Refractions are down. Revenue is down. Exam-only behavior is climbing.

And for many practices, the first half of 2026 has been much tougher than expected.

In this week’s episode of Power Hour, Eugene Shatsman sits down with Dr. Jason Lake, General Manager of PERC & Opti-Port, to examine real-time independent practice performance data and discuss what owners can do now to protect revenue, improve capture, and prepare for demand to return.

What the Numbers Are Showing

The data discussed in this episode represents approximately $1 billion in eye care transactions and more than one million annual refractions, primarily across independent practices.

The picture is difficult to ignore.

Refractions declined across much of the first half of the year, including a double-digit year-over-year decline in May.

Revenue followed the same pattern, with eight of the previous twelve months showing negative year-over-year growth and May producing a decline of nearly 14%.

At the same time, exam-only has increased by approximately four percentage points over the previous year and may soon cross 60%.

That would mean nearly six out of every ten patients receiving a refraction at an independent practice leave without making a same-day purchase.

Is Demand Gone, Or Delayed?

Dr. Lake believes the slowdown is less about patients no longer needing eye care and more about consumers becoming cautious.

Patients are feeling pressure from higher everyday expenses, employment uncertainty, and the cumulative fatigue of inflation.

Even when they come into the practice, they may delay eyewear, stretch contact lens supplies, avoid premium upgrades, postpone treatment, or leave after the exam without buying.

But delayed demand is not the same as lost demand. Patients will still need eye exams, eyewear, and treatment. The practices that prepare now will be in the strongest position to capture that demand when confidence returns.

Why Exam-Only Is Also an Operational Problem

Economic pressure explains part of the increase in exam-only behavior, but not all of it.

Dr. Lake points to another major issue: many practices have experienced significant staff turnover without rebuilding the sales skills, handoff processes, and cultural expectations that previously supported stronger performance.

A cautious patient combined with a vague recommendation and an undertrained optical team creates the perfect environment for walkout.

When those elements come together, patients are much more likely to walk out. That is why exam-only cannot be treated solely as something happening to the practice. It is also a performance issue that practices can influence.

Get Back to the Fundamentals

The core message of the episode is simple:

This is the time to sharpen the practice.

When volume slows, owners can use the extra capacity to improve the operation before demand returns.

That means:

• Treating every patient interaction as a valuable opportunity
• Strengthening the doctor-to-optical handoff
• Tracking capture rate and exam-only performance
• Creating daily accountability around walkout
• Training staff to communicate value instead of only quoting price
• Offering good, better, and best solutions for different budgets
• Improving recall, pre-appointing, and patient reactivation

None of these ideas are complicated, but they require clear expectations, consistent measurement, and active ownership.

The Recommendation Should Be Heard Three Times

One of the most practical strategies in the episode is reinforcing the recommendation throughout the patient journey.

• First, the doctor explains the need in the exam room.
• Second, the doctor repeats it during the handoff.
• Third, the optician confirms the recommendation before beginning the eyewear conversation.

Patients should not have to translate a vague clinical comment into a purchasing decision on their own.

The doctor establishes the need. The handoff preserves the authority of the recommendation, and the optical team helps the patient complete the care plan.

When done well, it does not feel like selling. It feels like continuity of care.

Value Requires More Than One Price Point

Practices should continue recommending the best solution.

But they also need credible alternatives when patients are feeling financial pressure.

Many practices are comfortable selling up the product ladder, but less prepared to guide patients down to a more affordable solution when necessary.

That creates unnecessary walkout.

A patient may not be ready for the $1,000 option. They may still accept the $500 or $300 option if it is presented properly. 

Dr. Lake recommends building a deliberate good, better, and best structure so the practice can preserve the relationship, meet the patient’s core need, and avoid sending them online or to a competitor.

The goal is not to become the cheapest practice. It is to give the patient a strong reason to stay instead of buying online or walking into a competitor.

Prepare Before Demand Returns

The strongest practices will not wait for the market to fix itself.

They will retrain the team, improve the handoff, review pricing and product options, strengthen patient communication, and build clearer accountability now.

This episode is a real-time look at what is happening across independent eye care and a practical reminder that economic uncertainty does not have to mean passivity.

The numbers may be challenging, but they also reveal where the opportunity is. When delayed demand returns, the opportunity will flow toward the practices that are ready to convert it.

Eyecare BOSS Live Summit

If you’ve been to conferences before, you’ve probably left with many great ideas and intentions, and then when you get back to your practice, nothing actually changes.

Eyecare BOSS Live is designed specifically with that in mind so you can not only know what to do to reach your goals, but also have the tools, strategies, and plans to implement lasting changes once you’re back. to change that.

This is a 2 and a half-day, invitation-only event (September 16–18 in Cleveland) designed specifically for practice owners who want execution, not just inspiration.

Inside the room:

• 200 growth-focused operators
• Peer-level masterminds
• Real conversations around revenue, staffing, leadership, AI, and specialty growth

And everything is built around one outcome:

You leave with a 90-day plan you can actually implement.

If you want to be considered, click the link below:

• The Q2 Data Is a Warning | See what current refraction, revenue, and exam-only trends reveal about independent practice performance.
• Consumer Confidence Is Changing Behavior | Understand why patients may be delaying care and becoming more price-sensitive.
• Exam-Only Is Also Operational | See how recommendations, handoffs, and staff training affect patient walkout.
• Value Needs Multiple Options | Learn why good, better, and best solutions can help retain cautious patients.
• Preparation Creates Opportunity | Discover how stronger systems can position your practice to win when demand returns.

Connect with Dr. Jason Lake

Dr. Jason Lake is the General Manager of PERC and Opti-Port, and a recognized expert in practice performance, metrics, and operational optimization in eye care. He works closely with practices across the country to analyze real-world data and identify the specific drivers of growth, efficiency, and profitability. Known for his practical, no-nonsense approach, Dr. Lake helps practice owners translate complex metrics into clear, actionable strategies that improve both patient experience and business performance.

• LinkedIn: https://www.linkedin.com/in/jason-lake-od/  
• Website: https://www.percalliance.com/

Connect with Eugene Shatsman

Eugene Shatsman is Host of Power Hour, Managing Partner of National Strategic Group, Co-Creator of The Eyecare BOSS, and a TEDx Speaker. A growth strategist and consultant to hundreds of optometric practices nationwide, Eugene specializes in scaling independent eye care businesses through structured strategy, marketing science, and operational clarity.

• LinkedIn: https://www.linkedin.com/in/eugeneshatsman/
• Website: https://eyecareboss.com/