What EBITDA multiple does an ophthalmology practice sell for?

Ophthalmology has no public index of transaction multiples, so the figures come from the M&A advisers who track the deals, and the two 2026 sources we could open agree on the headline split. CT Acquisitions' 2026 ophthalmology roll-up tracker and Physician Buyout Plan's ophthalmology sale guide both put add-on acquisitions at roughly 6x to 10x EBITDA and platform transactions at 10x to 15x, each attributing the framework to FOCUS Investment Banking. FOCUS's own pages returned a bot-challenge and could not be opened this run, so every figure here is quoted from a page that did load. The split is the one that drives every physician-services roll-up: an add-on brings its earnings into a platform that already has management, governance and payer contracts, while a platform buyer pays up for that infrastructure and the base to acquire from.

CT Acquisitions publishes a size ladder, again citing FOCUS. A single-site practice with under $1M of adjusted EBITDA clears 5x to 6.5x; $1M to $3M of EBITDA (mid-sized, emerging systems) 7x to 9x; $3M to $5M with multi-site operations and ASC ownership 9x to 11x; and $5M-plus platforms with established management depth 10x to 15x and up. The same source puts the premium for owning an ambulatory surgery center inside the MSO at one to three turns of EBITDA, and attributes it to 2026 cataract economics: the CY2026 Medicare fee schedule moved value from the surgeon's professional fee toward the facility, so a group that owns the ASC where its cataracts are performed keeps more of the margin a buyer underwrites. For a comprehensive practice that bills cataracts but does not own the surgery center, the same change is margin compression on its dominant revenue line.

Retina is the premium sub-specialty. The anchor deal is Cencora's acquisition of Retina Consultants of America, announced in November 2024: per Cencora's own announcement, it agreed to acquire RCA for approximately $4.6 billion in cash, holding about 85% ownership, with up to $500 million of contingent consideration in fiscal 2027 and 2028. FOCUS estimated the implied multiple near 18x, and CT Acquisitions quotes 18.4x while flagging it honestly as the FOCUS estimate, not a buyer-disclosed metric, with medium confidence on the precise number and high confidence on the directional retina premium. Comprehensive ophthalmology platforms, by the same reading, trade closer to 10x to 12x. Treat the 18x as the ceiling for a scaled retina platform, not a number a comprehensive practice should anchor on.

Worked example on the ladder: a two-location comprehensive group with $1.5M of adjusted EBITDA sits in the $1M to $3M tier at 7x to 9x, so $10.5M to $13.5M. Add ASC ownership and the one-to-three-turn premium takes the same earnings to roughly 8x to 12x, or $12M to $18M, which is why the surgery center is often the value driver rather than the clinic. Work out your adjusted EBITDA first, because the earnings figure you negotiate from moves the outcome more than the multiple does, and a buyer will rerun your 2026 numbers at the new fee schedule rather than trust last year's tax return. If a sale is one to three years out, the work is a finance project: normalized EBITDA, ASC economics a buyer believes, and a management layer that lets the practice run without you, which is what fractional CFO support is for.