The Lens Through Which We View Value

By Dr. Christopher Wolfe | For Optometrists and Their Teams

One of the most interesting effects of managed vision care is not what it pays. It is how it has shaped the way many of us think about value.

For decades, the economics of optometric practice were relatively straightforward. The comprehensive examination often carried a modest reimbursement, but it created an opportunity to prescribe glasses or contact lenses. The exam was necessary, important, and clinically valuable, but the financial reward was frequently tied to the product that followed. Over time, many practices became accustomed to viewing the examination as the pathway to something else rather than the destination itself.  "Converting the patient to medical" doesn't solve this problem but that is for a future blog post.

The result is a subtle cognitive bias that still exists today. We often feel more comfortable investing our time, energy, and attention into areas of practice that have a visible product or procedure attached to them. The challenge is that this mindset can influence how we perceive the value of patient care itself.

As optometry has evolved, the optical sale has not disappeared. It has simply taken on new forms.

Today, we see tremendous interest in myopia management, ocular surface disease, age-related macular degeneration, and glaucoma management. In many ways, this is exactly what should be happening. These are conditions that impact quality of life, visual function, and long-term ocular health. They deserve our attention, our expertise, and our commitment to managing them.

At the same time, it is difficult to ignore that each of these areas now contains products, technologies, or procedures that are non-covered or minimally covered. Myopia management may involve specialty spectacle lenses, specialty contact lenses, pharmaceuticals, or monitoring services. Dry eye care may involve thermal therapies, advanced diagnostics, or in-office procedures. Macular degeneration management may include treatment devices and nutritional interventions. Glaucoma increasingly includes laser procedures and other interventions that extend beyond traditional medication management.

None of these developments are bad. In fact, they represent meaningful advancements in patient care. The concern is that sometimes the discussion becomes centered on the technology, procedure, or product rather than the condition itself.

It is easy to become interested in dry eye because of an IPL device. It is easy to become interested in glaucoma because of a laser. It is easy to become interested in myopia management because of specialty lenses. But if we are honest with ourselves, the technology is not the reason these areas matter. They matter because patients are suffering from these conditions and because we have the education, training, and ability to help them.

The product or procedure should be the result of good patient care—not the reason for it.

Dry Eye Is a Good Example

Dry eye care provides a particularly interesting example because it illustrates both the opportunity and the potential pitfall.

Many patients with ocular surface disease are searching for relief. They are frustrated with fluctuating vision, irritation, burning, tearing, and contact lens intolerance. The solution to these problems is rarely found in a single bottle of artificial tears. Most patients have an underlying disease process that requires a comprehensive management strategy.

When we evaluate these patients appropriately, we often identify meibomian gland dysfunction, inadequate lid hygiene, poor blink patterns, evaporative dry eye, inflammatory disease, or a combination of several factors. Effective treatment typically begins with foundational therapies designed to address the underlying condition. Warm compresses, therapeutic masks, eyelid hygiene, cleansers, and appropriately selected ocular lubricants are frequently the first steps in helping patients achieve meaningful improvement.

The temptation for some practices is to simplify this process. A patient may present with ocular surface disease, but instead of implementing a comprehensive treatment plan, the recommendation is reduced to a bottle of drops because it seems easier, less expensive, or more convenient.

Unfortunately, the lowest-cost intervention is not always the most effective intervention.

If the primary driver of the patient's symptoms is meibomian gland dysfunction, a bottle of drops may provide temporary relief while doing very little to address the underlying disease. The patient continues to struggle, symptoms persist, and ultimately the patient concludes that treatment does not work. In reality, the treatment plan simply failed to address the condition that was causing the symptoms.

This is where treatment bundles can provide value for both the patient and the practice.

For example, a product such as the Peeq Pro kit creates a structured starting point for patients entering an ocular surface disease management program. The kit combines therapies designed to address multiple aspects of the disease process while creating consistency in how treatment is introduced. From a practice perspective, it also provides a predictable cash-pay offering with a fixed profit per kit sold.

What we sometimes see, however, is doctors unintentionally cannibalizing their own treatment strategy. Rather than presenting the complete solution, they begin breaking apart the bundle. The drops are sold independently because they appear to be the easiest component to recommend. The mask—which often represents one of the highest-value therapeutic components—is omitted. The result is that the patient receives the lowest-margin product while missing one of the interventions most likely to influence the underlying disease.

The better approach is to recognize that the kit serves as the entry point into care. It is designed for the patient who is beginning treatment and needs a comprehensive foundation. Follow-up visits then create opportunities to monitor progress, reinforce compliance, and recommend replacement drops, cleansers, or additional therapies as needed. The initial bundle establishes the treatment process. The subsequent products support long-term management.

Most importantly, this approach aligns the economics of care with the clinical needs of the patient. The goal is not to sell a kit. The goal is to improve ocular surface health. The kit simply provides an efficient way to begin that process.

The Lesson

The broader lesson extends beyond dry eye.

Whether we are discussing myopia management, glaucoma, macular degeneration, or ocular surface disease, the real value is never found in the product, the device, or the procedure. Those things matter, but only because they help us care for patients more effectively.

Managed vision care taught many of us to associate value with the glasses sale. As our profession evolves, we should be careful not to make the same mistake with dry eye devices, specialty lenses, nutritional therapies, or laser procedures.

The future of optometry is not built on finding new things to sell.

It is built on becoming better at identifying, managing, and solving patient problems.

When we do that well, the products and procedures naturally find their proper place in the treatment plan. They become tools that support care rather than the reason care is delivered in the first place.