Silverstein is a founding partner of Silverstein Eye Centers, in Kansas City, Missouri. He is also an assistant professor of ophthalmology at the University of Missouri Kansas City Medical School, and clinical professor of ophthalmology at Kansas City University of Medicine and Biosciences. 

E: ssilverstein@silversteineyecenters.com

Steven Silverstein, MD

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Cataract and refractive surgeons with an eye toward growth understand that investment and creative thinking are the fertilizers of progress. 

Each practice faces its own cash flow, operational, and competitive challenges, and there is no one-size-fits-all approach to building a bigger and better practice for the future. 

Still, some general principles may be applied to many practice types. 

Consider applying any or all of the below concepts to your practice as you look to thrive in 2021 and beyond.


Some practices try to take an incremental approach to staffing increases. 

Although hiring at a slow, even pace may seem like the least disruptive option, the truth is that it strangles your practice’s potential to grow and puts you at risk of being left behind by your competitors. 

Many practices are at or below staffing levels from the prepandemic age, yet patients are scheduling appointments with cataract and refractive surgeons at the highest rate in years. 

Without trained technicians, clerical workers, and other support staff, a practice cannot increase its patient volume.

Some of the staff you hire may already be experienced, as they will come from other practices that cut staff or shut down during the pandemic. Others will require training. 

Regardless of their skill set and work history, the staff you hire and train now will allow you to increase your clinical and surgical capacity in the future. 

That means a better experience for your patients and more realized revenue for your practice.


Offering new products and services is a reliable way to maximize the potential of a well-run practice. The startup costs of new offerings vary. 

After estimating your return on investment, you can calculate how long it will take for your investment to realize a profit.

Nonsurgical investments may be appropriate for some practices. The addition of allergy testing, for example, allows new revenue to flow into the practice while also offering your patients the chance to learn about proactively treating ocular allergies during certain times of the year or in certain situations. 

The addition of aesthetics into a practice may appeal to patients who have already considered premium offerings. Including an optical dispensary in your clinic provides patients and their families convenient options for glasses or contact lenses.

Alternatively, new surgical offerings may allow your practice to reach more patients or enhance the premium aspects of your more personalized surgeries. 

If you want to expand your patient base, consider adding minimally invasive glaucoma surgery (MIGS) to your practice repertoire. 

Because nearly all MIGS procedures occur alongside cataract surgery, anterior segment surgeons are well suited to incorporate this new technology into their practice.

If you wish to enhance the personalized offerings of your practice and build your reputation as a cutting-edge surgeon, adding drug delivery technology such as dexamethasone intraocular suspension 9% (Dexycu, EyePoint Pharmaceuticals) could be wise 

Dexycu (blue circle) is administered at the end of cataract surgery and can be visualized by the surgeon. 

Administering Dexycu at the end of surgery eliminates concerns about patient adherence to the steroid drop regimen and provides, in my experience, quiet eyes on postoperative day 1 and week 1. 

All of this helps to optimize the patient experience, which in turn leads to happy patients and possible future referrals. 

Any surgeon who is adding a new technology to reduce or eliminate postoperative drops needs to be up-to-date on the latest information regarding those technologies. 

Reimbursement must also be top of mind. Luckily, in the case of alternatives to drops for postoperative cataract treatment, the options on the market have favorable reimbursements.

It should be noted that adding a new surgical option, like Dexycu for cataract surgery or iStent inject W (Glaukos) for MIGS, often does not often require a major capital investment from the practice, and could be a low-cost way to open up new revenue streams in the near- and long term.

The investment of learning how to place a new premium IOL, for example, is time-based rather than cash-based. 

If you are willing to spend the extra time to expand your surgical offerings by learning how to use the latest technology, your practice will likely see a monetary return quickly.

 pandemic, many practices turned to telemedicine as a way to interact with patients. 

Although this may work for other specialties, it is not particularly conducive to ophthalmic practice. 

No diagnostic testing can be performed via telemedicine, and the frequent snags associated with telemedicine due to technology limitations and patients’ unfamiliarity with telecommunications often end up generating roadblocks to success rather than removing them. 

It is time to stress to your patients that telemedicine, while a pandemic necessity, is not well-suited to their needs. Get your patients back in the office.


Some practices see the capacity for growth limited by architectural realties. You can only fit so many diagnostic platforms in a single room, after all. 

Still, it may be time to reassess the strategy of your office’s layout as you commit to growing within the confines of your existing space.

Can a room that was formerly used as a catch-all for miscellaneous equipment be transformed into a space for technicians to capture patient imaging data? 

Could a more intentional patient journey through your practice lead to more efficient patient visits, and therefore more appointments per day? 

Questions like these require creative answers, and you may find yourself surprised at how small adjustments can have outsize consequences.


The above suggestions are not an exhaustive list of ways to fortify and expand your practice. 

Still, you might find them useful as you assess your future. Each surgeon is the expert in their practice’s potential to flourish. 

As you plan the growth strategies that are right for you for the coming years, look at your practice from an objective perspective and decide which paths forward allow the cost-benefit ratio that is right for you.


Silverstein is a founding partner of Silverstein Eye Centers, in Kansas City, Missouri. He is also an assistant professor of ophthalmology at the University of Missouri Kansas City Medical School, and clinical professor of ophthalmology at Kansas City University of Medicine and Biosciences. He reports the following relevant financial disclosures: Speaker and consultant for EyePoint.

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