Using Trends in Regional Exam Performance to Plan Your Growth Strategies

by | Jun 30, 2022 | Data Insights and Industry Trends

Savvy ECPs continually adjust business strategies to keep moving the needle towards improved business outcomes. To produce and maintain growth, practices will typically leverage business tools such as (but not limited to) strategic planning, benchmarking, staff training, and marketing.  While the case may be made for the effectiveness of these tools, we have to acknowledge the market factors that extend well beyond the front door of any eye care practice. Examining regional trends can be a major help in understanding and dealing with those market factors.

The reality is that ECPs operate in a larger “macro environment.” This macro environment is the realm of outside influences that impact business outcomes. Macro influences may include geographic, temporal, public health, meteorological, economic, technological, societal, and governmental factors. While these variables cannot be changed by an ECP, understanding the macro environment in which they operate helps put an ECP’s performance metrics into proper perspective, so the business can be adapted accordingly. 

Macro Factor Examples: COVID-19 and Geographic Territory

Geographic territory and the COVID pandemic are prime examples of macro factors. They are also both still relevant in the current business climate, so understanding how they relate to each other, and to your general region, can help you create strategies to improve performance in your own practice.  

We explored geographic differences and COVID’s impact on daily eye exam rates over 2+ years. To do so, we took a representative GPN sample of 2,600 ECP locations distributed across the US and analyzed their daily count of eye exams over 9 quarters, beginning in Q1 2020 and extending through Q1 2022.  We compared new COVID case rates over the same periods across the US Census Bureau’s nine census divisions. 


Over the 2+ year timeframe and across the US, ECPs in this sample averaged 12.3 eye exams per day. Daily eye exam rates for the entire US were highest in Q3 2021 (13.47) followed by Q4 2021 and lowest in Q2 2020.

New COVID cases per 100,000 population were highest in Q1 2022 (83.8) and 2nd highest in Q2 2020 (45.5). By Division, across the timeline, new COVID cases were highest in the East South Central Division (33.7). 

When looking at exam volume on a census division level: 

East South Central Division
  • The highest average daily eye exams per ECP location occurred in the East South Central Census Division (Alabama, Mississippi, Tennessee and Kentucky), where 13.71 eye exams occured per day per ECP location.
  • The East South Central Division ranked highest for average eye exams per day during 4 of the 9 quarters reviewed. 
West South Central Division
  • The West South Central Census Division (Arkansas, Louisiana, Oklahoma and Texas) was a close 2nd highest, averaging 13.54 daily eye exams.
  • The West South Central Division ranked on top for 3 quarters and tied for top rank in Q1 2022. 
New England Division
  • The New England Division (Connecticut, Massachusetts, Rhode Island, New Hampshire, and Maine) rounded out the top 3 with 13.04 daily eye exams. 
  • The New England Division had one quarter (Q4 2020) when they ranked highest for average eye exams per day.
Pacific Division
  • The Pacific Census Division (Alaska, California, Hawaii, Oregon and Washington) ranked lowest with an average 10.12 eye exams per day per ECP location. 


Census Division eye examination rates differ significantly, with the East South Central Division averaging the highest daily count per ECP. While the steep decline in exams in Q2 2020 was certainly triggered by COVID quarantines, we did not find significant correlations between the rates of new COVID cases and eye examinations rates across the timeline or Census Division. Testing for correlations included comparing the division weekly aggregate average daily eye examinations to new COVID case counts for the same week, as well as comparing to new COVID case counts 1, 2, 3 and 4 weeks prior. 

Regional differences in eye exam rates are likely the result of multiple macro factors. These factors may include differences in: ECP count to population, distribution of managed vision care coverage, local economic factors (e.g., household income, local employment rate) as well as local consumer profiles.

Use the map and table to look up your Census Division and benchmark your daily exam rates. 

Use this information to understand the macro environment within which you operate to gain perspective on geographic differences. For a detailed look at your local market neighborhood, check out localEyes reports.

By Ron Krefman, OD

Finding solutions in data science.


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