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When Dr. Cory Lapin opened his dedicated dry eye practice, he was not stepping into a polished operation with a large staff and years of established systems. Just four weeks in, the practice consisted largely of Lapin and a virtual receptionist, leaving him involved in nearly every part of the patient experience. Rather than seeing that as a limitation, he viewed it as an opportunity to understand exactly how his practice worked before eventually asking someone else to help run it.
In a conversation with Dr. Adam Ramsey on Play Chess Not Checkers, Lapin discussed the clinical decisions behind a specialty dry eye practice, from how he structures the initial examination to choosing technology and deciding how aggressively to treat patients. But beneath those decisions was a broader theme: a specialty practice works best when it reflects both the needs of its patients and the interests of the doctor building it.
Topics Covered :
Finding a Place in Dry Eye
Lapin did not enter optometry school knowing that dry eye would become his specialty. His interest developed as he became more involved in ocular disease and began recognizing how many patients were struggling with dry eye without finding meaningful relief. During residency, he was exposed to a dedicated dry eye clinic, reinforcing his belief that there was room for a more focused approach to the disease.
A chance meeting with Dr. Art Epstein helped turn that interest into a career direction. Lapin heard Epstein introduce himself as a doctor who exclusively treated dry eye—exactly the type of practice Lapin had been told might not work. He introduced himself that evening and, months later, sent Epstein an email asking about an associate position. The opportunity eventually took him to Phoenix, where he spent more than five years developing his approach to dry eye care.
Epstein also gave him a lesson that still shapes his practice: “Our patient is the most sensitive instrument we have.” Diagnostics can provide tremendous information, but they should not replace the conversation happening in the exam room.
Building the Exam Around the Conversation
Lapin tries to make that conversation easier by doing much of the information gathering before the patient ever enters the practice. Records, medical histories, medications and dry eye questionnaires are collected in advance, allowing him to review what has already been tried before the appointment begins.
Once the patient arrives, the examination moves through noninvasive ocular surface testing and slit lamp imaging before fluorescein is introduced. Anything that could disrupt the ocular surface is intentionally saved until the end. After the data is collected, Lapin turns the screen toward the patient and reviews the findings with them.
That education is not an extra step in the examination; it is part of the treatment strategy. When patients can see the problem and understand why a particular medication or procedure is being recommended, Lapin believes they are more likely to follow through. The initial dry eye evaluation can take an hour, but subsequent visits are typically shorter because that foundation has already been established.
How Much Treatment Is Too Much?
One of the more revealing parts of the conversation came when Ramsey and Lapin compared their approaches to treatment. Lapin generally favors addressing several problems early, getting the patient feeling better and then reducing the treatment burden over time. Ramsey takes a more incremental approach, adding therapies individually so that both doctor and patient can better understand which intervention produced a change.
Neither viewed the other approach as wrong. In fact, their discussion highlighted something more practical: the strategy may depend on the patient sitting in front of them.
A patient frustrated by months or years of symptoms may want to treat the condition aggressively. Another may become overwhelmed by several medications, procedures and home therapies introduced at once. Lapin will sometimes explain both approaches and simply ask which direction the patient prefers. That turns treatment planning into a shared decision rather than forcing every dry eye patient through the same protocol.
Building a Practice Around What Matters
Lapin’s plans extend beyond the clinic he has just opened. Over the next several years, he hopes to bring in another doctor, develop student rotations and eventually explore opening another standalone dry eye location. Creating a training environment could also help him identify future doctors who already understand the clinical philosophy of the practice.
Yet his larger message was not that every optometrist should open a dry eye center. It was that clinicians should pay attention to the parts of eye care that genuinely interest them and consider what could happen if they built more of their careers around those areas.
“The people I’ve found who are most successful lean into their passions,” Lapin said.
For Lapin, that passion became dry eye. His new practice is an opportunity to put years of clinical experience into a model of his own—one built around listening to patients, being willing to experiment and continually refining how care is delivered. The practice may look different a year from now than it does today, and for Lapin, that appears to be exactly the point.
