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Vision Council 2025 Industry Data: Exam Volume Declines, Spending Shifts & What's Next for 2026
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- [00:00]
A
Welcome back to the Power Hour, Optometry's biggest and longest running show. I'm your host, Eugene Schatzman. And today's episode is a little different because we're recording live from Vision Council's executive Summit. This is a room filled with CEOs, founders and eye care industry leaders who are all here to network, but also to understand what's actually happening in our industry and what to do next. So joining me today are Ashley Mills, she's the CEO of the Vision Council, and Elise Hinkle, who leads the research and insights group for the organization. And this is one of those conversations that I generally look forward to because this is also the time that the Vision Council releases all of their data for the previous year. So you're going to get a firsthand look at that data. And so you're going to hear this in this episode. How did exams do in 2025 relative to 2024? And I'm going to be honest, not great. And that's trend, and that trend is actually something that we can reverse. And we'll talk about how we can do that. We're also going to talk about what the patient data is saying about spending behavior and how consumers are making trade offs. We're going to look at how different categories moved, lenses, frames, contact lenses, planos, and what does all of this reveal about value perception. And we're also going to talk about what we should all be paying attention to and what practice owners should be thinking about when they plan for 2026. We also do a zoom out and talk about what the industry is doing in response. And this is where there's an opportunity for all of us to learn about what Vision Expo in Orlando is going to be like. So Ashley Mills walks us through what's changing with Vision Expo in Orlando, which is just coming up in a few weeks, and why it's being intentionally designed as a single destination event. What if you're an attendee, what are you going to expect to see on the show floor? And how vendors are being challenged to better support practice growth. We also touch a little bit on advocacy, which is some work that the Vision Council is doing, what's happening in Washington and how affordability and access to vision care are showing up in some conversations that the Vision Council is having. But at the end of the day, this episode is about Vision Expo. It's about data and it's also about a path forward. And so if you want a better understanding of what the data is telling us, how these signals connect to the decisions you're making in your practice or business and you want to get a preview of what Vision Expo 2026 is going to look like. Stick it. And let's get into this episode and before we go, a quick reminder to make sure that you're subscribed to the Power Hour on YouTube, Spotify or Apple Podcasts or wherever you get your shows so that you never miss an episode. And as always, if you have any questions, feedback or ideas for future shows, I'd love to hear from you. You can reach out to me directly@eugene shotsman.com or through the Power Hour website. All right, let's get into today's conversation.
- [02:51]
B
Welcome to the Power Hour. I am here with Ashley Mills and Elise Hinkle. And this is one of the episodes I absolutely anticipate every time that we do this. And the premise of this episode is we're going to talk about the data, the massive amounts of data that you've gathered to talk about what we learned about 2025 and then also where we're going to go in 2026. And then also we have a massive event coming up for the industry. That's Vision Expo in Orlando. And we're going to talk about what's going to be happening at that event and specifically the decision to make that one destination style event for the whole industry. So we got a lot to get to in this show, but we're sitting live at the Vision Council Executive Summit event. Ashley, tell everybody who doesn't know what this event's about, what's the purpose of this event and how does the Vision Council and why does the Vision Council put it on?
- [03:46]
C
This is a truly unique event actually for the vision industry. It's really the top 300 vision industry leaders. They come together once a year. They have an opportunity to do professional development. We do a lot of leadership learning. We talk a lot about the Vision Council's strategy and how we're working to promote growth for the whole industry. And they really find value in networking with each other and what they learn from each other. So we do a lot of talking about businesses, is this growth, what's coming, what to anticipate? And relationship building is just the most special part.
- [04:22]
B
And in the room, when you talk about leaders, just to give everybody some context, when we talk about leaders, talking about CEOs of companies, major companies that serve the industry, so many of the CEOs of the frame companies that served that pretty much everybody in the audience would know many of the CEOs of lab companies, people you Buy stuff from. They're all here and they're trying to figure out how to make their business better for, for you if you own a practice and how to support the practices that they, that they serve. And of course, there's, you know, people who sell to them and there's people with new ideas who are part of the conversation, people who are looking to get into the industry that are part of the conversation and, you know, just a really, really interesting mix. But a big part of what they're doing is they are here to kind of learn and understand the trends and to also prepare themselves for their big show. Because most of the people who are here are going to be exhibitors at Vision Expo. So let's talk About Vision Expo 2026. What's that going to look like, Ashley?
- [05:23]
C
It's going to look amazing, actually. Yes, you're right. The Vision council members make up about 80% of the trade show. So those are all the businesses you'll see. We have a huge push this year to make the show the one place that everyone in optical can come once a year to see absolutely everything that's new. So that's the latest innovation. That's product launch, that's new trends, that's full collections. This is the one big show. And the reason we did it was because everyone told us they don't have the time to be traveling around and being out of office, out of practice, not seeing patients. And so we've created the one catalyzing event that really unifies the whole industry one time of year.
- [06:08]
B
So what can people expect if they come to Vision Expo 2026 in Orlando this year?
- [06:13]
C
We have really deliberately built a program this year that's focused really on three driving forces in optical. One, of course, is fashion, wearability, wearables and how you know the products that patients and consumers want to have. The second is really focused on practice, growth and profitability. So one entire stage is dedicated to in real time, if you can improve capture rate by a couple percent, what that's going to mean to your office and how to do it as soon as you get back. And then the other stage is 100% innovation. All of the technology that's really leading this industry forward. We talked a lot about it at the Executive Summit and it'll be on full display at Vision Expo.
- [06:58]
B
And I'm super excited. And I think one of the practice growth tracks. I'm super excited. You'll hear in the app later that Jamie Rosen and I are unveiling a system for eye care growth it's called the Eye Care Boss system. But I'm also super excited to see some of that because you have a lot of new exhibitors also this year, people who are showing off their stuff to eye care practices and hoping to get people's attention. So talk about what's new in terms of, and maybe not specifically vendors, but in terms of the areas that you've set up.
- [07:31]
C
We have a hundred new exhibitors this year and they range from technology companies to independent eyewear designers and everything in between. At the summit, we talked a lot about this and you'll see it at Vision Expo. Audiology is an increasingly an increasing segment for us. Our panel yesterday at the Executive Summit talked about millions of dollars of growth for practices in the UK who have started offering audiology as a service. So you'll see a lot of audiology vendors as well and can learn how to incorporate that into your practice and serve your patients as well as putting AI into practice in patient care.
- [08:09]
B
Yeah, and it's interesting because I think you've got software vendors that are interested in supporting the practice, but you also have a lot of people who traditionally only sold hardware, but now they're selling much more software, hardware, integrated stuff with smart technology, right?
- [08:28]
C
Absolutely. Yeah. There's a big emphasis on medical technology at Vision Expo, kind of bridging the lens, the lab, the equipment and the fashion.
- [08:37]
B
And one of the conversations even today, which I'm sure will translate onto the show floor, is saying, look, if practices grow, then the industry grows. So how can you help practices grow? Well, you can make better product that makes them more attractive, or you can make product that, that helps a practice do its job more efficiently. So, for example, if you can go from seeing two patients, for example, to three patients an hour, well, what does that mean? What does that mean for everybody? Well, of course, the entire industry wants that to happen because they're seeing more patients, you're selling more frames, you're selling more lenses, but you're also creating a better environment for the communities that all those products ultimately support. And so it sounds like those themes are going to really translate to Vision Expo as well. And it's also in a nice destination. So what are some of the other unique experiences for people who are going.
- [09:27]
C
To be attending Vision Expo would not be Vision Expo without tons of parties and events. A lot of the major optical alliances are co locating with us and doing activations for their membership. We actually just had a very successful day in Washington last week with the alliances taking that message of what the government and what the economic impact is right now on Main street, both for independent practices and business businesses, and also what the impact's been on patients. They'll be at Vision Expo, plenty of receptions and opportunities for networking. Our continuing education program is trending so far ahead this year. We know people come to Expo to get the best CE and Expo also, we work really hard to make sure that our continuing education is predominantly exclusive to Vision Expo. But truly, it's the best three days you could spend a year if you want to grow your business and serve your patients.
- [10:20]
B
Yeah. And also see what's new in the industry so that you don't get benign. So I'm a big fan, obviously, of the show, but I think the show is also based on a lot of data. So I want to come back, Ashley, to you in a little bit when we talk more about the role of Vision Council. And I want to circle back to that thing you just mentioned about Washington. But I want to turn now, Elise, to you, to talk a little bit about the data. So if we look at 2025 and you now have the data, the numbers are in. What did 2025 look like? Now, before you answer that question, remind everybody the source of your data and how many millions of trans you analyzed in order to get here so that it's not just like, hey, we. We held a finger up to the wind and kind of got the. Got sort of a trend like, this is real stuff.
- [11:08]
D
Yeah. So. So we're pulling data from four main sources, two of which are transaction data. So the first is transaction data from a sample of 2,750 practices, mostly independent practices from across the US and in that data, it's pulling from their practice management system. So we have all kinds of information about who the patients are, how much they paid out of pocket, what product they purchased, how much managed vision care reimbursed. So that's the first transaction data source. The second gives us fuller coverage. So the first is kind of a sample of what's going on at the inpatient level. The second allows us to better understand the retailer level. So that's credit card data. And we have credit card data from, I think it's somewhere around 85,000 retailers, optical merchants, both online and in person. And then from that, we're able to understand that sort of the credit card swipes. So how much people spent in a transaction. And I think we have somewhere around 80 million records in the credit card database. I think I neglected to mention where the first transaction data set. We're somewhere in the neighborhood of 50 to 60 million transactions, what we're looking at there. So that is the definition of big data. Right. For those transaction data records. And then the third source is our consumer survey. So we run a monthly tracker both in the U.S. and Canada. But since we're talking about U.S. numbers now, the U.S. data is a poll of 4,000 U.S. adults, a representative sample of U.S. adults each month. So that leads up to 48,000 respondents each year. So that's another piece that's going into this mix of the model. It gives us more information, a little bit more about like how and why and what people are choosing that we don't get in a just pure transaction data record. We also get more information about sort of the demographics of people who are making eye care and eyewear purchases. And then finally, the fourth data source is location data. So we really closely track where optical, retail and independent practices are located in the US and so that's another foundational piece of our model. So those four, four pieces get brought together and baked into this big market estimates for the year.
- [13:24]
B
So I think we get have a high degree of confidence that the data is accurate and representative. Now let's talk about what the data show. What did we learn from 2025?
- [13:37]
D
So overall, the kind of headline is that there was some growth overall in the industry. So we track six products when we're talking about overall market estimates. So we're looking at exams and then we're looking at frames, ophthalmic lenses, contact lenses, and then two Plano categories. We have readers and Plano sunglasses. So those six products together, adding all of those up, we get sort of the industry value for the year. And 2025, that value is $69.5 billion. Big number. And that was year over year growth of about 4.4%. So 2.9, almost $3 billion growth year.
- [14:19]
B
Over year revenue, though. So that is revenue growth in revenue for the entire industry.
- [14:25]
D
That's right. So when we're talking about value, we're talking about what patients are paying out of pockets or consumers who are buying Plano products, what they're paying for the, for their products, plus for prescription products and exams, that that number also includes managed vision care reimbursement. So that's what we're talking about when I'm talking about value for the industry.
- [14:45]
C
Yes.
- [14:45]
B
Okay, so then let's dig into some of the categories. Specifically. Let's start with. What did you say the first one was? Exams.
- [14:51]
D
Exams, right. Yeah. So the story kind of overall for most of the Categories is that we saw some, I would say modest growth in value. So revenue up slightly a year over year, unit prices up slightly year over year. But for many of the categories, volume. So the, the counts of exams or the counts of units were down. And so that was true for exams. We actually saw a pretty, you know, for us, a pretty big decline in exam counts for the year. So all told, it looks like reflecting 2024 to 2025, we lost about 6, 7% fewer exams in 25 than 24.
- [15:33]
B
That is really significant. Like that's, that in itself could be the headline of the episode because if you think about it, the fact that there were 7% fewer exams across the board, first of all, for listeners, if you did better than 7% loss in terms of your exams, if you only lost 3% or if you gained 1% or if you gained 2%, if you had moderate exam growth or really any exam or some exam loss, but not quite 7%, you're doing better than average in the industry. Right. Because you're saying average across independents and also, and also corporate, you're seeing 7% loss interim. But what I think you also said is that, but the amount of money spent on exams went up. So you may have felt, you may have had fewer butts and chairs, but you may have made that up. And the fact that made more money per exam, is that right?
- [16:30]
D
Yeah. So that's what it looks like we saw. While a 7% decline in count, we saw 4% growth in exam related revenue or value.
- [16:42]
B
So what does that mean? Does that mean we're charging more per exam or we're getting bigger reimbursements for exams?
- [16:48]
D
Well, so yes, bottom line is that seeing a little bit more value per exam, if exam counts are down but revenue is up, that's just what it means, that the average exam price. So for us, when we're combining those two factors, patient out of pocket plus managed vision care reimbursement, we actually saw a $10 year over year increase in the per unit cost of an exam.
- [17:15]
B
So on average, across the thousands and thousands and thousands of exams that you tracked, on average, a patient spent $10 more this year than they did or last year, I guess, 20, 25 than they did the prior years.
- [17:28]
D
Yeah, that's right. I think it went from 95 to 105 dollars year over, or I'm sorry, 92 to 102 dollars, which is a big increase year over year in terms.
- [17:41]
B
Of the exam category.
- [17:42]
D
That's just in the exam category. Yes.
- [17:44]
B
Interesting. And so and that includes the managed risk carry person. So if I got a $50 managed Fair Vision reimbursement, I obviously had to have $150 cash out of pocket to balance that out, to get that to 102 or something like that, right?
- [17:59]
D
Yes.
- [17:59]
B
Okay, so let's dig in a little bit deeper. Oh, maybe let's look at the other categories first and then think what we can learn from this data. So what happened with frames, for example?
- [18:13]
D
So for frames, we had the year over year change in terms of value, an increase of 8%. So again, price increases for frames, but we had a unit loss of 3% year over year. So same story, value up, volume down, but a little bit of a different sort of ratio between the two. For frames in particular, I think frames were particularly price sensitive to tariffs this year. And so that's largely, I think, where we're seeing skin increase.
- [18:45]
B
And I think a lot of vendors encouraged practices to increase price for frames over the course of the year. And I think that's kind of a natural thing that a lot of people did. In May, April, frame companies said buy now to avoid the tariff increases that we have to impose later. And people bought now. And some practices said, okay, I bought it and I'm going to change the price as well so that, you know, can I keep my margin the same? So right, I kind of makes sense. Although it's interesting to me that we lost 7% of exams, but we only lost 3% of frame sales. So I think the picture is a little bit murkier for me.
- [19:30]
D
Okay, so then for lenses, this is the one prescription category where we saw a decline in both value and volume. So lenses, a decline of 1% in value and a decline in 6% in volume.
- [19:44]
B
Okay, so kind of makes sense that. But people are buying, it seems like they're buying more frames but fewer lenses.
- [19:57]
D
Well, I think they're buying a little bit less expensive lenses than they were the year before. In particular, last year was pretty strong in terms of the, the average cost of lenses. And so I think we saw a little bit of adjustment from that. So what we're thinking is that people are likely, you know, having some fewer add ons or treatments to their lenses this year potentially.
- [20:22]
B
Got it, got it. That makes sense. Okay, and what about contact lenses?
- [20:27]
D
So contact lenses also followed the value up, volume down story, although sort of minor value up of 1% with the overall volume down 5%.
- [20:40]
B
All right, so let's pause there for a second because these are the categories that are probably most relevant to somebody who's wrong to practice today. So again, if we're keeping notes, exam volume, the number of exams is down 7% in 2025. Number of frames we sold is down 3%, the number of lenses we sold is down 6% and a number of contact lenses we sold at the down 5%. That is not a rose picture.
- [21:08]
D
It's not, you know, the overall growth in the market, obviously that's a good thing. We want to see growth year over year, but it's not a sustainable long term growth when we're just seeing growth on price alone and not unit counts. Something that we were trying to dig into a little bit, especially on the exam side because that's a big number of a loss of 7% overall in the market. So one thing we did was look at our consumer survey data and in our consumer survey data we asked people who haven't had an exam in the last 12 months. We've been asking this of folks since 2022. And we asked them if you haven't had an exam in the last 12 months, why not? And it's, and it's open to everyone who's taking the survey, right? Because the whole general population, you know, could be having an eye exam. And so what we found over, so 22, 23, 24, it was all pretty steady in terms of the reasons people gave. The top reason was that they said, I don't have any issues with my vision, I don't, I don't need to have an eye exam. That's why they said they hadn't been in the last 12 months. However, in 2025 we started to see a shift in the reasons specifically related to exams. The reason wasn't as strong for frames or lenses. The reason was really stronger in exams here. This change where we saw a decline in people saying I haven't had an exam because I don't need one. That was a 6 percentage point year over year loss in terms of what they said, why they didn't have it. And then the second most popular reason was related to cost. So sort of combining the categories of my insurance doesn't cover the full cost of an exam or I can't afford the cost of the exam right now. Sort of combining those two categories and getting unique respondents there, we saw a corresponding 6 percentage point increase of that year over year. So people are telling us in the exam category that cost is top of mind. For them, cost is part of the reason they're delaying. And even people who are not saying they, it used to be they didn't need one. But now it's saying, well, maybe I do need one, but I feel like I can't afford it.
- [23:23]
B
That's interesting. So people don't necessarily see vision care as a must have. Well, I guess they see it as a little bit more of a luxury purchase. Right. Because if I have a serious medical malady, I'm going to go see the doctor regardless of what it costs. But I, it seems to me like what we're hearing from the Consumer Insight survey is that, yeah, I think my prescription changed, but I can wait it out because I can't really afford it right now. Yeah. Or I, I think it's too expensive. So this actually points to a much larger picture. And that's why I completely agree with the statement you just made, which is that this is unsustainable. Right. So I look at your 4% industry growth and I'm like, okay, that's nice. Okay. But that is really a problem because if I'm looking at the negative numbers on the volume side, 7% fewer exams, 3% fewer frames sold, 6% fewer lenses sold, 5% fewer contact lenses sold, just in the total number of things we sold. But then I look at the numbers of dollars, right. So again, 4% more in total dollars on exams, 8% more in frames. So I sold 3% fewer units, but I made 8% more money, which means that I charged my patients more. Which then adds to the problem because maybe that patient showed up for that exam in 2025, but now they're convinced they can't afford it next year. Right. At least, maybe that is one side of the line.
- [24:58]
D
Yeah. I think a lot of people sort of bundled the idea of an exam and eyeglasses cost sort of into one when they're thinking about this is the amount of money I spend when I go to the eye doctor. And I think the price, you know, when it gets into the hundreds of dollars, if people are anticipating a purchase of hundreds of dollars, they might be more reticent even to go in for an exam only kind of appointment.
- [25:21]
B
Yeah. And I think, I mean, maybe this has something to do with, we talked about this a little bit before, but in 2025, we kind of hit rock bottom on consumer confidence. Right. The University of Michigan tracks consumer confidence. And so when I am not that confident as a consumer, I am not spending that much money on consumables. And yet I think there's other choices consumers are making instead of buying glasses. One of the things you guys did that was amazing at this at this event is that you brought an economist who talked about where are people spending money? And yes, people are still money on. People are still spending money on travel and restaurants and things like that. But they're not spending money, I guess, or they're pulling back on how much money they're spending on eyewear or eye care. Right. Which is I think. So it's a concerning trend because the way I look at it is yes, we made more money, but we saw fewer patients as an industry, which means that the patients we did see are either not price sensitive or more likely an explanation is they had to come see us, but they may stretch whatever they bought from us for longer before the next exam.
- [26:31]
D
Yeah, I think that, that people are delaying purchases or maybe making some trade offs when they are making eyewear purchases about maybe sort of trading down a little bit as, as prices has increased or at least in their perception that prices have increased.
- [26:47]
B
So, so it's interesting. We'll come back, when we come back from the break, we'll talk a little bit about what we can do about this. But it's interesting that, you know, there are playbooks in place to get patients to come back to offices more often. There are playbooks in place to keep patients from becoming exam only patients and to help them understand the value of buying from the eye doctor and not necessarily taking their prescription online. There are playbooks in place for this kind of stuff. But as an industry, I think one of the things I'll ask after the break actually is how are vendors prepared to support them? How are vendors prepared to help practices keep more of their patients and help those patients be able to perceive that they're getting value? Because if I can't afford it, it may not be that I don't actually have the money. I can't afford it. It may actually be more about the fact that I don't see the value in spending the money on this versus going out to eat versus a vacation or something like that. So I'll be right back in the Power Hour and explore. Excited to hear your insights. All right, quick pause for Power Hour listeners. I'm here with my good friend Jamie Rosen. And if your practice is doing okay, but it still feels way harder than it should, this is for you, right, Eugene?
- [28:07]
E
So if you're busy and you're growing, but somehow everything still runs for you.
- [28:11]
B
And if you're in the day to day minutiae and every time you think about growth, it feels like more stress, more problems, not more freedom.
- [28:18]
E
And a lot of owners Just assume.
- [28:20]
B
It'S normal and it doesn't have to be. Which is why we're super excited to announce something that we're officially, officially unveiling this March at Vision Expo. It's the ICARE BOSS System. B O S S. So the ICARE.
- [28:32]
E
BOSS stands for Business Optimization and Scalability System. So it's a system that helps you optimize and scale your practice whether you're one location or whether you're 20 or more locations.
- [28:43]
B
And we developed it after working with thousands of practices coast to coast and seeing the same gaps and the same patterns over and over again. And Jamie and I used what we saw from some of the most successful practices out there, and we also used some other business literature, but we adapted this to specifically serve the unique needs of eye care today, which is really important.
- [29:04]
E
So what we see is that many successful practices have made a ton of mistakes and kind of tripped their way to success. But this is obviously slow, super iterative, and takes a ton of work and literally years. And the system we've created helps you learn from your mistakes and really the mistakes of others, eliminating those mistakes and fast tracking your own success.
- [29:27]
B
So most practices do not have a clear system for how to optimize their practice and also how to scale without the owner becoming the bottleneck, or if you keep people in your practice becoming the bottlenecks. And again, that's why we created ICARE Boss, because it focuses on five important parts. People, accountability, revenue, data and patient experience.
- [29:46]
E
Yeah, and all those five parts working together as a system is really critical. And that's what leads to the actual optimization or constant improvement of your practice. But also we include the tools that you'll need to support the growth, which is all part of the ICARE BOSS system.
- [30:03]
B
And scalability is really growth that doesn't have to break stuff as it happens. Right? So growth, where practices run on structure and not just talent of a few key people, is what scalability is.
- [30:16]
E
We'll be walking through the system on the vision stage at Vision Expo, offering CE and sharing tools and resources you can actually take back to your practice and use. This is not just theoretical information. It's super practical and very usable.
- [30:31]
B
So if you're doing fine, but you know you're capable of much, much more. And if you want growth and also some sanity, I think.
- [30:39]
E
Join us at Vision Expo March 11th through the 14th in Orlando.
- [30:43]
B
And by the way, for Power Hour listeners, use a special coupon code VE26POD to register and get free entry into Vision Expo. That's V E26P O D. So go.
- [30:55]
E
To visionexpo.com, click the register now button and use the code VE26POD and we'll see you there.
- [31:04]
B
All right, we're back in the power hour, and I've got Elise Hinkle and Ashley Mills from the Vision Council with me. And so, Ashley, I wanted to turn it back to you. So we had just talked before the break that it seems like consumers want more value from their eye exam, or maybe that's one way to help reverse this trend that we're seeing, which I think we all agree is fairly alarming. 7% of fewer exams in 2025 and 2024 is the wrong way of behaving. So what do you think the reaction is, or I guess when you guys brought up this information and how in front of your membership, what is the reaction from vendors who support eye care practices?
- [31:45]
C
Well, I'd love to just share with you. For those who don't know that, the mission statement of the Vision Council and the reason that manufacturers are a member of our organization is because we believe that together we can promote growth for all in the entire vision community. And that's 100% what all of our work is geared towards doing, including our work at Vision Expo, which. Which Vision Expo is one of the economic engines that allows the Vision Council to do what we do in terms of consumer awareness, data advocacy, et cetera. And so a lot of conversations here at the Executive Summit, while the economic numbers from 25 are disappointing, there was a lot of conversation here around opportunity as well. There is still tremendous opportunity, opportunity for growth. And I think that that will be on full display at Vision Expo. These manufacturers are clued in to how to really talk about the value of the product, the value of your vision, the price point. And our vendors range, every price point. I mean, everyone talks about a K shaped economy. I will at least does that. But at every price point there, there's a product for your patient face. And I think Expo is a good time to have those conversations with the designers and the companies manufacturing these products to really get the right story and help to make the case to the patient.
- [33:14]
B
Yeah, and I think the other thing I heard was a lot of talk about innovation, because innovation ultimately drives a better patient experience inside of the office. So if a patient sees that the doctor has the latest technology with the AI integrated experience, or really that the staff are well trained by a tool that helps them be a better resource for the patient or whatever is happening, that ultimately the vendors realize that they have to empower the practice to be able to communicate value to its patients. And I think that was really a big topic of conversation here. And I agree with you. It sounds like it will be unfolded display at Expo. You talked a lot about the mission to increase the number of exams across the industry. So what else has the Vision Council been focused on? And talk a little bit more about the advocacy piece, certainly.
- [34:14]
C
So again, our members believe that to get to growth, the strategy is to increase the number of eye exams. And that has been a strategy for decades. And we, we continue to believe that that's the way to do it. Our advocacy efforts, we have a very large footprint in Washington D.C. so we work on the regulatory affairs side. We, we were, we've been on the Hill for seven years talking, warning about the impact of tariffs on affordability and accessibility. This year we were able to go up with the Vision Council's data and say we can see it happening. We can see that the economic environment is causing patients to forego vision care. And then that also opens the conversation for us to explain to lawmakers that vision care is one of the most cost effective early healthcare innovations interventions, I'm sorry, that can not only detect disease and save billions of dollars down the road, but can in real time right now empower a patient to live their absolute best life. So, you know, for those lawmakers that are sensitive to increasing spending and funding and entitlements, it still resonates with them because they start to understand that a child who is able to see in school, learns, grows up and can get off of the system because they've been educated and they can grow and thrive. And similarly, seniors can maintain their independence well into late in life and drive and still work. And that is resonating right now. They care very much in Washington about the impact on, on Main Street.
- [35:57]
B
Yeah. And it's interesting to hear you talk about this because I think one of the big, I would say, you know, issues that for from an affordability standpoint is okay, I don't know if prices will necessarily go down if okay. But, but I think that there's a discussion about saying, well, eyewear is more of a medical device. Not necessarily, I don't know the detail. You may be able to help me with this. But rather than being being tariffed as a, you know, whatever fashion item or something, maybe there's some sort of exclusion you can have for malleable device and treat eyewear as such.
- [36:38]
C
We have tried that argument and we're not going to Give up the FDA categorizes vision glasses and lenses as a Class 1 medical device. Unfortunately, the United States Trade Representative's office did not see it the same way. And vision products got bundled up in everything. During the first Trump administration. The Biden administration held steady. They did not offer any exemption process. And it's just become very clear that the tariff issue isn't about industry or product. It's about countries and global negotiations. And that's where we are right now. We will not let up on it because if an exemption process is, is opened for whatever reason, we'll be right there to argue provision.
- [37:25]
B
Got it? Yeah. Well, it's good that somebody is doing that work and somebody's pushing for that kind of thing. But you said that government officials were receptive to the argument that vision is something that should be, that they should spend more money on. Is that right?
- [37:41]
C
That they should make sure that the environment isn't, isn't creating a barrier to care in the United States of America. In a first world country, everyone should have the opportunity to see an eye doctor once a year. Every child, every person. And it's resonating. And you know, when you, no one argues with it when you tell them, you know, Democrats have always thought things are too expensive and they want more people to have access to health care and vision care. Republicans now see that their, their, their constituents are foregoing necessary services and they want to alleviate that. They're also really interested in making sure that independent practices and businesses are able to grow.
- [38:25]
B
You're right. And I think that there is a massive ripple effect. And you described it, I didn't think about it until you said, but the massive ripple effect of overall people's welfare, meaning the, the ability for someone to do well in life is so dependent on them being able to have access to quality and vision care and eyewear. So that's. That. That's a really important argument. So thank you. I think on behalf of, as I think on behalf of our clients and our listeners for doing that work, but also what's ahead, like, what's the big push this year.
- [39:02]
C
I mentioned? We just had the opportunity to go to the Hill with the Optical alliance groups and they together collectively. This was the first time that industry, the vision Council was able to go in and talk with representatives who spoke for the millions of patients across the country. And we could say very specifically with every office we visited, how many of their constituents, how many practices were in their district, and how much prices had increased in their district over the last year. So it hit home what's next for us. We've reached out to the Centers for Medicare and Medicaid Services. We've penned a letter. It was signed by Congressman Jeff Hurdle out of Colorado, asking for if there is money allocated for health care, that vision, at least for children, is considered for funding, at least for children, but just not to leave vision out altogether. We've also drafted legislation that touches a lot of vision Council issues that really focuses on access and affordability.
- [40:08]
B
That's great. Well, so we'll keep. But we'll keep a close eye on the work that you're doing from that vantage point. And I guess, you know, as you were talking about general state of independent practices and what's the general state of the industry? I'm curious, Elise, do you guys have any data on what the actual industry looks like? How many practices are there total and what percentage are independent and what percentage are not independent? And how has that changed year over year?
- [40:40]
D
So we have this year. It's, it's an important part of our model to understand what the footprint of optical practices, both the optical retail locations and the independent practices, what that looks like. So for this year, we have a sort of a census count of 4,341, 44,000, 44,341 places in the US where you can get a comprehensive eye exam by prescription eyewear. So that number is broken out into two pieces. So 57% of that is what we classify as independent practices. And so for us, that means you have three or fewer doors under the same. And then correspondingly then we have 43% of the market. So about 19,000 practices, we classify as either a small chain, sort of medium chain or a large chain. So we're Looking at about 25,000 independent practices in the U.S. about 19,000 corporate locations.
- [41:48]
B
But the chains talk a little bit more about that definition. What's a small chain?
- [41:53]
D
With our independent definition, we have three or fewer doors under the same name. For the small chain, we're looking at 4 to 10 doors using the same name. And then medium is 11 to 49 doors and large is 50 or more.
- [42:08]
B
So some of those small chains could actually be independently owned.
- [42:11]
C
Yeah.
- [42:12]
D
So 4300 small chains would be in addition to that, 25,000.
- [42:16]
B
Got it. Okay, so let's talk about has that number grown or from an industry standpoint, is it grown, shrunk, stay the same?
- [42:25]
D
It's been pretty stable year to year. We've been tracking it, I would say pretty closely for about three years using the same methodology. And it's been sort of, you know, within striking distance year to year. So overall, pretty stable. A few openings, a few closings year a year, we're tracking that, but pretty stable right now.
- [42:43]
B
Got it. So, in general, the message is the industry is expanding, but cautiously, we're sending that message because in revenue, we're expanding, in exam volume, we're shrinking. There's a ton of work being done to try to drive people back in the into practices and I think Vision Expo will give people tools to potentially drive people back into practices. And of course, we talked during the commercial break. And also, just a quick reminder that at Expo there's a lot of ce. I'll be part of it. I think there's a lot of other really smart people who are presenting CE that helps make, helps battle some of these trends that we're seeing so that we're not seeing them again year after year. Because I agree with you, it's unsustainable. But again, thank you to both of you for the amazing work that Division Council does. Again, really look forward to this episode. Every time we do it every year and even throughout the year as you all gather the trends and the data from the millions and millions of transactions that you track. Just super fun to understand where the, where things are headed as we compare that to our client data and things like that. But again, thank you so much for the work that you do for the industry and also thank you so much for being on the show. Thank you.
- [43:56]
C
Glad to be here.