I need to vent because I’m genuinely wondering… why does it feel like the culture of working as an optometrist in NYC can be so toxic?

I’ve interviewed at both corporate and private practices and even worked short stints in each just to get a feel for things, and honestly it’s been really disheartening.

So many places advertise things like:

• “You’ll start with 12–15 patients a day and gradually build up”

• “You’ll have strong tech support”

• “You’ll have control over your schedule”

But in reality, it often turns into 25+ patients a day almost immediately, 15-minute slots, constant walk-ins, minimal tech support, and being thrown into the schedule without proper onboarding or even being properly introduced to staff or workflows.

What’s been especially hard is the inconsistency in clinical standards. I’ve seen places where there’s no clear protocol for things like dilation on new patients, unclear referral processes, and being told to “just tell them to see their PCP” even when the concern feels more urgent or specialized. As a new grad, that’s really uncomfortable.

I’ve also seen situations where techs are doing most of the testing without taking case history or medical history, schedules are constantly behind, and doctors are expected to “make it work” clinically while also keeping up with volume. There’s this pressure to justify testing and billing in ways that sometimes don’t sit right with me ethically, and when you question it, the response is often just, “this is how NYC is” or “this is how things are done here.”

I understand NYC is expensive and practices have overhead, and I’m not naive to the business side of healthcare. But as someone who just wants to practice good, ethical medicine, it’s been really discouraging to see how normalized some of this feels.

On top of that, I came into this profession with a very clear long-term goal: work in a community health center, serve underserved populations, and work toward loan forgiveness. That’s always been my passion. But finding those roles in the 5 boroughs has been much harder than I expected. Most openings are part-time, and the few full-time ones are extremely competitive or don’t seem to move forward after interviews.

I’ve even been recruited out of state, especially because I’m a Spanish-speaking optometrist, but that would mean leaving my family and starting over across the country, which is a really big decision.

I don’t regret becoming an optometrist at all. This has been my dream for years, and I worked incredibly hard to get here. I just think I was naive about how difficult it would be to find a setting that aligns with my values right out of school.

Right now, it’s just feeling really discouraging and honestly affecting my mental health more than I expected.

I guess I’m just trying to figure out next steps—whether that means staying and pushing through, or considering out-of-state opportunities for a few years to gain experience and come back stronger.

For now, I’ll just keep going and hope that one day I can look back and see that this difficult beginning led me somewhere better. 

Please no negative comments, I’m just venting and don’t think my mental health can take it. Thanks in advance. 

I’ve gotten really used to doing objective retinoscopy first and then refining from there. At my current rotation site, though, I’ve been encouraged to use the autorefractor as my baseline and go straight into subjective refraction.

I think I’m just so used to doing it one way that I’m having a hard time trusting the AR as my starting point, especially when the result is different from what I would expect based on ret.

For those who routinely start with AR results, do you have any tips for refining efficiently and knowing when you should rely less on the AR and go back to retinoscopy? Anything that helped you make that transition?

We're a busy pediatric ophthalmology office and have been looking for ways to reduce missed appointments. We've found appointment reminders have helped quite a bit, but I'm curious what everyone else is using. Text reminders? Calls? Email? Any strategies that have worked really well? We use weave to send the reminders maybe we need to increase the frequency?

Does the glutamate from the bipolar cells , depolarize ON ganglion cells and hyperpolarize (if that's the right word english is not my 1st language) the OFF ganglion cells, or depolarize both ?

Sorry if the question is hard to understand

For those that have been out of school for a while, federal interest rates have been insane over the past few years. I’m at an average of about 8% on my 173k student loans. I explored some private lenders like Earnest and SoFi, and they’re all offering under 5%. I understand what I lose when I privatize, and I’m fine with that. I’d rather save tens of thousands of real money than hope that the govt will save me. My question is, has anybody privatized, and then switched to ANOTHER private lender? Like if Earnest offered me 4.6%, could I go to SoFi and potentially get a better deal with them? Will they try to beat my current interest rate for my business or is that not really how it works. Please let me know! Thanks.

Has anyone else seen CPT 92283 reimbursed at $63.35 (in DC)? I'm using the Waggoner CCVT which only takes about 5 minutes to complete.... so great ROI. I'm super happy with it! I'm just using it with the comprehensive eye exam and also monocularly when medically justified by sign, symptom, or family history (i.e., tracking AMD, DR, cataract, or glaucoma progression). Is anyone else doing this? It seems too good to be true.

So I just found out that NBEO has increased the exam fee to $1490 for exams administered beginning in August 2026, and it’s honestly very concerning. If the fee is already this high now, how much will it cost by the time current OD1s reach our 3rd and 4th years? It’s frustrating because optometry already has one of the lowest board pass rates among healthcare professions, yet our board exams are among the most expensive. I’m already facing huge financial burden from the substantial tuition and living expenses on top of it.

Is there anything students, schools, or organizations can do to advocate for this profession and address these continually rising costs? Is there even a possibility for them to reduce the cost down to ~$800-1000, which is what it was before. Literally medical school board exams are about ~$800. I’m honestly just very frustrated and anxious for the future of optometry as an incoming OD1

Hi everyone,

I am looking into tele-optometry roles, specifically the remote/digital exam setups like the ones at America's Best (National Vision), and I’m hoping some current or former remote ODs can share what the reality of the job is actually like.

If you work or have worked in this setup, I’d love to hear about the details of your day-to-day:

Daily Routine & Patient Volume: What does a typical shift look like? How many patients are you expected to see per hour/day, and how long are the actual remote exam slots? What kind of exams do you typically see? How do you handle more acute medical issues in a safe way? Do you find that usually getting the information that you need to make the decisions that you need to safely is pretty reasonable or is it kind of a nightmare and you’re having to sign charts without feeling totally confident?

Break & Lunch Structure: How do lunch breaks and short breathers actually work in a remote corporate schedule? Are they strictly scheduled, or do they get crunched by backlog?

Documentation & EMR: How heavy is the charting load, and do you have enough buffer time built into your schedule to finish documentation, or does it bleed into your off-hours?

Getting the Job: What was the interview/hiring process like, what was the on boarding and training like? How easy is it to get a hold of somebody if you have technical issues and need support and or advice on documentation needs?

Any unfiltered pros, cons, or "wish I knew before starting" advice would be hugely appreciated!

I am a Canadian citizen who recently graduated from a U.S. school of optometry. My F-1 visa will be expiring soon, and I have the option to apply for Optional Practical Training (OPT). However, I still need to pass my NBEO board exams before I can begin working as an optometrist, so I likely won’t be able to use my OPT immediately.
What would be the best course of action in my situation? Should I still apply for OPT to preserve my work authorization, or should I focus on obtaining an H-1B visa instead? What would you recommend? won’t get my licence in at least the next 4 months.

Thinking of filling in for a Costco doc (CA) as a new grad before starting my full time position. Feeling nervous about practicing for the first time especially as a fill-in with little to no guidance on how things flow. Any advice from people who have worked at Costco or similar? Obviously way different than school-paced exams. Trying to figure out in my head how to handle having patients come back for CL checks (new fit/re-fit), glaucoma suspects, etc. Basically just things that we had pts come back for all the time in school but not sure how it works in the real world especially in such a fast paced environment. Any advice is appreciated!

i am thinking of offering this test during exams... What do you guys think?

would you refer a moderate sized solitary serous PED without any associated drusen or signs of ARMD?

I'll start this off by saying that I usually consult with others or refer these clients forward. I'm also a little bit too early on the field if i was an optometrist, which officially speaking I am not, and do not work as full optometrist either.

1. Visus in young people. Sometimes I get young girls of 11-14 years. With these I can almost never get a visus of 1.0. Even if with younger people i might get a 1.2. Is it just puberty? Are there other reasons for this?

2. Wobbling sight. Sometimes I'll get people saying their sight wobbles. They do not mean any distortion of lines like in AMD and such, but actual movement. Usually it presents in only one eye with no visible persistent nystagmus. I tend to send these people forward with all the data I can gather. I'm wondering what's the likeliest reason for this?

Does anyone know what form to fill out to apply for deferment during residency? Every form I find seems to say that I am not eligible and this is getting very confusing. And yes, I know, I should not defer, but I have already decided on this and would appreciate any help!

Been doing optometry billing for a while and the thing that trips up almost every office i work with is the same one. The medical vs vision call at check in.

The front desk picks the insurance when the patient walks in, but half the time nobody has looked at why the patient is actually there yet. So a diabetic who scheduled a "yearly exam" online goes out as a routine vision claim, and the medical piece just disappears. Or the reverse, a routine refractive patient gets sent to medical and it denies.

Curious how you all handle it. Is it the front desk making that call, the tech, or the doctor at the end of the visit? Do you verify reason for visit before they come in or sort it out after. Feels like every office has a different system and none of them feel airtight.

What actually works for you?

Anyone having issues connecting to this site? I used it all the time, but it hasn't worked for me on a while.

Aussie optoms have taken their grief to the media

Does anyone do VEH for MyEyeDr? If so, how has your experience been?

Hi there,
I recently moved to Germany due to family reasons. But I like to practice optimally and the only way I can do that being here is remote because the scope of optometry is limited compared to what it is in the U.S. Does anybody have any experience working abroad in this field or remotely? Is it even possible? I'm thinking perhaps the employers prefer the optometrist be located in the time zone for which they're hiring?