For-profit or not-for-profit structures differ in many ways—including, obviously, their mission. Learning how to manage the logistics of starting a not-for-profit company may be difficult. Here, the recently minted attending physician David Xu, MD, shares his experience cofounding, a resource designed to help medical students and ophthalmology residents navigate the steep learning curve of ophthalmology. The fact that Dr. Xu founded and improved upon this resource while he and his cofounders were still trainees makes it all the more impressive.

—Scott Krzywonos, Editor-in-Chief

Retina Today Business Matters: How did you come to found

David Xu, MD: In 2016, I cofounded with Benjamin Lin, MD, and Shawn Lin, MD, MBA. Ben was a medical student at UCLA at the time, and Shawn and I were second-year ophthalmology residents at UCLA. We all came up with a similar idea around the same time, and after some collaboration we founded EyeGuru.

RTBM: What is EyeGuru?

Dr. Xu: The chief mission of EyeGuru is to facilitate efficient learning for ophthalmology residents. We do that with learning tools such as spaced repetition learning, flashcards, and video tutorials. EyeGuru tries to fill in the blanks left by other ophthalmology resources. We don’t limit ourselves to any one subspecialty. We’re for all of ophthalmology.

RTBM: What need did you see in the field to start the company?

Dr. Xu: My cofounders and I noticed that ophthalmology has one of the steepest learning curves of any field of medicine, and we wanted to assist future ophthalmologists in their training. We knew firsthand the volume and variety of obligations that ophthalmologists-in-training juggle, and we thought we’d try to help. We were residents, not content experts, when we founded the site, but we knew best what a resident needed to know at every stage. This has given us an edge in creating useful and relevant content.

RTBM: Not-for-profits enter a marketplace in the same way a for-profit entity does. What was that experience like?

Dr. Xu: We knew we wanted to create a resource for trainees. This wasn’t a vanity project. It was a mission-driven organization. We carefully analyzed the other players in the space, thought about what unique offering we brought to the table, and built our website around our novelty. Focusing on the core of our product offerings allowed us to build a strong foundation.

RTBM: You mentioned that you and your cofounders all had the same approximate idea at the same time. What did EyeGuru look like in its earliest formation?

Dr. Xu: The original iterations of what eventually became EyeGuru were “virtual clinics.” During those early phases, we realized that pattern recognition was so important to learning and practicing ophthalmology. We realized that having a library of images, rather than a single image, was important for learning diseases. Finally, we realized that creating frameworks of understanding were incredibly important for a new learner.

My colleagues and I loved flashcard-based learning because it allowed us to digest and repeat knowledge at our own pace rather than a textbook’s pace. We knew that we wanted to make a resource that helped users learn in a similar way. Doing so meant that we could learn anywhere—at home, on our cell phones, at a workstation at the hospital. EyeGuru was specifically optimized for mobile devices so our users could access it from their phones. We wanted to make sure that no matter where you were, you were getting the same content.

RTBM: Describe how the organization has grown since its founding in 2016.

Dr. Xu: We’ve grown substantially. When we first started, hardly anyone knew about us. Now, our estimates indicate that between 50% and 75% of incoming ophthalmology residents in the United States use EyeGuru. We have more than 1,000 page views per week.

RTBM: How do you add content to the site?

Dr. Xu: We’ve added a lot. EyeGuru has five arenas that users can access: essential residency articles, imaging practice modules, flashcards, video tutorials, and a blog on periodical content. We’ve collaborated with faculty mentors at UCLA, where my cofounders and I conceived of this idea. We’ve also collaborated with the Retina Vitreous Group in Los Angeles and have expanded our international collaborations with Aravind Eye Hospital in India.

RTBM: Creating a company that runs for profit is one thing. Creating a not-for-profit entity is another. At what point did you and your cofounders decide to take a not-for-profit route?

Dr. Xu: We knew we wanted to be a not-for-profit resource from the moment we started. We make that as clear as possible on the website—we say that it’s 100% free on the homepage’s banner. To stay true to that spirit, we collaborate with trainees for content creation. They help us identify knowledge gaps, and they allow EyeGuru to provide comprehensive and efficient learning.

RTBM: Even not-for-profit businesses have operating costs. Is EyeGuru generating income?

Dr. Xu: We are committed to the not-for-profit model, so our collaborations with industry exist only insofar as they enhance the educational experience for our users. Some industry members such as Alcon have been open to providing educational grants. Others, such as Volk, have provided sample lenses so that our team can review them.

The chance to review lenses illustrates what makes EyeGuru unique. We know that ophthalmic lens selection stresses some residents, and there is little guidance on how to select the lens that’s right for you. Our article reviewing lenses is one of our most highly read pieces. I’ve had many users comment to me about that article in particular. When a resident tells you, “Thank for helping me figure out which lenses to buy when I started residency,” you know that you’re doing a good job.

RTBM: What elements of EyeGuru became more important than you anticipated?

Dr. Xu: Search engine optimization was a key element to our success, as was improved user navigation. Those technical aspects play a crucial role in keeping a website functioning.

Beyond the technical side, reaching out to new residents is important. We’ve improved our process for doing so in the past few years. Our biggest push for new users aligns with the academic calendar—when the summer rolls around, it’s our time to inform new residents of this resource.

We don’t have a large budget—or any budget, really—for marketing. We rely on word-of-mouth. Over time, this has built a community-style resource with an intimate sense of learning. Encouraging dialogue on the site has helped, too. Access to certain elements of EyeGuru require signing up for a free membership. We ask that list of members to refer other trainees who may find the resource useful.

RTBM: Sometimes you nail it the first time. Which early successes of EyeGuru have had staying power?

Dr. Xu: We’re very proud of our “essentials” series of articles (Figure). We focused on what ophthalmology residents need to learn in day 1, in week 1, in month 1, etc. Rather than provide basic knowledge, these articles provide a framework of understanding your new role as ophthalmology resident. The traffic numbers for that series shows us that residents continue to find it useful.

RTBM: What is next for EyeGuru?

Dr. Xu: My cofounders and I are transitioning away from content creation and more toward an oversight role. Now that we are no longer trainees, we connect our contributors to collaborators and mentors. It’s been a really rewarding role. We hope to continue to grow the site.

Remember, when we started, we had just a dozen or so articles. Now, we have a full-fledged community of trainees who seek to better each other’s residency experience.


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