It’s been a dream of mine to open my own dedicated dry eye disease (DED) clinic—a place where diagnostics and advanced treatment technologies come together to help people feel and see their best. I’m thrilled to report, I’m working on making this dream a reality! Here’s a look at my journey so far. (See "My Office Space Considerations," below.)

Right after my residency at Cincinnati Eye Institute, I moved to Phoenix, Arizona, to work with Dr. Art Epstein at the Dry Eye Center of Arizona. He was a pioneer in DED, who sadly passed away in 2022, but I am grateful for the 3 years I spent learning from Dr. Epstein.

 

During this time, we performed up to 50 in-office DED treatments a week. That experience gave me a strong foundation in both clinical care and in the operations of managing a specialty practice. I learned how to create a schedule that efficiently incorporates in-office procedures, as well as navigate discussions around out-of-pocket costs with patients.

 

Those years also introduced me to advanced in-office dry eye treatment technologies, such as intense pulsed light (IPL).

 

Armed with 5 years of experience in Phoenix, I felt ready to take on ownership of my own DED clinic. As a result, I returned to Cincinnati, Ohio, to launch a cold-start practice focused exclusively on DED and ocular surface disease.

The Work Behind a Cold Start

 

It can also be a bit of a catch‑22 with financing and leasing, as both banks and landlords often want confirmation from the other before you can move forward. For this reason, I worked in parallel—talking with banks early, running financial projections through my consulting group, and lining up equipment plans—which allowed me to move quickly once I finally found the right space.

 

Another reality of starting a practice is generating income while your practice is still getting up and running. There are several options, including part-time or fill-in work, or speaking and consulting for industry. Whichever option is the best fit for you, I highly recommend making sure that your new practice is still your top priority; otherwise, it can get too easy to focus on your current position rather than what you are trying to build.

 

I’ve also learned that you only get one shot with the banks to determine how much they’ll lend you, so it’s critical to have your numbers and plans in order before you apply. I am thankful for the advice of friends who started their own practices and counseled me to: “Ask for slightly more than you think you’ll need.” As with any project, unexpected expenses are inevitable.

During this time, I’m also laying the groundwork to grow in a new market by taking a traditional, boots‑on‑the‑ground approach: meeting with local optometrists and other doctors and healthcare providers, such as rheumatologists, and primary care providers who see many patients who have DED.

 

Because I do a great deal of lecturing and speaking, both nationally and within the region where I’m building my practice, I have also been able to build recognition for when my dedicated DED clinic will open.

 

Additionally, I have an established network of friends and classmates already practicing in the area whom I stay in touch with regularly.

This boots-on-the-ground approach, lecturing and speaking, and relationships are helping establish a robust referral network once my doors officially open.

 

For most cold starts, I would expect the entire process to take 6 months to a year, depending on the type of practice and location. Two of the biggest milestones are getting loan approval and finding your physical practice space. I worked somewhat in reverse compared to most, as I found my lease space before finalizing my loan– although I had several preliminary discussions with banks ahead of time–so I was ready to go once I settled on a location. The benefit of this approach was that it allowed me to get a more accurate dollar amount when determining my loan number.

My clinic will be designed as a referral-based center dedicated exclusively to treating DED. My goal is to be a resource for other doctors—a place they can confidently send patients for high-level dry eye and ocular surface disease care.

 

Every piece of equipment has been selected to allow me to zero in on the specific issues behind each patient’s DED and create a truly personalized treatment plan.

In my pretest area, I’ll use a dedicated ocular surface analyzer to capture detailed data about the tear film and meibomian glands, allowing me to examine tear quality and quantity more thoroughly.

 

Additionally, I’ll have a slit lamp that has DED testing built into it, including anterior segment photography, so I can show patients pictures of exactly what I’m seeing.

 

On the treatment side, I’ll use IPL, which targets multiple contributory factors to dry eye, including inflammation, which is often a key underlying factor of meibomian gland dysfunction, and improves tear breakup time, meibum quality, and reduces the proinflammatory  telangiectatic blood vessels typically associated with ocular rosacea.

 

I’ll also use radiofrequency (RF) to complement IPL when needed, delivering targeted heat to stimulate collagen production, while also reaching into the deeper tissue to target the clogged meibum within the meibomian glands.

  

Additionally, I’ll bring in a dynamic muscle stimulation (DMSt) device to address eyelid laxity and poor blinking mechanics. Beyond these other advanced treatments, I will perform microblepharoexfoliation and ocular surface lavage as in-office ocular surface hygiene procedures.

 

My Vision of Success

The Right Time