The Secret to Growing a Thriving Eye Care Practice with High-Value Specialty Services

Summary

Power Hour Optometry: The Secret to Growing a Thriving Eye Care Practice with High-Value Specialty Services

Hosted by Eugene Shotsman, Episode released on March 5, 2025

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Introduction

In the March 5, 2025 episode of Power Hour Optometry, host Eugene Shotsman welcomes Dr. Jordan Dow from Dow Family Eye Care to discuss innovative strategies for expanding an eye care practice beyond routine exams. Recorded live at Vision Expo in Orlando, this episode delves into unlocking new revenue opportunities through high-value specialty services, effective patient interactions, and the integration of cutting-edge technologies like myopia management and Revital Vision.

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Practice Overview

Dr. Jordan Dow begins by sharing the journey of Dow Family Eye Care, which he launched in Jacksonville, Florida, in 2017 as a "cold start" from scratch. Overcoming initial challenges, including the COVID-19 pandemic, the practice has grown to see 100-150 patients weekly with plans to open a second location and expand the team.

Dr. Jordan Dow [02:15]: "We started with nothing but a hole in the ground... we slowly added different types of technologies into our office."

Dr. Dow emphasizes the practice’s commitment to differentiating itself through technology, specialty care, and exceptional patient experiences.

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Patient Interaction and Pre-Testing

A key factor in Dow Family Eye Care's success is their comprehensive approach to patient interactions. Upon entering the office, patients are greeted warmly to create a family-friendly atmosphere. The pre-testing process involves standard eye exams augmented by personalized questioning about the patient’s lifestyle and daily activities.

Dr. Jordan Dow [04:28]: "Our technicians are always asking questions... they're asking about their lives, about how they're doing, what their weekend was like."

This personalized approach allows Dr. Dow to tailor recommendations based on individual needs, thereby unlocking opportunities for specialty services without making patients feel like they are being sold additional products.

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Revenue and Specialty Services

Dow Family Eye Care achieves significant revenue growth by integrating specialty services into their comprehensive exams. Approximately 20% of their patients engage in specialized treatments, contributing to an average revenue of over $500 per patient, even among Medicaid recipients.

Dr. Jordan Dow [12:07]: "Average when it comes to Medicaid patients... we have Medicaid patients paying for myopia management programs."

Dr. Dow highlights that specialty services are seamlessly incorporated into regular exams, emphasizing solutions that genuinely improve patients’ lives rather than just upselling products.

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Myopia Management

A significant portion of the discussion centers on Dr. Dow’s myopia management program, which boasts a high acceptance rate among patients. The program involves thorough consultations and tailored treatment plans to slow or stop the progression of myopia in children.

Initiation and Consultation

Patients diagnosed with myopia are educated on the condition and its progression, shifting the narrative from inevitable worsening to proactive management.

Dr. Jordan Dow [15:37]: "Traditionally we just say, here are your glasses, see you next year. But now we have ways to slow it down or even stop it."

Treatment Options

Dr. Dow offers various myopia management options, including different drops, glasses, and contact lenses, allowing flexibility based on each patient's needs.

Dr. Jordan Dow [21:23]: "About 40 to 50% do soft contact lenses, 40 to 50% do orthokay."

Economic Model

The myopia management consult is offered free of charge to lower barriers for patients, leading to a high conversion rate. Pricing for the program ranges from $200 to $600, depending on the complexity and specific needs of the patient.

Dr. Jordan Dow [30:45]: "We charge differently, anywhere from 200 to $600 for the patient."

Dr. Dow ensures transparency in pricing and offers financing options to accommodate various financial situations, enhancing patient trust and willingness to invest in their eye health.

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Revital Vision Technology

Introducing Revital Vision, a groundbreaking FDA-approved home-based vision training program, Dr. Dow discusses its integration into Dow Family Eye Care. This technology focuses on training the brain to improve contrast sensitivity and visual acuity, offering solutions for conditions previously deemed untreatable in adults.

Patient Experience

Patients use a dedicated app to undergo vision training sessions from home, involving tasks that enhance brain processing related to vision. The program typically requires 30-minute sessions, three to four times a week, over two to three months.

Dr. Jordan Dow [27:24]: "It's like training for a marathon or taking piano lessons... little bite-sized sessions."

Results and Impact

Preliminary feedback shows significant improvements in vision quality, with some patients experiencing measurable enhancements in acuity and contrast sensitivity during follow-up visits.

Dr. Jordan Dow [35:54]: "There's a patient... his wife says, 'I don't even see what this is. I don't see what you're talking about.'"

Revital Vision positions Dow Family Eye Care as a technology leader, offering patients access to advanced treatments that enhance overall vision performance without additional chair time or equipment.

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Economics and Billing

The introduction of specialty services like myopia management and Revital Vision adds a substantial revenue stream to the practice. While myopia management remains a self-pay service due to the lack of insurance coverage, the high patient acceptance rates and flexible pricing ensure profitability.

Eugene Shotsman [41:43]: "You're charging $200 to $600... it's as much as a pair of glasses in some cases."

Revital Vision, similarly, is a patient-paid service that requires no extras on the practice’s end, making it an attractive high-margin offering.

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Conclusion

Dr. Jordan Dow’s innovative approach at Dow Family Eye Care showcases how integrating high-value specialty services and embracing new technologies can significantly enhance practice growth and patient satisfaction. By focusing on personalized patient interactions, transparent pricing, and offering cutting-edge treatments like myopia management and Revital Vision, Dr. Dow has successfully built a thriving, technology-forward eye care practice.

Dr. Jordan Dow [23:53]: "Confidence is the most important thing... every practitioner could have some version of myopia management in their practice."

This episode of Power Hour Optometry underscores the importance of evolving beyond traditional eye care services to meet the diverse needs of patients, ensuring both practice growth and improved patient outcomes.

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Notable Quotes

• Dr. Jordan Dow [02:15]: "We started with nothing but a hole in the ground... we slowly added different types of technologies into our office."
• Dr. Jordan Dow [04:28]: "Our technicians are always asking questions... they're asking about their lives, about how they're doing, what their weekend was like."
• Dr. Jordan Dow [12:07]: "Average when it comes to Medicaid patients... we have Medicaid patients paying for myopia management programs."
• Dr. Jordan Dow [15:37]: "Traditionally we just say, here are your glasses, see you next year. But now we have ways to slow it down or even stop it."
• Dr. Jordan Dow [21:23]: "About 40 to 50% do soft contact lenses, 40 to 50% do orthokay."
• Dr. Jordan Dow [27:24]: "It's like training for a marathon or taking piano lessons... little bite-sized sessions."
• Dr. Jordan Dow [35:54]: "There's a patient... his wife says, 'I don't even see what this is. I don't see what you're talking about.'"
• Dr. Jordan Dow [30:45]: "We charge differently, anywhere from 200 to $600 for the patient."
• Dr. Jordan Dow [23:53]: "Confidence is the most important thing... every practitioner could have some version of myopia management in their practice."

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About Revital Vision

Revital Vision is a pioneering FDA-approved home-based vision training program that enhances contrast sensitivity, visual acuity, and overall vision performance. Suitable for conditions like adult amblyopia, post-cataract vision issues, minor refractive errors, and sports vision, Revital Vision offers eye care professionals a high-margin, patient-paid service with no additional chair time or equipment needed. To learn more, visit revitalvision.com.

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About Power Practice

Power Practice is a premier consulting group dedicated to helping eye care practices achieve operational freedom, resolve complex issues, and drive growth. Offering expert coaching and consulting services, Power Practice empowers practices with the tools and strategies needed to thrive in a competitive market. Visit powerpractice.com for more information and access to free resources.

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This summary captures the essence of the podcast episode, providing a comprehensive overview of the strategies discussed by Dr. Jordan Dow to grow a successful eye care practice through specialized services and innovative technologies.

Transcript

[Dr. Jordan Dow]

Foreign.

[Eugene Shotsman]

Welcome to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Shotsman. And today's episode is definitely going to be a fascinating one for anyone looking to expand their practice beyond routine exams or to refine your ability to drive cash, procedures and specialty care. So we recorded this episode live in Orlando at Vision Expo in the Launchpad Innovation booth. And my guest today is Dr. Jordan Dow, and he's doing some really innovative things at his practice. Jordan began as a cold start for context, and this was a few years ago, and now he's built Dow Family Eye Care into a thriving technology forward practice that prioritizes specialty care, patient experience, and definitely premium service offerings. So what do we cover today? We cover a lot. First, we talk about how patient conversations can unlock new revenue opportunities. We discuss the role of pre testing in your practice and how it sets up the premium treatment plans. And their conversations between talk about how Jordan has successfully implemented myopia management, including how he even gets Medicaid patients to pay for myopia programs. And we also do a deep dive into a new and emerging technology that trains the brain to improve vision and also how Jordan uses it in his practice. So most importantly, we talk about the mindset of how to structure patient interactions so that specialty services feel like a natural next step for patients and not a sales pitch. So before we dive in, three things. Number one, this episode is sponsored by Revital Vision, one of the innovators featured at Vision Expo. We actually have a show coming out in a week or two which includes a deep dive into all of their technology and innovations. Number two, quick reminder to subscribe on YouTube, Spotify, Apple Podcasts, or wherever you get your shows so that you never miss an episode. And number three, if you want to connect with me, share feedback or suggest future guests, or just reach out, visit Eugeneshotsman.com I love hearing from you guys. Now let's go to the show.

Hi, welcome to the Power Hour. My guest today, Dr. Jordan Dow. Jordan, I am excited to talk to you because you're doing so many different things in your practice and it feels so innovative. Why don't you just give the audience a quick overview of your practice and kind of how you got into it?

[Dr. Jordan Dow]

Yeah, so we opened up as a private practice at Dow Family Eye Care out in Jacksonville, Florida back in 2017. And when we opened up the practice.

[Eugene Shotsman]

It was a cold start.

[Dr. Jordan Dow]

It was a cold start. It was a cold start. So started with nothing but a hole in the ground. And we opened up and we really wanted to separate ourselves. We wanted to be a little bit different. We had a lot of different ideas what we wanted to do. And we slowly added different types of technologies into our office. Things like myopia management, things like neuralens, radio frequency and ipl. You know, we have a lot of different ways that we've been able to treat patients just in our little practice.

[Eugene Shotsman]

Okay, so your cold start gives the audience a little bit of an idea of volume so that they understand kind of, you know, the kind of practice that you're running.

[Dr. Jordan Dow]

Well, you know, as we were growing, obviously being a cold start, you know, slow start, and then we had that nice little Covid that went right there in the middle. And so now we've really been able to grow into a practice where we're seeing about 100, 150 patients a week. It's myself and my associate. We're about to open up a second location and have another associate coming on board. And so we've really been growing. Great. Because I think we're offering something different.

[Eugene Shotsman]

To the community from a volume standpoint. What percentage of your patients are what I call. Let's kind of start breaking down the numbers a little bit. And it's okay if they're approximate, but approximately what percentage of your patients are primary, comprehensive exams and nothing else. And then what percentage of your patients are something that you'd call a specialty in your practice?

[Dr. Jordan Dow]

So the thing about specialty is I think that specialty is actually should be part of a comprehensive exam. I think when we're talking about the patients, we're not searching for specialty patients. They're coming in with everyday problems, they're coming in with everyday complaints. And so most of our patients come in just as a general exam. And we're just simply hearing what their problems are, not just what their complaint is, but how their eyes are affecting their lives. Sometimes it's headaches, sometimes it's dryness. And we're actually educating them on options out there that they've never heard of before.

[Eugene Shotsman]

So tell me more about how this pre screening happens in your office. Maybe. Let's start with the whole patient flow in your office. Somebody walks in and, you know, they, I don't know, like they googled eye doctor and they found you and they walk in the door. Give me a feel of what Dow family eye care feels like.

[Dr. Jordan Dow]

Patient walks in and, you know, first thing is our staff has to be very welcoming. This is a family atmosphere. We want them to feel like they are taken care of. And when they go through the Workup process. Our technicians are always asking them questions. It's not just sit at the machine and take a picture. They're asking questions about their lives, about, you know, how they're doing, what their weekend was like, you know, what they have plans coming up, what's in their lives? And then they get in the room and I have a conversation with them. My first question to a patient isn't, how are your eyes? It's how are you? You know, how was your weekend? What do you have planned for? And so we have a conversation. I learn more about a patient's life and we use that information to basically make their lives better, which is how we're able to make the recommendations that we do.

[Eugene Shotsman]

And let's go back for a second to the pre testing. So what kind of pre testing are you doing in your patients?

[Dr. Jordan Dow]

Well, you know, we're just a standard practice. We come in and for a patient that's coming in for their comprehensive, which again is most of them, we're doing auto refractor. We're, you know, Iop check, you know, we have an optimap, you know, nothing too crazy out there versus most practices. I feel like it's really what separates us is the questions is really what direction can we take it? And so during it, if we're finding headaches, we're going to run screening for neurolens. If we have dry eyes, we're going to run a screening with a mammographer. If it's a patient who's under age of 18, we go ahead and run, you know, corneal topography with axial length so we can start tracking them for myopia management, regardless of what their prescription actually is. So it really differentiates based on what the patient's actually coming in, talking about.

[Eugene Shotsman]

By the way, do you charge extra for any of this pre testing?

[Dr. Jordan Dow]

Only the optimap. Everything else we just offer as part of our routine.

[Eugene Shotsman]

Okay, so patient comes in for a comprehensive and then they go through this pre testing and then they're in the room with you. Now you're asking lifestyle questions. Now, to you it probably seems routine, but let's go through exactly what that looks like. So when you're talking to them about their, first of all, have they filled anything out that kind of gives you a hint of what rock to look under? And if they filled something out, what does that look like?

[Dr. Jordan Dow]

So first off, my technicians are fantastic at asking their questions and they're just going to type a little summary of how their conversations have went with the patients. What sort of problems are they experiencing. And so I'm able to know what the general problem is before I start talking. But then I start asking about what do they do if they're a new patient? What do they do for a living? What do they do when they're not working? What do they do for fun? What's important to them in their lives? If you can teach someone to basically golf better, they're going to love you.

[Eugene Shotsman]

Right. And when you're talking to them about this, how long is a typical exam for you?

[Dr. Jordan Dow]

For me, we usually do, well, 20 minute exam slots. And so we go in, have our conversation, and the conversation is a good, you know, five, six, seven minutes of it. And then we go through the testing and then it's the education part. And I think the education is just as important as the questions on the front end.

[Eugene Shotsman]

Got it. So let's now dig in. And I. One of the reasons I'm setting up this preamble is because I want people to understand that it doesn't have to take super long time. But when you're having this quality conversation with the patient, it opens the door up to a whole bunch of specialty services, specialty care, which probably pays substantially more than just selling frames and lenses, right?

[Dr. Jordan Dow]

Yep, absolutely. And our patient demographics are all over the place. Even in terms of insurance. We see a lot of managed vision care, a lot of Medicaid patients, and yet because we do all this testing without classifying based on the insurance, we have Medicaid patients paying for myopia management programs.

[Eugene Shotsman]

Okay, this is going to get really, really interesting when we dig into that. So I do want to know how you get a Medicaid patient to pay for my opiate management program. But let's back up for a second. So you're doing the, you're asking them about lifestyle questions and, you know, they tell you that they're a golfer or they tell you that, you know, they're, you know, as maybe you're asking kid related lifestyle questions. What do those sound like?

[Dr. Jordan Dow]

You know, it's really just, it's. Every patient's different. You know, when you're seeing a family, you're talking to them about, you know, what are they doing at home, what are they doing together, you know, what's their weekend? And it's really, I'm looking for how do they use their eyes? The amount of times that you ask a patient, you know, are you having issues seeing? And they say, no, my vision's fine. But then you start probing into how they're actually living Their lives. And you start hearing about headaches. You start hearing about fatigue and strain. You start feeling like they don't feel comfortable driving at night. So you start hearing these little things when you ask these questions.

[Eugene Shotsman]

Exactly. Okay, perfect. So you got. By the way, are there any favorite questions that you're asking that you're like, that you're. That you've learned over the years that you're like, okay, these are great lifestyle questions to ask.

[Dr. Jordan Dow]

Yeah, tell me what you're doing when you're not working. What would you be doing if you were not here with me right now?

[Eugene Shotsman]

Okay, great. And so somebody might say, oh, I'm going boating. Or somebody might say, we watch TV or we just chill and relax and that kind of thing.

[Dr. Jordan Dow]

You learn what's important to them. You hear what they want to do with their lives, because that's going to be the part that they want to improve just as much as their work.

[Eugene Shotsman]

And what's the follow up on that? Once you say, okay, yep, I'm going.

[Dr. Jordan Dow]

Boating, well, then I start finding out some sort of story I have about boating, you know, and make it relatable. You know, it becomes a conversation. You know, they tell me about, you know, something about what they enjoy doing. I want to be able to have a conversation with about it. If I don't know nothing about it, if I don't know anything about boating, I want to ask them to tell me something about boating. What does that mean? What does boating look like to them?

[Eugene Shotsman]

Okay, so then they get into the conversation of, okay, this is why this lifestyle. This is what I do. And then how do you bring it back to. And how is your vision while you're boating?

[Dr. Jordan Dow]

You know, you listen for the little cues. You know, the, you know, hey, how's the glare? Do you feel like you had to squint a lot? You know, how is. You know, do you feel like you have to. You're getting a headache when you're having to work too hard on the computer, if you're playing video games, do you get tired after a bit and are your eyes watering a lot? You start hearing these little things. And that's something that as eye care professionals, we've gotten great at overall, is being able to hear patients complaints and finding a solution to them.

[Eugene Shotsman]

Okay, so I love this. So you've gotten really deep in lifestyle. Now comes the time for recommendation. Talk to me about how you do that.

[Dr. Jordan Dow]

Well, I try knowing what we have available to us and knowing that a patient probably has never heard of any of these things. I bring it back to what's affecting them the most. If the patient is saying something where their eyes are getting tired at the end of the day and they're getting a headache and they just want to go home and take a nap. Okay, well, here's something where we can talk about making your strain a lot less. Make it so you feel a lot more comfortable at the end of the day. If we're talking about myopia, that one's pretty cut and dry. Where if your kid's showing signs of myopic progression, we go and talk to them about that. It's really going to be about, now we've gotten this information, now we know the patient, and now they feel comfortable talking to us, asking us questions. Now we're able to truly have a. A good conversation about, you know, what direction do we want to do to make their lives better.

[Eugene Shotsman]

Got it. Great. So when you transition to it, you kind of get them to prioritize their concerns. Right. So is that glare while you're boating a big. A big issue for you like that? I'm just paraphrasing what you're telling me, and then you get them to explain, and then you get to say, well, okay, so I might have something for that. Now, before we go into your recommended treatment options and things like that, let's talk about numbers. Revenue per patient. And do you track that? And how do you track it? And do you track it by the specialties?

[Dr. Jordan Dow]

Yeah, we don't track it by the specialties. It's kind of all lumped together. And so I know for us, we average, you know, $500 per patient. Average when it comes to Medicaid patients.

[Eugene Shotsman]

Yeah, because there's a lot of practices that are listening. They're saying, well, we don't take Medicaid. So. But in this case, you're saying you take Medicaid and Also you have a 500 plus revenue per patient. Okay, great.

[Dr. Jordan Dow]

Absolutely.

[Eugene Shotsman]

And then what percentage of your patients do some sort of what we'll call specialty?

[Dr. Jordan Dow]

Ooh. Yeah. So that's. That's a tough one, I'd say, because we offer so many different ones and there's always something that we can do for a patient, maybe 20%.

[Eugene Shotsman]

Okay, so 20% of your patients end up doing some sort of specialty. And what percentage of the patients that you recommend specialty services to actually take you up on a treatment plan?

[Dr. Jordan Dow]

I mean, close to all of them. You know, when we're talking about a recommendation for a specialty, it's because we found something that's important to them and how to affect their lives. And so typically when patients are hearing about the benefits, they want to fix it too. They want to make it better. And now that we've had the conversation, they're trusting my recommendation on it. And usually it's not about, you know, if they want to do it or not. I already know they want it to be fixed. It's about how do we get them to convert, how do we land the plane.

[Eugene Shotsman]

Got it. Okay, so we have a high percentage of patients that take you up on it. And we're going to talk about some of the specifics and how you do this in a moment. But the one other question is, obviously price comes up. And with some of these specialties, do you explain the price? Does your optician explain the price? Do you have a treatment coordinator tell me how your office is staffed?

[Dr. Jordan Dow]

Yeah. So it depends on what we're doing. If we are going to go ahead and talk about myopia management. That's a big conversation with a lot of different potential price points. And we have a patient come back for a consultation where they meet with one of my staff members that's been trained to do the consultation. Same with dry eye treatments for something like revital vision, which is the new thing that we've been bringing to our office recently. That something is a little bit lower on the cost level for the patient, still very profitable for us, but something that they'd never heard of as well and can help with a lot of different patients. So when we start talking about that, that's something I can just talk about to the patient in the chair and get them interested and signed up right away for that.

[Eugene Shotsman]

Got it. Okay, so we're gonna come back to. We're gonna go through these one by one. Let's start with myopia management. So you have a myopia management. So you have a kid in your chair. And you know, so how do you start that conversation with the patient? Cause you're saying you have a pretty high acceptance rate for your treatment plan. So let's talk about how you do that.

[Dr. Jordan Dow]

So first off, it's what are we trying to accomplish when we have the kid in the chair? And maybe they didn't know they were myopic. Maybe they failed a screening and the parent didn't think the kid was telling the truth. Maybe the kid's been complaining for years and now we're finally getting into get checked out. First off, we're saying they are myopic. We tell them what that means. We talk about it as a disease. It's a change in the eye structure. We're saying this is something that has happened and it's going to get worse as the kid grows. The eye is going to continue to change and this is just going to keep getting worse and worse and worse every single year. Now, traditionally we just say, here are your glasses, see you next year. And that's all we can do, knowing it's going to get worse and worse and worse. But now we have ways to get in the way of that. We can slow it down or even stop it in some cases where we can actually keep the eye from progressing, keep your kids eyes from getting worse. And now they are invested, now they want to know how to do this because they don't want their kid to be in, you know, the terrible high glasses prescriptions, right?

[Eugene Shotsman]

So you say this to the parent, and most of the time the parent says, okay, fine, tell me more. And then your, your plan then is to bring that kid back for a myopia management consult.

[Dr. Jordan Dow]

I give them a very brief rundown of what this is. You know, okay, we have different drops and glasses and contact lens options that work, you know, like this, this, this. And so that's a lot of information. That's a lot of questions you want to have. We actually give them the information, tell them to check our website because it has some information on there. Do your research, come in with questions, because I want to talk more about this. I tell them, don't get glasses today because this is serious. We need to address this. We need to come up with the right plan, come back another day, and we're going to fix this for you.

[Eugene Shotsman]

Okay? And then, so tell me about the myopia management consult. Is that a medical appointment or is that a. How do you bill that?

[Dr. Jordan Dow]

Because we have such a high conversion rate, we actually don't charge for the consultation because we know most patients are going to convert because they're going to come in. We'd rather have the patient not have any barriers to keep them from coming in for that consultation when they learn they want to fix it. We've been fortunate enough to figure out how to have that high conversion rate. It makes it worth it for us to do more consultations at no cost.

[Eugene Shotsman]

Well, it kind of makes sense to me that you would say to a parent, hey, I need to spend more time with you, educating you on this. I need you to come back for free at no cost to do a full myopia management consult. Is that what you call it? By the way myopia management consult or whatever.

[Dr. Jordan Dow]

We do a free consultation where we talk more about the different options. And another big point that we want to try to tell them is come in with questions. You do research, come in and you tell me what you find, because I want to make sure that you are invested this as much as I am, and I'm talking to the child as well. The child is going to have their own say, no matter what. So.

[Eugene Shotsman]

Got it. Okay, so then take me through the myopia management consult. What are you doing? How's it go?

[Dr. Jordan Dow]

Yeah, first off, if we're doing a consultation, a lot of times another parent will come into the office with them. And so we have mom and dad there. You know, we have brothers and sisters, and everyone wants to be there. And we go into the, you know, general information of what is myopia and, you know, go in more details.

[Eugene Shotsman]

By the way, an important part. You said you would want to have the mom and the dad there.

[Dr. Jordan Dow]

Yeah.

[Eugene Shotsman]

You want to have the, the. All the decision makers in the room. Smart move. Right. Because then there's no. We've got to go talk to so and so about this.

[Dr. Jordan Dow]

Exactly. At the end of the consultation, there should be a decision. All right? Even if that decision is to wait and see, it's still a decision. There should be no meandering. We are very confident that this is what we need to do. I, you know, we'll say it's very similar to glaucoma. If you have a patient coming in with, you know, IOPS of 35, you're not saying, let's think about this. You know, go ahead and go home and tell me if you want to go on drops or something.

[Eugene Shotsman]

Right.

[Dr. Jordan Dow]

You know, we're saying, no, this is what we need to do. If they say, I don't want to do drops, okay, then we're going to do surgery or something and we treat our myopia patients the same way. You know, we need a solution at the end of this. We need to know what's going on. So come in prepared with questions, come in with information. We're giving you information so you can go home and do research and bring in all the decision makers because we're going to figure this out now.

[Eugene Shotsman]

They have no idea what it costs beforehand.

[Dr. Jordan Dow]

Correct?

[Eugene Shotsman]

Okay.

[Dr. Jordan Dow]

Yeah.

[Eugene Shotsman]

Great. So that. Okay, so now you're here. You explain what myopia management or what myopia is to the. To the parents. You explain it to the. You. Do you run additional. Is there any additional testing or anything?

[Dr. Jordan Dow]

No, because We've already done that all on the front end. We've already done axial length and topography. You know, we've already done everything that we need to.

[Eugene Shotsman]

Got it. Okay, great. So patient. Patients there, the parents are there, you've talked about myopia. Then what's the. How do you transition into. Okay, so these are your options or not?

[Dr. Jordan Dow]

Yeah. So we do the general information, and then we go into the how do we fix it? We talk in depth, pros and cons, about each of the different, you know, options that we have in our office and make sure they understand how they work. And then at the end of it, we go over what the schedule is, and then we go over what the pricing is. We're very detailed about it. It's very transparent. We actually have a PowerPoint presentation that we have a slide up there that shows it very clearly. We have a form that we bring out so they can see it physically, and we just tell them this is what it is. And, you know, it's different price points depending on what they're doing. And, you know, we offer, you know, different financing options through, you know, CareCredit, Sunbit, those kinds of things. And so it's all about, how do we make this work?

[Eugene Shotsman]

And by the way, what do you price your myopia management program at?

[Dr. Jordan Dow]

So it does vary. You know, that's a bigger question. You know, we have it separated. Our orthokay patients are paying something different than our patients who just want to go under atropine. And I think that's what gives some flexibility to patients all across the board, that there is an option for them.

[Eugene Shotsman]

So you give. So you have a range and Low.

[Dr. Jordan Dow]

End on your range, $600.

[Eugene Shotsman]

Okay. High end on your range, 23. Okay. So can you say. So there's two ways we can treat this, A or B? I recommend A. Yeah, I'll say.

[Dr. Jordan Dow]

You know, all things, you know, taken into account here of what your prescription is, what it's been like working with the child, me knowing how sensitive they are around their eyes, how do they do when they got the drops in, you know, all this, these little details that come in during the. The exam, we're able to use that information to make the best recommendation for the patient.

[Eugene Shotsman]

Got it. Okay, great. So. And you're saying you have a really high acceptance rate on this?

[Dr. Jordan Dow]

Yeah, yeah.

[Eugene Shotsman]

Do you also, at that point, give them glasses? And, you know, because you said in the beginning they didn't get any.

[Dr. Jordan Dow]

And the reason why I tell them that is because I've given A brief run through of like, what orthokeratology is. And so basically I tell them, if that sounds interesting to you at all, don't get glasses right now because in two weeks you won't need glasses.

[Eugene Shotsman]

And so what percentage of your patients end up going with drops? What percentage go with lenses?

[Dr. Jordan Dow]

I'd say about, you know, 40 to 50% do, you know, soft contact lenses, 40, 50% do orthokay. And then the remaining kind of five, 10, kind of varies around there is some combination of glasses, drops.

[Eugene Shotsman]

Got it. Okay, great. And you're finding no issues with. And you mentioned the financing thing. That's an important part of the conversation. But you're finding no issues with parents then saying, okay, I need to do this for my kid, I need to move forward.

[Dr. Jordan Dow]

I think it's about understanding the situation, understanding being relatable to them, understanding that this is something that I'm not just telling them to do this because I said to, but because this is going to make their lives better and that we are as invested in trying to find a solution as well. Sometimes it is just, okay, we just need to get you regular glasses and come back in six months and do a check and see how things are at. But now you know what it costs. Now you know what to plan for. And we just have to find a way to make this so that in the future he or she is not going to have this worst prescription.

[Eugene Shotsman]

Got it. Okay. So now, and when you're thinking about, oh, by the way, one question I didn't ask is when you're explaining myopia, how do you explain the progression component? Because that's, you know, that's the big fear, right? That's the thing we want patients or parents to really understand. And I've heard from other providers that that's the thing that's hardest to explain. It's also the thing that, you know, it's like the thing you can't see. So it's hard to explain.

[Dr. Jordan Dow]

Well, I tell them that if your eye was a normal size, then you would have no prescription. If it's a little too short, you're farsighted. If it's a little too long, it's nearsighted. And basically, as your child has grown, their eyes have grown longer as well. And that has made their prescription change. They used to not be nearsighted. Now they are. And unfortunately, they're going to continue growing. And as they get taller, their eyes are going to continue to grow as well. And so we know their prescription is going to Continue getting worse and worse and worse every single year.

[Eugene Shotsman]

Great. That's a fantastic explanation. That seems like it makes perfect sense. And it would make sense to a parent, because a parent understands their kid's gonna grow. Okay, perfect. So we talked about myopia management. Anything else you want to add with kind of tips for the audience? One thing I really liked about what you said, and I just want to call it out, is that you're not really giving them the option. You're delivering this with enough confidence that it's not a. You're gonna have to do something. You're gonna have to do something today, and I'm recommending this.

[Dr. Jordan Dow]

Yeah, basically, I think confidence is the most important thing. We all know that myopia management is important. We all know that if there were no barriers, that we would want every myopic child to be in myopia management. So treat them that way. Get them into myopia management, have the confidence, and if there's a lot of resources out there on how to learn how to do this more effectively, more efficiently. There's so many different ways to be successful with this that I think that every practitioner could have some version of myopia management in their practice.

[Eugene Shotsman]

Are you talking about price or is your counselor are talking about pricing?

[Dr. Jordan Dow]

It depends on who's doing the consultation. And so we save the pricing for the actual consultation. And if it's myself doing it with the PowerPoint presentation and we go through, then, yeah, I'll talk about the price. If it is my technician, then they will go over it. But I always tell the patients, we have a range of sometimes this to this, and it just depends on what we choose. And really, when we come back, we'll go through which option we think is best and figure out a way to make it happen.

[Eugene Shotsman]

Got it. Okay, that's great. Okay, so that's myopia management. I think that's a lot of useful information on that front. You mentioned something new, and this whole revital vision thing certainly came up. And there's one of the reasons why I wanted to cover it at Expo here, because it's kind of a new concept for the industry. So let's talk about your experience with that.

[Dr. Jordan Dow]

Yeah. So first off, I'll say this is very new to the United States, but the technology's actually been out there in the world for a while. And when I first heard about it, my first reaction was, that sounds crazy. I want to do some research. And so I went back and I looked at all the studies. What this actually Is is this is a at home training program that you can put a patient through on their own computer where they are teaching the brain to see better by improving contrast sensitivity. By improving contrast sensitivity, you're improving acuity. By improving acuity, you're improving stereopsis. And there's 30 years of studies showing us getting to this point. And so when we're talking about the patients and they're coming in with problems, for me, it's how can I make your life better? And there are a lot of patients where there was no solution. An amblyopic patient who's an adult, they're 30 years old and they've had 2050 vision out of one of their eyes their whole lives. And they've accepted it, I've accepted it. That's just the way they are. You have that frustrating patient where they're 45 years old and they should have been reading glasses three years ago, but they just refuse to do it. Patients that have difficulty driving at night glare, and I don't have any solution except for giving them glasses that they don't want to wear because they see 2020 uncorrected already. And so when we have all these different patients, these are the ones that I go home with and I'm thinking, what could I have done better? Like, what can we do? Because I want to help every patient and these are ones that I can't. And so revital vision, because it's working on a different system than what we are typically working with. Normally we're taking the eyes and we're making the eyes see better. We're doing different things to improve the health of the eyes, or we're improving the refraction, but whatever lands on the retina, that's what the patient gets. And so what viral vision is doing is it's allowing the brain to process the information better so they just simply see better at the end of their training. And so there it's FDA approved for adult amblyopia, which is the only thing out there that does that and a huge range of different things that we can treat anytime. You have a patient that could benefit from improved contrast sensitivity. That's what we're really talking to patients about here.

[Eugene Shotsman]

Okay, so what is the patient experience with this thing? Because you're saying this is at home, so what am I doing? If I'm the patient, what am I doing at home?

[Dr. Jordan Dow]

So we give them access to a license and they're able to log in and create their own little portal. But then they have a computer screen, they Sit about, you know, five feet away from the computer screen. It has to be in a dark room and it has a good list of instructions when they're first doing this. So it's a very good tutorial on how they're supposed to set this up. But they're basically going on their own computer at home and it's giving a sequence of questions, it's giving two different pictures, boom, boom, back to back. And one of them has, I tell patients the real answer and one of them does not. And they're just picking which one had the real answer. And as they get them right, the questions get harder and harder and harder. As they get them wrong, it gets a little bit easier. And so it's this constant push, it's this constant training. Just like anything else. I tell my patients it's very similar to training for a marathon or taking piano lessons. You're doing these little bite sized sessions and these sessions last for about 30 minutes. They do the session about three or four sessions per week. And they want to get to between 30 and 40 sessions, depending on what we're trying to fix. At the end of that, the Studies are showing 100% improvement in contrast sensitivity, two and a half lines, improvement in acuity, improved stereopsis. It's pretty consistent. Pretty wild how in many ways it's improving things.

[Eugene Shotsman]

You're saying after how long?

[Dr. Jordan Dow]

About 30 or 40 sessions. So that ends up being about two to three months.

[Eugene Shotsman]

Wow. And that improvement is. It's not just according to the software. You can bring them back into clinic and you can see that.

[Dr. Jordan Dow]

Yeah, absolutely. You know, if you have the ability to measure contrast sensitivity, that's great. But if you're talking about an adult amblyo, that's an easy thing to kind of gauge. They were 20, 40, you know, two months ago and now they're 20, 25. 2020. That's amazing. That's something, that's a patient that we've written off traditionally. We have said there's nothing we can do for this patient and now all of a sudden they're not amblyopic anymore.

[Eugene Shotsman]

Right. So what's interesting to me is that first of all, not a lot of people know about this, but what is the resistance? So first of all, there's so many questions. Let's start with the. When you explain this to the patient, how does a patient take the fact that you're giving them homework and you're going to charge them to do that homework?

[Dr. Jordan Dow]

Again, it comes down to what are we trying to fix and how Much it matters to them. You know, we don't talk about this to every single patient, just every patient that's having a problem. If that patient is talking about, oh man, I can't drive at night because glare is terrible. You know, I had, I have these multifocal iols that just now I can't drive at night anymore and it's terrible. Or if it's again, you know, amblyope, if they're not wanting to wear reading glasses, whatever it is, we frame the conversation around that problem and we actually, you know, tailor the program to that specific problem as well. And so sometimes we'll have, you know, a patient that comes in that, you know, kid needs, you know, improved, you know, sensitivity under the lights while playing baseball, but then the parent doesn't want to wear reading glasses. And so we're actually talking about the same program at two different levels for each one. But it's really taking it again. How are we solving your problem? How are we, how are we fixing this?

[Eugene Shotsman]

And it's so important that your lifestyle questionnaire, kind of lifestyle conversation that you spent an extra three minutes having with the patient, it feeds right into this.

[Dr. Jordan Dow]

It is.

[Eugene Shotsman]

Okay, so let's talk about the economics of this whole thing. How does the patient pay? What's it cost? How do you make money? How does the really like. Is there a billing code for this?

[Dr. Jordan Dow]

There isn't a code right now. While it is FDA approved, there is a CPT code for adult amblyopia. It's not being taken by any insurances yet. So this is still a self pay service. And depending on the program, we charge differently, anywhere from 200 to $600 for the patient. And what that includes is that includes their access to the license and it includes all the information and data that we're able to monitor from the office as well to see how the patient is doing on their results. In certain ones, the company Revital Vision will actually send them glasses to help with the training for an early presbyope or a low myope. And really we do a couple follow up visits, one at the 50% mark and one at the session completion and they will actually get email reminders to come in to see us during those as well.

[Eugene Shotsman]

So you bring them into the office for those assessments?

[Dr. Jordan Dow]

Yes, it's just a quick little acuity check, just hey, how are you doing? And move on. It does not take a lot of time. Takes less time than a contact lens check.

[Eugene Shotsman]

Do patients actually do this every day? Is that like there are a few.

[Dr. Jordan Dow]

Of them that are, you know, and what's nice is I can go ahead and bring up my list of patients, you know, with my portal, and I can actually see how everyone's doing. I can see how many sessions they've done. I can see when their last session was. And we can have my. I have my technicians actually call to remind them, hey, it's been a while. Why don't you go ahead and, you know, tell me if there's any problems with this? And sometimes it's what, they went on vacation, sometimes they forgot life got in the way. Bring them in, show that there's some improvements and show them their results, and they'll get right back on the train.

[Eugene Shotsman]

Right now, the license lasts for how long?

[Dr. Jordan Dow]

So, yeah, the license actually lasts for one year or 80 sessions. All right, so it's more than enough, considering that even for an adult amblyope, you're capping them out at 40 sessions. That's just a big old buffer zone. Just in case you do need to restart. It does need a few more sessions. They did take a vacation.

[Eugene Shotsman]

So if I don't do it consecutively, do I have to restart? Or like, how many days can I take off if I'm a patient?

[Dr. Jordan Dow]

So when you actually have that tutorial, it says don't do it. Don't skip more than seven days in a row. All right? I tell them do three or four a week. But there's also. It actually does a lockout after 24 hours. So they can't just do it every single day and then just be done in two weeks.

[Eugene Shotsman]

Weeks.

[Dr. Jordan Dow]

It's something where, you know, there has to be some spacing. You have again, this is like taking piano lessons. You can't just practice for eight hours in a row and just be good. You have to kind of do multiple different sessions over the course of a period of time. And that's what we're doing. We're training the brain to do something different.

[Eugene Shotsman]

Well, and I love the comparison to piano lessons for your eyes or something like that, because it really is. I mean, it is teaching you and your eyes and your brain to. To see differently with the same stimuli.

[Dr. Jordan Dow]

And one thing that's really cool about this is we tell patients, you know, the studies are showing that this sticks, it lasts. It's not something they have to do every single time, not every single year. They come in, they have to redo the same price and the same training. They have studies that show one year later it's stable, two years later it's stable, and they're working on a study right now where they're looking at what the five year results are.

[Eugene Shotsman]

Interesting. How many practices are using this worldwide, do you know?

[Dr. Jordan Dow]

It actually only launched in January of this year in the United States, but worldwide, oh boy. I don't honestly know. A few thousand.

[Eugene Shotsman]

We'll ask the company. Maybe we'll put something at the end of the show that kind of explains that. Now, how did you decide to get into this? Because this is. Obviously you're kind of on the innovators list for a reason. But why did you decide that you were going to offer this to your patients? And why is it that, like, you know, how did you even. Obviously, anything new that hasn't been tried by 100 of your colleagues is a little bit of a risk. Is it going to work? Are the patients going to have a good result? Tell me.

[Dr. Jordan Dow]

So really it came down to, you know, what we've done in our practice has been separate ourselves through our technology, through the resources that we have. And so I actually had the company reach out to me and say, hey, we kind of are looking at, you know, marketing this in the United States. Would you be willing to help out? And I told them I need to look at the research first. And so I actually went onto their website and I went through all of their studies. They have about 28 studies or so out there right now, going back again 30 years. And, you know, I'm a tough one to convince with these kinds of things. And so when I went through the studies and I was able to see the results, the consistency of the results, regardless of the condition that was being fixed, you know, they have studies ranging from, you know, amblyopia to again, low myopes, early presbyopes. They have diseases, keratoconus, nystagmus, stargardts. They have studies on all of these different things and seeing the same consistent results, no matter what we were trying to do from different study coordinators and things like that, it really gives it an air of stability. I really became a believer that the technology would work, it made sense, and that the results were consistent for us, even though it's only been out for a couple months, we're very excited to try it out for patients to be at the forefront of this technology because we already have the benefit of having 30 years of studies showing that it works. It's just a matter of, let's do it for our patients now.

[Eugene Shotsman]

And have you seen your patients come back and they actually have results that they can talk to you about?

[Dr. Jordan Dow]

So we haven't quite had the opportunity to have anyone go for the full three, four months yet or two, three months yet. But we do have some there at their halfway points. And we're getting feedback when I go through and we're getting feedback from the patient. There's one in particular I think is great because it's an adult male about 42 years old. They're low myope and their early presbyope. And so they're kind of in this. Which one are we trying to fix? And when they started, their wife was over their shoulder just kind of watching and saying, yep, that's easy, that's whatever. And then at the halfway point, he's answering questions correctly and his wife who's just kind of watching over the shoulder is like, I don't even see what this is. I don't see what you're talking about. And so just, just seeing that story, hearing that story of how the wife is seeing how much of improvement is happening in her husband's eyes because he's been doing the training. It's just such a cool thing to see.

[Eugene Shotsman]

Yeah, that's interesting. And it'll be awesome to circle back with you once you've had, I don't know, some significant number of patients go through and then you can tell us and we'll do a little follow up to this episode. Maybe put it in the show notes in a few weeks or maybe a few months. Is that what are the patient experience points and really can they talk about their lifestyle again and say, well, you fixed this doctor, that's amazing.

[Dr. Jordan Dow]

Yeah, I'm really excited to see what happens. We have about 30 or 40 patients doing this now at some level and we have them all over the place. I have amblyopes, nystagmus, I have a lot of those little low refractive patients. I have a bunch of, honestly going back to my opiate management, a bunch of orthokay patients that are seeing 20, 25 because you know, there's some residual prescription. And now we're putting them onto this program additionally and it's cleaning up that vision that they have. And so we have patients all over the spectrum on who we're helping with this and I'm really excited to see what the results are going to be when we're all said and done. But so far they've been very promising.

[Eugene Shotsman]

Yeah. And what's fun about this is that it's helpful for the patients. And by the way, let's talk about treatment acceptance plans when you're presenting this to patients Obviously, you're saying there's a little bit of a new thing. Right. And so what percentage of the patients that you talk to about this end up saying, oh, awesome, let's try it?

[Dr. Jordan Dow]

Yeah. So first off, I'll say that we have not done any extra marketing on this. The only patients that we have talked to about this are the ones in the chair in front of us. We don't have the materials yet on how to kind of have this go out there. And so every patient that we're having this conversation with, it is new. It is crazy. It sounds like a snake oil pill. Right. And what I tell them is I welcome them to go and look at the studies. I've seen the studies. They've made me a believer. I really want to see how this goes. And really, when we're talking about how badly does the patient want to see better without being as dependent on their reading glasses, how is it affecting their driving at night? And when you have these patients that are frustrated and you're just saying, I have a solution, this is a new solution. Are you willing to try it? It's a few hundred dollars. It's as much as a pair of glasses in some cases. But this might be something that helps for forever.

[Eugene Shotsman]

And do you find yourself in a place where those patients are ready and willing to accept it? And what percentage of the patients that you talk to about this? Yeah, absolutely. It's from. Right?

[Dr. Jordan Dow]

Yeah. Honestly, there isn't a huge amount, high percentage that are wanting to jump in and do it. There's a lot that are interested and want to see as well. Just like a lot of doctors out there. And we're just recommending it so many times because it doesn't take more than two minutes to explain to a patient, I'm teaching your brain to see better. And there's so many of them that are very excited and want to try it right away. And there's a few that, yeah, they want to be able to wait this out and see how it goes. But I make a note in their chart saying, hey, we talked about this. They're thinking about it when they come in for a follow up. Let's go ahead and see how they're doing.

[Eugene Shotsman]

That makes perfect sense. What I love about this is that it positions you as a technology leader. Right. Like, my doctor is doing something new, my doctor is trying something new. So there's no downside to having the conversation, in my opinion, because what you're saying to the patient is, I have access to technology that most people don't have. And I have the ability to leverage that technology to help you do something that most practices don't. And so that's a big differentiator. And it's also kind of an interesting point of loyalty. Whether that patient takes you up on that treatment plan or not, you've already positioned yourself as different in their mind. And I think, you know, kind of, as you mentioned, that being a technology, using a technology to differentiate your practice seems like this is a key component of it.

[Dr. Jordan Dow]

Yeah. And it's amazing how many times the patient says, well, I don't know if I really want to do this, but I tell you what, you know, my wife would love this because she hates driving. Nice. She makes me drive all the time. And so it is, it is something they're remembering. It's something that's becoming part of what they think of me in our practice. And so it really has become another differentiator for us. And it's nice because it doesn't take away from anything else. Yeah. This patient has better ability to read up close, but they still see better with glasses. We're still prescribing glasses. We're still. It hasn't affected our capture rates or our per patient revenue for glasses at all. It's just simply something to enhance the analogy that I'm telling to patients is if you have a 55 inch TV and you want it to be better, you could upgrade to 4K or you can get a bigger TV, but if you got a bigger TV and got 4K, it's even better. That's really where we're at.

[Eugene Shotsman]

I love your analogies. This is great, Jordan, thank you. One more time. The economics, as you said, you're charging $200 to $600. And it sounds like there's so a wide variety of reasons why you might do that. Just explain a couple.

[Dr. Jordan Dow]

Yeah, well, I tell patients it depends on the amount of blur that we're trying to fix. If we're talking about someone who has a keratoconus and they just can't see with glasses better than 2040, 2050, that's going to take more training sessions. It involves more data entry on my end when I'm looking at things in the computer system. And so there's more that we're trying to fix, there's more we're trying to do, and it's a longer session. And so the. That's very reasonable to both myself and the patient. That's going to cost a little bit more. When you're talking about the Refractive things, they can't quite see what they need to see without glasses. And so instead of being as dependent on the glasses, we're trying to override that and make it so their brain can take over. Revital Vision actually will send them glasses to help with the training. Just some low power that will not actually make that so they can see it home during their day, but it will push them to work their eyes harder and improve them. That's going to be a mid tier. If we're talking about you're already 2020 and we're just trying to see a better quality. Your multifocal IOLs soft multifocal contact lens patients. How many of your soft contact Lens patients see 2020 in the office but say they can't see anything when they walk outside? We're offering this to them as just an additional add on on top of their contact lenses. And so if they're already in a place, we're just trying to enhance their vision. That's the lowest tier.

[Eugene Shotsman]

That's interesting. Okay. I love this. I think this is a fascinating topic. I can't wait for the follow up to see how this, how what's happening and what kind of feedback you're getting from your patients. So we'll certainly circle back with you. Really enjoyed having you on the show, Jordan.

[Dr. Jordan Dow]

Thank you, Eugene.

[Eugene Shotsman]

This has been a fascinating conversation.

[Dr. Jordan Dow]

Yeah, I loved it. Thank you so much for having me.

[Eugene Shotsman]

On and congratulations on all your success.

[Dr. Jordan Dow]

Thank you. Thank you.

[Revital Vision]

This show is sponsored by Revital Vision. Imagine if your patients could train their brain to see better whether they need glasses or not. Revital Vision is a revolutionary FDA approved home based vision training program that helps patients improved contrast sensitivity, visual acuity and overall vision performance. Here's how it works. After a standard eye exam, qualified patients are prescribed a simple app based vision training program that they can do from the comfort of their home. Just 30 minute sessions three times a week for about 10 weeks. And the results? An average of 2.5 lines of improvement on the eye chart and a 100% boost in contrast sensitivity. Revital Vision is already helping patients with adult amblyopia, post cataract vision struggles, minor refractive errors and even sports vision performance. And for eye care professionals, it's a high margin patient paid service that requires no additional chair time, no new equipment and no insurance billing hassles. If you're looking for a new revenue stream that truly changes patients lives, visit revitalvision.com to learn more and start offering this breakthrough technology in your practice today. Revital vision. Train your brain. See better.

[Eugene Shotsman]

Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier consulting group who helps practices achieve freedom of time, confidently solve practice issues, and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there, and they're ready to help. You want to learn more? Go to powerpractice Dot. There's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the Power Practice might be right for you. Go to powerpractice.com to find out more.