We talked to a surgeon recently who's one of the most productive ophthalmologists at his PE-owned practice. He does hundreds of cataract surgeries a year, generates strong revenue across multiple service lines, and was trained in refractive surgery during his fellowship.

He hasn't done LASIK in years, and the reason has nothing to do with his skills or his desire to operate. His PE group won't buy the equipment.

Asking for Equipment and Getting Told No

He's asked them multiple times over the years. Every time, the same answer: the capital outlay isn't justified, we don't know what the volume would be, it's not in our current investment thesis. So here's a surgeon generating millions in annual revenue for a platform that structured his employment agreement to keep him in place, and they won't spend $250,000 on an excimer laser so he can practice the full scope of his training. A laser that would pay for itself in 12 to 18 months at moderate volume. A laser that would make him happier, more fulfilled, and more productive as a clinician.

They'd rather keep him grinding cataracts on their schedule with their equipment in their facilities because cataracts are predictable, insurance-reimbursed, and recurring. PE loves recurring revenue because it's easier to model on a spreadsheet and easier to sell to the next buyer when they flip the platform in 3 to 5 years.

Refractive surgery doesn't fit that model. It's cash-pay, which means you have to market for it. It requires upfront capital for equipment that depreciates. It demands ongoing investment in technology because patients expect the latest platforms. Buying a $400,000 femtosecond laser for one surgeon's clinical interest doesn't fit a PE exit timeline, so it just never happens.

The Refractive Revenue PE Is Leaving on the Table

But look at what the numbers actually say. The national average for LASIK is about $2,250 per eye. At 80 bilateral procedures a month, that's $4.2 million in annual refractive revenue with roughly 40% gross margins and equipment payback in under 18 months. The economics are obvious to anyone who's willing to invest past the next quarterly earnings call. But PE isn't willing because the capital commitment is real and the payoff requires patience, and patience doesn't exist when your fund has a 5-year horizon.

A full refractive suite with an excimer laser, femtosecond laser, and diagnostics runs $750,000 to $1.25 million depending on the platform and build-out. That sounds like a lot until you realize a moderate-volume practice breaks even on that investment in 12 to 18 months and generates $4 million or more annually after that. Premium LASIK with wavefront-guided or topography-guided treatment runs $2,500 or more per eye. SMILE procedures, which only require a single femtosecond laser and no excimer at all, charge $2,000 to $3,600 per eye. The revenue is there for anyone willing to invest in the equipment. PE just isn't willing.

What Happens to Ophthalmologists Who Can't Practice Their Full Training

This is what kills us about the situation. This surgeon's refractive skills are atrophying every single year he doesn't operate a laser. The muscle memory fades and the confidence with new platforms erodes while he watches residents half his age get certified on equipment he was trained to use a decade ago. PE isn't just denying him a piece of equipment. They're slowly erasing a part of who he is as a surgeon, and they don't even realize it because they've never held an instrument in their lives.

He's not the only one either. PE firms have acquired over 550 ophthalmology practices since 2011 and they preferentially target retina specialists and high-volume injection prescribers because those procedures are insurance-reimbursed and recurring. KFF Health News found that 43% of top Lucentis prescribers had PE investment versus only 8% of ophthalmologists overall. The money follows the injections because injections don't require capital expenditure and you're just buying vials and billing Medicare.

So what happens to surgeons who want to do more than what PE allows? They ask, get told no, ask again next quarter, get told no again, and eventually start looking for a way out. We keep hearing the same story from different surgeons in different states and it always ends the same way. The surgeon realizes that the people controlling their career have never performed a single procedure and have no intention of investing in anything that doesn't fit a financial model.

How We Handle Equipment Differently

We don't tell surgeons which procedures they're allowed to perform. If a surgeon wants to add LASIK to their practice, we fund the laser, install it, and get out of the way. We don't put a markup on equipment because we don't need to squeeze margins on the small stuff the way PE does. We make money when the practice grows, and practices grow when surgeons are practicing everything they were trained to do.

Your PE group won't buy you a laser because it doesn't fit their exit timeline. We'll buy you one because we actually plan on being here long enough for it to matter.

This article is for general educational purposes and is not investment advice.

Verdira is a healthcare acquisition platform focused on ophthalmology practices. Physician ownership. Transparent structure. No volume quotas. If you are evaluating private healthcare investments and want to understand the mechanics of this market, we are open to thoughtful conversations.

Contact info@verdira.com | 307-381-3734 | verdira.com