Adding a specialty to your practice helps you do more for patients in need while standing out in the community. The fastest growing one in optometry is dry eye, but ODs are also turning their attention to specialty contact lenses, vision therapy, low vision and myriad other niches. Here’s what these opportunities can do for you.

What it Brings to the Table

First and foremost, adding a specialty provides enjoyment. You wouldn’t specialize in an area if you didn’t have a passion for the patients and the subject matter. We spend more time at work than almost any other sphere of life, so it’s worth maximizing our enjoyment of it. As the saying goes, find work you enjoy and you’ll never work a day in your life. 

A specialty also brings in esteem and recognition. In this day of information on demand and social media, patients are looking on the internet for doctors who can help their condition and who specialize in the field. 

Finally, you’re likely to see growth and success as your practice expands in all areas beyond the specialty. Dry eye patients, for example, may have other associated ocular conditions such as glaucoma, cataracts and contact lens wear issues.

Your Options

Dry eye centers are popping up everywhere, and 90% or more are run by optometrists. In the United States, there are an estimated 30 to 50 million people with dry eye disease, but only about 1.5 million are currently being treated with therapeutics.1 We can help these patients dramatically today: advanced diagnostics such as osmolarity, MMP-9 testing and meibography can help us catch dry eye earlier and allow us to initiate treatment.

Once diagnosed, patients have pharmaceuticals available to treat dry eye, superficial punctate keratitis and flare-ups and treatments for obstructed meibomian glands, including lid debridement and highly effective hydrating compresses. For the biofilm that develops in almost all forms of dry eye disease, we have blepharoexfoliaton and new lid scrubs. 

Even our most basic therapies— artificial tears—are more advanced than ever. Other advances include 180-day dissolving punctal plugs, neurostimulation and omega fatty acids with GLA/EPA/DHA. Dry eye specialty clinics are now packed with myriad treatment options to help every patient, no matter their clinical signs and symptoms. 

Retina is another specialty opportunity to better serve a large patient base. Age-related macular degeneration (AMD), for example, is similar to dry eye in its prevalence: likely to double in the next decade or two. As with dry eye, tools now exist for early diagnosis, such as dark adaptometry, better imaging with optical coherence tomography and better monitoring technology. Even multiple treatment options exist such as nutritional supplements with carotenoids, AREDS formulations for intermediate AMD, spectacle lenses that block high energy visible light, anti-VEGF injections for wet AMD and even intraocular implants for advanced AMD. 

Low vision is another key player in advanced AMD therapy—and an entire specialty for some practices. In fact, any patient not correctable to 20/20 might benefit from a low vision intervention. 

Patients with diabetic retinopathy (DR) also benefit from doctors who can better communicate among the professions (e.g., endocrinologists, primary care providers, retina specialists), monitor appropriately and refer should proliferative DR signs or diabetic macular edema present. 

Almost every aspect of optometry stands as a potential specialty for your practice: glaucoma, vision therapy, contact lenses, pediatrics—the list goes on. If you select an area of particular focus, take the time to educate yourself extensively. Visit other doctors who already specialize in the field—work with a retina group if you want to focus on patients with diabetic retinopathy, for example—join societies specific to that area and gain extensive experience. 

Any area of eye care with a substantial need can be an important focus that will differentiate your practice, enhance your day-to-day enjoyment and help countless patients. 

1. Steinberg et al. Equity Research Americas, May 18, 2017:1-38.