Ophthalmology Private Equity Trends
A Category in Transition and Opportunity
Ophthalmology has been one of private equity’s longest-running specialty plays in physician practice management. The combination of procedural volume, ASC economics, demographic-driven demand, and a still-fragmented independent practice landscape has sustained buyer interest through broader market headwinds. But deal volumes have changed meaningfully, two landmark exits have informed pricing expectations, and an aging inventory of PE-held assets is building toward a 2026 exit wave. Here is what the data shows.
Deal Activity: Volume Down, Significance Up
According to the VMG Health 2025 Healthcare M&A Report, eyecare was historically the largest single specialty category in physician practice M&A, peaking at 101 transactions in 2020. Since then, deal volume has declined steadily as early consolidation waves absorbed the most accessible independent practices.1
Eyecare Deal Volume by Year
| Year | Transactions |
|---|---|
| 2020 | 101 |
| 2022 | 87 |
| 2023 | 47 |
| 2024 | 26 |
Source: VMG Health, 2025 Healthcare M&A Report, December 2024
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Despite the decline in volume, the dollar significance of ophthalmology transactions has never been higher. The specialty produced two of the most consequential physician services exits in recent memory, and the remaining PE-backed portfolio is aging toward forced liquidity.
PitchBook’s Q3 2025 Healthcare Services Report confirms that vision practices are among the specialties with the highest proportion of assets held for more than five years, a structural setup for accelerated exit activity. Across all healthcare services PE, nearly 50% of backed companies carry hold times greater than five years, with vision and dermatology disproportionately represented in that cohort.2
Landmark Transactions Anchor the Market
Two exits in late 2024 and early 2025 established the ceiling for ophthalmology platform valuations and illustrated the strategic logic of pharmaceutical distributors pursuing specialty physician MSOs.
Select Notable Ophthalmology Transactions
| Platform | Acquirer | Deal Value | EV/EBITDA | Notes |
|---|---|---|---|---|
| Retina Consultants of America | Cencora | $4.6B | 15×–23× | ~85% stake; ~300 retina specialists; 36 acquisitions since 20203 |
| PRISM Vision Group | McKesson | $850M | N/A (disclosed) | ~80% stake; early 2025 exit by Quad-C1 |
Sources: Scope Research Healthcare M&A Valuation Database (RCA multiple); VMG Health 2025 Healthcare M&A Report (PRISM, Eyecare Partners)
RCA’s transaction is particularly instructive. Formed in March 2020 with a $350 million investment from Webster Equity Partners, RCA completed 36 acquisitions before its $4.6 billion exit to Cencora, an 85% stake acquisition that expanded Cencora’s specialty distribution network into retina.3 According to Scope Research’s Healthcare M&A Valuation Database, RCA was marketed at $200–$300 million in EBITDA, implying a multiple of 15× to 23×, in line with historical comps at the platform end and extending above them.3
Valuation Benchmarks
Ophthalmology valuations bifurcate sharply between platform-level and add-on transactions. Scale and subspecialty mix are the two primary levers.
Ophthalmology Valuation Ranges by Practice Scale
| Practice Profile | EBITDA | EV/EBITDA Range |
|---|---|---|
| Small group (1–3 MDs, limited ASC) | <$3M | 5–9× |
| Mid-sized group (3–8 MDs, some ancillaries) | $3–7M | 8–12× |
| Large group/platform (multi-site, ASC, retina) | $7M+ | 12–20× |
Source: Market observations consistent with Scope Research Healthcare M&A Valuation Database (255 disclosed physician practice EBITDA transactions) and PitchBook Q3 2025 Healthcare Services Report; intended for educational purposes only. Actual pricing varies by transaction.
The RCA exit at 15×–23× anchors the upper bound of the platform tier, though Scope Research notes that this range “extends above the top of the historical range for office-based physician specialist platforms” and reflects unique strategic synergies with pharmaceutical distribution.3
Key Value Drivers
Buyer diligence in ophthalmology consistently centers on a defined set of clinical and operational characteristics:
| Factor | Effect | Why Buyers Pay More |
|---|---|---|
| Owned ASC (cataract, retina procedures) | ↑↑ | Facility-fee income, margin expansion, procedure control |
| Retina subspecialty | ↑↑ | High reimbursement, chronic disease volume, pharma distribution value |
| Multi-site, multi-physician depth | ↑ | Reduces key-person risk; improves payer negotiating leverage |
| Commercial payer mix | ↑ | Higher rates, fewer denials, predictable collections |
| Strong optical retail / premium lens / dry eye | ↑ | Cash-pay diversification; higher blended margin |
| Single-surgeon concentration | ↓ | Limits buyer pool; succession risk |
| Declining surgical volume | ↓ | Buyers underwrite growth; stagnation reduces bids |
PitchBook highlights that ASC-linked specialties, including ophthalmology, orthopedics, and GI, remain among the most active consolidation categories in healthcare services precisely because of their margin structures and procedure scalability.2
2026 Outlook: Exit Wave Incoming
Multiple structural forces are converging to drive heightened ophthalmology M&A activity in 2026.
Aging PE Inventory. PitchBook reports that over 70% of PE-held PPM assets are now held for more than seven years, creating significant pressure on sponsors to execute exits.2 Vision practices are disproportionately aged, setting up a wave of secondary transactions, recapitalizations, and strategic sales.
Global PE Capital Inflow. Bain’s 2025 Global Healthcare Private Equity Report estimates that global healthcare PE reached $115 billion in deal value in 2024, the second-highest total on record, with North America representing 65% of activity.5 Mid-market funds, the primary consolidators in ophthalmology, are outperforming by focusing on specialty-driven platform building, a model that ophthalmology continues to support.5
Reimbursement Stability. While Medicaid cuts and ACA subsidy reductions pressure primary care and multispecialty groups, ophthalmology’s procedural reimbursement environment has remained comparatively stable in 2024–2025, supporting continued buyer confidence.2
PPM Activity Poised to Rebound. PitchBook’s Q3 2025 report projects a “substantial upturn in activity in 2026” for PPMs as valuation gaps between buyers and sellers converge and regulatory assessments of state-level PE restrictions confirm no material long-term impact on deal activity.2
The convergence of aging inventory, renewed PE capital, and stable procedural demand makes ophthalmology one of the most compelling categories for practice owners evaluating a transaction in the next 12 to 24 months.
FOCUS Investment Banking provides sell-side M&A advisory for healthcare practice owners. To discuss your practice’s value and readiness for transaction, contact our team here.
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Sources:
1. VMG Health, 2025 Healthcare M&A Report, December 2024.
2. PitchBook Data, Inc., Q3 2025 Healthcare Services Report, Brian Wright et al., November 18, 2025.
3. Scope Research, Healthcare M&A Review 2024, December 2024.
4. PitchBook Data, Inc., 2026 Healthcare Outlook, Brian Wright, Aaron DeGagne, CFA, et al., December 2, 2025.
5. Bain & Company, Global Healthcare Private Equity Report 2025, 2025.
