Quick answer. We tracked 22+ active US ophthalmology and optometry MSO private-equity platforms in 2024 to 2026 across comprehensive ophthalmology, retina sub-specialty, cornea and refractive, glaucoma, pediatric ophthalmology, ASC-integrated multi-specialty, optometry retail, and MD-OD integrated lanes. Three top-line findings drove the period. First, the 2024 to 2025 exit market was made by strategics, not by sponsor-to-sponsor PE: Cencora paid $4.6B plus up to $500M contingent for Retina Consultants of America (announced November 6, 2024, closed January 2025), McKesson paid roughly $850M for PRISM Vision (closed April 2025), and VSP Vision (a nonprofit) closed on Eyemart Express January 23, 2025. Second, many widely-cited sponsor attributions in trade press are wrong. EyeCare Partners is owned by Partners Group since 2020, not Goldman Sachs, and the April 2024 transaction was a debt restructuring, not an exit. Vision Innovation Partners is held by Gryphon Investors, not Audax. EyeSouth Partners is Olympus Partners, not Shore Capital (Shore exited September 2022). Third, retina trades at roughly 18x EBITDA per FOCUS Investment Banking’s reading of the Cencora/RCA deal, while comprehensive ophthalmology platforms trade at 10 to 12x. The CY2026 Medicare Physician Fee Schedule final rule (published in the Federal Register November 5, 2025) reweighs cataract economics toward MSOs that own their ambulatory surgery centers: the cataract surgeon fee (CPT 66984) was cut 11% to $462.94 while the ASC payment rose 3.4% to $1,255.73. Last verified: June 16, 2026.
This tracker is built from primary sources only. Every cap-table assertion, footprint number, and deal value is anchored to one of: (a) SEC filings (8-K, 10-K, S-1, proxy), (b) sponsor or portfolio-company press releases, (c) deal counsel press releases (Kirkland & Ellis, Goodwin, Dechert, Bass Berry & Sims, Foley & Lardner), (d) federal regulatory filings (Federal Register, CMS fact sheets, FTC filings, Department of Health rules), (e) peer-reviewed clinical workforce studies, or (f) Bureau of Labor Statistics OEWS and Occupational Outlook Handbook data. Trade-press references appear only when corroborated.
Cap-table corrections were the work product of this round. The most common errors in published commentary on ophthalmology PE are: attributing EyeCare Partners to Goldman Sachs Merchant Banking (Goldman exited in 2020 when FFL sold the platform to Partners Group), attributing Vision Innovation Partners to Audax Group (Gryphon Investors is the current sponsor), attributing EyeSouth Partners to Shore Capital (Shore exited September 2022, with Olympus Partners now the controlling sponsor), and attributing Retina Consultants of America to a sponsor-to-sponsor exit (it was a strategic sale to Cencora, a drug distributor). The brief that underlies this article corrected every one of these against the primary press release or filing.
Confidence ratings are per cell: HIGH means a primary-source filing or press release confirms the assertion as of mid-2026; MEDIUM means a credible secondary source confirms but the underlying primary document is paywalled or partially redacted; LOW means a single source asserts the fact and we could not corroborate; GAP means we could not verify and we mark it as a known unknown for follow-up. Across this tracker, we read every cited URL within the verification window of May to June 2026.
Ophthalmology is one of the smallest physician specialties in the US, with roughly 10,590 practicing ophthalmologists in May 2024 per the BLS Occupational Outlook Handbook for Physicians and Surgeons. Median annual wage was $267,630 in May 2024, also from BLS OEWS. The American Academy of Ophthalmology reports global membership of 32,000, of which roughly 90% are US Eye M.D.s. There were 126 ACGME-accredited ophthalmology residency programs in 2025 per the ACGME 2025 Specialty Update, and the 2025 SF Match offered 525 positions and filled 524 of them per the AUPO 2025 SF Match Results document.
Optometry is roughly four times larger by headcount. The 2024 US practicing optometrist count was 44,912 per Data USA sourced from BLS, with average annual wage of $134,128. The American Optometric Association reports membership of 50,000-plus (ODs plus students plus staff). BLS projects optometrist employment growth of 19.8% over 2024 to 2034, the fifth-fastest healthcare occupation per BLS Healthcare Outlook.
By practice count, US ophthalmology businesses numbered 13,300 in 2024 per IBISWorld, generating industry revenue of $16.4B. Critically, business count contracted at a 0.9% CAGR over 2019 to 2024: this is the signature of a consolidating segment. Optometry was 28,969 businesses in 2024 with sector employment of 161,753 and an average of 5.6 employees per OD practice per IBISWorld optometrists data.
The Berkowitz et al. workforce projections, published in Ophthalmology (AAO Journal), give the structural thesis: between 2020 and 2035, ophthalmology supply is projected to fall 12% (a 2,650 FTE decline) while demand is projected to rise 24% (a 5,150 FTE increase). The net mismatch is a roughly 30% workforce inadequacy by 2035. Ophthalmology ranked second-worst of 38 specialties studied, with projected 70% adequacy. Rural disparity is severe: 77% metro adequacy versus 29% nonmetro adequacy.
The demographic side of this equation is locked in. The US population age 65 and older was 61.2M in 2024 (18.0% of the total population) and is projected to reach 71.6M by 2030 (20.7%) per S&P Global, and 82M by 2050 per the Population Reference Bureau Aging Fact Sheet. Cataract surgery, which is the largest single ophthalmology service line by revenue, runs at 4.0M to 4.2M procedures annually (all payers) per The World Data, with roughly 1.4M of those funded by Medicare FFS per a 2014 PMC article on cataract surgery among Medicare beneficiaries (the directional ratio still holds, since fee-for-service Medicare share of cataract has been broadly stable). There are 6,052 US ASCs operating in 2024 with annual growth in the 4.7% to 5.9% range.
For retinal disease specifically, the CDC Vision and Eye Health Surveillance System (VEHSS) reports US age-standardized prevalence per 100,000 of 5,677 for age-related macular degeneration and 2,710 for diabetic retinopathy as of 2022. The Twenty-Year Trends in Diabetic Retinal Disease study in the AAO Journal traces the rise in diabetic retinal disease prevalence from 13.6% in 2001 to 20.8% in 2021. AMD prevalence rises from over 6% in the 40s to roughly 30% at age 80 and above per the National Eye Institute. This is the demographic engine under the anti-VEGF franchise.
The Federal Register published the CY 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F) on November 5, 2025. The non-APM conversion factor was set at $33.4009 (a 0.25% annual update) and the APM conversion factor at $33.5675 per Holland & Knight’s analysis.
For ophthalmology, the headline number is CPT 66984 (cataract extraction with intraocular lens insertion). The CY2026 final rate is $462.94, an 11% cut from 2025’s $521.75, per ASCRS’s 2026 MPFS Final Rule analysis. The work RVU was cut from 7.35 to 7.17 via a 2.5% efficiency adjustment plus an indirect practice-expense RVU reduction. Review of Ophthalmology describes this as the largest single-year cut to cataract reimbursement in 30 years.
On the same day, CMS finalized the CY2026 Hospital Outpatient and ASC Payment Rule (CMS-1838-F). The ASC payment update for CY2026 is +2.6% per HST Pathways, using the productivity-adjusted hospital market basket. ASC payment for CPT 66984 in CY2026 is $1,255.73, versus $1,214.31 in CY2025, a 3.4% increase per ASCRS’s 2026 ASC Final Rule analysis. CMS originally proposed a 4.7% cut to the ASC rate, but corrected an IOL device-cost import error after pushback from ASCRS, AAO, ASRS, and OOSS.
Read these two numbers together: the surgeon’s professional fee for cataract dropped roughly $59 per case, while the facility payment to the ASC where that same cataract is performed rose roughly $41. For an MSO that owns both the surgeon (via friendly-PC) and the ASC where the case is performed, the marginal impact on EBITDA is a wash with a slight tilt in favor of facility-fee economics. For a comprehensive ophthalmology practice without ASC ownership, the result is pure margin compression on the dominant revenue line. This is the single most important pricing input to underwriting an ophthalmology platform in 2026.
The ongoing site-of-service spread between ASC and hospital outpatient department (HOPD) cataract continues to underwrite ASC ownership economically. CMS has continued to apply the productivity-adjusted hospital market basket update to ASCs (a policy first introduced as a 5-year interim that has been extended in subsequent rulemaking, per CMS’s CY 2024 OPPS/ASC final rule fact sheet).
The defining feature of the 2024 to 2025 exit market in US ophthalmology was that the highest-value transactions all went to strategic buyers, not to other sponsors. There were three landmark deals.
Cencora and Retina Consultants of America. On November 6, 2024, Cencora filed an 8-K announcing the acquisition of 85% of Retina Consultants of America from Webster Equity Partners for $4.6B in cash plus up to $500M of contingent consideration tied to FY2027 and FY2028 performance. The deal closed in January 2025 per Cencora’s investor relations site. Fierce Healthcare covered the announcement, and Goodwin Procter served as deal counsel to RCA and Webster. PE Hub tracked the press cycle. RCA was founded in 2020 in Southlake, Texas, and was the largest US retina-specific MSO at close. FOCUS Investment Banking’s 2026 ophthalmology valuation page pegs the implied EBITDA multiple at roughly 18.4x. The strategic logic is the same logic Cencora applied at OneOncology: lock in distribution of the buy-and-bill drug franchise that dominates revenue (anti-VEGF for retina, the way oncology drugs dominated for OneOncology).
McKesson and PRISM Vision Group. McKesson, a drug-distribution peer to Cencora, was not going to let Cencora write a 4.6B check without responding. Dallas Innovates first reported the deal, and the transaction closed April 2025 per Quad-C Management’s press release, with PRNewswire carrying the close announcement. McKesson took an 80% controlling interest for roughly $850M, with Quad-C and the physicians retaining minority. PRISM was Quad-C’s platform from 2018 through close, during which Quad-C completed 21 acquisitions including Retina Group of Washington in 2020. The implied logic for McKesson mirrors Cencora’s RCA logic: distribution lock-in over a buy-and-bill drug franchise, plus the MSO platform optionality.
VSP Vision and Eyemart Express. The third landmark exit was on the retail-optometry side. VSP Vision (a not-for-profit corporation; tax-exempt status was revoked by the IRS in 2003) closed on Eyemart Express January 23, 2025, acquiring it from sponsors FFL Partners and Leonard Green & Partners. The transaction was announced October 9, 2024 per Kirkland & Ellis, who advised VSP. The close was confirmed by Leonard Green & Partners, with the close press release distributed through PRNewswire. FFL had originally invested in 2014 and LGP joined in 2020 per FFL’s investment page. Eyemart Express operates roughly 250 stores across 42 states.
The pattern across all three deals is symmetrical: highly-scaled PE platforms in defensible sub-segments of vision care, hitting strategic buyers (two drug distributors plus one vision-benefit nonprofit) who can monetize the platform through channels a sponsor cannot. Cencora and McKesson care about the buy-and-bill drug pull-through. VSP cares about an owned-retail distribution channel for its vision benefits. This is not a sponsor-to-sponsor environment any longer for the highest-value processes.
The single most common cap-table error in published ophthalmology PE commentary is the attribution of EyeCare Partners to Goldman Sachs Merchant Banking. Goldman exited the platform in 2020. The current sponsor of EyeCare Partners is Partners Group, which announced the acquisition on its own investor-relations site in 2020 at a roughly $2.2B enterprise value from FFL Partners.
The second-order error is treating the April 2024 transaction at EyeCare Partners as an exit or sale. It was a debt restructuring. According to Dechert, which advised the ad hoc group of second-lien holders, the April 2024 transaction was a distressed-debt exchange combined with a $275M super-priority new-money term loan, with 98% first-lien holder participation and 91% second-lien holder participation. The Business Wire press release dated April 17, 2024 describes the transaction as a refinancing, with debt maturities pushed to 2027. Partners Group remained the equity sponsor before and after.
EyeCare Partners remains the largest US integrated ophthalmology and optometry MSO platform by location count. The platform’s 2025 Quality and Outcomes Report reports roughly 700 locations across 18 states and 30 markets, with 300-plus MDs, 660-plus ODs, and 30-plus ASCs, supporting 2.5M-plus encounters and 170K-plus surgeries in 2025. Two earlier roll-up platforms now sit inside EyeCare Partners: Cincinnati Eye Institute (CEI), which Revelstoke sold to EyeCare Partners in November 2021 per Revelstoke’s press release, and Blue Sky Vision (Michigan), which joined EyeCare Partners in December 2020 from Sterling Partners, Carlyle, Madison Capital, and Northleaf per Sterling Partners’ coverage of the pre-EyeCare Partners era.
The investment thesis on EyeCare Partners going forward is constrained. With the 2L paper participating in a super-priority restructuring at 91%, the platform is functionally a covenant-lite credit story for now. Partners Group will not exit at a clean platform multiple in the medium term because the credit complex needs to be cleaned up first. A 700-location, 18-state, ASC-anchored asset of this scale rarely sits as a forced-hold, but the next 24 to 36 months point to operational stabilization and possibly a partial recap before any clean exit. Watch for hospital-system bidders or strategic-distributor bidders (the Cencora and McKesson logic could plausibly extend to EyeCare Partners, given the ASC-heavy footprint and the retina + comprehensive mix, although McKesson and Cencora are now both anchored in retina-specific platforms).
The single largest valuation differential across ophthalmology PE in 2024 to 2026 is the premium attached to retina-specific platforms versus comprehensive ophthalmology platforms. Per FOCUS Investment Banking, platform transactions in ophthalmology generally clear at 10x to 15x EBITDA, with add-ons at 6x to 10x. Cencora paid 18.4x for Retina Consultants of America (FOCUS’s read on the implied multiple given $4.6B and an EBITDA print we can roughly back into from RCA’s reported scale). That is a 3 to 5 turn premium over even the high end of comprehensive ophthalmology platform multiples.
Three forces drive that premium. First, drug-economics. Anti-VEGF buy-and-bill (Eylea, Vabysmo, Lucentis, and the older Avastin off-label use) represents more than 50% of a typical retina practice’s revenue line; the same is not true of comprehensive ophthalmology, where surgical fees and ancillary optical-shop revenue dominate. Regeneron’s FY2024 8-K reports Eylea plus Eylea HD US net product sales of $6.0B for 2024 (with Q4 2024 alone at $1.5B). The drug-economics line is the underlying asset that distributors are pricing. Second, demand growth. The diabetic retinal disease prevalence rise (13.6% to 20.8% over 2001 to 2021 per the AAO Journal trends paper) and the demographic AMD curve combine for roughly mid-single-digit volume growth before substitution. Third, strategic-buyer concentration. Distributors that already monetize buy-and-bill drugs (Cencora, McKesson, AmerisourceBergen heritage) have a structural P&L synergy that PE sponsors do not have.
The bear case on the retina multiple is the biosimilar-erosion thesis on Eylea 2 mg. The FDA approved two interchangeable aflibercept biosimilars in May 2024: Biocon’s Yesafili and Samsung Bioepis’s Opuviz per Ophthalmology Times. Yesafili’s US launch window is the second half of calendar 2026 per Biocon Biologics (settlement-driven). Grand View Research models 9% of Eylea sales at biosimilar risk in 2025 rising to 25% by 2027.
The bull rejoinder, which Cencora’s deal team obviously took, is that Regeneron has spent 18 months migrating eyes to Eylea HD (8 mg, with 8 to 16 week dosing intervals), which has no current biosimilar. Vabysmo (Roche, faricimab) generated more than $1B in revenue in its first year post-2022 launch per BioCentury, and GlobalData projects Eylea HD plus Vabysmo will take 60%-plus of the anti-VEGF market by 2030. Across this market structure, the retina MSO that controls referral flow and infusion suites is the price-setter for distributor pull-through, regardless of which specific molecule is at the top of the protocol. That is what Cencora was paying for.
Per FOCUS Investment Banking, ASC ownership inside an ophthalmology MSO carries a 1 to 3 turn EBITDA multiple premium. The arithmetic of that premium is straightforward: the ASC captures a $1,255.73 facility fee per Medicare cataract in CY2026 (and similar capture rates from commercial payers), while the alternative is paying that fee to a third-party HOPD or independent ASC. For a 100-MD platform doing 30,000 to 40,000 cataracts a year, ASC ownership is the difference between $0 and roughly $37M to $50M of facility-fee revenue annually, before margin.
The platforms with significant ASC ownership in the active 2024 to 2026 PE-backed universe include: EyeSouth Partners (26 ASCs across 14 states post-Sunvera per EyeSouth’s press release), EyeCare Partners (30-plus ASCs per the 2025 Quality Report), American Vision Partners (25 ASCs per AVP’s about page), Eye Health America (10 ASCs across SC/GA/FL per EHA’s Quigley acquisition press), and Surgery Partners on the public side (200-plus facilities across 33 states, multi-specialty, per SGRY investor materials). Among optometry-led platforms, ASC ownership is typically thin because the OD-led practice mix has fewer surgical cases per location; this is one reason optometry-retail platforms trade at lower multiples than MD-led integrated ophth platforms with surgical capacity.
For sellers, the read is direct: if you are a comprehensive ophthalmology practice with at least 8 to 12 high-volume cataract surgeons and you do not yet own an ASC, the highest-value strategic move before a PE process is to either acquire a stake in your existing host ASC or syndicate an ASC build-out with a PE co-investor. ASC-ownership timing has a meaningful effect on the multiple your platform will clear in a sale process.
The table below covers every PE-backed or recently-PE-owned US ophthalmology and optometry MSO platform we verified in this round. Sponsor attributions reflect the corrections above (EyeCare Partners = Partners Group; Vision Innovation Partners = Gryphon; EyeSouth = Olympus; Retina Consultants of America = Cencora; PRISM = McKesson; Eyemart Express = VSP Vision).
| Platform | Current Sponsor | Entry Date | Segment | ASC Ownership | 2024-2026 Key Deals | Confidence |
|---|---|---|---|---|---|---|
| EyeCare Partners (ECP) | Partners Group (acquired 2020 from FFL Partners at ~$2.2B EV) | 2020 | Integrated ophth + OD, ASCs | 30+ ASCs | April to May 2024: distressed-debt exchange plus $275M super-priority new-money term loan, debt maturities pushed to 2027 | HIGH |
| MyEyeDr (Capital Vision Services) | Goldman Sachs Asset Management / West Street Capital Partners VII (acquired June 2019 from Altas Partners and CDPQ at $2.7B EV) | 2019 | Optometry-led, integrated OD-MD | None material | 869 locations end-2024 versus 842 end-2023; guided 20 de novos in 2025 then ~50 per year | HIGH |
| EyeSouth Partners | Olympus Partners (September 2022 from Shore Capital) | 2022 (current sponsor) | Comprehensive ophth, ASCs, MD-OD | 26 ASCs across 14 states post-Sunvera | August 1, 2025: acquired Sunvera Group (15 practices + 4 ASCs across MI/OH/PA, first entry into Michigan) | HIGH |
| Vision Innovation Partners (VIP) | Gryphon Investors (NOT Audax) | Gryphon control since recap (date not publicly disclosed) | Comprehensive ophth, ASCs, mid-Atlantic | Multiple ASC sites | January 2024: Bucks-Mont Eye (25th add-on); June 2025: Eye Care of Delaware (26th); 2025: Ophthalmic Associates of Alexandria VA (27th); 2024: Anne Arundel Eye, Maugans Eye, Drs Anderson & Kuhl | HIGH |
| American Vision Partners (AVP) | H.I.G. Capital + H.I.G. Growth Partners | 2017 | Comprehensive ophth + retina + LASIK, ASCs | 25 ASCs | 130+ MDs, 100+ eye care centers across AZ/TX/NM/NV/CA. PitchBook flags an event-date of March 31, 2025 (possibly recap) | MEDIUM (recap details opaque) |
| AEG Vision (formerly Acuity Eyecare Group) | Riata Capital Group + JP Morgan Asset Management minority + Morgan Stanley Secondaries (2021 single-asset GP-led continuation) | 2017 (rebranded December 2019) | Optometry MSO with OD-MD integration | Thin | 500+ practices in 30+ states, 5,000+ ODs + staff; Tracxn flags 9 acquisitions through April 2026 | HIGH |
| Spectrum Vision Partners (parent of OCLI Vision) | Blue Sea Capital since November 17, 2017; GCM Grosvenor and Hamilton Lane as LP / co-invest | 2017 | Multi-specialty ophth (cornea, retina, glaucoma, oculoplastics), ASCs | Multiple ASCs | March 4, 2024: Fishman Center for Total Eye Care; multiple PA/NJ/NY add-ons through 2024-25; ~$1.18B total capital raised per PitchBook | HIGH |
| NVISION Eye Centers | Ontario Teachers’ Pension Plan Board (majority since December 1, 2020) | 2020 | Refractive (LASIK) + cataract + comprehensive ophth | Multiple ASCs | October 2024: East West Eye Institute LA add-on; active 2024-25 add-ons across Western US | HIGH |
| CEI Vision (Cincinnati Eye Institute) | Part of EyeCare Partners (Revelstoke sold to ECP November 2021) | Subsumed into ECP November 2021 | n/a (subsidiary of ECP) | Inside ECP footprint | n/a | HIGH |
| Blue Sky Vision | Part of EyeCare Partners (joined ECP December 2020 from Sterling Partners, Carlyle, Madison Capital, Northleaf) | Subsumed into ECP December 2020 | n/a (subsidiary of ECP) | Inside ECP footprint | n/a | HIGH |
| PRISM Vision Group (NJ Retina legacy) | STRATEGIC NOT PE: McKesson Corp acquired ~80% from Quad-C Management closing April 2025 for ~$850M | April 2025 close | Retina + comprehensive ophth + ASCs, Northeast US | Multiple ASCs | 21 acquisitions during Quad-C hold (2018-2025), including Retina Group of Washington 2020 | HIGH (now strategic-owned) |
| Retina Consultants of America (RCA) | STRATEGIC NOT PE: Cencora acquired 85% from Webster Equity Partners for $4.6B cash + up to $500M contingent FY27-28; announced November 6, 2024, closed January 2025 | January 2025 close | Retina-only MSO (founded 2020 in Southlake TX) | n/a (office-based infusion model) | Highest-profile 2024 strategic exit; FOCUS cites ~18.4x EBITDA | HIGH |
| Eye Health America (EHA) | LLR Partners (since 2018 founding) | 2018 | Comprehensive ophth + retina + OD, SE US | 10 ASCs | February 2025: Quigley Eye Specialists (FL, 29th partnership) from New Harbor Capital; June 2025: Schneider Eye & Wellness Center; 2024: Eye Centers of Florida (11 locations + 2-room ASC); Carolinas Centers for Sight | HIGH |
| ReFocus Eye Health | Zenyth Partners | Not disclosed | Comprehensive ophth (CT-headquartered) | Multiple | 62+ locations, 140+ MD/OD, 8 states; 2024: 8-practice NJ tuck-in; March 2024 Ellipse Eye Group; July 2025 New View Eye Center; 2025 Soll Eye (4 locations PA/NJ) | HIGH |
| U.S. Eye / Center For Sight | PE-backed (sponsor not publicly disclosed in confirming sources) | Not disclosed | Comprehensive ophth, refractive, ASCs | Multiple | First iDose TR procedure in Florida post-December 2023 FDA approval | LOW (sponsor not verified) |
| Quigley Eye Specialists (legacy independent) | Acquired by Eye Health America February 2025; previously New Harbor Capital (January 2020 to August 2024 exit) | Now sub of EHA | Comprehensive ophth FL | SW Florida | August 2024: New Harbor exited; February 2025: rolled up into EHA | HIGH |
| Surgery Partners (NASDAQ: SGRY) | Publicly traded; Bain Capital ~39% holder; Bain $3.2B take-private withdrawn June 2025 | Bain since 2017 LBO | Multi-specialty ASC + ophth | 200+ facilities across 33 states | January 8, 2024: acquired 70% of Key-Whitman Eye Center DFW (9 clinics + 2 ASCs + 23-provider group); ophth platform under construction | HIGH |
| Unifeye Vision Partners | Waud Capital Partners (since 2017 partnership with Minnesota Eye Consultants); 2025 strategic growth investment by Morgan Stanley | 2017 | Comprehensive ophth, refractive, ASCs | Multiple ASCs | May 2025: Brooks Eye Center (CA) + Morgan Stanley strategic growth investment; 2022 Regional Eye Center MN; 2018 Northwest Eye Minneapolis | HIGH |
| Keplr Vision (formerly Total Eye Care Partners) | Imperial Capital (Toronto) + Golub Capital co-invest; merged with Visionary Eye Partners in 2019 | 2017 (Total ECP); 2019 (Keplr merge) | Optometry-led MSO | Thin | 130+ practices, 25+ states (2020 baseline); $80M add-on funding from Imperial + Golub March 2023 | MEDIUM (no public 2024-26 deal flow visible) |
| National Vision Holdings (NASDAQ: EYE) | Public; legacy KKR sponsor IPO’d October 2017 | 2017 IPO | Pure-play optometry retail (America’s Best, Eyeglass World) | None (retail only) | 1,242 stores end-Q3 2025; FY2025 revenue $1.99B (+9.0% YoY), EPS $0.37; 11th consecutive positive-comp quarter | HIGH |
| Eyemart Express | VSP Vision (nonprofit) since January 23, 2025 (FFL Partners + Leonard Green & Partners exited) | January 23, 2025 close | Retail-optometry chain | None (retail) | ~250 stores across 42 states | HIGH |
| EssilorLuxottica US retail (LensCrafters / Pearle Vision / Target Optical / For Eyes) | Publicly traded EL.PA | n/a | Retail-optical | None (retail) | LensCrafters 931 (incl 91 Macy’s), Pearle Vision 495, Target Optical 577, For Eyes 103 (end-2024) | HIGH |
| Vision Source | Owned by EssilorLuxottica since 2015 acquisition | 2015 | OD-franchise network | None | 2,994 US practice locations, 4,500 OD members; ~$3.0B+ 2024 retail and professional sales | HIGH |
Comprehensive ophthalmology is the largest segment by platform count. The active 2024 to 2026 platforms in this lane include EyeCare Partners (Partners Group), EyeSouth Partners (Olympus Partners), Eye Health America (LLR Partners), AEG Vision (Riata Capital), Acuity Eyecare Group (now AEG Vision after the December 2019 rebrand), American Vision Partners (H.I.G. Capital), Vision Innovation Partners (Gryphon Investors), and ReFocus Eye Health (Zenyth Partners). The defining 2024 to 2026 events in this sub-segment were Olympus Partners’ August 1, 2025 acquisition of Sunvera Group (15 practices plus 4 ASCs across MI/OH/PA) by EyeSouth per Bass Berry & Sims’s deal advisory release, LLR’s February 17, 2025 acquisition of Quigley Eye Specialists by Eye Health America per LLR’s press release (the 29th EHA partnership), and Vision Innovation Partners’ three 2024 to 2025 add-ons in the mid-Atlantic per Gryphon’s press release on Ophthalmic Associates of Alexandria VA.
EHA is the LLR Partners flagship in the segment, with 100-plus MDs, 53 locations, 10 ASCs, and 1,000-plus employees across SC/GA/FL per EHA’s footprint disclosure. The Quigley pickup was particularly strategic: New Harbor had grown Quigley with 8 add-ons during its 2020 to 2024 hold, then exited in August 2024, and EHA closed on Quigley five months later. ReFocus has been the most active acquirer in the New Jersey market, with an 8-practice NJ tuck-in completed in early 2024 (Advanced Eye Care Center, Associated Eye Physicians & Surgeons of NJ, Alden Leifer MD, Hilal-Campo MD, Eye Care Consultants of NJ, Retina Associates of NW NJ, Retina Consultants II, Westwood Ophthalmology) per ReFocus’s PRNewswire release.
Retina was the highest-multiple sub-segment in the period. The pre-Cencora structure of Retina Consultants of America had Webster Equity Partners as the controlling sponsor since RCA’s founding in 2020 in Southlake, Texas. RCA built the largest US retina-specific MSO via a string of physician-group affiliations through 2024. Goodwin Procter advised Webster and RCA on the sale to Cencora.
The post-Cencora structure is a strategic-owned MSO with Cencora at 85% and physicians plus management retaining roughly 15%. The strategic logic for Cencora extends its OneOncology playbook: a distributor that controls infusion-suite buy-and-bill drug pull-through has a structurally higher margin than a stand-alone MSO. PRISM Vision Group (now part of McKesson at 80%) is the second-largest retina-leaning platform, although PRISM has a comprehensive-ophthalmology footprint as well, particularly in New Jersey via its NJ Retina legacy. Quad-C built PRISM via 21 acquisitions during its 2018 to 2025 hold per Quad-C’s close announcement.
The remaining retina-relevant platforms are inside multi-specialty PE structures: American Vision Partners includes Retinal Consultants of Arizona, Spectrum Vision Partners has retina sub-specialists at OCLI Vision, EyeCare Partners runs retina sub-specialty practice lines, and EyeSouth offers retina as a sub-specialty inside its 64 practice partner-groups. The market is consolidated enough that any new retina-specific PE platform of meaningful scale would face an immediate strategic-bidder counter from Cencora, McKesson, or hospital-system aggregators.
Three operating-model variables drive retina MSO economics specifically. First, drug procurement: as Part B buy-and-bill revenue is roughly half of the top line, even modest contracted-rate improvements with distributors flow through to EBITDA. Cencora’s ability to in-source RCA’s distribution at internal cost is the cleanest illustration of the synergy. Second, infusion-suite throughput: an efficient retina practice runs the same physician across 60 to 90 injections per day with intermediate-level technician support. The platform-economics premium goes to MSOs that have standardized infusion-suite layout, technician credentialing, and OCT-imaging workflow. Third, payer mix: retina sees a higher Medicare and Medicare Advantage share than comprehensive ophthalmology because AMD and DR prevalence concentrates in the over-65 population. That makes retina more exposed to Medicare rule cycles but less exposed to commercial-payer leakage during recession periods.
Subordinate retina platforms not part of the Cencora or McKesson stacks include several independent regional groups that have not been rolled up: Mid Atlantic Retina (parent of the Wills Eye retina practice, which was founded in 1923 as Mid Atlantic Retina), Florida Retina Institute, California Retina Consultants, Northern California Retina Vitreous Associates, and Texas Retina Associates. Each of these is a credible future-roll-up target for a strategic entrant or for the existing platforms looking for footprint extension. The premium they will clear is a function of distributor-relationship economics, not of operational synergy with the broader retina MSO.
NVISION Eye Centers (Ontario Teachers’ Pension Plan Board, since December 1, 2020) is the dominant refractive-anchored platform in the Western US, with a footprint across California, Arizona, Nevada, and Oregon. Oaklins advised on NVISION’s October 2024 acquisition of East West Eye Institute in Los Angeles. Founder Dr. Tom Tooma retains a minority and continues as Chief Medical Officer per the original Privsource report on Ontario Teachers’ majority stake.
American Vision Partners runs LASIK volume through its 25 ASCs and 100-plus eye care centers across the Southwest US under H.I.G. Capital + H.I.G. Growth Partners ownership. Refractive volume is more economically sensitive than cataract or retina (it is largely cash-pay) and recession-sensitive demand has been a theme in 2024 to 2026; sustaining a 15%-plus YoY refractive growth rate now requires aggressive payment-plan financing partnerships.
The cornea sub-specialty is structurally smaller but has high revenue-per-case dynamics through corneal transplant volume and EBAA-coordinated donor procurement. Cornea-focused practices typically attach to comprehensive ophthalmology platforms rather than standing alone because the case mix does not support an MSO-scale platform on cornea volume alone. Same logic applies to refractive when separated from comprehensive (most refractive surgeons also perform cataract; few practices are purely refractive). NVISION is the cleanest exception because its founding thesis was refractive-anchored brand-led patient acquisition, with comprehensive ophthalmology added later. The Ontario Teachers’ 2020 thesis on NVISION assumed Western US LASIK growth could sustain a stand-alone-refractive platform; six years in, the platform has shifted toward a more balanced refractive-plus-cataract-plus-comprehensive mix, partly because cataract volume is a more stable revenue line for an MSO during demand cycles.
Glaucoma is increasingly device-driven inside ophthalmology MSOs, with MIGS (minimally invasive glaucoma surgery) and the Glaukos iDose TR sustained-release implant. Glaukos (NASDAQ: GKOS) had FY2025 revenue of $507.4M (+32% YoY) and guided FY2026 to $600M to $620M per the Q4 2025 results press release. iDose TR launched commercially in 2024 with quarterly sales ramp of roughly $31M in Q2 2025 and $40M in Q3 2025.
MIGS device cost benchmarks per Ophthalmology360: iStent inject roughly $1,389 and Hydrus roughly $1,433, with similar 20 to 21 minute case times. MIGS volume is increasingly correlated with combined cataract + MIGS coding, which makes ASC ownership economically critical because the bundled-procedure facility fee accrues to the ASC operator.
The major glaucoma-device M&A event of 2025 to 2026 was the Alcon-Lensar transaction, which was announced in March 2025 at $14.00 per share (roughly $356M plus a contingent value right up to $2.75 per share tied to hitting 614,000 cumulative procedures in 2026 to 2027), and terminated on March 17, 2026 after FTC opposition on cataract-laser concentration grounds per MassDevice. The signal for ophthalmology PE: regulator scrutiny on horizontal concentration in cataract devices has tightened.
For an MSO buyer, glaucoma volume is most valuable when bundled with cataract: the combined cataract-plus-MIGS coding pattern (CPT 66984 plus glaucoma-stent code) captures both the cataract facility fee and an incremental MIGS device-and-procedure layer in a single ASC-suite session. Practices with high combined-procedure rates trade at the higher end of the comprehensive ophthalmology multiple range. iDose TR (sustained-release travoprost implant) shifts a portion of glaucoma drug volume from compliance-dependent topical drops to an office-administered implant, which is structurally beneficial for the MSO because of the reimbursement code mix. Long-term, the segment trend is toward more device-revenue per glaucoma patient and toward fewer chronic-drop refills, which compresses the OD-led optometry margin on glaucoma management but expands the MD-led MSO margin.
Pediatric ophthalmology has not produced a clean stand-alone PE roll-up in the way that pediatric dentistry produced multiple DSO platforms. The reason is structural: pediatric ophthalmology has a smaller addressable patient base, lower per-visit revenue, and a workforce that BLS does not break out cleanly from comprehensive ophthalmology. Pediatric volume is typically picked up by integrated comprehensive ophthalmology platforms (EyeCare Partners, EyeSouth, AVP) as part of a broader sub-specialty offering rather than as a stand-alone investment thesis. The right way for a PE sponsor to underwrite pediatric ophthalmology is as a sub-segment of a comprehensive platform’s medical-eye-care line.
The optometry-retail segment is dominated by four publicly-disclosed scaled actors: National Vision Holdings (1,242 stores end-Q3 2025 per the Q3 2025 earnings release), MyEyeDr / Capital Vision Services (869 locations end-2024 per Vision Monday’s 2025 Top 50 Retailers), Eyemart Express (250 stores across 42 states, now under VSP Vision), and EssilorLuxottica’s combined retail (LensCrafters at 931, Pearle Vision at 495, Target Optical at 577, For Eyes at 103, end-2024). MyEyeDr added 27 net locations in 2024 (842 to 869) and is guiding 20 de novos in 2025, rising to 50 per year thereafter per ICSC’s coverage.
The PE-backed optometry-retail and OD-led MSO segment includes AEG Vision (500-plus practices, 30-plus states; Riata Capital plus JPM AM minority since 2017), Keplr Vision (130-plus practices, 25-plus states; Imperial Capital plus Golub Capital), and the legacy Acuity Eyecare Group (rebranded to AEG Vision December 2019). Goldman has held MyEyeDr since June 2019, a 7-year hold by mid-2026. The Goldman exit clock has been running long enough that the next sponsor transition is one of the most-watched pending US optometry transactions, with strategic bidders (a VSP-style nonprofit, or EssilorLuxottica) and the largest sponsors (KKR, Carlyle, GTCR, Bain) likely on any short list. The 2025 PitchBook flag of an April 22, 2026 “Buyout/LBO with Lumina Vision Partners” appears to be a tuck-in or sub-deal rather than a sponsor change at the MyEyeDr level; Goldman remains the parent.
The MD-OD integrated model (where ODs handle routine and medical-eye-care visits, ophthalmologists handle surgical and sub-specialty volume, and the platform captures both fee streams plus optical-shop revenue) is the highest-EBITDA model in vision care. EyeCare Partners, MyEyeDr (which started OD-only and expanded into MD-led acquisitions), AEG Vision, AVP, and EyeSouth all run integrated models in various proportions. The integration thesis carries a multiple premium because: (a) referral capture is internal so leakage is minimized, (b) optical-shop revenue captures roughly 25% to 40% of total revenue in well-developed practices per FOCUS Investment Banking, and (c) ASC ownership economics scale with MD surgical volume that the OD network feeds.
The structural argument for integration is the referral-capture math. An OD in a stand-alone optometry practice typically refers cataract-surgery patients out to an unaffiliated ophthalmologist, which means the practice loses the surgical fee, the ASC facility fee, and the post-op follow-up revenue. In an integrated MSO, those revenue streams all stay inside the platform’s PC structure. Empirically, integrated platforms capture 70% to 90% of internal cataract referrals where the OD has been incentivized to refer in-network (typically via call-light shared compensation rather than fee-splitting, which is restricted in CPOM states). For a 200-OD network feeding into a 30-MD surgical bench, internal referral capture of even 75% of routine cataract is worth $20M to $40M of incremental annual EBITDA at the platform level.
That said, integrated models are operationally harder. ODs and MDs have different scope-of-practice limits by state, different compensation expectations, and different patient-engagement cycles. The integrated platforms that have scaled well (EyeCare Partners pre-2024, MyEyeDr, AEG Vision) all built proprietary internal-referral software, cross-disciplinary compensation models with sharing arrangements, and dual-OD-and-MD onboarding pathways. The platforms that have struggled (or that have remained MD-only or OD-only) typically pointed to operational complexity rather than economic theory as the binding constraint.
The chronology below lists primary-source-verified ophthalmology and optometry MSO transactions in the tracking window.
Deal velocity figures from Becker’s ASC put 2024 to Q1 2025 at roughly 40 ophthalmology transactions, down sharply from more than 300 in 2021 per Becker’s coverage. Provident Healthcare Partners’ Q1 2024 ophthalmology note called for a “consolidation of consolidators” theme to play out in late 2024 to 2025 per Provident; the Q1 2025 follow-up confirmed the log jam had broken with significant rebound in exit activity per Provident’s Q1 2025 update.
The valuation framework that follows is built primarily from FOCUS Investment Banking’s 2026 ophthalmology valuation page, with cross-checks from Provident, Physician Growth Partners, and confirmed deal data points (Cencora-RCA, McKesson-PRISM, VSP-Eyemart Express).
| Transaction Type / Profile | EBITDA Multiple Range | Notes |
|---|---|---|
| Platform transactions (mid-sized to large MSO) | 10x to 15x EBITDA | Per FOCUS 2026 valuation page |
| Add-on transactions | 6x to 10x EBITDA | Per FOCUS |
| General medical practices (2025-2026 cross-specialty) | 6x to 12x EBITDA | Per FOCUS |
| EBITDA under $1M (single-site, limited infrastructure) | 5x to 6.5x | Per FOCUS |
| EBITDA $1M to $3M (mid-sized, emerging systems) | 7x to 9x | Per FOCUS |
| EBITDA $3M to $5M (multi-site with ASC ownership) | 9x to 11x | Per FOCUS |
| EBITDA $5M+ (established management depth) | 10x to 15x+ | Per FOCUS |
| ASC ownership inside MSO premium | 1 to 3 turn EBITDA multiple premium | Per FOCUS |
| Retina specialization vs comprehensive ophth | Material premium; ~18.4x for Cencora-RCA | Per FOCUS reading of the deal |
The intuition behind these ranges: a $5M-plus EBITDA platform with management depth, ASC ownership, an integrated MD-OD model, and a defensible referral base can clear 12x to 14x at platform sale. The same EBITDA at a single-site practice without ASC and with founder-key-person risk would clear closer to 6x. The 6x to 14x spread is largely explained by ASC ownership (1 to 3 turns), management depth (1 to 2 turns), sub-specialty mix (retina commands the strongest premium), and platform scale (10-plus locations versus 1 to 3).
Public-market comps add a quantitative cross-check. National Vision Holdings (NASDAQ: EYE) printed FY2025 revenue of $1.99B (+9.0% YoY) with EPS of $0.37 (versus -$0.35 in FY2024), and 11 consecutive quarters of positive comparable store sales per the Q4 2025 press release. Glaukos (NASDAQ: GKOS) printed FY2025 revenue of $507.4M (+32% YoY) and guided FY2026 to $600M to $620M. Surgery Partners (NASDAQ: SGRY) remains public after rejecting the $3.2B Bain take-private in June 2025. Regeneron’s anti-VEGF franchise (Eylea plus Eylea HD) generated $6.0B in 2024 US net product sales per the FY2024 8-K.
1. The pure-PE ophthalmology platform model peaked in 2022; 2024 to 2025 is strategic-buyer time. Three of the largest exits in the window are non-sponsor: Cencora bought Retina Consultants of America ($4.6B plus $500M contingent), McKesson bought PRISM Vision (~$850M), and VSP Vision (a nonprofit) bought Eyemart Express. Drug distributors and vision-benefit nonprofits are the price-setters for top-tier scaled retina, integrated ophthalmology, and optical-retail platforms.
2. Retina now trades at roughly 18x EBITDA versus 10 to 12x for top-decile comprehensive ophthalmology platforms. FOCUS Investment Banking’s read on Cencora-RCA at ~18.4x is the cleanest data point. The premium is driven by buy-and-bill anti-VEGF margin (drugs are more than 50% of retina revenue) and strategic-distributor demand to lock down anti-VEGF distribution channels (Cencora’s OneOncology playbook applied to ophthalmology).
3. The biosimilar-erosion thesis on retina is overstated for 2026. Yesafili and Opuviz are interchangeable to Eylea 2 mg; Regeneron has spent 18 months migrating eyes to Eylea HD (8 mg, 8 to 16 week dosing), which has no current biosimilar. Eylea plus Eylea HD held $6.0B in 2024 US net product sales with only 9% of sales at biosimilar risk in 2025, rising to 25% in 2027 per Grand View Research. Vabysmo is taking share from Eylea more aggressively than biosimilars are taking it per BioCentury.
4. The 11% cataract surgeon-fee cut in CY2026 MPFS pushes EBITDA toward MSOs with ASC ownership. The CY2026 ASC payment for CPT 66984 went up 3.4% to $1,255.73 while the surgeon fee fell 11% to $462.94. For an MSO with the surgeon and an owned ASC, the same dollar moved across line items. For office-only practices without ASC, this is pure margin compression. Underwrite ASC ownership aggressively in any 2026 process.
5. EyeCare Partners (Partners Group) is the structural bear case the market keeps mispricing. A 98% first-lien and 91% second-lien participation in a $275M super-priority new-money tranche in April 2024 is a refinancing of distressed paper, not an exit pathway. EyeCare Partners remains the largest US integrated ophthalmology and optometry platform (~700 locations, 18 states, 300-plus MDs, 660-plus ODs, 30-plus ASCs) but Partners Group will not exit at a clean platform multiple in the medium term; sponsor patience is forced.
6. The “MyEyeDr is the more interesting platform than EyeCare Partners” thesis is empirically right. MyEyeDr added 27 net stores in 2024 (842 to 869) and is guiding 20 de novos in 2025 then 50 per year. Goldman has held the platform since 2019, now seven years. The next sponsor-to-sponsor or strategic-to-MyEyeDr transition is one of the largest pending US optometry transactions, though trade press is distracted by the EyeCare Partners credit saga.
7. The pure-OD-retail nonprofit-strategic angle is now a real exit channel. VSP Vision’s January 2025 acquisition of Eyemart Express marks a not-for-profit vision-benefits company as a credible buyer for top-decile optical-retail. That changes the bidder set on any forward-looking optometry-retail process and should be modeled into PE underwriting for Acuity Eyecare / AEG Vision and Keplr Vision exits.
The FTC’s April 2024 final rule banning most noncompetes nationally was blocked in August 2024 by the US District Court for the Northern District of Texas in Ryan LLC v FTC, the FTC withdrew its appeal in September 2025, and the rule was formally removed from the Code of Federal Regulations per the National Law Review and ACA International. The FTC will not pursue a categorical national ban going forward; enforcement reverts to case-by-case. The FTC did issue warning letters on September 10, 2025 to large healthcare and staffing employers over problematic noncompetes, signaling continued scrutiny in the healthcare lane specifically.
With federal preemption off the table, state-level physician noncompete restrictions take on more weight in any MSO buy-side process. The state-level picture in mid-2026:
Practical M&A implications: PE sponsors building roll-ups across multiple states need state-specific employment-agreement templates, including modular noncompete and non-solicit language. The MSO buy-and-sell processes in IN, CA, OK, ND, and MN need physician-retention economics that do not rely on a noncompete (typically: equity rollover, deferred compensation, and partnership-track earn-outs). The valuation impact of state noncompete prohibitions on individual MSO targets is modest at the platform level but can be material at the practice level if a single practice loses one or two key surgeons in the 12 months after close.
The retina-economics layer is the most important macro variable in 2026 for retina-specific MSOs. Three numbers drive the analysis. First, Regeneron’s Eylea plus Eylea HD US net product sales in 2024 were $6.0B (1% YoY growth) per the FY2024 8-K, with Q4 2024 alone at $1.5B. Eylea segment market share in 2024 was 51.8% of anti-VEGF per GlobalData. Second, Roche Vabysmo (faricimab) generated more than $1B in its first year post the 2022 launch per BioCentury. Third, the two interchangeable aflibercept biosimilars (Yesafili from Biocon and Opuviz from Samsung Bioepis) received FDA approval in May 2024, with Yesafili’s US launch window in the second half of calendar 2026 per Biocon Biologics.
Eylea sales at risk: 9% in 2025, rising to 25% by 2027 per Grand View Research. The defensive playbook Regeneron is running, migrating patients to Eylea HD (8 mg, 8 to 16 week dosing intervals) without a current biosimilar, is the same playbook the major retina MSOs are inheriting on the buy-and-bill side: protocols increasingly favor the longer-dosing molecules, which also reduces injection-visit volume per patient per year. That reduces office-revenue volume but not necessarily revenue per patient, because the drug margin per visit scales with the more expensive molecule. The net effect on retina MSO EBITDA per patient is small but the cash-cycle benefit (fewer visits per patient with the same revenue capture) is positive for operating margin.
The strategic-buyer view, which Cencora’s $4.6B price tag implies, is that the underlying anti-VEGF demand grows at mid-single digits driven by demographics regardless of which molecule wins on share. The platform that controls the referral funnel and the infusion-suite economics is the price-setter for distributor pull-through. The biosimilar mix shift may compress drug-margin per dose but expands volume and gives Cencora and McKesson the negotiating power on contracted-rate distribution that pure sponsors do not have.
A second-order point worth flagging is contracted-rate dynamics on commercial-payer anti-VEGF. Commercial payers (Aetna, UnitedHealthcare, Blue plans) have moved aggressively to step-therapy protocols that force the use of Avastin (off-label, far cheaper) before Eylea or Vabysmo. The MSO’s bargaining position with commercial payers depends on geographic referral-market dominance: if a retina MSO controls 60% of retina referrals in a metro market, the commercial payer has to negotiate. If the MSO controls 20%, the payer dictates. That is the underlying reason platforms with retina sub-specialty footprint trade at a premium even when they are not retina-pure: bargaining power with commercial payers is operational density, and density is captured in the MSO’s own footprint.
From a sponsor’s perspective on retina exits, the deal-counsel pattern through 2024 to 2026 makes clear that strategic-distributor processes use a different deal mechanic than sponsor-to-sponsor processes. The Cencora-RCA transaction had a contingent-consideration tail (up to $500M on FY27 and FY28 performance), which is unusual in a clean PE-to-PE secondary but is common in strategic transactions where the buyer wants to share execution risk with retained physician-management. Practice sellers and broker advisors should expect strategic-buyer processes to include earnout structures or contingent consideration tied to two to three year post-close performance, particularly on integration retention milestones.
Ophthalmology has long been a top-3 Medicare Part B drug spend specialty alongside oncology and rheumatology. Medicare Part B drug spend in ophthalmology grew at roughly 15% CAGR over 2008 to 2021, reaching 11.0% of total Part B drug spend by 2021 per CMS’s Medicare Drug Spending Dashboard and ASPE. That is the size of the addressable pool that drug distributors now own a controlling slice of.
Corporate Practice of Medicine doctrine is the legal backbone of all PE-backed physician roll-ups in the US, including ophthalmology. Roughly 33 states plus the District of Columbia have some form of CPOM restriction per Permit Health’s 50-state guide and MedPath’s 50-state guide. The architecture in CPOM states is invariant: a friendly Professional Corporation (PC) owned by a licensed physician owns the licensed practice; the MSO entity (owned by the sponsor) provides management services to the PC under a long-term Management Services Agreement. The MSA captures management fees that approximate the practice’s residual cash flow after physician compensation and fixed costs.
Texas is among the strictest CPOM enforcement states, with the Texas Medical Board active in policing fee-splitting and corporate ownership per Permit Health’s Texas CPOM guide. Pennsylvania, Massachusetts, and Arizona explicitly cover optometry in CPOM bans, which affects optometry-led MSO structuring as well. Friendly-PC nominee-shareholder structures, captive-PC structures, and physician-employment-only structures all see use depending on state. Practical takeaway for sellers and buyers: the MSA terms (especially management-fee calculation, term and renewal mechanics, and non-substitution rights) are where most CPOM-state structuring risk sits at diligence. Sponsors that have refined MSA templates over 5-plus practice acquisitions in a given state have a structural diligence edge in subsequent processes.
The state-level wrinkle for 2025 to 2026 is the rise of CPOM-adjacent disclosure requirements at the state attorney-general level. California AB 3129 (effective January 1, 2025) requires advance notice and AG review of certain healthcare transactions involving private equity acquirers above defined thresholds. Indiana, Oregon, and Massachusetts have parallel-track disclosure or notification regimes in effect for 2025 to 2026. These regimes do not block transactions but they add 30 to 120 days of pre-close review time and create written-record disclosure of management fee structures. The diligence calendar for a PE MSO acquisition in a notification-regime state needs to add a state-AG review window upfront, with the corresponding effect on closing deposits, signing fees, and transaction-financing commitments.
For practice owners in CPOM states, the MSA economics typically arrive at a management fee that ranges from roughly 12% to 25% of net revenue depending on practice scale, surgical mix, and sponsor pricing. The economics work because the MSO undertakes capital expenditure, technology, payer contracting, recruiting, and administrative back-office responsibility, while the PC retains professional fee revenue and physician compensation. Comparing offers across sponsors at sale, the headline EBITDA multiple is only part of the picture; the MSA terms (management fee level, growth-share mechanics, ASC-revenue allocation, post-close compensation grid for retained physicians) materially affect physician take-home over the 5-to-7-year hold. A 14x platform multiple with a 25% MSA fee can be worse for the retained-physician seller than a 12x platform multiple with an 18% MSA fee. Practice owners should diligence MSA terms with as much care as headline price.
The Berkowitz et al. Ophthalmology Workforce Projections 2020-2035 paper in the AAO Journal is the single most important workforce input for any ophthalmology PE thesis. The key projections:
By contrast, the optometry workforce is growing. BLS projects 19.8% optometrist employment growth over 2024 to 2034, the 5th-fastest healthcare occupation per the BLS Healthcare Outlook. Practicing US optometrists grew from 29,827 in 2014 to 44,912 in 2024 per Data USA, a roughly 50% increase per decade. The two workforce lines diverge: ophthalmology supply contracts while optometry supply expands.
The implication for PE underwriting:
The Berkowitz projections create a binding constraint on platform growth. Any MSO platform that intends to grow through tuck-in acquisition has to plan for a shrinking ophthalmologist supply pool over a 10-year window. There are three structural recruiting levers that the strongest 2024 to 2026 platforms have built into their model.
The first is residency-program partnership. EyeCare Partners, EyeSouth, and AVP have all developed structured residency-mentorship programs that give recent graduates exposure to private-practice operations, ASC equity opportunities, and structured partnership pathways before the formal post-residency offer cycle starts. The signal value of these programs to a graduating resident is that the platform is signaling a 10-year career path, not just an employment slot. Programs with active residency-partnership relationships report 2-to-3x higher new-graduate hire-and-retain rates than programs without.
The second is RVU-share compensation, where the physician’s pay is tied directly to relative value units billed (with appropriate CPOM-compliant structure). RVU-share models attract surgeons because they are transparent and they reward production. They also align the physician’s personal economics with the platform’s volume objectives. EyeSouth and EHA have been particularly aggressive on RVU-share comp grids in their 2024 to 2026 add-on closes. The drawback is operational complexity: RVU-share requires accurate work-RVU capture, regular audit, and per-physician productivity reporting that smaller practices often lack at sale.
The third is ASC equity. The single most powerful recruiting lever for a surgeon is the opportunity to take an equity stake in the ASC where they perform cases. ASC equity converts a fixed-salary employee relationship into a pseudo-partnership: the surgeon shares in facility-fee revenue (proportional to ownership), accrues tax-advantaged distributions, and develops a long-dated stake in the facility’s enterprise value at any future sale or recap. CPOM rules in most states permit ASC ownership by surgeons separately from the underlying PC structure, so the ASC-equity lever is independent of the friendly-PC architecture. Platforms that offer ASC equity to recruited surgeons (rather than holding all ASC equity at the platform level) consistently report higher new-MD attraction and 7-year retention.
Combine the three levers and you get a recruiting story that some platforms use as an explicit pitch in front of independent practices considering a sale. AEG Vision, MyEyeDr, and EyeCare Partners have each built recruiting-focused marketing pages targeting independent ophthalmologists with the embedded pitch: “join us via your practice sale and get all three levers in one transaction.” The strength of the pitch correlates with the platform’s actual ASC and residency footprint, not with the headline EBITDA multiple offered.
FOCUS Investment Banking’s 2026 valuation framework calls out ancillary revenue capture of 25% to 40% of total revenue as a marker of a well-developed practice. The three big ancillary categories are: optical shop sales (frames, lenses, contact lens), diagnostic testing (OCT, visual field, fundus photography, corneal topography, IOL master), and dry-eye programs (LipiFlow, IPL, BlephEx, custom-compounded therapeutics).
Optical shop revenue is the largest ancillary category by gross dollars, typically 15% to 25% of total practice revenue for a comprehensive ophthalmology practice and 25% to 40% for an OD-anchored practice. The gross margin on optical retail is in the 50% to 65% range, but the contribution margin after staffing, inventory carry, and dispensing-frame allowance to insured plans is 25% to 40%. Optical shop revenue is sticky (patients return for replacement frames every 18 to 24 months) and recession-tolerant (insured-plan optical benefits are relatively unaffected by economic cycles). For an MSO, the standardized optical-shop format and contracted-vendor frame and lens sourcing typically deliver 200 to 400 basis points of contribution margin improvement versus single-site independent operation.
Diagnostic testing revenue (CPT 92132 to 92134 for OCT, CPT 92083 for visual field, CPT 92250 for fundus photography) is bundled into the technical-component fee that bills to Medicare and commercial payers separately from the office-visit E&M code. Diagnostic-testing revenue is a near-pure-margin add to office-visit volume because the technician time and equipment depreciation are largely fixed cost. A 5-MD practice with full diagnostic-testing capture (OCT, VF, FP, IOL master, topography) can produce $1M to $2M of incremental annual revenue compared with a similar practice that refers diagnostic testing out. MSOs standardize this by installing a baseline diagnostic-suite at every location, regardless of size.
Dry-eye programs are the newest ancillary category and have higher inter-practice variation. The market for dry-eye disease therapeutics (Xiidra, Restasis, Cequa, the Tyrvaya nasal spray) plus in-office device-based therapies (LipiFlow, IPL, BlephEx) is large but the practice-level economics depend on patient-conversion rate and cash-pay willingness. Practices that have built integrated dry-eye programs typically report $300K to $1M of incremental annual revenue and 60% to 75% contribution margin. The variation across practices is high enough that a sophisticated MSO buyer will diligence dry-eye program revenue separately, often valuing it at a lower multiple than core surgical revenue because of the cash-pay revenue volatility.
For an ophthalmology or optometry practice owner considering a PE process, sponsor fit varies materially by practice profile. The table below maps practice characteristics to likely platform buyers based on the 2024 to 2026 acquisition pattern.
| Practice Profile | Likely Platform Buyers (by 2024-2026 pattern) | Notes |
|---|---|---|
| Comprehensive ophth, SE US (FL/GA/SC), 2 to 8 MDs, 1 to 3 ASCs | Eye Health America (LLR); EyeSouth (Olympus); ReFocus (Zenyth) for FL adjacency | EHA’s 29-partnership track record in FL is the proof point |
| Comprehensive ophth, mid-Atlantic (MD/PA/VA/DE/NJ) | Vision Innovation Partners (Gryphon); ReFocus (Zenyth); Spectrum Vision Partners (Blue Sea) | VIP’s 27-add-on momentum makes it the most active acquirer here |
| Comprehensive ophth, Southwest (AZ/TX/NM/NV/CA) | American Vision Partners (H.I.G.); NVISION (Ontario Teachers’) for refractive | AVP’s 100+ center footprint is the regional density anchor |
| Refractive-anchored, Western US | NVISION (Ontario Teachers’) | Western US LASIK is NVISION territory |
| Multi-specialty ophth (cornea, retina, glaucoma, oculoplastics), NE US | Spectrum Vision Partners (Blue Sea); EyeCare Partners (Partners Group) | SVP’s OCLI Vision base is the strongest NE multi-specialty fit |
| Retina-only, scaled | Cencora (RCA), McKesson (PRISM); strategics dominate this lane | Sponsor exits in this lane are unlikely given 18x retina multiples |
| OD-led MSO, multi-state retail | AEG Vision (Riata); Keplr (Imperial); MyEyeDr (Goldman); VSP (potentially) | Goldman’s 7-year MyEyeDr hold sets up a near-term auction |
| Integrated MD-OD platform, multi-state | EyeCare Partners (constrained by credit), EyeSouth (Olympus), MyEyeDr (Goldman) | Integrated-platform buyers are scarce relative to OD-only or MD-only |
| Optical retail, multi-state | VSP Vision (nonprofit), EssilorLuxottica retail, National Vision | Sponsor-to-sponsor in this lane has been quiet since 2024 |
| Pediatric ophth, regional | Comprehensive ophth platforms (EyeCare Partners, AVP, EyeSouth) as sub-specialty tuck-in | No stand-alone pediatric ophth roll-up exists |
| ASC operator (multi-specialty including ophth) | Surgery Partners (SGRY) on the public side; stand-alone ASCs sold into MSOs by sub-specialty | The Key-Whitman model is SGRY’s ophthalmology ASC build path |
The single best fit-question for a seller to ask is not “who is the biggest” but “who is hiring our reference attorneys and our reference CPAs in your most recent close.” Deal-counsel concentration is a strong proxy for sponsor-execution capability in a given subsegment. Goodwin Procter (RCA), Kirkland & Ellis (VSP-Eyemart), Bass Berry & Sims (EyeSouth-Sunvera), Foley & Lardner (multiple), and Dechert (EyeCare Partners 2L) are the recurring counsel names; advisor concentration on the deal counsel side is the best lead indicator of sponsor experience curve.
What happens after close is where actual EBITDA gets created. The 2024 to 2026 acquisitions where management teams have publicly reported post-close performance share a consistent operating playbook.
The first 90 days focus on systems migration: EMR conversion (or single-tenant configuration of the platform EMR, typically Modernizing Medicine, NextGen, or eClinicalWorks for ophthalmology), payment-system consolidation, payer credentialing transfer, and IT-stack integration. The single biggest avoidable post-close revenue loss is payer credentialing delay, which can hold up 30 to 90 days of cash flow at any closed practice. Sophisticated MSO buyers prepare credentialing-transfer paperwork 60 to 90 days pre-close to compress this window.
Months 4 through 12 focus on operational standardization: technician training, OR scheduling, ASC throughput optimization (if the platform has ASC ownership), and patient-flow standardization. Quick wins typically come from compressing patient-throughput inefficiencies (one-room-per-physician versus three-room rotation, technician pre-work for diagnostic testing, OCT and IOL master capture at every clinical encounter). Margin improvement in this period is typically 200 to 500 basis points of revenue.
Months 13 through 24 focus on ancillary revenue scaling: optical-shop format standardization, diagnostic-testing capture, dry-eye program rollout, and supplemental service-line launches (e.g., medical aesthetics in select markets, premium-IOL upgrade marketing). Margin improvement in this period adds another 100 to 300 basis points. Cumulatively, a well-executed 24-month post-close integration adds 300 to 800 basis points of EBITDA margin to the acquired practice.
The platforms that have built repeatable integration playbooks (EyeCare Partners pre-2024, EyeSouth, EHA, MyEyeDr) capture this margin uplift more consistently than platforms that have not. Practice sellers should ask, in any sponsor-platform conversation, for specific examples of post-close margin improvement at comparable acquired practices in the 24 months following close. The answer differentiates serious operators from sponsors that have only completed two or three closes in the relevant geography.
Healthcare M&A multiples broadly experienced a peak in late 2021 and early 2022 followed by 100 to 300 basis points of multiple compression through 2023 and into 2024. The 2024 to 2026 period saw partial recovery in ophthalmology specifically (the FOCUS 2026 multiple ranges are at or above the historical 2018 to 2020 range), driven by the strategic-buyer entry and the demographics tailwind. Other physician-services segments (dermatology, urology, GI) have shown shallower recovery, with dermatology platform multiples specifically reported at 9x to 12x by 2025 versus 12x to 15x in 2021.
The contrarian read on the current ophthalmology multiple environment is that strategic-buyer deals (Cencora, McKesson, VSP) re-rated the platform multiples upward by giving sponsors a clear exit path at premium prices, even as sponsor-to-sponsor processes remained subdued. The risk to the current multiple environment is that future strategic transactions need to either continue at similar pace or rationalize back to sponsor-to-sponsor pricing. As of mid-2026, no further strategic-distributor-to-MSO announcements have been publicly disclosed since the Cencora and McKesson transactions, although Walgreens-Boots Alliance has been speculated as a potential third-mover into ophthalmology distribution given their prior interest in healthcare services.
For PE platforms not in retina specifically, the next 18 to 24 months should see incremental sponsor-to-sponsor activity as platform holds reach 5-to-7-year exit windows. The platforms most likely to see process activity in this window: NVISION (Ontario Teachers’ since December 2020, now 5+ year hold), MyEyeDr (Goldman since June 2019, now 7-year hold), AVP (H.I.G. since 2017, now 9-year hold per H.I.G. Capital portfolio data), Spectrum Vision Partners (Blue Sea since November 2017, 8-year hold), and Acuity / AEG Vision (Riata since 2017, 9-year hold). Among these, NVISION and MyEyeDr are the cleanest near-term exit candidates because the underlying platform performance has been strong; AVP and Acuity are likely to require additional operational work pre-exit.
The following items we could not verify to a primary source within the window of this round and are flagged for follow-up reporting.
For an ophthalmology or optometry practice owner contemplating a sale, the 12 to 24 month window before any process is where most multiple-uplift work happens. The work falls into seven buckets.
1. Financial-statement cleanup and audit readiness. Most independent practices run a cash-basis income statement with informal personal-expense add-backs. PE buyers will require GAAP-converted financials, a Quality of Earnings exercise (typically performed by a Big-4 or top-100 accounting firm at seller’s cost), and 24 months of audit-grade revenue and expense detail. The earlier this work is done (12 to 18 months pre-process), the cleaner the EBITDA bridge presents to bidders. A clean QoE bridges to roughly half a turn of multiple lift on average.
2. Physician-compensation normalization. Most independent practices pay physicians at distribution levels (the owner-physician takes what remains after expenses), not at market salary. PE buyers normalize this to a market-comparable compensation grid, typically 35% to 45% of professional collections for surgical specialists. The delta between owner-physician distribution and normalized market comp is an EBITDA add-back; the cleaner this is documented, the more credible the platform-EBITDA baseline. Sellers should engage a healthcare compensation consultant to baseline the normalization 12 months before any process.
3. Real-estate separation. Many owner-physician practices own the underlying real estate (clinic, ASC, or both) in the same entity as the practice. PE buyers typically want to separate the real estate into a real-estate-only LLC and have the operating practice lease back at market rent, with the seller often retaining real-estate ownership. Doing this restructure 12 to 24 months before the process protects from CPOM-state related-party scrutiny and from at-close re-papering costs.
4. Payer contract review and renegotiation. Practice payer contracts with Medicare Advantage and commercial payers are typically negotiated at the practice level; the MSO post-close will use platform-scale contracting to improve rates. If a practice has below-market rate contracts at sale, the buyer may not pay for the contracted-rate uplift potential because they will capture it post-close. Sellers who renegotiate 12 to 18 months pre-process capture more of the rate uplift in their sale price.
5. ASC equity assessment. If the practice operates in or near a hospital outpatient department for cataract or other surgical volume, the seller should evaluate whether a practice-owned or syndicated ASC is feasible before sale. Even minority ASC ownership accretes 1 to 2 turns of multiple. The lead time on de-novo ASC build is 18 to 36 months including permitting, so this is the longest-lead pre-process action.
6. Key-person succession. PE buyers will scrutinize key-person concentration risk: if the owner-physician produces 50%-plus of practice revenue, the buyer’s offer will reflect succession risk discount. Mitigating this 12 to 24 months pre-process via associate-physician hires, mid-career partner recruitment, or fellowship-graduate onboarding lowers the succession risk premium that the buyer extracts.
7. Advisor selection. The right M&A advisor for a practice sale is one with vertical-specific recent close experience. The recurring ophthalmology-deal advisors as of mid-2026 include FOCUS Investment Banking, Provident Healthcare Partners, Physician Growth Partners, Cain Brothers, Brentwood Capital Advisors, and Citi Capital Markets at the high end of the practice-size range. For practices below $3M of EBITDA, regional healthcare investment banks or broker-style advisors typically deliver better economics than national-platform investment banks.
This checklist is the same content as the practice-owner intake brief CT Acquisitions provides to ophthalmology and optometry owners considering process initiation. The 12 to 24 month preparation window is the largest single lever a seller has on final cleared price.
CT Acquisitions maintains a sibling series of physician-services PE roll-up trackers that share the same primary-source methodology and confidence-rating framework. For practice owners and PE professionals doing comparative analysis across specialties:
For practice-level exit preparation, see:
The next 24 to 36 months will determine whether the strategic-buyer cycle of 2024 to 2025 was a structural reset or an episodic event. Six catalysts to watch.
First, the EyeCare Partners credit cycle. The April 2024 refinancing pushed maturities to 2027. By late 2026 the platform will need to either deliver clean operating-EBITDA growth that supports a normalization of the capital structure, or face a second restructuring event. Watch for Partners Group’s portfolio commentary in their 2026 annual reporting cycle.
Second, the MyEyeDr exit clock. Goldman’s 7-year hold by mid-2026 is at the upper end of typical fund-investment horizons. A sponsor-to-strategic or sponsor-to-sponsor process announcement on MyEyeDr would be the largest US optometry transaction since the 2019 close, and the implied multiple would set the comp for AEG Vision, Acuity, and Keplr exits over the following 24 months.
Third, the third-strategic-distributor entry into ophthalmology. With Cencora and McKesson having each made their move, the obvious candidates for a parallel transaction are AmerisourceBergen heritage (now part of Cencora), Walgreens-Boots Alliance, CVS Health, or one of the hospital-system-aligned distributor structures. Any third-strategic entry would re-rate the comprehensive ophthalmology multiple upward.
Fourth, the biosimilar volume curve. Yesafili’s second-half-2026 US launch and Opuviz’s subsequent launch will produce actual market-share data for the first time. The bear-case (25% Eylea share loss by 2027) versus the bull-case (continued Eylea HD migration with biosimilar take only at the 2 mg cohort) will resolve over 2026 and 2027 with quarterly Regeneron earnings disclosures.
Fifth, the CY2027 MPFS proposed rule cycle. CMS typically publishes the proposed rule in July of the prior year. Watch the CY2027 proposed rule (expected July 2026) for any further adjustment to CPT 66984 work RVU or to the ASC payment formula. The CY2026 cataract cut may be revisited based on physician-organization pushback.
Sixth, state-level CPOM and notification-regime evolution. California AB 3129 took effect January 1, 2025 and the first 12 months of implementation data will be public by mid-2026. Other state AGs (NY, IL, MA, OR, WA) may follow with parallel disclosure regimes. The cumulative effect on PE-healthcare M&A transaction calendars will be material if more than five additional states adopt notification regimes by 2027.
Collectively, these six catalysts will shape the underwriting framework for any ophthalmology MSO acquisition or exit in 2027 to 2028. We will update this tracker quarterly as new primary-source data becomes available.
Federal regulatory and statistical:
SEC EDGAR filings:
Specialty bank and advisor research:
Clinical and academic:
Deal counsel and sponsor press: Goodwin Procter, Kirkland & Ellis, Dechert, Bass Berry & Sims, Foley & Lardner. Sponsor sources include Partners Group, Olympus Partners, Shore Capital Partners, Gryphon Investors, Riata Capital, H.I.G. Capital, LLR Partners, Waud Capital, Blue Sea Capital, Zenyth Partners, Imperial Capital, New Harbor Capital, Webster Equity Partners, Quad-C, Revelstoke, Goldman Sachs Asset Management, FFL Partners, Leonard Green & Partners. See inline URLs in each platform row.
EyeCare Partners has been owned by Partners Group since 2020, when Partners Group acquired the platform from FFL Partners at roughly $2.2B enterprise value per Partners Group’s press release. Goldman Sachs is not the current sponsor (Goldman was an earlier holder that exited in 2020). The April 2024 transaction at EyeCare Partners was a debt restructuring with a $275M super-priority new-money term loan, not an equity exit.
Cencora paid $4.6B in cash plus up to $500M in contingent consideration tied to FY2027 and FY2028 performance for 85% of Retina Consultants of America. The deal was announced November 6, 2024 per Cencora’s 8-K and closed in January 2025. Webster Equity Partners was the selling sponsor.
McKesson paid roughly $850M for an 80% controlling interest in PRISM Vision Group. The deal closed in April 2025 per Quad-C Management’s close announcement. Quad-C and the physicians retained minority interest.
FOCUS Investment Banking’s 2026 valuation framework cites platform transactions at 10x to 15x EBITDA, with add-ons at 6x to 10x. Sub-$1M EBITDA single-site practices clear 5x to 6.5x. $5M-plus EBITDA platforms with established management depth clear 10x to 15x-plus. ASC ownership inside an MSO adds a 1 to 3 turn premium. Retina sub-specialty clears a material premium; FOCUS reads Cencora-RCA at roughly 18.4x.
CPT 66984 (cataract extraction with intraocular lens) was cut 11% to $462.94 in CY2026 versus $521.75 in CY2025 per ASCRS, the largest single-year cut to cataract reimbursement in 30 years. At the same time, the ASC payment for CPT 66984 in CY2026 went up 3.4% to $1,255.73 per ASCRS’s ASC analysis. The net effect is to push cataract economics toward MSOs that own their ASCs.
The FDA approved Yesafili (Biocon) and Opuviz (Samsung Bioepis) as interchangeable aflibercept biosimilars in May 2024. Yesafili’s US launch window is the second half of calendar 2026 under a Biocon-Regeneron settlement per Biocon Biologics. Grand View Research estimates 9% of Eylea sales are at biosimilar risk in 2025, rising to 25% by 2027.
Alcon and Lensar terminated their March 2025 transaction (originally $14.00 per share, roughly $356M plus a contingent value right up to $2.75 per share on cumulative procedure milestones) on March 17, 2026 after FTC scrutiny on horizontal concentration in cataract-laser devices per MassDevice. The signal: regulator scrutiny on ophthalmology-device consolidation has tightened.
Goldman Sachs has held MyEyeDr (Capital Vision Services) since June 2019, when it acquired the platform from Altas Partners and CDPQ at $2.7B enterprise value. By mid-2026 that is a seven-year hold. MyEyeDr added 27 net stores in 2024 and is guiding 20 de novos in 2025 then 50 per year per ICSC. The next sponsor-to-sponsor or strategic-to-MyEyeDr transition is among the largest pending US optometry transactions, though no public announce date has been disclosed.
As of mid-2026, California, North Dakota, Oklahoma, and Minnesota have broad noncompete prohibitions covering physicians per Physicians Practice. Indiana SB 475 (effective July 1, 2025) bans physician noncompetes with hospitals and hospital systems. Pennsylvania, Colorado, Illinois, Virginia, Louisiana, Arkansas, and Maryland have additional 2025 healthcare-specific restrictions per Foley & Lardner. The FTC’s April 2024 national noncompete ban was vacated by ND Texas in August 2024; the FTC withdrew its appeal in September 2025.
Per Berkowitz et al, AAO Journal: ophthalmology supply is projected to fall 12% between 2020 and 2035 (a 2,650 FTE decline) while demand rises 24% (a 5,150 FTE increase), producing a roughly 30% workforce inadequacy by 2035. Rural disparity is severe: 77% metro adequacy versus 29% nonmetro adequacy. Ophthalmology ranked 2nd worst of 38 specialties studied on 2035 adequacy.
No. VSP Vision operates as a not-for-profit corporation; the IRS revoked its tax-exempt status in 2003 per VSP’s public record. VSP owns Visionworks, Marchon Eyewear, Eyefinity, VSP Optics, Eyeconic, and (since January 23, 2025) Eyemart Express. VSP is a vision-benefits provider with 85M-plus members and 41,000-plus doctors in network.
The closest precedent is Cencora’s own OneOncology playbook: a drug distributor acquiring a physician-led MSO to lock in distribution of the buy-and-bill drug franchise that dominates revenue. The same logic underwrote McKesson-PRISM (drug distributor plus retina-and-ophth MSO). The strategic logic is structural: distributors that monetize buy-and-bill drugs (anti-VEGF for retina, oncology drugs for oncology) have a P&L synergy that PE sponsors do not.
CT Acquisitions is an M&A research and advisory firm focused on US lower-middle-market and middle-market healthcare services transactions. This tracker is part of a series of physician-services PE roll-up briefings that combine primary-source verification (SEC filings, federal regulatory rules, sponsor and deal-counsel press releases, peer-reviewed workforce studies) with practical guidance for practice owners considering an exit and for PE professionals underwriting platform investments. Our methodology is documented inline in each tracker, with per-cell confidence ratings and an explicit limitations section that flags every known unknown. We update each tracker as new primary-source data becomes available. For questions on a specific platform, deal, or sub-segment in this tracker, or to discuss exit preparation for an ophthalmology or optometry practice, contact CT Acquisitions through our practice-owner intake channel.
Last updated: June 16, 2026.