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Dr. Volker Wendel founded Sanoptis in 2018 in Switzerland with Carsten Horn. Six years later, the group has grown to more than 400 locations across six European countries. The group was initially backed by PE firm Telemos Capital, who then sold it to Belgian holding company Group Bruxelles Lambert (in 2022). Wendel explains to us how the group is able to add value to ophthalmologists who join the network and shares which areas the group will be focusing on in the coming years.

“When we acquire a stake in a surgical centre, we ensure that the chief physicians retain a significant ownership share,” Wendel says. “We partner with local ophthalmologists who continue to run their clinics both medically and entrepreneurially, meaning we do not interfere in daily operations. Of course, the doctors need commercial support. If there is a capable commercial director in place, we collaborate with them. If not, we appoint someone suitable for the role, after consulting the doctors. This approach allows us to manage the centres as part of a larger network while maintaining strong local leadership, as we’re convinced that operations need to be run locally.” 

Dr. Volker Wendel, Founder & CEO, Sanoptis

HBI recently reported on the rise of entrepreneurship amongst ophthalmologists, as evidenced by a first-of-its-kind conference for ophthalmologists interested in running their clinics as businesses held in Italy in March this year, called ‘Ophthalpreneurs’.

“One of the founders of Ophthalpreneurs is actually now part of our network. Basically what we’re after when we’re looking for partners are people who are not only excellent ophthalmologists, but ideally entrepreneurs, i.e. people who want to develop their centre with us, open new facilities, expand operation theatres etc. It’s a very interesting thing that you find in ophthalmology more than other medical specialities,” Wendel says.

“When we do acquisitions we do it clinic-by-clinic, centre-by-centre. That way we can choose our partners, and have direct contact with doctors. We acquire surgical centres/hubs, which might already have some satellite practices around the region, so it’s not typically a single practice we’re negotiating with, it’s more ophthalpreneurs that have already developed an entity of a certain size. Once we have acquired such a hub, we then acquire consultation practices, but it’s the hub that acquires the practices, or opens greenfield locations. We’re not interested in buying single practices or clinics all over the country because it doesn’t make much sense from a managerial and service provider perspective.” 

The synergies which ophthalmologists can benefit from when they join the network come more from top line growth than from cost reductions. 

“I would say the synergies are 80% top line and only 20% cost reduction. As an example, an ophthalmologist in our network may decide they want to offer additional services, e.g. premium lenses. These are a big thing for cataract patients, who can upgrade to premium lenses and get rid of their glasses, in combination with medically induced surgery. Then there’s the issue of how to educate and inform patients, and how to sell the lenses, which in most countries will require some kind of co-payment from the patient. We can support the clinic to organise the local processes for this. 

“The same is true for new technologies like laser-assisted cataract surgery. If a surgeon is interested, we are able to acquire the necessary equipment for a competitive price, we can then teach the surgeon how to do the surgery. By being part of our network, the doctor will have benefitted from a much faster and steeper ramp-up. We can also help them open new surgical theatres, which is always a painful process for them the first time they do it. We know how patient flows work.

“These things lead to higher revenue rather than lower costs. If you organise the practice in the right way, and have the right patient flow, you can treat many patients without any loss of quality. You can even increase quality, due to the ophthalmologists being highly experienced as they see the same health problem over and over. You can recognise what the problem is more easily. This is why we can deliver added value to our members.”

In the six years since it was founded, Sanoptis has managed to become the largest player in its two core markets, Germany and Switzerland. The group is now rapidly expanding in four new countries.

“In the last two years we’ve entered Austria, Greece, Italy, and now Spain,” Wendel says. “In all these markets we’re focused on the private pay sector. This is a big difference to Germany and Switzerland, where we’re working with statutory insurers, although on the operational side it’s not that different. In Germany and Switzerland, we’re offering a lot of premium services, especially for cataract patients. But there’s not a huge gap with what statutory insured patients get and what you can get by paying extra. In Switzerland you can almost say every patient is private, because the statutory cover is so good. That’s why we decided to go to southern countries: as well as having private markets, there is a higher willingness for patients to pay out of pocket compared to other countries, because there’s a big gap with what you can get compared to if you stay in the public system. We see increasing opportunities in these countries.”

Wendel says that Sanoptis plans to continue adding 50+ clinics to the network each year, and these will be in the six countries it already operates in. 

“Our goal is to have a meaningful market position in each of the countries we are presently in. We will be mostly focused on the four new countries. If you look at Austria and Greece, we are probably already the number one player because these are relatively small markets with no groups around. On the other hand, Italy and Spain are much bigger, and in Spain, there are already some big consolidators. Additionally, we still have growth potential in our core countries, Germany and Switzerland, so our strategy will be a balanced mix of consolidating our positions in existing markets while pushing for growth in new ones.”

When asked why the group isn’t present in the UK, he says: “In the UK it’s a totally different game. In recent years it’s become about doing more standard surgeries that were previously done by the NHS and are now being outsourced to the private sector, in particular cataracts. I think it will be interesting to see what happens once this wave of people on the waiting list has been reduced. Some of the big UK players are quite established, and they’ve built up a lot of capacity with additional facilities in the last few years. It will be intriguing to see whether there will be a need for that capacity long term. Then you have some smaller groups which are focused on the private pay sector. They have a different approach, offering more high-quality services like premium lenses.

“So in the UK, the cake has already been shared, and that’s why we’re not very likely to enter the country. But never say never.”

In terms of new innovations in the sector, Wendel is excited about the prospects for new drugs in development for dry age-related macular degeneration (AMD): “Dry AMD treatment is a big up-and-coming topic. To date we’ve just been able to treat wet AMD. But dry AMD is the more common form. Now there are new drugs coming to market. Apellis (a biopharma company) received FDA approval for its new drug last year, and now European approval is pending. In Switzerland, it’s already possible to receive treatment with this new drug because they generally accept FDA approval. Since this is a very common disease we see a lot of potential patients. It’s a chronic disease so you can’t cure the patient, but you can slow down the rate at which it progresses. Regardless, we see a lot of potential there, and have already started treating some patients in Switzerland.

“Usage of AI in diagnostics is another exciting area, especially for macular degeneration, to detect as early as possible. Still, of course, the final decision is up to the doctors, but these algorithms are already very accurate. AI-based software solutions can detect better than the average doctor, and we’re only at the beginning. Many of the diagnostic devices we use are imaging devices that can be highly supported by AI. It will increase the quality and efficiency of care. That could be a very important lever in the future.”

Given all this, Wendel believes there is huge untapped potential for improving people’s lives with ophthalmology. 

“The beauty of ophthalmology is that the demand is there because of the ageing population and the technical means are there. In many other areas, for example oncology, the demand is there but treatments are still quite limited. Some types of cancer still can’t be treated effectively. In ophthalmology the value for money is incredible: for a premium cataract you pay nearly the same as for a dental implant. To be able to see again clearly is life changing. Nothing against dental implants, but does it really change your life? In ophthalmology you can really offer excellent services to many patients. Many ophthalmologists would like to improve what they offer their patients but simply don’t have the means, time, or finances to do so.”