Ophthalmology EBITDA Multiples (2026 Update)
Ophthalmology has remained one of the most consistently sought-after physician specialties in healthcare M&A. Even as overall dealmaking slowed through 2023–2024, the sector benefited from high-acuity demand, stable reimbursement, and expanding surgical volumes, particularly in retina and ASC-based procedures.
In 2026, investor interest remains strong, but pricing has become more sensitive. The result is a valuation landscape that, relative to prior years, rewards operational maturity and penalizes smaller practices lacking infrastructure or clarity around growth.
What you’ll learn in this article:
Where ophthalmology EBITDA multiples stand in 2026, and how platform vs. add-on transactions are being priced in the current market.
Why certain practices command premium valuations, including the roles of retina exposure and ASC ownership.
How scale influences multiples, with clear benchmarks for small, mid-sized, and platform-level groups.
Which operational and financial factors most strongly affect valuation outcomes, based on buyer diligence patterns.
How 2025–2026 market conditions shape buyer appetite and pricing, including PE hold times, reimbursement stability, and demand for high-acuity providers.
Current EBITDA Multiples in Ophthalmology
Ophthalmology practice valuations split sharply between platform and add-on transactions. Platform deals (which today are often private equity-backed) can command strong double-digit multiples, especially for groups with multispecialty coverage, retina service lines, and owned ASCs. Add-on deals trade at lower but stable multiples, with valuations driven by factors like scale and physician mix.
| Transaction Type | EBITDA Multiple | Typical Profile |
|---|---|---|
| Platform Transactions (Initial Platform Investments, PE Exits, Large Combinations) |
12–20× | Large groups with established infrastructure, management depth, and significant ancillary revenue. PE-backed groups that are well integrated with physicians depth and alignment can command premium multiples, especially with strategic fit (e.g., retina). |
| Add-On Transactions (Bolt-On Acquisitions) |
5–11× | Smaller practices acquired by existing ophthalmology platforms to expand geographic coverage or clinical capabilities. Some very large add-on transactions can trade above 11× EBITDA. |
Source: works cited combined with guidance from internal bankers, based generally on knowledge and experience. Actual pricing varies with each transaction based on many factors. Intended for educational purposes only and not a guarantee of any outcome.
Key drivers of range include: Size and stability of EBITDA, depth of provider and ownership bench (including age of sellers), ASC ownership and contribution margin, retina exposure and subspecialty mix, market density and referral patterns, and payor mix and procedure weighting.
These ranges align with the trend that premium physician-service platforms with surgical leverage frequently outperform multispecialty groups on a relative basis. PitchBook’s Q3 2025 Healthcare Services Report further notes that multispecialty deals and ASC-linked services remain among the most active areas of consolidation, reinforcing the valuation strength of high-acuity ophthalmic models.
Why Ophthalmology Commands Premium Valuations
While not every practice sells at the high end of the range, several structural drivers support above-average outcomes compared to other specialties:
1. High-Acuity, Procedure-Driven Revenue
Ophthalmology blends clinical visits with consistent surgical volume. Cataract, retina, and glaucoma procedures create recurring, defensible demand and predictable utilization, factors that investors continue to prioritize. Although cataract surgery itself is non-recurring, supply/demand levels in many markets create a recurring revenue-like model. PitchBook highlights that procedural specialties with essential-care dynamics have benefited from favorable utilization in 2025, supporting valuation stability across provider groups even as payers experience margin pressure.
2. Growing Retina Subspecialty Supply Constraints
Retina services are capacity-constrained in most U.S. markets. Specialized training requirements and demographic-driven disease incidence (e.g., diabetes, AMD) position retina practices at the premium end of the ophthalmology valuation spectrum. These groups combine high reimbursement reliability with long-term demand and significant barriers to entry.
3. ASC Ownership as a Multiplicative Value Driver
Ownership in a single specialty, affiliated ambulatory surgery center is often the most influential valuation lever. ASCs create margin expansion, diversification, facility-fee income, and a clear path for post-close optimization. Across healthcare services transactions in 2026 benchmarks show that surgical infrastructure, including ASCs and imaging, drives valuation lift and expands buyer pools.
4. Predictable Patient Volumes and Demographic Tailwinds
An aging U.S. population continues to increase demand for ophthalmic care. Investors consistently view ophthalmology as “recession-resistant,” with stable procedure volumes even during economic slowdowns.
5. Potential Platform Formation Activity
Though already well-populated by private equity, ophthalmology has fewer mature consolidators than dental or dermatology, leaving room for new platform creation. Mid-market private equity firms remain active, consistent with broader PE focus on specialty-focused platform building.
How Scale Influences EBITDA Multiples
While ophthalmology valuations are strong at both platform and add-on levels, scale remains the most consistent determinant of price. Larger practices with stable physician rosters, multiple locations, and diversified ancillaries usually achieve meaningfully higher multiples.
Scale Tiers and Expected Ranges
| Practice Profile | EBITDA | Expected Range |
|---|---|---|
| Small Group (1–3 MDs) | <$3M | 5–9× |
| Mid-Sized Group (3–8 MDs) | $3–7M | 9–12× |
| Large Group / Platform | $7M+ | 12–20× |
Source: works cited combined with guidance from internal bankers, based generally on knowledge and experience. Actual pricing varies with each transaction based on many factors. Intended for educational purposes only and not a guarantee of any outcome.
Scale enhances multiples by: Reducing infrastructure build-out for buyers, supporting payer negotiation leverage, stabilizing referral patterns across subspecialties, improving OR scheduling and throughput in ASCs, and demonstrating leadership depth and governance maturity.
PitchBook’s Q3 2025 analysis reinforces that mid-market platforms represent the strongest pricing leverage across healthcare services, aligning with ophthalmology’s scale advantages.
Subspecialty Mix and Premium Segments
Subspecialty mix plays a central role in ophthalmology valuation, with certain clinical areas consistently commanding premium pricing:
| Subspecialty | Valuation Impact | Key Drivers |
|---|---|---|
| Retina | Premium (top of range) | High-acuity procedures, injection volume, chronic disease management, national capacity constraints |
| Cataract-Dominant | Mid-to-upper range | Predictable surgical volume, ASC synergies, strong throughput. Utilization of premium technologies can greatly enhance margins. |
| Comprehensive | Mid range | Diversified services, limited subspecialty, ASC ownership |
| Optometry Integration | Supporting factor | Patient flow, surgical funnel stability, case volume visibility |
Impact of ASC Ownership on Multiples
ASC ownership remains the strongest valuation lever in ophthalmology. A group with a well-utilized ASC, especially one performing a high volume of cataract procedures, typically achieves:
Higher EBITDA margins
Stronger recurring revenue
Predictable OR block utilization
Clear levers for post-close operational improvement
Across healthcare, PitchBook notes that ASC-linked specialties (ophthalmology, orthopedics, GI) remain among the most active segments for consolidation due to their margin structures and procedure scalability.
ASC ownership often places practices at or above the midpoint of the platform multiple range. While specific uplift varies by practice, ASCs are widely associated with materially stronger valuation outcomes.
Market Conditions Influencing 2025–2026 Multiples
Beyond practice-level fundamentals, several macro trends are shaping ophthalmology valuations heading into 2026:
1. Selective but Stabilized Private Equity Appetite
PitchBook’s Q2 and Q3 2025 updates show that healthcare services PE activity has stabilized and is expected to rebound through 2026 as valuation gaps narrow and regulatory uncertainty decreases. This selective environment places a premium on practices with clean financials, visible physician stability, clear growth levers, and demonstrated compliance rigor.
2. Aging Inventory of Held Assets
PitchBook reports that vision is among the specialties with the highest percentage of PE-held assets aging past the five-year mark, suggesting a wave of exits may surface in 2026. This increases both buyer and seller activity, potentially tightening valuations.
3. Reimbursement Stability
While Medicaid cuts and commercial payor pressures affect primary care and multispecialty groups, ophthalmology’s procedural reimbursement environment has remained comparatively resilient in 2024–2025.
4. Demand for High-Acuity Specialists
Investor focus has shifted toward specialties with predictable utilization and procedural leverage, including ophthalmology, orthopedics, and oncology. This matches Bain’s findings that mid-market funds are concentrating on specialty-driven strategies.
What Strengthens Valuation Outcomes
Several operational and financial fundamentals consistently influence where an ophthalmology practice lands within the valuation range. The factors below represent the areas buyers scrutinize most closely during diligence.
| Valuation Driver | What Buyers Look For |
|---|---|
| Documented, Defensible EBITDA | Clean, normalized financials, well-supported add-backs, transparent and consistent physician compensation methodologies. |
| Multisite Density & Regional Strength | Market coverage that enhances referral flows, improves recruiting, and increases negotiating leverage with payors. |
| Physician Alignment & Retention | Long-term alignment structures, stable tenure, clear governance frameworks that reduce retention and succession risk, successful recruiting history. |
| Operational Maturity | Strong revenue cycle functions, reliable ASC throughput metrics, accurate coding, consistent monthly reporting. |
| Technology & Data Infrastructure | Modern EHR systems, analytics capabilities, and workflow tools that minimize integration friction and support scalable operations. |
2025–2026 Outlook for Ophthalmology M&A
Indicators suggest that ophthalmology valuations will remain strong through 2026, driven by stable reimbursement, increasing cataract and retina demand, likely return of PE activity after regulatory pause, upcoming exit wave of PE-held vision assets, demographic tailwinds, and strong buyer interest in ASC-heavy models.
PitchBook’s 2026 Healthcare Outlook projects continued strength in healthcare services acquisitions as utilization rises and PE hold times normalize in 2026. For sellers, this environment rewards preparation, building financial clarity, strengthening ASC operations, retaining physicians, and articulating a credible multi-year growth plan.
Requesting a Copy of This Report
FOCUS Investment Banking specializes in maximizing transaction value for healthcare practice owners through our proven quarterback approach to M&A advisory. Our team has completed more than 20 transactions for ophthalmology practices and ASCs since 2019.
If you’d like to learn more about our healthcare investment banking services, you can reach out to Eric Yetter ([email protected]) or Andy Snyder ([email protected]).
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