize treatment to each child, which is essential in expertise areas and this includes spectacles, soft contact lenses, orthokeratology, environmental management like outdoor time and atropine drops. 

Dry Eye Disease (DED)/Ocular Surface Disease (OSD)

There are several FDA-approved prescription medications, multiple in-office treatments including IPL and LLLT, and at least five in-office thermal treatments and microblepharoexfoliation available.

Two potentially new and exciting procedures awaiting FDA approval include ELM (Eyedetec), which provides a vibrational stimulus to liquify meibum and OptiVize (BlephEx), which incorporates a low current to eradicate biofilm on the ocular surface and eyelids. And don’t forget the products a good dry eye center should offer to patients—effective lid scrubs, artificial tears, sleep strips (SleepTite) and nutritional supplements (HydroEye).

There are three exciting developments in the nutrition space, including an improvement on the product with the highest published successful data of any dry eye nutritional product to date—HydroEye (ScienceBased Health), a new anti-inflammatory supplement (Blink NutriTears, Bausch + Lomb) and the Dry Eye Drink (Bruder), a highly effective hydration drink. The nighttime version contains chamomile, melatonin and valerian root, all known to aid in sleep, in addition to the potent anti-inflammatory ingredients like turmeric.

I can’t overstate the importance of quality sleep in managing DED. Personally, the Dry Eye Drink, HydroEye and SleepTite have been my saviors for improving my dry eye, and being able to say this to patients goes extremely far.

Neuro-Optometry

This is likely the most underserved field in eye care, with only 635 neuro-ophthalmologists in the US or about one for every 675,000 people.⁵ With most being in academic centers, patients often wait more than six months for an appointment. Many of the issues can be diagnosed and often addressed by a well-trained optometrist in this field. The most common issue, migraine headaches—in particular, ocular-related headaches—can be resolved with the Neurolens technology that is common in general optometry offices. Doctors practicing vision training also play a key role in neuro.

Given the advancements in retinal disease and the unfathomable fact that there are over 100 prescription drugs in development, ODs can carve out an age-related macular degeneration (AMD) center or focus more on monitoring and managing diabetic retinopathy and work with retina specialists, PCPs and endocrinologists. AMD alone includes dark adaptation, confocal retinal imaging (Eiden, iCare USA), AREDS2 formulations vs. overall eye health with carotenoid formulations, spectacles with virtual reality to offset the central scotoma (Eyedaptic) and proper referring for geographic atrophy, given the potential we’re seeing in compliment inhibition drugs like Syfovre (Apellis) and Izervay (Astellas).

The future may include photobiomodulation for dry AMD in an optometry office. Even comanagement, especially with light-adjustable lenses (RxSight) that are managed postoperatively by optometry, is a fast-growing field of expertise.

All of these can invigorate your practice and provide services to a highly underserved population; personally, the response from patients in my OSD clinic is so rewarding that it’s contagious and perpetuates further growth, staff retention and overall gratitude for what we’re able to do on a daily basis. 

Dr. Karpecki is Director of Cornea and External Disease at the Kentucky Eye Institute in Lexington KY.   He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.

1. Rotterdam I, Rotterdam II, Blue Mountains Eye Study, Beaver Dam Eye Study. 2. Chen J, Wang, J, Qi Z, et al. Smartwatch measures of outdoor exposure and myopia in children. JAMA Netw Open. 2024;7(8):e2424595. 3. Tailor PD, Xu TT, Tailor S, et al. Trends in myopia and high myopia from 1966 to 2019 in Olmsted County, Minnesota. Am J Ophthalmol. 2024;259;35-44. 4. Flitcroft DI, He M, Jonas JB, et al. IMI – defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. IOVS. 2019;60(3):M20-30. 5. Pakravan P, Lai J, Cavuoto KM. Demographics, practice analysis and geographic distribution of neuro-ophthalmologists in the United States in 2023. Ophthalmology. 2024;131(3):333-40.