Grow your practice through anterior segment specialization

Technologies such as swept-source optical coherence tomography, corneal topography, and corneal tomography now allow for earlier and more accurate diagnosis of corneal irregularities such as keratoconus. Image credit: AdobeStock/Emiliano

My journey into anterior segment care began while leading the specialty contact lens clinic at the Naval Medical Center in San Diego, California. There, I treated complex corneal conditions and postsurgical complications in patients from around the globe. Later, I transitioned into private practice, taking over a specialty clinic from a retiring optometrist who had spent decades treating patients with corneal transplants or keratoconus.

Today, with mounting financial pressures on private practice optometry, many clinicians are searching for sustainable ways to maintain profitability and purpose. Specializing in anterior segment care has allowed me to build a distinctive brand, offer high-value services, and meet a critical need in my community—all while preserving revenue in an increasingly challenging environment.

Over the years, my clinic has become one of the leading providers of keratoconus care in the country. I’ve learned firsthand that developing a niche offers multiple advantages, such as the following:

• Stronger brand identity in a crowded market
• Ability to command premium pricing for expert care
• Increased referrals from general optometrists and ophthalmologists
• Higher patient retention due to trust and specialization

The power of advanced imaging

Figure 1. Shows how easy it is to evaluate and diagnose corneal ectasia and keratoconus. Corneal data can be customized to allow for anterior and posterior topography, combined with pachymetry as well as epithelial and stromal thickness. In this case, steepening can be seen on both the anterior and posterior maps. However, the steepening is not in the typical location we would normally see in ectasia or keratoconus. The epithelium thickens over the corneal apex, and the stroma thins, supporting a diagnosis of atypical keratoconus. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

Advancements in imaging have significantly improved the precision of anterior segment disease detection. Technologies such as swept-source optical coherence tomography, corneal topography, and corneal tomography now allow for earlier and more accurate diagnosis of corneal irregularities such as keratoconus. These tools help clinicians map the shape, curvature, and biomechanical properties of the cornea with unprecedented precision, enhancing diagnostic accuracy.

Figure 2. Biometry in a patient with both keratoconus and high axial length from degenerative myopia. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

Recently, I incorporated the Anterion multidisciplinary imaging platform by Heidelberg Engineering into my practice. This system captures ultra-high resolution, 3D images of the anterior segment, giving me the power to identify subtle degenerative changes, diagnose complex corneal conditions, and tailor treatment plans to each patient’s individual needs.

Early detection of keratoconus is critical: It opens the door to timely intervention with specialty scleral lenses or proactive treatments that may slow disease progression. Modern scleral lenses incorporate advanced technologies, including wavefront-guided and digitally molded designs. Pairing these innovations with high-quality diagnostics increases clinical efficiency and gives me confidence in the initial diagnosis and long-term monitoring.

Patients also respond positively to this technology. High-resolution imaging builds trust and reinforces the perception of precision and cutting-edge care. For many, it becomes a reason to stay with our clinic.

Investing in tech, elevating your brand

Figure 3. High resolution imaging along 5, 16.5 mm radial scans. This allows for a quick and comprehensive assessment of the fit of the scleral lens. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

The ability to diagnose and manage complex cases with confidence has transformed my practice into a destination for advanced eye care. Tools that provide multidisciplinary diagnostics do more than improve clinical outcomes; they also differentiate the practice in a crowded market and create a pathway to sustained profitability.

These cases aren’t easy. Many of these patients have already seen multiple providers and carry a history of frustration and failed solutions. But therein lies the opportunity to make a real impact, change lives, and create loyal patients who become advocates for your expertise.

Figure 4. Shows the fit of a scleral contact lens on an eye with a penetrating keratoplasty and an IC-8 Aphthera pinhole intraocular lens implant. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

Anterior segment technology also enhances other areas of care. Orthokeratology, for instance, has become a widely embraced specialty within optometry. Imaging is key in tracking corneal changes and evaluating treatment success. For me, investing in a comprehensive platform that integrates topography, biometry, and epithelial mapping was the right decision not only for my practice, but for my patients. Having that full-picture view of each patient’s cornea has truly transformed my clinical approach.

Building expertise, expanding influence

Figure 5. Slit lamp image of a corneal RGP lens on a patient with keratoconus. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

For optometrists interested in anterior segment specialization, I encourage investing in ongoing education. Attend hands-on workshops, enroll in clinical courses, and seek mentorship opportunities from experienced specialists. Observing in high-level clinics and training with advanced instrumentation can dramatically accelerate your growth and confidence in managing complex cases.

Figure 6. Slit lamp image of a keratoconus patient with INTACS wearing a scleral lens. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

You can also enhance your professional presence by contributing to academic journals, publishing case reports, and participating in relevant conferences. Staying connected to current research and cultivating peer networks opens doors to collaborative learning and innovative patient care. At my practice, we function as a teaching facility because we believe in investing in the future of our profession through education and mentorship.

Final thoughts

Figure 7. Slit lamp image of an orthokeratology (Ortho-K) patient. (Image courtesy of Randy Charrier, OD, FAAO, Dipl CCLRT)

Optometrists who commit to anterior segment specialization and embrace state-of-the-art imaging technology can redefine their value to patients and referring providers. By creating a high-impact niche, you not only weather the pressures of declining reimbursements and rising costs, you also position yourself as a leader in advanced vision care.