Finding Your Niche and Owning Your Future

Optometry can be as flexible, versatile, and rewarding as you make it. My path led me to build a specialty lens and anterior segment practice, but your niche might be dry eye, vision therapy, myopia management, or something completely different. The key is the same: Figure out what you love, and intentionally design your career around it.

This article shares how I found my niche, built a highly focused practice, and continue to grow.

DISCOVER YOUR NICHE

I trained at the University of Houston College of Optometry and later completed a cornea and contact lens residency at the University of Missouri–St. Louis, where I focused on specialty contact lenses. The residency was an incredible learning experience and allowed me to learn from leaders in the field while rapidly deepening my clinical skills.

While I valued the experience, it is not the only path to specialization. Conferences such as the International Congress of Scleral Contacts and the Global Specialty Lens Symposium, along with industry-supported in-office workshops and mentorship, offer meaningful opportunities to develop expertise.

After graduation, I joined a private practice and spent 3 years working to grow a specialty lens practice within the existing office. I learned a lot from that experience, and I found that I liked leaving work at work, not having to make business decisions, and the ability to focus more on patient care and less on practice operations. But the experience had some downsides, too. I had limited control over scheduling and visit length, I couldn’t always add the technology I wanted, and I found I didn’t love managing the optical or insurance.

I saw what worked and what didn’t, and I carried those lessons into my own practice. Another important lesson I took from that practice was the emphasis on the patient experience and creating a “Ritz-Carlton” feel in the office. Thoughtful attention to small details down to how the space is presented communicates professionalism and care before a word is ever spoken (Figure 1). Patients notice these details, and they often associate them with confidence, trust, and being in capable hands. That philosophy has strongly influenced how I design both my clinical flow and physical spaces today.

During those years, I spent a lot of time on self-reflection, and I realized that my favorite days where when I saw patients with myopia, specialty contact lenses, and anterior segment disease. I thought, “How cool would it be if I could just do that all the time—and not have to do the things I don’t enjoy?”

Once I was honest about this, the next step was obvious: create a practice that focused almost entirely on the parts I loved.

BUILDING A HIGH-TECH PRACTICE

I found a 900-square-foot suite—tiny, but perfect for what I needed—and spent 4 months remodeling. One of the advantages of running a niche practice without optical is that you don’t need a lot of square footage.

Today, the practice has a concierge feel. Every new patient is scheduled for a 2-hour initial consultation, follow-up visits are 45 minutes, and I rely heavily on high-tech equipment. I have a Pentacam AXL Wave (Oculus), an Ovitz xwave aberrometer, and a Solix OCT (Optovue). Despite all that technology, patients comment most on the big-screen TV that cost about $200—they love seeing their eyes up on the screen.

Two years after opening in Charlotte, North Carolina, I added a larger location in Raleigh, North Carolina—about 1,500 square feet.

GOING OUT-OF-NETWORK

My practice does not contract with any insurance companies, and all patients are self-pay. Because of this, I can schedule patients however I feel is best, and my fees reflect the time, technology, and expertise involved. I have found that self-pay patients tend to value and appreciate their care more than patients who use their insurance. I often notice that these patients have a deeper understanding of the investment they’re making.

BUILDING A REFERRAL BASE

One of the biggest mental barriers when starting a practice is the “eat what you kill” feeling. What if no one comes? What if you can’t sleep at night worrying about the numbers? I thought long and hard about that worst-case scenario and decided the potential reward was worth the risk. While still in private practice, I aggressively marketed myself, inviting doctors to lunch or coffee. I also lectured on keratoconus, myopia control, and related topics to demonstrate that I was serious and knowledgeable.

Once I opened my practice, I continued to do fill-in work for many doctors in the area to introduce myself, build trust, and supplement my income until my practice got off the ground. Many of my top referring doctors are those I’ve filled in for when I was starting the practice. In the first year, I received referrals from about 100 different doctors, many of whom were optometrists who preferred not to manage complex scleral or keratoconic fits, particularly those practicing in settings where repeated follow-ups are not financially feasible. I also receive referrals from cornea specialists, along with other ophthalmic subspecialties such as retina, oculoplastics, and glaucoma, often for patients with complex postoperative or anterior segment needs.

It’s crucial that you maintain those relationships. Referring doctors receive a custom tumbler, a thank you for the referral, and a detailed letter about the patient encounter. Patients are always sent back to their referring provider (unless the provider doesn’t want them) so it’s clear that I am not competing for primary care. At Thanksgiving, referring doctors get gift cards with handwritten notes.

STRUCTURING A LEAN, VIRTUAL-FIRST TEAM

When I first opened, I answered phones, emails, and texts on top of seeing patients. After about 6 months, it was too much to handle alone, and I hired my first virtual assistant. While she initially answered phones and emails and handled billing, she now serves as a virtual receptionist via a tablet at the front desk—greeting patients, checking them in, collecting payment, and scheduling follow-up appointments (Figure 2).

I initially contracted her through an agency (Hello Rache) but eventually hired her full-time. I have since hired two more virtual assistants (via Upwork) to help with scribing and other clinical support. One other staff member works in-office 8 to 10 hours per week, primarily doing lens insertion and removal training.

Once I found myself consistently booked out by a month or more, and while I was pregnant with my third baby, I brought in an associate. Today, my Charlotte location is a two-doctor clinic with the addition of Heather Cipperly, OD, and my Raleigh location is led by Madison Moss, OD. Both are exceptional clinicians who bring thoughtfulness, curiosity, and a shared commitment to excellence in specialty care. We collaborate closely on complex cases, openly discuss challenges, and learn from one another daily. Building a team of doctors who genuinely enjoy working together has been one of the most rewarding parts of growing the practice.

GROWING AS A LEADER

I’ve learned over time how important leadership and team dynamics are; those skills aren’t taught in optometry school. Much of that learning came from listening to my team and paying attention to what they enjoyed and what made them feel appreciated. Over time, I realized that people are motivated in very different ways. For one of our team members, I surprised her with tickets to see her favorite K-pop band. It was the happiest I had ever seen her in response to a gesture of appreciation. Understanding what truly motivates people is essential if you want them to feel valued, enjoy their work, and be able to work together long-term.

For broader support, I’ve found tremendous value in the professional community, particularly spaces where doctors openly share ideas, challenges, and solutions without feeling like competitors. Having access to that kind of collective wisdom was especially helpful early on, and it reinforced how important collaboration is when building something new.

As my practice has evolved, my deepest professional support now comes from a small group of colleagues I met through specialty lens meetings. We stay closely connected through regular conversations and a group text where we share everything from vendor frustrations—“This prosthetic lens company isn’t working out, who are you using?”—to challenging clinical cases. Having a trusted core group to problem solve with, exchange ideas, and lean on has been invaluable and continues to shape both my clinical growth and the way I approach practice ownership.

MAKE IT YOUR OWN

My path—a small, tech-heavy, out-of-network, referral-based specialty practice—is just one vision of what optometry can be. Your vision will be different based on what parts of our field excite you and what drains you. Imagine your ideal day and ideal patient, and work backward from that vision to design your practice.

When you do that, you can build a career centered on the parts you love, and that passion will lead to the best patient care possible.

Editor’s Note: This article summarizes a virtual YoungOD Connect mentoring session in which Dr. Cerenzie shared how young optometrists can identify their niche early and shape their career path intentionally. ChatGPT 5.2 was used to adapt the original transcript for length and clarity.