What if the path to improving vision care—and building financial sustainability—was as close as your hospital’s optical shop?
At Dr. Shroff’s Charity Eye Hospital in India, that question led to a bold decision: stop outsourcing optical services and bring them in-house. Their goal is to reach 25% profitability, cover 8 hospitals and 107 vision centers, and—most importantly—made eyeglasses more affordable and accessible to the people who need them most.
But this isn’t just a financial story. It’s about people.
It’s about patients who can finally see clearly enough to work, study, or care for their families. It’s about staff who are now trained, empowered, and connected to a deeper mission. It’s about communities gaining access to better care and stronger local economies.
👓 Why Own Your Optical Shop?
Uncorrected refractive error (URE) is one of the leading causes of vision loss worldwide, especially in low-resource settings. Many eye hospitals outsource their optical shops, which often means losing control of:
Pricing – profit is managed by a company, not the hospital
Product quality – limited control over lens quality and frame styles
Revenue – shared with another entity
Patient experience – staff training and patient wait times may be inconsistent
Scalability – opening centers in less profitable locations
Shroff’s experience shows that owning the optical journey can create a ripple effect:
✅ Better patient outcomes through integrated care ✅ Faster service with in-house lens edging labs ✅ New revenue to support free or subsidized care for their mission ✅ Local job creation and staff retention through training and incentives
🔧 How Did They Do It?
The team at Shroff took a thoughtful, step-by-step approach:
Piloted the model in one hospital before scaling.
Obtain all required licenses and certifications to operate legally with the help of corporate lawyer
Used a tiered pricing model—affordable (~$2.50) frames for low-income patients and premium options for others.
Trained community health workers and clinical staff to identify refractive needs and refer patients.
Built an in-house lens edging lab for faster, cheaper delivery.
Created a transparent supply chain and invested in on-site teams at every hospital and vision center.
Managed cash flow at each level of the supply chain.
💡 What Can Other Hospitals Learn?
If you’re thinking about launching or improving an in-house optical shop, here are a few takeaways:
🛠️ Start small. Pilot, learn, and grow.
🧭 Keep patient flow smooth. Make it easy to go from prescription to purchase in one visit.
👥 Invest in people. Your staff are your most valuable asset. Train them, reward them, and give them a mission to believe in.
📊 Track your data. Sales, customer feedback, and costs are all tools for smart scaling.
💬 Let’s Talk!
Are you exploring an in-house optical model? Already running one and have lessons to share? I’d love to hear from you!
What’s working—or not—in your context?
What questions do you have for the Shroff team of experts?
➡️ Comment below! Let’s learn from each other and build something better—together.
Glaucoma in Uganda are estimated at 3.6% of blindness cases. But in busy clinics, early detection of glaucoma may be challenging. Seva is pleased to support this project with Dr. Shamiim Namwaswe, expected to start in May, 2025. We welcome your questions or guidance from your past experiences as we begin this work.
Lira Regional Referral Hospital provides eye care in the northern hilly regions of Uganda where patients have few eye care options. Currently, there is no visual field testing for glaucoma at Lira and a review of the last quarter (Oct-Dec, 2024) shows 64 patients were diagnosed. Of those, 36 are on treatment and 11 were referred to another clinic.
The addition of an easy-to-use and reliable visual field testing method should improve glaucoma detection and treatment rates.
Patients with glaucoma typically present with some peripheral vision loss and optic nerve damage or optic disc lesions are observed during examination. It is best practice at Lira to evaluate intraocular pressure for every patient but there can be erroneous readings if the contact isn’t properly placed.
If the standard exam reveals that glaucoma is suspected, patients are referred for additional testing approximately 340 km away since a Humphrey visual field analyzer isn’t available locally. The visual field test costs approximately 100K Ugandan shillings and may take 2 days for patients to travel, wait to register, complete the testing and return home. The cost and inconvenience could result in patients not getting the treatment they need to preserve their sight.
Expanding the glaucoma service at Lira is straightforward given the technology advancements toward visual field testing on any device, like a laptop. This service would allow immediate evaluation of visual field at Lira, resulting in faster diagnosis and earlier initiation of therapy.
Patients at Lira have varied experiences but the journey outline is presented below.
Patients typically present with they are noticing changes in their peripheral vision that are causing challenges in their daily lives.
The hospital is a reasonable journey away for many patients and bus routes are generally available, though the journeys can be long (5 hours for some remote patients) and crowded.
When patients arrive, they are greeted and sent to a central point for initial counseling and screening. Patients with visual issues are sent to the eye department where they are:
Screened for visual acuity
Assigned a number
Sent to a clinical room for an eye exam. Here, the Clinical Officer will examine the patient and if they see a risk for glaucoma, they will call Dr. Shamiim. She will perform the more advanced eye testing and confirm suspected glaucoma.
For patients with suspected glaucoma, they will be guided to the laptop with Eyeonic for visual field testing.
Younger patients will likely be able to test independently given the visual and audible cues from the software.
Older patients may not speak English well or be less comfortable with the technology so Clinical Officers or Counselors will help to guide them through the process.
After glaucoma is confirmed, counseling is critical to explain the condition, what medication is available, what will happen if the patient does not adhere to their treatment plan, and how to use the medications properly. It is critical to explain that the lost vision will not return – we are preventing continued visual loss. Setting proper expectations and noting that repeated testing is available when patients return for refills or if they see continued worsening is critical.
Medical treatment is started first. Eye drops are available at Lira or locally and tablets are available for cases that are more severe. Patients are asked to follow up 1 month after receiving eye drops since the eye pressure is expected to drop after 3 weeks or use. If the first medication fails (i.e. pressure remains high), they will try another medication. After the 3rd failed medical attempt, surgery at the government hospital is advised. In some cases, patients may refuse medical help or present with very severe cases where surgery is recommended earlier.
Adding Eyeonic for visual field testing on a laptop creates an opportunity for glaucoma awareness campaigns for patients and referring physicians.
Juniors, or Clinical Officers, perform the initial eye exams and call Dr. Shamiim when necessary. These professionals are younger in general – and a majority embrace change. Most of them would be happy to have additional tools, and may know the team at Eyeonic, adding a level of trust. They would like not having to refer patients to other centers since patients can easily take the test at Lira.
It is important to have a complete, easy training process since they are eager to learn. This process will cover glaucoma reminders as well as details on how to use Eyeonic.
There are other critical stakeholders for the new testing introduction. The Ministry of Health has District Health Officers who should be made aware, in addition to the Lira hospital, health centers that refer patients to Lira, and the Lira eye care team. These activities – expected to take less than a day and ideally added to existing meetings or gatherings – will help to drive demand.
MOH – district health officer (may need multiple meetings for these district officers).
General hospital staff
Lira Referral eye care team
Training for regional team
Back up training for regional teams
Eyeonic was selected for visual field testing given its flexibility, affordability and presence of staff members in Africa.
How do you approach visual field testing and glaucoma awareness? Do you have advice as Dr. Shamiim begins her study? We’d love for you to comment below and let us know what you think!
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