Niche Necessities

Consider these six “must haves” to increase the likelihood your specialty will be successful

After ruminating, for roughly a decade, on whether to make my dream a reality by starting a sports vision training specialty, I decided to commit. The result: Performance 20/20 opened its doors in Stamford, Conn., in January 2016.

In evaluating this experience, here’s a list of what I think are the “must-haves” to increasing the likelihood of any niche becoming a success.


Are you considering adding the niche because you have a fervor for it and believe it will improve patients’ lives or because you’ve heard doing so is a good idea, based on marketing research or a desire to increase your practice revenue? If your reason is the former, your niche has an excellent chance of becoming successful because you’ll be willing to put in the several — and I mean several — hours it will take to make it that way.

I spent and spend a lot of time on Performance 20/20 not just seeing athletes, but also fielding calls, answering emails and more. It’s hard work, but I love it! Having competed in Division 1 track and field and playing several other sports, this niche was a natural for me. Also, I’ve found that when you genuinely love offering a service, whatever it is, those either thinking about the service or already getting it can tell, which sends the message that you’re committed to giving them the best. They want to be a part of that.


If you already have a passion for the niche, you, likely, already have the needed education as well. For example, as I’m a sports enthusiast and had been considering opening Performance 20/20 for a decade, I kept up-to-date on the latest sports vision training techniques, equipment and related prices.

Many societies and organizations are dedicated to optometric niches, so you may want to look into joining them and even networking with fellow members to pick their brains about what has made their niches successful. Further, consider contacting the AOA for guidance, as the association contains several subgroups, in my case, the Sports and Performance Advocacy Network, that may be helpful. Many of these organizations offer meetings, conferences, workshops and CE.


Optometric Niches

→ Low Vision

→ Neuro-Optometry

→ Pediatrics

→ Specialty Contact Lenses

→ Sports Vision

→ Vision Therapy


It helps to identify a need for your niche before starting it. Begin by evaluating the records of your current patients to see whether enough have presented with the ocular/vision need(s) to make adding the niche worth it. Also, ask them, face-to-face, whether they or a nearby friend or family member would be interested in the niche. Further, assess Census Bureau data for the local area your practice resides to make the patient need determination.

In my case, sports are extremely competitive in my area, especially hockey and lacrosse. Many of our athletes are playing on multiple travel teams, use personal trainers, private coaches, nutritionists, chiropractors, etc. I knew these athletes would want the chance to take their performance to the next level.

Also, when I asked parent patients whether they’d be interested in having their athletic child improve her eye/hand coordination, reaction, anticipation, timing, decision-making and overall athletic performance, I received a resounding, “yes.” Who wouldn’t want to become a better athlete?

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If you’re as driven about metrics as you are about patient care, you’ll have an easier time adding and managing a specialty vs. someone who isn’t a number cruncher. This is because you’ll know exactly what you’ll need, in terms of capital outlay and a break-even point. Successful specialties are well thought-out and planned before executed. This business sense should include assessing:

  • Local competition, if any. If you discover one or more practices offer the niche you want to provide, do some reconnaissance, in terms of the services they offer, what devices they have, etc. There may very well be a way you can differentiate yourself, and a lot of times, there are plenty of patients to go around.
    We are the only stand-alone sports and performance training center in our area. While there are a few similar clinics in the country, we are one of the few offering the array of training we do. If you have a genuine passion for your niche, patients will seek your services, regardless of the competition.
  • Needed equipment. Playing it conservatively or going all-out on niche equipment depends on the specific niche, the strength of your patient base, your comfort level and your other patient care responsibilities. In the case of the former two, you’d likely want to consult with other practitioners who offer the niche to see what they bought and why. If you would prefer to dip your toes into the niche, due to an already thriving primary care practice, you’ll likely want to be conservative with your equipment purchases and then build on, as the patient base for the niche grows.
    I went all-out with equipment for Performance 20/20 because it was something, and remains something, that doesn’t exist in our area. Also, I had the knowledge, comfort level and the time to put into it as much as I’d put into my primary care practice. Performance 20/20 houses Neurotracker, FITLIGHT Trainer, Senaptec Sensory Station, Senaptec Strobe Goggles and traditional VT tools, including Marsden balls, HART charts, Brock strings and agility equipment.
  • Staffing. This is likely going to be a work-in-progress, but again, you can get an idea of what to start with by consulting with other practitioners who already operate the niche you want to add.
  • Patient scheduling. Assess the availability of the patients for the niche, so you can determine when to schedule them, while still seeing your primary care patients. Realize you may have to add practice hours.
    For example, Performance 20/20 caters to mostly student athletes. As a result, we tend to offer training sessions in the afternoons, evenings, weekends and during school holidays and vacations.


Is your current practice space large enough to accommodate the niche? This is something particularly important to take into account when determining equipment purchases: Where are you going to put that state-of-the-art technology? Do you have enough exam rooms or space for the potential additional patients?

Just as I went all-out with equipment purchases for Performance 20/20, I also decided to lease a separate space to see these athletes, keeping in mind both the space needed for the equipment (and future purchases) and training. Through a very knowledgeable and helpful real estate broker, Performance 20/20 made its flagship home in a former New York Sports Club Complex, occupying about 700 square feet.


Once you have the above five must-haves in place, it’s important to implement internal and external marketing, so you can make both current and potential patients aware of the niche.

Internally, consider related posters and brochures. Regarding the latter, I didn’t anticipate the need for paper brochures because everything is digital nowadays. That said, parents asked for them constantly. As a result, we designed a one-page summary of the services we offer. Also, because ice hockey and lacrosse are the most popular sports in our area, we created custom pamphlets on how we can help those athletes.

When it comes to external marketing, consider cold-call emails, social media and videos. I have spent, and continue to spend, a lot of time sending email blasts to local coaches and sports associations to let them know I’d love the opportunity to help their athletes. In turn, many of these athletes have become my patients. Also, I’ve parlayed these communications into presentations about the role of vision in sports. This, too, has led to additional athletes.

For social media, Instagram, in particular, has been a huge success for Performance 20/20. Both parents of athletes and potential patients “see” what we’re doing and then request a personal visit. In fact, we’ve gotten so many requests, we developed our own roughly four-minute promotional video to educate parents, coaches and prospective patients on what Performance 20/20 offers. (See .)

Marketing takes time with any niche, I think, but once you get the ball rolling, it picks up momentum.

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Performance 20/20 had a soft opening, serving two to three athletes a week. But it grew, and today, it sees 15 to 20 athletes a week. We have plans to expand to a second location in the near future, as well as offer on-site, mobile training to teams, camps and facilities.

One of the greatest gifts of being an optometrist is the ability to integrate our interests and passions into providing eye care. Adding a niche allows for this, and I’ve found the aforementioned must-have’s enable success. OM