What Optometrists Need to Know Before Starting a New Practice

There’s something thrilling about opening your own optometry practice from scratch. The space is yours, the brand is yours, and so is the vision (pun intended). But let’s be real: cold-starting a practice in 2025 is not a task to be taken lightly—and the path to profitability is more complex than it used to be.

With rising inflation, more aggressive insurance denials, and ever-growing overhead, launching a cold-start optometry office is a high-stakes equation. Still, for those ready to take the leap, it can be one of the most rewarding decisions of their career.

Here’s what aspiring owners need to consider before opening their doors.

Startup Costs: Higher Than Ever

From leasing your space to filling your optical shelves, upfront costs in 2025 are steep. Rising interest rates and inflated supply chain costs mean you’ll spend more than you would have just a few years ago. This includes:

• Renovation and build-out
• Clinical equipment (auto-refraction, imaging, diagnostic tools)
• EHR and billing software
• Optical inventory and lab tools
• Working capital for the first 6-12 months

Even digital systems are getting more expensive, with SaaS platforms hiking rates to reflect their own rising expenses. Every dollar needs to be accounted for—and that brings us to your best friend during this journey: the financial pro forma.

The Financial Business Plan

A cold start with no roadmap? That’s a recipe for burnout. A solid financial business plan doesn’t just get you a loan—it becomes your financial GPS.

Break it down by:

• Revenue estimates: Number of exams, average sale per patient, projected second-pair sales, etc.
• Fixed and variable costs: Rent, salaries, utilities, subscriptions, marketing, and vendor contracts.
• Cash flow forecasts: When money comes in, when it goes out, and how much runaway you will have in the early month.

Use it to test base-case and worst-case scenarios. Would you survive if 20% of your claims were denied? What if your patient volume lags for three months?

RCM Can Make or Break You

Revenue cycle management is often the last thing ODs want to think about—but in a new practice, it’s everything. Delays in reimbursement can break your momentum. Denials can cripple your cash flow.

Make sure your RCM strategy is airtight from day one:

• Clean claims
• Real-time eligibility checks
• Timely follow-up
• Consistent staff training

If you’re wearing multiple hats, automation will be your best friend.

Build with Purpose

The cold-start journey in 2025 isn’t easy, but it can be deeply fulfilling. If you build your business with a sharp plan, the right tools, and a mindset for adaptability, you won’t just survive—you’ll thrive.

Opening your own doors means writing your own future. Just make sure you’ve done the math first.