About the Author(s)


Pheagane M.W. Nkoana Email symbol
Department of Optometry, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa

Citation


Nkoana PMW. Optopreneurship for a competitive and sustainable optometry practice in South Africa. Afr Vision Eye Health. 2024;83(1), a868. https://doi.org/10.4102/aveh.v83i1.868

Review Article

Optopreneurship for a competitive and sustainable optometry practice in South Africa

Pheagane M.W. Nkoana

Received: 11 June 2023; Accepted: 17 Nov. 2023; Published: 30 July 2024

Copyright: © 2024. The Author(s) Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Optopreneurship entails the entrepreneurial activities within the optometry industry. The term is new and derived from optometry and entrepreneurship. Optometrists are professionals who are responsible for screening, examining, diagnosing, treating and managing vision and eye health problems through the provision of optical devices and therapies. Optometry business and entrepreneurship have been poorly studied.

Aim: To provide an overview of optopreneurship and optopreneurial activities for competitiveness and sustainability in optometry practice from a South African perspective.

Method: Literature was reviewed from Google Scholar, PubMed and ScienceDirect databases using key terms such as entrepreneurship, health entrepreneurship, optometry entrepreneurship and optometry business used.

Results: Thirty-four scholarly articles were found to be relevant for the review. Fourteen articles were on entrepreneurship, 13 on eyecare and optometry, 2 on optometry business and 5 on healthcare entrepreneurship. Additionally, 24 websites were reviewed to provide evidence on entrepreneurship and optometry business. Though optometry business has higher revenue turnover potential, conglomerates exhibit superior business acumen over individual practitioners. Optometrists should enhance their business acumen and entrepreneurial agency by identifying underserviced areas such as to stay competitive.

Conclusion: Engaging in optopreneurial activities will help optometrists to develop competitive advantage. There is a need to develop and collate optometrists’ business acumen and clinical skills. More research is required in optopreneurship.

Contribution: This article seeks to highlight the overview of entrepreneurial activities and opportunities for optometrists in South Africa, and the need to develop a business acumen and entrepreneurial mindset to gain a competitive advantage.

Keywords: optopreneurship; entrepreneurship; optometry business; optometrists; competitive sustainability.

Introduction

Optopreneurship has not been used in formal literature but was derived from two words optometry and entrepreneurship for the purpose of this article to describe the activities of optometrists characterised by using innovative ways and taking calculated risks in using resources, skills and vision to create, manage and scale optometry-related businesses to create and/or provide products and services to meet the needs of the eyecare market.1 It basically outlines the entrepreneurship activities of optometrists and should further be understood from the organisational context, entrepreneurial performance and entrepreneurial behaviour.1 Firstly, from this perspective, optometry organisations should be understood to be optopreneurial when they are small to medium in size, when individuals are self-employed or when establishments are new although the criteria are inconsistent. Secondly, optometry organisations that are innovative and have positive growth should be regarded as optopreneurial. Thirdly, in terms of behaviour, optometrists should recognise or create opportunities or exploit or commercialise an opportunity.

Optometry is a regulated healthcare profession that is concerned with screening, examination, diagnosis and management of conditions of the eye and visual system through the use of optical devices such as spectacles and contact lenses, vision therapies and pharmaceutical agents among other strategies.2 In South Africa, optometrists are registered with the Health Professions Council of South Africa (HPCSA) and their registration assumes that they possess defined knowledge, skills and competencies (KSC) for caring of patients with vision and eye health problems.2 The registration of optometrists with the HPCSA grants them an opportunity to earn a living from activities aligned with their practicing of the profession.2

Pre-1994, South African optometry services were characterised by provision of optical devices and less concerned with overall eye health with the service limited minority and privileged few who afforded out-of-pocket payments.3 Post-1994 and today, more people can afford optometry service through medical aid schemes and out-of-pocket payments, while non-affording majority using the public service access not only the optical devices but also complete vision and eye healthcare.3 According to Vision Magazine Online,4 about 8.7 million (14.6%) of the South African population wear some form of vision correction and Council for Medical Schemes5 estimates that about 14.8% are covered under medical aid schemes. These figures are quite low and suggest that most people cannot afford private optometry service and therefore may use public services. There are about 4310 optometrists practicing in 2900 practices today (as at November 2023), which has increased the competition; hence, entrepreneurial-inclined optometrists have opportunities to get a larger portion of this segment of the population that use private optometry.4

Entrepreneurship has been applied in various industries and fields for centuries with multiple definitions by researchers from various perspectives depending on the industry or sector.6 Researchers such as Drucker have defined entrepreneurship as ‘an act of innovation that involves endowing existing resources with new wealth-producing capacity’ (p. 308).7 Although consensus could not be reached regarding the definitions of entrepreneurship, Schumpeter’s definition, from the economist perspective, provided five distinct scenarios as examples of entrepreneurship, which included:

[I]introduction of a new good, or a quality of good, introduction of a new method of production, the opening of a new market and the conquest of a new source of supply of raw materials and the carrying about of new organization in any industry. (p. 46)8

Entrepreneurs have a competitive attitude, are self-motivated, possess high levels of self-confidence in things they do, and apply customer-centric mindset in their approach to business.9

Optometry entrepreneurship

Optometry entrepreneurial activities

Table 1 presents the layout of optometry entrepreneurial activities (OEAs) that are classified as commercial, corporate, academic, social or unconventional10 for commercial activities; independent optometrists operate single or group of private optometry practices, which are of small scale and conglomerates operate large-scale group of optometry stores. Corporate entities, such as public hospitals and clinics, and private hospitals provide optometry services to consulting patients. An observed trend, however, is that most private institutions rather provide ophthalmology unlike optometry services. Academic institutions run optometry clinics, which are platforms to train optometry students. Although these university-based optometry clinics are not profit-driven, they are expected to generate some income for their sustainability. Social entrepreneurship is concerned with undertaking processes and activities to develop innovative products and services to enhance social wealth, which commercial practices are unable to provide.11 Social enterprises such as the South African National Council for the Blind (SANCB), Blind South Africa (BlindSA), Retina SA and Keratoconus Foundation of South Africa (KFSA) participate in social optopreneurship in South Africa. They play an important part of service provision because of the limitations experienced by both corporate and commercial practices.11 Unconventional entrepreneurial activities in the optometry business such as optometry consulting, manufacturing and advocacy are also important aspects that generate more revenue and/or have a potential to do so.

TABLE 1: Optometry entrepreneurial activities.
Benefits of entrepreneurship

As suggested by entrepreneurship literature, optometrists who engage in entrepreneurial activities may contribute to economic growth, wealth generation, social change and community development.12

Economic growth

Through entrepreneurship there is exchange of products and services between businesses and their end-users.9 Like in any industry, optometrists purchase optical equipment, optical devices such as spectacle frames, spectacle lenses and other consumables. They further acquire rental space for their operations, which entails exchange of money and hence develops the economy. The website Statistica.com13 projects a 2023 global estimated revenue of R2.68tr in the eyewear industry. The revenue projections for the top three performing countries such as the United States, China and Germany are R639.7bn, R285.9bn and R161.49bn, respectively. The projected revenue for South Africa is estimated to be R9.37bn.13 Of the South African estimate, R4.25bn will be revenue from spectacle lenses only.13 Global economy has grown recently, hence providing more disposal income to families to afford eyewear and eyecare (dollar-to-rand exchange estimates of June 2023).14

Wealth generation

Self-employed persons usually have a higher earning potential as compared to employed individuals.15 Self-employed optometrists may be regarded to be optoprenuers based on the newness of their practices or stores and the size provided – they are small to medium sized and they show growth or profitability.1 Self-employed optometrists by this classification are regarded as optopreneurs, as they generate wealth when they are profitable. A 2013 US-based survey showed that self-employed optometrists earned on average about R2.9m per annum as compared to R2.1m of employed optometrists in 2013.16 According to Gulledge,16 optometrists working in a practice should be paid on average 20% of the gross revenue of the practice. An additional 10% from the revenue should then be paid to the owners. Hence, if the owners do any optometric activities, they should earn about 30% of the revenue collected, that is, 10% more than what an employee optometrist earns.16 From this view, self-employed optometrists may be said to earn more than employee optometrists, although various methods may be used to determine the income including bonus packages.

Social change

Products such as smart glasses and anti-fog, scratch resistance, glare-reducing anti-smudge lenses together with opportunities for online sales are likely to drive market share.17,18 Comfort-enhancing products such as artificial tears that are eyedrops or gels relieve symptoms of dry eyes and further enable patients with drier eyes to wear contact lenses.19 While these products are readily available in the market, optometrists with a good business acumen may source and sell top brands with excellent quality as a marketing strategy, which may not be ordinarily the case with other optometrists. Optometrists who source the right products to meet the needs of their patients to their satisfaction can change their social and financial well-being. Patients whose specific needs are met are more likely to be loyal.

Community development

European eyewear market has recently grown because of persons seeking trendy and fashionable eyewear, Chinese market was affected positively by eyecare awareness in children, and young adults and ageing population in the United States are developing hyperopia and myopia.11 Availability of eyecare services and products enhances the well-being of communities and their activities in the economy.18

Typical entrepreneur in optometry

Optometry has been commonly practiced by private practitioners, with conglomerates and franchises taking a significant proportion of the optometric market.3,20 Private optometrists use their distinct clinical skills and agentic nature to capture the intended customers,20 hence mostly thrive by word-of-mouth referrals within families and communities. This strategy may have had impact but is supposedly limited by influx of other competitors, especially conglomerates, within a particular area. Conglomerates have big budgets for marketing their practices. They develop special relationships with suppliers including rental facilities for their stores to keep the costs low. They further associate with funders such as medical aids or insurance companies to have special arrangements and benefits.20

Literature has confirmed that even though private practitioners have distinct clinical competencies that appeal to their customers, they tend to lose out because of their lack of business acumen.20 Those who acquire skills in running business tend to attract more customers through application of superior marketing skills and superior customer satisfaction rates.21 Some collaborate to bolster their competitive edge through knowledge and skills sharing, and sharing of technology.22

The advent and growth of conglomerates and franchises have completely affected the layout competition in the optometric industry.23 Conglomerates, unlike private practitioners, employ the services of entrepreneurs and business-minded individuals whose interest is on opportunity recognition and development of competitive advantage to grow the business aspect of the institutions with no specific interest on the clinical aspects.24,25 They develop strategies such as pricing and cost saving, marketing, payment options and strategic alliances with nonrelated but critical players that affect the industry.24,25

Entrepreneurs solve problems

Entrepreneurs should be able to solve problems within their industry,1 and the role of the optopreneurs should be to reduce the burden of refractive errors and visual impairment and further to reduce the higher costs and a lack of access to eyecare especially in rural areas. Besides the average optometrist in a standard practice on a daily basis, nongovernmental institutions such as the International Agency of Prevention for Blindness (IAPB) and African Eye Institute (AEI) are some of the organisations whose interest was on reducing the burden of visual impairment.26 Vision-in-a-box initiative has its intention on solving the problem of access to eyecare in hard-to-reach areas using low overhead structure as compared to the traditional brick-and-mortar structures.27

Creating new markets

Initiatives such as myopia control were developed to solve world problems of visual impairment and present an opportunity for income generation. In line with myopia control, a number of companies have developed spectacle products such as the MyopiLux by Essilor, MyoSmart by Hoya, MyoVision by Zeiss and also contact lenses such as MiSight 1 day by Cooper Vision, NaturalVue by Visioneering Technologies.8 While these products are available to all optometrists, only those who can use their distinct skills to fit them to patients and also sell them are mostly likely to enhance loyalty of their old patients or attract new clientele. Besides the use of these products, optometrists may use their distinct skills in the fitting of specialty contact lenses, such as orthokeratology procedures – a service not provided ordinarily by optometrists. The increasing prevalence in conditions such as keratoconus28 has also brought to light the specialty contact lenses fitting skills as a means to compete. Instead of recycling patients between optometrists, those with entrepreneurial mindset may identify the underserviced contact lens markets as an opportunity for market development.

Entrepreneurs as market leaders

To this end, Specsavers has proved to be the market leader in optometry industry especially in South Africa with its innovations, both clinical and business in approach, to appeal to its customers. Such innovations give these conglomerates a leverage, which is perceived to monopolise the industry with the highest number of stores in Southern Africa with over 270 stores, marketing channels on the internet and television. Payment options including the credit facilities, Kids Right to Sight programme through the Khanyisa Fredrick Marigny Lello (KFML) holdings, and their strategic alliances with the Automobile Association and South African Association of Retired Persons increase Specsavers’s competitiveness and market share.29 Specsavers further influences on the distribution and funding channels through the KFML holdings and Preferred Provider Negotiators (PPN) network, respectively.30

The recently introduced Specsavers graduate programme, whose aim is to attract the top optometry students to join the group upon completion, is another initiative for competitiveness.30 Graduates are, at the initial stages, cultured into the Specsavers values and trained further to develop a business acumen.30 Irrespective of the obvious domination of the Specsavers brand, several other optometry groups including Torga Optical, Vision Works, Spectacle Hut, Osman Group, Bierman Group, Eyecatchers Optometrists and other individual practitioners continuously introduce, with success, a significant number of stores with vibrant offers and options demonstrating greater optopreneurial attributes to the market. Of interest are also the variations of the eyecare enterprises that moved to deviate from the typical provision of clinical products and services to unconventional activities that support the practice of optometry. SB Media Promotions provides the optical assistant magazine, which is instrumental to document the optical tariffs and codes for optometrists and provides advertising services and training for continuous professional development.31 Vision magazine online and Eyesite.co.za provide information about Continuous Professional development (CPD), practice management, fashion trends products and services accessible online.4,32 Advancements by Blue Konnect that provides professional development, practice management coaching, advisory and support are some of the significant strides made by optometrists in optopreneurship.33 The VisionStryt on the other hand provides organisational and talent development services to optometry practices. It also boosts publication of five practical guides on ‘Strategic Guide for Optometrists’, ‘Marketing Guide for an Eyecare Industry’, ‘Practical Guide to Anterior Segment Conditions’, ‘Practice Guide for Optometric Staff’ and ‘Business Guide to Optometrists’.34

Conglomerates mobilise resources, both human and capital, which enable them to compete. On the other hand, private practitioners may lack resources to withstand competition. Some strategic alliances that are mostly buying groups such as Value Vision Optometrists, Dynamic Vision Optometrists35 and Optical alliance optometrists were observed to collate resources and skills to compete to share costs and enhance their competitiveness especially against larger groups. The strategic alliances should be encouraged to find ways to collectively develop new market share against larger leading and dominating groups.

Entrepreneurial opportunities in optometry practice

Entrepreneurship is concerned with opportunity identification, development of new markets and solving problems.36 Some of the opportunities are presented in this section as enablers of OEAs.

Access and quality of care

The common challenge facing optometry today is the access to and quality of eyecare.37 Current research in optometry has focused on public service, which has been characterised by a lack of basic equipment of quality, and very few institutions have high-tech equipment to provide comprehensive service. In most of these institutions, services such as contact lenses fitting, binocular vision care and low vision care are not provided.38 More studies are required to contrast this phenomenon in private optometry service against that in public service.

Anecdotal data suggest that consulting patients do not receive comprehensive information about their eye conditions and treatment options even where spectacles were prescribed. Patients therefore develop a sense that their optometrists prescribe spectacles to any consulting patient even if patients do not clinically need them such as to generate income. This myth may be assumed to result from a lack of patient education required by the professional guidelines of the regulating bodies.39 Optometrists need to be able to provide sufficient information and communicate with their patients,39 which may also be an excellent business strategy.

In addition, the American Optometry Association40 reported that optometrists miss an opportunity to discuss contact lenses as management option for every two of three patients they examine. This could explain the low rate of contact lenses fitting among consulting patients. This may be attributed to several factors including the lack of skill and knowledge of optometrists to fit certain type of lenses,40 a lack of equipment used in fitting contact lenses40 or simply a lack of optopreneurial mindset of not identifying contact lenses fitting as a gap to use to remain competitive and to get better than peers. This strategy will mostly appeal to the optometrists with high entrepreneurial conscience.

Development of services and products

What characterise optopreneurs should be their ability not only to develop new markets but also on innovation of products and services that appeal to their customers. Although optopreneurs may not specifically be in the manufacturing front, their contexts may entail introducing the products and services to the satisfaction and convenience of their new and old customers. Optometrists may use contact lenses as an innovation when patients are switched from spectacles to contact lenses to improve cosmesis.41 Orthokeratology allows patients to be free from any form of correction during the day to conveniently go about their activities such as participating in sports.42 Also, parents may be spared the challenge of their children developing myopia through the use of change of lifestyle.42 The vision and quality of life of keratoconus patients may significantly improve with specialty contact lenses use, although the service is not provided universally by optometrists.29 Those optometrists who embrace providing these services benefit from the niche market of patients requiring the service.

Development of new markets

Optometry is a profession that provides numerous opportunities, which are yet to be fully explored. Unlike many other professions where patients can be rehabilitated, when patients lose their sight, they poorly react to rehabilitation, hence they may drop out of the economic participation.43 The ability to apply the clinical approaches to rehabilitate such patients is a distinct skill, which not many optometrists possess such as the case with keratoconus. This special population of patients is a newer niche market to explore. Environmental optometry appeals to corporate clientele44 such as those in mining and other industries whose employees require the use of personal protective eyewear (PPE), and those with operations that pose direct environmental challenges with likelihood of affecting the eye and vision health of their employees. The profession has not succeeded, if attempted, to regulate the provision of PPE as a sole responsibility of optometrists. Consequently, anyone can therefore supply PPEs provided they can meet the specifications of the requiring client.

Ideally, only a qualified optometrist should determine and provide the type of PPE after assessing the specific needs for the environment and the individual needs of the workers as required by the corporate client. Furthermore, sporting patients also require optometry care to enhance their performance,45 although the profession has not successfully found its footing to carve out a niche of sporting patients. There has been some sort of training although the ‘sports optometrist’ has not been fully introduced as a full member of the technical staff in sports like other professions such as sports medicine, physiotherapy and sports nutrition.

Contact lenses wear is low among patients, and contact lenses are also perceived to be dangerous to the eyes.41 Optometrists, therefore, have the onus to demystify this myth and misconceptions on the risks of wearing contact lenses.41 Through intense patient education, an ordinary optometrist may appeal to a large proportion of consulting patients to try out contact lenses,46 given the new generation of contact lenses, which provide excellent comfort and health to wearers.47 This is not only a clinical requirement but also an entrepreneurial opportunity.

Solve new problems

South Africa has a problem of poverty and larger proportion of citizens, about 47%, depend on the social security grants for daily living.48 This suggests that many persons are vulnerable to social ills, including access to health and eyecare. Besides public service, which is evidently having a number of challenges, possible access to eyecare service may be through the agentic nature of either not-for-profit, non-governmental or social enterprises that may use their social innovations to create financial income or partner with for-profit institutions as part of corporate social investment (CSI) programmes.49 This presents an opportunity for social optopreneurs to advance their agentic mission of providing products and services where other optometrists are unable to provide access to eyecare.

Barriers to entrepreneurship in optometry business

Entrepreneurship education

Entrepreneurship education is one of the critical barriers to developing and sustaining enterprises. At least 33% of enterprises are likely to close their shop in the first 2 years and 50% after 5 years of operation.50 Optometrists with poor entrepreneurial insights may fail to deliver real value beyond price. Shortfalls such as the ability to connect with their patients as target audience and inadequately engaging patients for optimum conversations regarding the eye and vision health and management options may be observed.51 They may be unable to create awareness to guide purchasing decisions of the patients, may lack authenticity and transparency, insights to compete with market leaders, vision to lead their establishment and financial management insights specifically on controlling expenses.51 While optometrists are adequately trained as clinicians, observations are that they go through a module that summarises the entire business management52 to which entrepreneurship may be covered within a lecture period or two or not covered at all. Besides this challenge, some programmes couple the business management course with the ethics of practice within a 6-month module.52 There is a potential to overwhelm students who may only aim for a minimum pass mark without any intention of excelling in the module.

A lack of innovation

Optometry is a profession that deals with both products such as spectacles and contact lenses and services such as vision and eye health examination.2 There are innovative ways that optometrists can implement to make their service appealing to the end-user with examples from Specsavers, VisionStryt and SB Media discussed earlier. If patients are satisfied by the service, they are likely to refer their family and friends.53 Other pertinent issues that offer convenience to patients may include the ease of access, direction to the practice or professional reception patients receive from frontline staff when they arrive to inquire or consult.54 High technology in the consulting rooms may provide ease, efficiency and effectiveness of examination with audio-visuals and imaging used to support clinician’s skills in clinical examinations and decision-making.54 Using innovative means to engage the patients during education and the ability to present treatment and management options from patient findings may distinguish optometrists with entrepreneurial abilities from those without. Besides the quality of products and services provided, after-sales support and engagements may influence patients’ decisions on whether to consult with same optometrists or to opt for another. Optometrists who provide this support of engagements may benefit better than those who do not. Anecdotally, it was observed that many optometrists stock up branded eyewear including spectacle frames and sunglasses as the primary approach to satisfy their patients with less consideration on the elements of the services they offer to their patients. Hence, the patients will be loyal to the brands and disappear when they get better brands at the next optometrist. Optometrists should aim to achieve a customer lifetime value with their patients, which is positively related to customer satisfaction, commitment and trust on the brands and the provider so as to keep them within the practice for long. Losing a patient entails that the practitioner may have lost the customer lifetime value.55 Patients may be enticed to commit to an optometrist because of special considerations they get such as speedier service, tailor-made packages and additional individualised services.55 Newer innovative ways beyond common trends such as ‘buy one and get one free’, ‘bring a family member or friends’ and ‘packages for the pensioners’ can be explored.

Gender variations

There is a newer trend that has seen the number of women optometrists on the edge to surpass their male counterparts globally.56 This may have resulted from an intentional enrolment target by optometry schools, which aimed to balance an initially skewed male-dominated industry. Another possibly is that women generally apply in large numbers to enter optometry schools than their male counterparts. While the enrolment is 70% in the US optometry schools, it could be similar elsewhere even though not documented.56 This is reflected by an almost equal number of male and female graduates, although the number of female graduates is growing.56 Entrepreneurial activities in females seems to be lagging as compared to those of their male counterparts. More female optometrists prefer to be employed than being self-mployed.56 While this is not true for all female optometrists, the notion is further supported by the current female marginalisation in all industries globally. There are distinctions of prominent self-employed female South African optometrists who excel in optometry entrepreneurship, who run private practices and successful conglomerates like the Spectacle Hut and then Torga Optical.

Socioeconomic and student debt

Graduates are generally affected by students’ debt at graduation.54 This is a barrier to setting up practices and pursuing entrepreneurial activities immediately after graduation. In the United States, some graduates refinance their debt to establish optometry practices, which tends to have a higher economical boost.54 In South Africa, a country with the most unequal societies, there is a similar burden of students’ debt. Indebted graduates rather opt to work for a few years to generate capital to use for entrepreneurial activities.54 The recent free higher education policy has reduced the burden in South Africa, although there is a challenge with students in the missing middle who do not afford out-of-pocket payments and do not qualify to receive the free education grant.57

Crime

South Africa has been affected heavily by crime, which is a barrier to entrepreneurship. Crime levels and insurance costs have caused many businesses, especially small businesses, including optometry practices, to close down.58 Many of these businesses are forced to close down if they are hit by crime or any other business disruption because they do not afford the high costs of insurance hence not insured. The 2021 July unrest which was characterised nationwide public violent protests, destruction of property and looting59 and many optometry practices were looted, and optometrists lost their businesses. This coupled with the dearth of stable electricity had dire consequences.

Limitations and future research

The major limitation of this review was the lack or poor availability of scholarly information regarding optometric education and business. The review therefore relied heavily on entrepreneurship literature and available data from research institutes and optometry associations worldwide. To the best of the author’s knowledge, there is limited research conducted in optopreneurship and future studies should consider validation of some of the gaps identified in this article, including a lack of optopreneurial activities by gender, enrolment of optometry students by gender, surveys on salaries of optometrists, number of stores by individual optometrists and conglomerates, the intensity, and effectiveness and efficiency of the practice management modules in optometry education.

Discussion and conclusions

Bolstering entrepreneurship education may have a positive and lasting impact on optopreneurship growth worldwide. Optopreneurs may develop entrepreneurial knowledge and skills, a higher self-esteem to approach business ventures and to identify commercial opportunities in the eyecare industry equipping them with the ability to turn the opportunities into concepts they can commercialise, manage resources and initiate business ventures.

Like the case of strategic alliances of conglomerates, independent optometric practitioners should consider collaborating with each other to combine their skills, competencies and resources in order to reduce their shortcomings that come with resource limitations.25,26 There is an opportunity to acquire high technological equipment, even if it is costly, by sharing costs, the benefits of which will include the ability to co-manage patients in between the practices and leverage on each other’s knowledge and skills.

Furthermore, there are limitations in providing services such as contact lenses fitting, binocular vision care and low vision care for various reasons including a lack of equipment, which is subsequently followed by skill fade.38 Investment in personal development through formal and informal education cannot be replaced. Continuous professional development is one such opportunity optometrists may take to gain insight into the skills they lack such as fitting contact lenses for special populations such as keratoconus patients and those requiring orthokeratology. Besides the clinical skills, optometrists may take up management and business studies to equip themselves with skills to run their eyecare businesses.

Optometrists must engage with their clientele and understand their needs, which can help to identify challenges faced by patients in the eyecare front. Keratoconus is proving to be common in populations living in warm and dry conditions such as in Limpopo, KwaZulu-Natal38 and also the North West provinces of South Africa and may present an opportunity as a niche market for scleral lenses fitting. Access to gadgets that require near work presents an opportunity to optometrists to apply myopia control principles, which may positively affect income generation. Without undermining other specific needs of niche communities, setting up business that can further curb these broader societal problems has an ability to boost income generation.

Entrepreneurship is about innovation and optopreneurs need to develop creative ways to deliver services and products to patients. Patients will always be loyal to the services they receive and not necessarily the products, and optometrists need to take cognisance of this fact and educate the frontline of their service to treat patients as clients like in any other service business.

Acknowledgements

Competing interests

The author declares that this article was written in the interest knowledge contribution and not influenced by any financial or personal relationships.

Author’s contributions

P.M.W.N. is the sole author of this research article.

Ethical considerations

This article followed all ethical standards for research without direct contact with human or animal subjects.

Funding information

The author received no financial support for the research, authorship, and/or publication of this article.

Data availability

Data sharing is not applicable to this article.

Disclaimer

The author declares that views expressed in this article are those of his own and are not necessarily views, position or policy of his affiliated agencies.

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