According to VisionWatch Canada (published by The Vision Council) reports, 87% of US consumers wear plano sunglasses, versus only 62% in Canada, a significant difference. It is not a seasonal aberration. The 62% penetration level has held fairly steady through each of the four seasons, since the VisionWatch Canada data started tracking data in 2014.
Plano sun may jump out at you as a summer-based sales opportunity, but as we head into fall, it’s important to remember, it’s a year-round chance to protect your patients’ eyes while boosting optical revenues.
Sunwear offers a dual opportunity: protect eyes from ultra-violet radiation and blue light, while enabling the wearer to have fun making a style statement. How many fashion pieces offer the wearer both health benefits and style savvy?
Source: VisionWatch, The Vision Council
But despite this great opportunity, many independent optometric practices are still missing out on plano sun sales. The top sellers of plano sunwear, according to The Vision Council’s VisionWatch statistics are sunglass specialty shops, followed by drug/grocery/mass/warehouse clubs, department and specialty stores, optical chains, and sporting goods stores. After all those sellers, come independent opticals, capturing $155 million in sales of plano sunwear in the first quarter of 2017.
Compare that to the $1,703.6 million in plano sun sales captured by sunglass specialty stores. The only plano sun sellers tracked by VisionWatch that ranked lower than independent opticals were flea markets/street vendors.
To help turn that sales-losing trend around, I spoke to my optician friends, and together we came up with this list of plano sun sale promotions and marketing strategies that work:
Discount for Contact Lens Annual Supply Buyers: Offer “25% off non-prescription sunglasses with purchase of a year supply of contact lenses.”
Market to LASIK Patients: “Same-day discount on sunwear for LASIK patients.”
Advertise Wide Inventory: “We sell 150+ sunglasses in our office, and we offer the service of cleaning and free adjustments. Stop back by every 3-4 months for tune-ups to make sure your sunglasses fit comfortably. Purchasing sunglasses from us means also purchasing high-quality customer service.”
Promote Memorable Optical Displays: Post photos of your sunglasses on display in your optical on Facebook and Instagram, with a message like: “Check out our ‘Wall of Sunglasses.’ Drop by and find your perfect pair.”
Offer Superior UV Protection. “Do you know if your sunglasses protect your eyes from the sun? If you buy from us, we guarantee UV protection. Know what you’re getting–and protect your vision.”
Prescribing in the Exam Room Means Selling in the Optical Let’s back it up to the exam room. Knowing your patients’ sports, hobbies, the amount of driving they do in a week, travel patterns, dry eye problems, sensitivities to sunlight, and their personal style, is the first step. Uncovering those personal details, and prescribing accordingly, makes your optician’s job easier.
Prescribing sunwear should never be about selling; it should be about presenting solutions and improving lives. When you invite a conversation about the patient’s biking, golf game, love of hiking or fly fishing adventures–whatever takes them outside and on the road or trails–you are showing the patient that your prescription is a customized solution, especially for them.
Suggest a Sunwear Demo in Hand-Off When you hand-off to your optical staff, suggest a demo of the lenses you have prescribed, such as a polarized pair of sunglasses for driving, or a wraparound pair for golf.
Train Staff to Speak Like Plano Sun Experts Have you had a sunglasses meeting to be sure all your staff is on the same page about selling sunwear? Are you absolutely sure your staff has expert knowledge of tints, ideal lens color choices for sports and other technical details?
Tints. Opticians should be conversant about the benefits of the many different tints of sun lenses. They should be able to match the ideal tint with the patient’s favorite outdoor hobbies and sports.
Driving Sunwear. Be sure opticians can discuss how the right pair of “drivewear” sunglasses can make accidents less likely, and can make the experience of driving safer and more comfortable. Point out the benefits of polarized sunglasses in deflecting glare while on the road, and how polarized lenses compare to photochromatic lenses like Transitions.
Impact resistance. Prepare staff to explain to patients why it’s important that their sunwear be able to withstand impact, and how high-quality sunwear meets FDA standards for impact resistance.
Wraparound protection. The optician should be able to explain how wraparound protection offers a greater UV shield to the eyes, preventing UV rays from getting in at the sides of the eyes.
Blue light protection. Opticians should be educated about what harmful blue light is, and why sunwear that protects against both UV radiation, in addition, to blue light, is important.
Editor’s Note: Comparison of Canadian and American Plano Sunwear Market
Source: VisionWatch Canada Q1 2017, The Vision Council
is a licensed optician, and owner of Spirited Business Advisor, a consultancy that works with small businesses, including independent eyecare practices, on how best to serve customers and generate profitability. To contact her: colleenhannegan@yahoo.com
After two years of development, Google is releasing a re-engineered version of Glass designed specifically for use in the workplace, according to Vision Monday. The tech giant made headlines earlier this week by announcing that the new eyeglass-mounted wearable, called the Glass Enterprise Edition, is now available to businesses through a network of “expert partners” that have participated in the development process.
“Workers in many fields, like manufacturing, logistics, field services and health care find it useful to consult a wearable device for information and other resources while their hands are busy,” Google said in a statement. “That’s why we’ve spent the last two years working closely with a network of more than 30 expert partners to build customized software and business solutions for Glass for people in these fields.
There are currently more than 50 customers using Glass including AGCO, DHL, Dignity Health, GE Aviation, NSF International, Sutter Health, The Boeing Company, and Volkswagen according to Google.
The Glass Enterprise Edition differs significantly from Glass Explorer, the consumer version that Google pulled off the market a couple of years ago following consumer concerns about styling, privacy and pricing. One of the most important differences is that the Glass Enterprise Edition is designed to be attached to frames, rather than be incorporated into a frame.
The new units also have more power, improved battery life and better processing power so it can support people using multiple applications at once. Other upgrades include an improved camera that takes clearer pictures, including in low light, and connectivity with other devices, such as keyboards. Glass uses a custom build of Android and only comes with a camera app that allows users to take photos or videos and features voice commands and control capabilities.
Google said Glass devices and software are sold and supported exclusively through the Glass Partners network. The Glass Partners will provide pricing based upon customer needs. The cost can vary based on level of software customization, customer support and training required.
Glass is the product of several companies that are part of Alphabet, the sprawling holding company Google formed in 2015 that also houses Nest and Google itself. The Glass product team will spend a lot of their time at Google X, a “moonshot factory” which has labs, hardware expertise and a number of pioneers in wearable computing.
The team will also work closely with the Google Cloud team as well as Google’s hardware organization which is still supporting the consumer version of Glass.
Satisfied patients who return and refer others, and the retention of employees, are two separate goals that have something in common: Effective new employee training can help you achieve both.
My 2 full-time doctor practice, which has 10 support staff members, takes a structured approach to training new employees. This helps keep turnover low and customer service high. We have an annual employee turnover rate of about 5 percent compared to the Management & Business Academy average of 20 percent annually.
To keep turnover low and ensure successful onboarding, my office manager and I are both involved in the training. I am usually more involved in the initial process, and my office manager and other support-staff members are more involved in training new employees in the specifics of their job roles.
According to a 2016 study by the Society for Human Resource Management, employers can expect to spend between 6-9 months of an employee’s salary to replace a new employee. Forbes estimates the minimum cost to be one month of salary (and in some cases as much as seven years!). In a typical optometric office, I would expect that figure to be closer to three month’s salary, or about $7,600.
Dr. Cass (center) with members of his staff. Dr. Cass says a structured new employee training program ensures that every new hire is able to provide a consistent patient experience.
Show New Employee Patient Experience New employees in our office are introduced to each staff member and given a tour of the office.
The tour walks the new employee through the process that the patient would go through, so the employee can understand the part their job plays in the process. I then personally visit with the employee and explain our practice history, mission statement and philosophy.
The new employee is then paired with the employee who has the most experience doing the things the new employee will be doing. The first day is typically spent with the new employee watching the experienced employee while taking notes. Questions are strongly encouraged and time is taken to thoroughly answer any questions.
Provide Job Aids The new employee is given printed copies of:
An employee manual
An office manual
Compliance manual (Privacy, Security, OSHA)
They also are given a checklist of tasks they will be expected to learn during training and specific training guides for their position. Click HEREto see an example of one of these checklists.
For further help, we give employees training guides related to tasks required for different patient encounters. For example, here are some guides we gave the technician we just hired (Click on these links for complimentary PDFs).
Set Probationary Period During the first week the doctor, or office manager, meets with the trainer and the new hire at least once per day. The checklist is reviewed daily the first week. After the first week the doctor and office manager check in with the employee once or twice per week until the checklist is completed and the employee’s work is reviewed and spot-checked.
We consider new employees probationary for the first 90 days, but have not had to let someone go during the probationary period thanks to our thorough hiring process. We usually have employees integrated well within the first 30 days, and are refining the training process during the next 60 days.
Elicit Feedback from New Employee
We recognize that employees come to us with unique experiences, knowledge and perspectives. We actively seek feedback from the employees and suggestions for ways to improve our processes. We also give employees a significant amount of freedom in how they complete tasks related to their job. We want them to be trained well, but we also want them to make the job their own.
Taking the time to properly train and onboard staff is well worth the effort. Your practice can only be as good as your staff. And as good a doctor as you may be, it is important to keep in mind that your staff members are the first voices your patients hear when they call, the first faces they see when they arrive, and the last interactions they have before they leave.
“There are three types of people in this world: those who make things happen, those who watch things happen and those who wonder what happened.” – Mary Kay Ash, Founder of Mary Kay Cosmetics
Your employees may be qualified for their jobs, and full of potential, but they can still use encouragement from you, their boss, to take initiative.
Recently, I walked into the exam room and noticed a new paper towel dispenser. Our previous model had a tendency to get jammed, either producing a wad of too many towels or shreds of not enough. But this new contraption was motion sensitive, delivering a perfect single sheet on command. A little thing, sure, but nice. Sure enough, the other exam rooms had new dispensers, and so did the bathrooms. Assuming my husband and partner had ordered them, I thanked him for the upgrade. But he shook his head and said it was our new office manager who had ordered them and installed them. And she did that all…unprompted.
When I thanked her, she shrugged and said that she noticed it was a problem and fixed it. Not to be dramatic, but this display of action made my heart swell. Because doesn’t it seem so hard to find employees who take the initiative on their own? Motivated employees who look for ways to help outside their normal job duties is an attribute that can turn a decent employee into an amazing asset. Do certain people simply possess this personality trait? Or is there a way we can train our employees to take the initiative?
Defining Initiative
“Work behavior characterized by its self-starting nature, its proactive approach and by being persistent in overcoming difficulties that arise in pursuit of a goal,” is how researchers Michael Frese and Doris Fay define initiative. In other words, to show initiative, you do things without being told. You act instead of react. If you want employees who can think on their feet and take unprompted action, here are a few guidelines to help develop initiative.
Foster a Supportive Environment with Open Communication
Employees need to feel comfortable in their work space. They need to feel like they are part of a team. As a leader, the boss may have more experience and knowledge, but employees need to understand that their input is valued. Make an effort to let employees know you’re excited to hear their thoughts. Create a process for employees to submit ideas even if time for a face-to-face meeting is limited. If an employee knows their boss is supportive, they will be more willing to take steps without constant verbal approval.
Encourage Safe Failure
It takes courage to show initiative, especially if the employee fears their superior will disagree with their actions or suggestions. If employees work in a practice where the doctors are always micro-managing them, they will be averse to taking new action without supervision. Motivate employees to take action with continual support and encouragement. Let employees know that after they are fully trained, they have the go-ahead to make decisions within their job description to address problems. Then, once they successfully handle a sticky issue, or take the initiative to fix something on their own, compliment them. Successful endeavors provide a learning experience and will build confidence.
Let your employees know that taking the initiative doesn’t always involve solving problems. Initiative also involves looking for ways to help. For example, if there is a stack of referral letters that need to be scanned, an employee who accomplishes that task without being asked to do so should be praised. Sometimes a simple thank you is enough to teach that initiative is expected and appreciated.
Educate Your Employees How to Spot Opportunities and Potential Improvement
Employees who show initiative do so by identifying opportunities that their colleagues have missed, and then act upon those opportunities. Instruct your team to be on the lookout for areas within your practice that could use improvement. Tell employees to think about the following:
What would our patients want us to improve?
What small problems could grow into bigger ones if left unchecked?
What slows our work flow or makes it more difficult?
What is frustrating or irritating within our office to either the patients or the staff?
Tell your team to look for these things, and once identified, recognize them not as problems, but opportunities to improve and grow.
Employees should be encouraged to take initiative to resolve problems or improve quality of service within your practice.
Some people innately take initiative, but others need to be gently prodded, taught and rewarded for taking risks they may fear. When employees are independently resourceful, even in small ways, take time to recognize and commend the effort, and hopefully that will set forth a path for all employees to take extra steps for the benefit of the entire practice.
How do you empower employees to take the initiative? How do you help employees feel safe enough to follow their instinct in making your practice better?
Editor’s Note: The Future of Independent Optometry in Canada
While US and Canadian markets have their differences, the migration of independent practices to “corporate entities” such as Iris and FYIdoctors is undeniable. The players may be different in the US but the forces of change are very similar.
Dr. Chou’s title question, “Is Independent Optometry Still Desirable?” is likely a passing thought, or more, for many. We invite you to a discussion of this topic in a Canadian context. If you’ve considered the move or have made the move to a corporate entity, what are the factors that have made you question the value of remaining independent?
Scroll down to the end of the article to view and add your comments.
These days, the light drawing newly minted optometrists to practice ownership may seem more like a distant flicker. With the financial realities of heavy student debt and supporting a family, the path to ownership is strewn with obstacles. Still, many of us aspire for “independent optometry,” lured to this concept like moths to the porch light. Indeed, it’s been a worthy and fulfilling journey for most, and I’ve experienced this firsthand. But today, I take the position that, at least for some, it’s no longer all that it’s cracked up to be.
As a profession, we struggle with some fundamental issues. One is: What is “independent optometry?”
Our esteemed colleague Mark Wright, OD, FCOVD, defines independent optometry based on the ability to make changes. For example, you are “independent” if you can set your own work hours, decide which third-party plans you accept, what fees you charge, the décor of your practice, what products you use, which staff you hire, and so forth. Who wouldn’t want these things? After all, freedom is a deep-rooted, celebrated American value. “Independence” seems synonymous with virtue, placed on a pedestal for all to marvel and move toward.
But does the privilege of making changes to your practice come at such a high cost that you become enslaved to your business?
In the report, “Private Equity and the Investment Effect,” I mentioned that I transferred ownership of my practice to a larger one in a private equity-affiliated deal. After 16 years of ownership, I now am an employee. I have ostensibly relinquished the ability to change the business. But, oddly, while I no longer pass Dr. Wright’s litmus test for being “independent,” I feel more independent in many respects. How is this possible?
I’ll tell you why.
Today, I am much more diversified against the financial risk posed by ill-guided online and remote refraction, online eyewear, and the de facto consumer ability to buy disposable contact lenses without a valid prescription. The office lease is no longer secured in my name with a personal guarantee. If a disgruntled former employee files a frivolous and unsubstantiated wrongful termination claim, the time expenditure and exposure to financial loss falls on someone else’s shoulders.
Further, I can take extended time out of the office without the discomfort of high fixed-overhead expenses mounting in my absence. If there is a staffing-related problem, I’m not burdened with smoothing it out. Maintenance interruptions, from the printer breaking down, to a plumbing leak, to the security alarm getting triggered after hours, are out of my hands. Network security, and complying with increasing regulatory requirements, are managed by someone else.
This isn’t to say there is a complete absence of stress, however.
I’m still learning as corporate changes are implemented, and to be sure, some of these changes – including conversion to a new electronic health record that is used mostly by physicians – have alienated loyal and longstanding staff. (The EHR functionality relevant to optometry seem like they were developed as an afterthought, and I am still reserving judgment on whether this EHR can maintain workflow efficiency for most optometric practices.) Additionally, despite the absolution of business management responsibilities, I have found it difficult to watch someone else take them over if performed without the previous level of skill, time expenditure and attention to detail. But for most urgencies (e.g., plumbing leak), any member in our office just notifies the director of operations to get it fixed.
In short, I can be a doctor.
As an employee, the concept to aspire to is that I can direct my attention toward caring for the patient, with minimal outside distractions. No longer must I direct a large part of my time and attention toward managing IT, regulatory compliance, risk management, human resources, advertising and public relations, accounting, business development, buying and inventory management, billing and collections, and so on. It’s not that I hate all those things. In fact, I enjoyed, and was good, at some of them. For those doctors who enjoy the business aspects more than clinical practice, the CEO approach described by another esteemed colleague, Neil Gailmard, OD, MBA, FAAO, is a sound and worthy model to pursue.
I believe that many optometrists will still experience the greatest feeling of independence from practice ownership. Yet for other optometrists, the right employment arrangement will provide the greatest freedom. There are merits to each modality, and what’s best depends on individual circumstances and personal preference. Fortunately, there are good opportunities for ODs to go from employee to owner, and vice versa. For OD-owners looking to transition to employment, private equity-affiliated consolidators offer a relatively new alternative to exit ownership – yet this path requires careful planning to reduce the risk of post-transfer surprises.
BRIAN CHOU, OD, FAAO
Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.
Trevor is a partner in a multi-doctor, four-location practice on Vancouver Island.
A serial entrepreneur, Trevor is constantly testing different patient care and business
models at his various locations. Many of these have turned out to be quite successful, to the point
where many of his colleagues have adopted them into their own practices.
Dr. Trevor Miranda
Doctor of Optometry
Cowichan Eyecare
University of Waterloo 1995
Cowichan Valley, BC
What is currently the most exciting thing in your field to help patients?
For me, the advancements in Dry Eye diagnostics and treatments have allowed improvements in the quality of life for patients that have previously suffered from dry eye disease. We recently added Lipiflow to our Dry Eye treatment protocol. There are lots of advancements coming down the pipeline. Besides improving patients’ vision, treating and improving dry eye symptoms is very fulfilling, as often those complaints have been overlooked by other practitioners.
What advice would you give a new grad today?
Learn a Subspecialty such as vision therapy, low vision, dry eye treatments and specialty contact lens fits (scleral and ortho-k). Join a practice that is going to help you understand the business of eye care. You need to run your practice as a business so you can afford great equipment, great staff, and a great work environment. You should find a mentor that will help teach you; join a network like Eye Recommend. Private practice is a very rewarding and fulfilling mode of practice. Enjoy your job and remember to value each of your patients and every staff member you interact with. Run your practice – don’t let it run you.
What is your most effective marketing tool platform?
Word of mouth referrals continues to be our most effective to attract patients to our offices. It is important to exceed our patient’s expectations to improve the likelihood they will refer their friends and family to us. We believe in having a marketing budget (we use 2% of our gross revenues) and we spend it. We are a big believer in SEO and a billboard on the Trans-Canada Hwy. We also do two newsletters in the community per year. Getting out to do talks, being part of service clubs such as Rotary, being active in the chamber of commerce and carrying your business cards wherever you go are other effective tips. Our staff are also great referring new business to our practices.
When was the last time you laughed?
I laugh constantly – I’m laughing at this question! I tend to be a loud laugher; I probably should be embarrassed but I’m not. One time at the Tim Hortons drive through after run/walking 56 kms with one of my staff we had a hysterical laughing fit and I couldn’t place my order. I believe laughter should be encouraged in the workplace. I want to have fun at work. When I hear my staff or patients laughing it makes me feel good. (please don’t laugh at my lameness)!
Have you changed since high school?
OMG – who hasn’t! Besides being older, wiser and better-looking nothing has changed! (:
As a financial advisor, a phrase I often use is: “If you fail to plan, plan to fail.” That saying is especially apt when discussing preparing for the sale of a practice.
OD practice owners often leave substantial money on the table by not taking the proactive, pre-sale steps necessary to gain maximum valuation for their practice at their retirement.
Here are three essential aspects of your business to have in order before you put your practice on the market.
Balance Sheet
A balance sheet is one of the most important financial documents that a business can own. It is, by most counts, a good scorecard and fitness indicator of the health of a practice. Sometimes also called the statement of financial condition, there is a lot of information that a potential buyer will learn about your practice just by looking at the different components of your balance sheet.
Having an unhealthy balance sheet is a good way to start off on the low end of the sale price spectrum, and rightfully so. Why would you expect anyone to pay a premium for a financially unhealthy business?
A balance sheet is broken up into two main parts: assets and liabilities. Subtracting liabilities from your assets gives you the amount of equity that you have in your business. That’s why you’ll often hear balance sheets described as “assets = liabilities + shareholder’s equity.”
You can look at the assets side of the balance sheet in three broad, sub-categories: cash, inventory and accounts receivable (A/R).
Buyers love a business that has cash. As the phrase goes, “cash is king.” Cash-on-hand is usually a good indicator that the business has a short A/R collections period, strong sales and few debt obligations. It also speaks to “ammunition” that could be used by the new buyer to make changes, or invest in the practice. Because of this, future cost of capital is lower than if the buyer would have to finance future purchases and take on additional debt.
Having an A/R that is in check demonstrates prompt collections from your office. No buyer wants to see a high number in the A/R column, especially high numbers in the 60 and 90 days past due category. Ensuing prompt payment (and communicating that to your patients upon their visit) can help keep that low.
On the liabilities side of the sheet, the “captain obvious” statement is that having as little debt as possible is the best case scenario. If a practice does have debt, having a “quick ratio” that is above 1 demonstrates that the practice can satisfy their debt obligation from cash flow. The larger the quick ratio, the healthier the cash flow as it relates to debt. The quick ratio is calculated as follows: current assets – inventory divided by liabilities. “Current assets” are described as cash and cash equivalents, marketable securities and accounts receivable.
If you do have debt on the practice, ensure that the terms of your debt are most favorable given the current interest rate environment, needs of your practice and cash flow. Look at establishing lines of credit with a bank instead of using a credit card for monthly purchases. Do what you can to eliminate, or reduce, your debt as much as possible—it is directly related to the valuation you’ll receive on your practice.
Sales When looking at the potential opportunity of buying into a practice, one of the factors that can send a buyer running to the next deal is looking at a practice that has declining sales and collected revenue. Declining sales usually indicates an unmotivated doctor and staff, stagnant marketing, unsatisfied patients (low repeat/reoccurring patient visits) and low patient referrals. Fixing these challenges and deficiencies requires an additional combined investment of time, energy and/or money—all above and beyond the required investment of these three qualities when buying a business.
In the best case scenario of the buyer proceeding with the purchase of your practice, expect them to use these attributes as powerful negotiating points and justification when most likely making you an offer that is below what you were anticipating, needing, or wanting, for your practice.
To combat this possibility, ensure that you are keeping your “foot on the gas” in the years leading up to selling your practice. Having steady or increasing sales and collected revenue is appealing to a buyer—it indicates that there’s a sound marketing plan in place and a repeatable, sustainable and scalable business to be acquired.
In addition to having steady, or growing, sales, demonstrating that you have strong reoccurring revenue from a core patient base demonstrates that you deliver a patient experience that keeps them coming back to your office for their eyecare needs. In an ever-increasing competitive world, in which the value of eyecare continues to be perceived as devalued and undercut in price, showing a strong recall system and high show rates proves that you and your team provide a great patient experience.
Strong Inventory A strong inventory (specifically your frame inventory) also is appealing to a buyer, but make sure that your inventory is the right kind of inventory.
This means having an up-to-date optical that has frames that are reflective of your patient base, multiple price points and current fashions and styles.
Having an outdated, small selection of frames increases the chance of having a bad first impression on patients when they walk into your optical, which can increase the chance of patients walking out the door with their Rx and right to the online marketplace—lost potential revenue for a future buyer of your practice. Not only will those weaknesses cost your practice money; they also will leap out at potential buyers, lowering your sale price.
ADAM CMEJLA, CFP®, CMFC®
is a Certified Financial Planner and president of Integrated Planning & Wealth Management, LLC, a financial planning and Registered Investment Advisory firm that works with optometrists nationwide. For more information: Contact Adam at or adam@integratedpwm.com or 317-706-4748.
Contact lenses can be a lifestyle-enhancer for patients and a profitability-builder for practices. You can maximize patient satisfaction, and the potential to grow your profitability, if you find ways to help patients to succeed in contact lens wear and not drop out.
Studies show that contact lens patients return more frequently for office visits and contribute more revenue over time than do eyeglasses-only patients.
In addition to working part-time at We Are Eyes in Boca Raton, Fla., I teach at Nova Southeastern University College of Optometry. In most typical primary care practices, approximately 30-40 percent of patients will be contact lens wearers. At NSU, I work primarily in the contact lens clinic, so 90 percent of my patients are contact lens wearers. Recent studies reveal that the typical contact lens drop-out rate in the U.S. is approximately 10 percent, but it can range up to 60 percent.
How Much Are CL Dropouts Costing You? It is challenging for the typical optometric office to determine the financial impact of contact lens drop out. Many doctors rarely calculate it. But if you do the math, there is significant money at stake when a patient drops out of contact lenses.
For example, contact lens examination fees for standard hydrogel, or silicone hydrogel, lenses typically range between $60-$100, and average revenue for an annual supply of contact lenses range from $100-$500 per year. That adds up to a revenue loss of $160-$600 per year per patient.
So, if you take into account the entire lifetime of a typical contact lens wearer, every time a patient drops out of contact lenses, a practice could be losing upwards of $20,000 -$30,000. If five patients drop out, this could add up to $100,000 for the practice. In addition to that, if a patient is dropping out of their contact lenses because they are unsatisfied with the doctor, or the lenses that the doctor prescribed, a practice could potentially loose their optical business and referrals from friends and family also.
Curb Discomfort: Ask the Right Questions The most common reason for contact lens drop-outs is discomfort, mostly related to dryness. Patients also drop out because of blurred vision, the cost of the examination and supplies, the inconvenience, or fears of complication from wearing contacts. And many patients won’t tell the doctor exactly why they are dropping out.
Therefore, the first step in preventing dropouts is asking the right questions of every contact lens wear. The only way you can prevent contact lens drop-out is by identifying the problem to begin with.
Never ask: “How are you doing with your contacts?”
Never ask: “Are you doing OK with your contacts?”
Always ask: “How do your contacts feel at the end of the day compared to the beginning of the day?”
Always ask: “How can I make your contacts even better?”
Stay Ahead of Discomfort and Complications
Once you have asked the right questions, the next step in preventing drop-outs is by making improvements before complaints occur, or get worse. Even if a patient denies discomfort, I always try to prescribe something new to each patient. Contact lens technology is constantly evolving and improving. There is a strong likelihood that there is a better contact lens available today, compared to the last time the patient was examined. If a patient is already wearing the newest lens, then I re-educate them about the most appropriate artificial tears to use. I prescribe a specific re-wetting drop and a specific dosing, even if the product is available over the counter.
Prescribing daily disposable lenses is another way to reduce contact lens drop-outs. Many long-time contact lens patients are unaware that single-use lenses are the standard, not the exception, now. There are many daily disposables to choose from for spherical, toric and multifocal patients. Single-use lenses are ideal for the part time wearer, but for the full-time wearer, as they can provide superior comfort and convenience.
When offering daily disposables, focus on the benefits, rather than the technical features. Educate patients on the health benefits, minimized risk of infection and complications, and superior end-of-day comfort.
Most manufacturers will provide diagnostic lens sets at no charge. So, there is no initial cost to an OD to educating, and enabling patients to experience, new lenses! I can’t think of any other situation in optometric business where there is no initial financial investment needed. But ODs have to be willing to use the newest lenses and prescribe them to their patients with confidence. And ODs have to know that contact lens technology is constantly evolving. In a year, there may be yet another lens that they have to learn about and be willing to try.
Address Dry Eye The majority of patients, who drop out of soft contact lenses because of lens discomfort, have dry eye. So, managing underlying dry eye is critical. Eyecare providers should recommend a specific brand-name artificial tear and a specific dosing, along with other vitamin supplements, as part of the treatment regiment.
There should also be a discussion regarding environmental factors that can lead to dry eye, such as ceiling fans and air conditioning vents blowing directly toward the eyes. And even if a patient does not need prescription-strength medications for dry eye, they should be monitored closely.
But continued monitoring is even more important if a contact lens wearer needs to be on a topical medication for dry eye such as Xiidra or Restasis. A re-evaluation and re education every 3-6 months can significantly prevent contact lens dropouts.
When it comes to dry eye from more chronic, severe ocular surface disease, scleral contact lenses can revolutionize a practice. I have many patients with severe Sjogren’s disease that cannot tolerate standard contact lenses. Patients with true keratitis sicca often see better with scleral lenses. Scleral contact lenses correct for a patient’s refractive error, but can act as a shield from the elements to protect the cornea from dehydration.
In addition, the sterile saline used to fill the scleral lens before it is inserted acts as therapeutic tear reservoir. This can heal a patient with significant corneal superficial punctate keratitis or filamentary keratitis.
Prescribe Multifocal Contact Lenses Many presbyopic patients believe that if they have to wear glasses over their contacts to read and work on the computer, then they might as well just wear glasses full time. This is the reason many presbyopic patients drop out of contact lens wear. For that reason, multifocal technology can also help to reduce dropout rate.
Patients should be educated that multifocal contact lenses have improved dramatically recently. They provide a better range of vision compared to monovision, and now even single-use multifocal lenses are available. For part-time wearers, daily disposable multifocal lenses can provide comfort, better ocular health and vision, as well as convenience.
THUY-LAN NGUYEN, OD
Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometry and works part time as an associate at We Are Eyes in Boca Raton, Fla. To contact her: TLNGUYEN@nova.edu
Here’s a sobering thought. Seven hundred years after glasses were invented, there are still children in the world suffering from severe vision loss—simply because they have no access to a pair of glasses. And once children develop even a common eye condition such as myopia (shortsightedness), life for them will no longer be the same.
That’s why Dr. SooJin Nam from Eyecare Kids is so passionate about children’s vision. Good vision allows children to experience all the joys of childhood—identify colours, count objects, see shapes, play outdoors, recognize loved ones’ faces.
“As a behavioural optometrist, I am fortunate to be in a position that allows me to help children with real vision problems,” say Dr. Nam. “Every optometrist knows the importance of good vision and the impact it has on children. It is our desire that all kids have access to eye care and glasses in order for them to achieve their best.
Dr. Nam has proudly introduced Optometry Giving Sight’s Our Children’s Vision program into her practices because it’s easy to implement and it’s a great way to have fun with her patients.
“When our little patients come to us and we see how their quality of life improves tremendously because of what we do, we desire it for every child with a vision problem,” she said. “Our children are our future, so I see nothing more important than giving them the best chance in life.”
Dr. Nam implements the program by making a donation for every pair of glasses sold in her practice. Optometry Giving Sight provides marketing items including posters, counter cards and social media materials to promote their generosity to their patients.
After every glasses purchase, the patient receives a small card emphasizing that because they purchased glasses there, the practice will make a donation to help a child in need to receive an eye exam and a pair of glasses.
Optometry Giving Sight also provides tear-off sheets to give to each patient to remind them of the importance of an eye exam for the children in their lives. The sheet has an area for the practice to stamp their contact details to invite patients to call to set up an appointment for their own children.
The benefit for practice participation in the program is two-fold: a large amount of positive publicity as patients see the practice making a difference in the lives of children around the world, and every patient is reminded of just how important good vision for children is and to make eye exam appointments for their own children.
“Optometry Giving Sight’s ‘Our Children’s Vision’ campaign support materials are available to any optometric practice in Canada. If you wish to use OGS materials as part of your social marketing program to support your practice, please contact Corinne Waldon at canada@givingsight.org or 1-800-585-8265 ext 4.”
Not too long ago, we introduced you to Jane and Steven Buchan, a pair of licensed optometrists who are looking to take the next step in their careers by purchasing an independent eye care practice. It’s a daunting leap forward for them, but they’ve chosen this route for several reasons:
They will be working with an existing client base, instead of developing one from scratch.
They don’t need to build the office from the ground up, choosing instead to renovate and maintain the existing facility.
They will have the opportunity to take over, learn from and build on the financial history and business plan of the previous business owner.
They will be able to get the business up and running faster than if they were starting net new.
They now have better chances for securing a good loan or additional lender support, as the existing business already has its own financial statements and a cash flow history that can be used to demonstrate profitability.
They’re both incredibly excited and anxious to begin putting their name on a business that they can own and grow together. Despite the comprehensive optometry training and experience they’ve acquired in recent years, they still somehow find themselves completely overwhelmed by the mountain of paperwork and obligations looming over them as they prepare to purchase. Who do they turn to for help?
The good news is that there are professionals you can count on whose expertise ties directly into complex business transactions such as these. The acquisition of any business is a big game and life changer for any healthcare professional, so it’s always good to take time and seek out specialized advice. Whether you are a seller or a buyer, arming yourself with the knowledge and counsel of licensed, reliable professionals is a benefit that cannot be understated.
Certified Public Accountant
Arguably the most important step in preparing to sell or buy a business is to make sure that its financial records are clean, up to date and duly completed. For sellers, it is also a good idea to make sure that all outstanding payments (to vendors or from customers) are settled before putting the business up for sale, as any unpaid balances increase the liability of a business and the risk associated with purchasing it.
This is where a certified accountant comes in handy. An accountant is your guide into doing due diligence and delving into the nitty gritty of the company’s financial paperwork. This will include anything from cash flow statements, evidence of working capital, accounts payable and receivable, previous and current vendor contracts, employee files, tax records, employment agreements, lawsuits, debts, leases, and all other details related to the company’s history. Accountants for both the seller and the buyer will need to examine these records. For either party, accountants will help you devise and negotiate a financing strategy that best aligns with your interests over the course of the transaction, taking into account important considerations such as capital gains deductions, tax deferral opportunities, purchase and sale of assets, purchase and sale of shares, valuations and potential sources of funds. Long after the business sale has been terminated, you will continue to rely on the help of your accountant to help you improve your business plan, maximize profitability and maintain the financial documentation required of you by the government and your shareholders.
Lawyer or Specialized Business Sale Attorney
Because businesses vary in size, specialty and complexity, it is important to find a law firm or a lawyer whose abilities cater to your specific professional needs. One of your first steps should be to reach out to your network to see if anyone has recommendations for firms or professionals with industry-specific experience, preferably a lawyer who has handled a similar transaction for another eye care professional in the past. Once you find a lawyer who appears to be a good fit, do not hesitate to check and ask for references.
An experienced, trustworthy lawyer can be one of your most valuable assets in detangling the intricacies that surround a business sale. As a seller, a business sale lawyer can assist you with drafting the necessary paperwork to prep the sale, which includes non-disclosure agreements, letters of intent, regulatory approvals, and agreements of purchase. As a buyer, your lawyer can help you evaluate the health of the business in question, examine the tax and liability implications of the acquisition, outline agreements related to shares and equity, and vet the contracts and clauses that are involved in the purchase.
In most cases, a lawyer can provide an objective second opinion on many aspects of the business sale that would have otherwise gone unnoticed and without consideration. This is the type of decision that will change your life and impact your family for several years to come. Your lawyer will be there with you every step of the way to help you face the more difficult questions that you will have to consider:
“What are the responsibilities of your business partner and/or your significant other if you were suddenly deemed unfit to continue working?”
“What will happen if the business defaults before the entire loan amount is paid?”
“In case of a drastic change of circumstances, is there flexibility for renegotiating repayment terms and what assets can be used to help repay the balance?
Like accountants, lawyers can also assist buyers with due diligence, which for them includes thorough research on the business’ history and finances, with a projection of its sustainability and future profitability. Most importantly, they represent your best interests when collaborating and communicating with all the parties involved in the transaction.
Since legal services are largely a buyer’s market, you have more leverage than you think when negotiating your attorney fees. At the same time, you must be cognizant of the specialization and the quality of the service provided and be ready to pay an appropriately high fee for their time and experience. Revising an existing contract or drafting one from scratch, can cost a business owner thousands of dollars for that single document. To make sure you are both on the same page, it is important to communicate your needs and your intentions for the business to your attorney early on. For the rest of the transaction and beyond, they will have a great influence on the success of your acquisition, and how well the business itself succeeds post-transition.
Business Market Brokerage
This type of brokerage is very different from other types of brokerages that you may already be familiar with. A reliable full-service business sale brokerage can provide a premium service to sellers by overseeing and coordinating the business’ entire transition from one owner to the next. A brokerage can act as the liaison between your lawyer, your accountant, the valuator and all other professionals that represent you or your buyer. The broker will also help prepare your business for sale by establishing a list of potential buyers and ensuring that a selected buyer is a good fit for the purchase. According to Jacqueline Fleischmann, Director of Business & Legal Affairs for ROI Corporation Brokerage, experience counts: “You want to identify a broker with proven expertise and a track record in your industry. Look for a brokerage that understands how an optometry practice is operated and managed. A good brokerage will be able to provide insight about current trends in the industry and how they translate to your region/location.” Brokers are typically paid a commission based on the final sale price. Jacqueline also says, “If a broker demands a fee up-front, this is a red flag.”
Brokers also help relieve business owners of much of the stress and time-consuming follow-up related to overseeing the business sale. Most buyers and sellers tend to have limited experience with these types of sales, and selling a practice that one has spent years to develop can be extremely stressful for business owners. Jon J. Walton, the General Manager of MBC Brokerage, says, “One of the most critical aspects of a broker’s job is to keep emotions of the seller and the buyer down. It is scary for all parties, and it is easy for them to get stressed out and unintentionally sabotage the sale because they allow their emotions to get the best of them.” By hiring a broker to oversee the transaction on the business owner’s behalf, the owner can continue to run the business as usual, or devote time to commitments other than what is already required for the business acquisition.
Appraiser
A professional appraisal is required to evaluate the business and establish a fair market value for it. This is done by examining its financial history and analyzing its ability to maintain its sustainability and profitability in the future, by examining it in the current economy, the economy’s projected future state, trends in the industry, the business’ current assets and liabilities and other factors relevant to the business. Although the seller almost always has an professional appraisal done as part of the preparatory work for establishing the sale, a buyer can choose to have their own appraisal done as well. This appraisal will also be required when applying for financing and most major financial establishments have strict requirements that appraisers must meet for the appraisal to be considered.
Certain brokerages like MBC Brokerage and ROI Corporation Brokerage also provide professionally-recognized appraisal services in addition to their regular role as business transaction brokers. Walton sums up the teamwork aspect of the sale very nicely: “Appraisers, brokers, lawyers and accountants all have different jobs, but we all work together to ensure everything is done properly for the seller or buyer… It’s not just about selling a business, but transferring and preserving a legacy”.
Conclusion
When you purchase a practice, you are not only investing money in the business, you will also be dedicating hard work and sacrifices in the years to come so you can allow it to grow and mold it to your vision of what it should be. As terrifying and exciting as that journey may seem, there’s no need to go at it on your own. With a trusted team of experts on your side, you’ll have the resources and the confidence to make good decisions, while dedicating your own time and energy towards your family, yourself and towards nurturing the business that fuels your dreams.
LYANNE AUGUILAR
Lyanne Aguilar is a Toronto-based writer who specializes in finance and healthcare-related content, both in English and French
That’s why Dr. SooJin Nam from Eyecare Kids is so passionate about children’s vision. Good vision allows children to experience all the joys of childhood—identify colours, count objects, see shapes, play outdoors, recognize loved ones’ faces.
