Offices and Clinics of Optometrists

SIC 8042

Companies in this industry

Industry report:

This category covers establishments of licensed practitioners having the degree of O.D. (Doctor of Optometry) and engaged in the practice of optometry. Establishments operating as clinics of optometrists also are included in this industry.

Industry Snapshot

According to the Bureau of Labor Statistics, there were approximately 111,580 offices of optometrists in the United States in 2010. Approximately 70 percent of the eye care market is delivered by optometrists. Doctors of optometry examine, diagnose, and treat a variety of diseases and disorders of the vision system, the eye, and associated structures. Services rendered by optometrists include the prescription of glasses and contact lenses, rehabilitation of the visually impaired, and the diagnosis and treatment of ocular disease.

Organization and Structure

Sixty-seven percent of optometrists worked out of their own clinics or offices and were self-employed. Unlike ophthalmologists, they are not medical doctors. Optometrists examine the eyes to evaluate eye health and visual acuity and to diagnose eye diseases and eye conditions. Optometrists are not qualified to perform eye surgery, but they can prescribe corrective treatment, including glasses, contact lenses, vision therapy, and low-vision aids. Doctors of optometry (ODs) can also use drugs to treat diseases of the eye.

Some optometrists worked as independent contractors associated with a chain of eyewear providers. Commercial vision-care centers are also an option for optometrists establishing their practices. The majority of optometric practitioners worked full time. Most ODs are in general practice. Some, however, specialize in the client base, working with the elderly, children, or partially sighted individuals, and others specialize in services, providing contact lenses, sports vision wear, or vision therapy. A few teach or conduct research.

All 50 states and the District of Columbia require optometrists to be licensed upon obtaining a doctor of optometry degree from an accredited school or college. ODs must either pass a state board examination or the National Board of Examiners in Optometry exam. There is some reciprocity between states concerning licenses; all 50 states and the District of Columbia, however, require that optometrists complete a specified number of continuing education hours to renew their licenses.

Training consists of a four-year undergraduate degree and two-to-three years of pre-optometric study at an accredited school. In the early 2010s, there were 21 colleges of optometry in the United States and Puerto Rico accredited by the Council on Optometric Education of the American Optometric Association. Those applying to an optometric program must take the Optometry Admission Test, which measures academic ability and scientific comprehension. Competition to gain admittance to these schools is fierce.

Optometrists wishing to teach or do research may study for master's or PhD degrees in visual science, physiological optics, neurophysiology, public health, health administration, health information and communication, or health education. One-year postgraduate clinical residency programs are available for optometrists who wish to specialize in family practice optometry, pediatric optometry, geriatric optometry, vision therapy, contact lenses, hospital based optometry, primary care optometry, or ocular disease.

The American Optometric Association was the largest trade association in the industry, representing more than 35,000 optometrists, students of optometry, and optometric technicians in the United States. Founded in 1898, the Association aimed to make available and improve the quality of eye and vision care for all. The group focused on helping its members achieve the highest standards of efficiency and patient care. It also represented the industry to government and other health care organizations.

Background and Development

The practice of optometry began with the invention and subsequent refinement of eyeglasses in the early nineteenth century. Optometry guilds were formed at this time, and the practice eventually was regulated under statutory law. Jewelers were actually some of the first professionals to use eye charts and sell glasses to the public.

The industry in the United States expanded during the Civil War when the government purchased large quantities of binoculars and microscopes for the war effort. Eyeglasses became plentiful and, by the end of the nineteenth century, schools were teaching the science of optics, often in combination with instruction in watch repair.

Door-to-door peddlers, jewelers, and optometrists all sold eyeglasses in the late 1800s. At the beginning of the twentieth century, however, physicians conducted most of the eye examinations. "Refracting opticians," who provided the same service, later became known as present-day optometrists. In some fairly fundamental ways, optometry practices have operated the same way for decades with clients continuing to optometry offices to secure eyeglass prescriptions, which are sent to an optical laboratory. The lab makes the glasses according to specifications and sends them to the officiating optometrist, who subsequently fits them to the client.

In the late 1960s, however, mass marketing of optical products and services changed some optometry practices. Vision-care chain stores emerged, but many states prohibited doctors from working in them. Some chain stores, such as Sears and Kmart, circumvented these restrictions by leasing space to optometrists, who worked independently but were able to lease space at below market rates. Doctors often profited from discounted rent and equipment. This partnership enabled chain stores to advertise that they provided full-service vision care at their facilities.

Competitive Structure.
The advent of vision-care chain stores contributed to a loss of market share for private doctors of optometry. Private practitioners sell their businesses on the quality care and services they provide and emphasize personal service and attention. Often this is communicated by word of mouth and not through the aggressive marketing techniques used by chain stores.

Vision-care chain stores have resorted to coupons and other special deals to attract customers. Some also promoted their quick turnaround time in filling eyeglass and contact lens prescriptions. Private practitioners began to reduce the waiting time for glasses and contacts in an effort to remain competitive. In addition, they expanded their private practices to include lab services, which enabled them to fill prescriptions in a shorter time.

Financial Structure.
Overhead costs for maintaining an optometric practice have increased since the mid-1980s. According to the "State of the Profession 1996" in Optometric Economics, the ratio of net income to gross income declined. Expenses for staff totaled 14.7 percent of gross income, while total laboratory expenses made up 28.9 percent. Other costs included rent and utilities (6.6 percent), contributions to retirement plans (1.7 percent), and miscellaneous office expenses (15.9 percent). The average net percentage for a practitioner was only 32.2 percent of the gross income. Expenses took a higher percentage (77 percent) of gross revenues of optometrists practicing in the eastern region of the United States, while expenses were lowest in the South (63 percent).

During the middle of the first decade of the 2000s, offices and clinics of optometrists were responsible for $4.74 billion of the industry total, representing 91.3 percent of the market. There also were 587 offices classified as specialized optometrists that generated $163.1 million in revenues. Other optometrists included those specializing in contact lenses (556 offices, $128.4 million), geriatric (50 offices, $19.3 million), low vision (69 offices, $18 million), pediatric (128 offices, $57.5 million), visual training (121 offices, $50 million), and group and corporate practice optometrists (150 offices, $94.1 million).

Optometry ranks as one of the nation's 10 best income-earning professions, offering incumbents considerable occupational variety and stable work hours. Types of practice included private or group practice, private industry, public health services, armed forces, community health centers, and health maintenance organizations. The U.S. Bureau of Labor Statistics reported that optometrists' mean net annual income was $105,820 in 2010, up from $89,000 in the mid-1990s.

According to the American Optometric Association's (AOA) annual American Eye-Q survey, consumers worried more about losing their sight (43 percent) than their memory (32 percent) or their ability to walk (12 percent). However, the economic recession at the end of the first decade of the 2000s resulted in fewer people making regular trips to their optometrist. The AOA found that 36 percent of Americans were cutting back on visits to their doctors because of the recession. More than half (52 percent) indicated that they were making fewer visits to their eye care specialist.

Despite a drop in clients at the end of the first decade of the 2000s, U.S. News & World Report included optometry on its list of the country's 30 best career choices. According to the report, optometrists can do much of what ophthalmologists can, without the more extensive educational requirements. In addition, as the baby boom generation ages, the demand for eye care professionals was expected to increase because most eye problems increase as age advances.

While optometrists had over the years made some headway in earning the ability to provide additional services beyond eye exams and fitting glasses, at the end of the first decade of the 2000s, industry advocates were hard at work to push state legislatures to increase optometrists' professional domain. During 2009 more than five states considered legislation to expand the scope of optometrists' practices, although not all were passed into law. According to a 2009 American Medical News report, "The bills sought expanded authority for optometrists to perform surgical procedures, inject drugs and Botox, and prescribe medications--including some controlled substances and new contact lenses that dispense medicine." Such bills, supported by the AOA, were hotly contested by the American Academy of Ophthalmology and the American Medical Association, which represented the interests of ophthalmologists and medical doctors, respectively.

In addition, the number of optometrist offices that computerized their patient records in the 2010s was expected increase significantly. The American Recovery and Reinvestment Act (commonly known as the Stimulus Bill), which was passed by Congress earlier in 2009 to jumpstart the sagging economy, provided financial incentives for health care practitioners, including optometrists, who used electronic health records (EHRs) beginning in 2011.

Current Conditions

In 2011 there were a total of 1,356 optometry students who received a regular OD degree from one of 21 U.S. colleges of optometry, including Puerto Rico. Of those students who graduated, 65 percent were female. white Americans made up 60 percent, followed by Asian Americans and Pacific Islanders (27 percent), African Americans (3 percent), Hispanic (5 percent), with the remainder comprising other nationalities.

According to IBISWorld, this industry was worth approximately $14 billion in 2011, and the industry was expected to continue to grow slowly through the 2010s, boosted by an aging American population and a recovering economy.

Industry Leaders

The industry remained highly fragmented in the early 2010s, with the largest four firms accounting for just 2 percent of total revenues and the 50 largest operators accounting for 6.5 percent of total sales. The leading U.S. retailer in vision care services was LensCrafters, a subsidiary of Luxottica Retail, with more than 965 stores in North America. Luxottica held a large portfolio of eye-related products and services, including Pearle Vision optical shops, Sunglass Hut, Watch Station, Watch World, and the Oakley sunglasses brand, acquired in 2007. Pearle Vision had 880 locations in the United States, Canada, Puerto Rico, and the Caribbean. About half were company owned and half were franchised. Luxottica reported sales of $7.3 billion in 2008.

Eye Care Centers of America Inc. of San Antonio, Texas, posted revenues of $538 million with more than 400 optical stores under the brand names of EyeMasters, Binyon's, Hour Eyes, Stein Optical, VisionWorks, and Vision World, while employing 5,400 people. It is a subsidiary of health insurer Highmark. About 200 of National Vision's 450 eye care centers are located in Walmart stores. The company specializes in offering low-cost prescription glasses and contacts. It also operates under the names America's Best Contacts & Eyeglasses, Eyeglass World, and Optical Shoppe. National Vision is a subsidiary of Berkshire Partners. U.S. Vision of Glendora, New Jersey, reported sales of $172.1 million and 3,000 employees. U.S. Vision, a wholly owned subsidiary of Refac Optical Group, operated approximately 520 optical shops within J.C. Penney and Sears department stores.

Workforce

Optometrists earned an average of about $27,000 in their first full year of practice in 1984. By 2010 the mean annual income for optometrists had risen to more than $105,000. The middle 50 percent could expect to earn between $84,000 and $150,000.

According to the AOA, 81 percent of all Americans needed prescription eyewear. Employment of optometrists was expected to grow about as fast as the average for all occupations through 2016 in response to the vision care needs of a growing and aging population. By 2016 estimates suggested that there would be 36,000 optometrists in the United States, representing an 11 percent increase from 2006. The maturing baby boom generation, together with rapid growth in the oldest age group, was projected to drive growth. As baby boomers began to reach their 60s, they were expected be more likely to visit optometrists and ophthalmologists because of the onset of vision problems in middle age. The demand for optometric services also would increase because of growth in the oldest age group, with their increased likelihood of cataracts, glaucoma, diabetes, and hypertension. Employment of optometrists also was expected to grow due to greater recognition of the importance of vision care, rising personal incomes, and growth in employee vision-care plans.

Anticipated productivity gains that would allow each optometrist to see more patients was the only detriment to projected growth in employment for optometrists. The gain would result from greater use of optometric assistants and other support personnel, as well as the introduction of new equipment and procedures. Demand was also maintained because of the limited number of school, which also limited the number of optometrists entering the field each year.

Replacement needs were low, stemming almost entirely from retirements. Optometrists generally remained in practice until they retired, with few changing occupations.

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