August 31, 2026
By Nicholas Despotidis, OD, FAAO, FOVDR, FIAOMC
Image provided by Dr. Despotidis
After 40 years in private practice, I’ve had the privilege of watching optometry evolve in remarkable ways. I’ve witnessed extraordinary advances in diagnostics and treatment options. Yet when I speak with colleagues across the country, I am consistently reminded of a quiet truth: the happiest and most successful practices don’t necessarily have the largest practices or latest equipment.
Instead, they share something far more fundamental. They have intentionally built their practices around the values they hold closest.
Every practitioner defines success differently. For some, it is financial independence. For others, it is time with family, or the opportunity to make a lasting impact on patients’ lives. None of these definitions is inherently right or wrong. The practices that thrive over the long term are simply those whose daily decisions consistently reflect their core values.
For me, those values have always been autonomy, financial security, respect and appreciation—from my patients, my staff and my colleagues.
Myopia Management Changed Everything
Myopia management became the avenue through which I could express those values. Caring for children over many years creates relationships that extend well beyond prescribing a treatment. Parents aren’t simply purchasing a service; they are placing their trust in me to protect their child’s future. Carrying that responsibility has been one of the greatest privileges of my career.
Equally important, myopia management required me to slow down.
Treating progressive myopia in a child isn’t a transactional 20-minute exam; it is a multi-year partnership. To make it work, I had to stop rushing from one exam room to another. Early in my career, I mistakenly believed that being busy meant being successful. Over time, I realized that wasn’t true—either financially or personally.
Today, families leave my office understanding not only what I recommend, but why. Those unhurried conversations have strengthened trust, improved treatment acceptance and created patient relationships that endure long after active treatment is initiated.
While this sounds straightforward, executing it is far from easy.
Devoting More Time to Our Patients
For many practices, accepting vision plans creates a business model built on volume—a treadmill where you must move faster and faster to see more and more patients just to offset declining reimbursements. Slowing down to spend more time with each patient feels financially terrifying when you’re on that treadmill. Making the transition required us to fundamentally change the way we practiced, and change is incredibly difficult—even when you know it is the right thing to do.
Several years ago, my partners and I made the difficult decision to discontinue participation with vision plans. It wasn’t a choice driven by frustration alone, nor is it a path that is appropriate for every practice. Rather, it reflected our desire to devote the time and attention to each patient that the standard reimbursement model simply wouldn’t allow.
As American Academy of Orthokeratology and Myopia Control (AAOMC) founder Cary Herzberg once stated, vision plans were “taking up space in our offices rent-free.” His perspective challenged me to look closely at the practice I had created and confront the changes necessary to find true fulfillment—financially, emotionally and professionally. I needed a practice that directly reflected what I valued most.
Looking back, I don’t believe successful practices distinguish themselves by being the first to embrace every new technology or treatment. They distinguish themselves by having the courage to make difficult decisions—even when those decisions run counter to prevailing trends. They invest in themselves, continually refine the patient experience, remain deeply committed to evidence-based care, and build systems that consistently deliver on their promises.
Perhaps most importantly, they never stop evolving.
Follow the Evidence
Myopia management has also taught me the importance of following evidence rather than assumptions. Early in my career, many clinicians believed rigid gas permeable contact lenses slowed myopia progression. It was only through carefully conducted, randomized clinical research that we learned otherwise.¹ That experience reinforced an invaluable lesson: our responsibility isn’t simply to adopt new treatments, but to continually evaluate them as better evidence emerges.
The most successful clinicians understand that not every decision they make will be the right one. They don’t allow mistakes or missteps to stall them; instead, they learn from them and pivot when clinical results and firsthand experience point them in a better direction.
Build Around Your Values
After decades in practice, I’ve come to believe that success isn’t ultimately determined by how many patients you see, how many exam rooms you have or how high your gross revenue is.
It is determined by whether you’ve built a practice that reflects who you are.
Ironically, myopia management didn’t make our practice successful. It did something much better: it gave us the freedom to build the kind of practice we always wanted—one centered on the autonomy to care for patients the way they deserve…and in the process, practice growth became an inevitable byproduct of practicing according to our values.
 |
Nicholas Despotidis, OD, FAAO, FCOVD, FIAO, has one of the largest practices in the country specializing in myopia management. He’s the lead author of two books, My Children are Nearsighted Too and A Parent’s Guide to Raising Children with Healthy Vision. His workshop SuperChargeYourPractice is the most sought-after practice management course offered at the Vision by Design symposium. His TEDx talk “A Childhood Disease Worth Preventing” educates parents on the growing number of children affected by myopia and possible treatments available to them. Learn more about Dr. D and contact him here. |
References
1 Walline JJ, Jones LA, Mutti DO, Zadnik K; CLEERE Study Group. A randomized trial of the effects of rigid contact lenses on myopia progression. Arch Ophthalmol. 2004;122(12):1767-1773.
Read more practice management stories here
