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Beyond Refraction, Frames and Contacts

Posted by Ilena Di Toro | Posted on December 31, 2019

When an eye doctor graduates from school most likely he or she will work in a practice that offers primary vision care which includes refraction and dispensing of frames and contact lenses. Still, vision care is more than just having someone behind a phoropter. So, many eye doctors are forgoing the optical dispensary and focusing exclusively on specialty care.

One big reason for this is that there is more than one provider of routine eye care in a community. That’s a lot of competition for eyeballs. Not the mention, the inventory and staffing needs of an optical dispensing practice aren’t cheap, it can run between $20,000 to $100,000. So, specializing can be good for business, as well as for the health of a community. Since a specialized practice can cost less to establish, the money that would have been used for frames and employees can be utilized for other aspects of the business or to set aside as a nest egg/emergency fund. In addition, insurance can be a real pain to figure out. Therefore, a practitioner of a specialized practice has more freedom to charge for services accordingly.

One practice that concentrates on vision therapy is Twin Forks Optometry and Vision Therapy ( ) in Riverhead, New York. The owners, Miki Lyn Zilnicki, OD, FCOVD, and Jessica Fulmer, OD, FAAO, FCOVD, had completed residencies in vision therapy and this fueled their desire to provide this to patients. They opened in August 2015 and practice focuses on managing ocular disease, pre/post op vision care, and vision therapy for those who experienced a traumatic brain injury (TBI). The doctors regularly meet with other eye doctors to explain their practice and many refer patients to them.

The doctors at Twin Forks Optometry aren’t the only ones specializing. As the population ages there will be a greater need for specialized vision services, so many eye doctors are either adding specialized services to their practice or they just provide specialized services. While research is adding to the understanding of what vision is and laying the groundwork for new treatments, many have vision issues related to macular degeneration or TBI and they need help now, not in five or ten years.

Jerome Legerton, OD, MS, MBA, FAAO, is an eye doctor who specializes in low vision. What lead him to that specialty were two things. One, he worked with Frank A. Brazelton, OD, MsEd who wanted to bring a high level of professionalism to the field. Two, Legerton liked helping those who lost their vision achieve or maintain a level of independence. He aims to helps patients with low vision achieve that through an optometric approach that utilizes spectacle mounted aids. Legerton feels that this approach makes the most of residual vision as opposed to what he calls a “lazy approach” which has a patient pick a vision aid without any instruction or adjustments.

Another doctor that specializes in low vision is Robert Joyce, OD. He had worked in low vision clinics and didn’t like the lack of measurable results that could be demonstrated to the patient. So, he developed procedures and standards to help patients with low vision see the progress they are making. “I have had patients regain their ability to read after not being able to read for 5 years,” Dr. Joyce said. “They know that it might take some hard work, and it might be different from anything they have done in the past, but it pays off.”

While it can be challenging to get patients in the beginning, once other doctors and grateful patients know about the services being provided, a specialized practice will be the go to place for those who need more than glasses or contacts.


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