AI in Eye Care
July 2026
Stand in Piazza San Marco early enough in the morning, before the crowds arrive, and the Basilica does something to your sense of time. The mosaics above the doors were laid by artisans who knew they would never see the building finished. The current structure was consecrated in 1094, and generations kept adding to it anyway — a dome here, a golden ceiling there — each contributing to a vision no single lifetime could contain.
A few days later I was in Milan, standing in front of the Duomo. Construction began in 1386. The Madonnina went up on the highest spire in 1774. The façade was finished in 1813. The last bronze door wasn't installed until 1965. Five hundred and seventy-nine years, start to finish. The men who quarried the first Candoglia marble were working on a building their great-great-great-grandchildren would not live to see completed.
I was in Italy for EssilorLuxottica Days, and moving between those old stones and the company's showcase of what comes next, I kept returning to the same thought: past is prologue. History doesn't just sit behind the future — it sets the stage for it, and a vision takes time to see materialize. Because what I saw over those days was a company making large (cathedral-scale!) bets — and the question I kept turning over is what that means for the rest of us in eye care as AI reshapes the industry.
Big swings
EssilorLuxottica is not making one bet. It's making at least three, simultaneously, and each would be a bet-the-company move for almost anyone else.
Smart glasses first. The Ray-Ban Meta line has sold millions of units, the Oakley collaboration has extended the franchise into performance wear, and Meta was reported last year to have taken a stake of roughly 3% in the company — a multibillion-dollar endorsement of the idea that the face is the next computing platform, and that whoever owns the frame owns the real estate.
Then medical. In a few short years the company has assembled Heidelberg Engineering, one of the most respected names in retinal imaging; Espansione Group in ophthalmic devices; Cellview in retinal imaging; Optegra's ophthalmology clinics, recent surgical expansion of some LensCrafters; and Nuance Audio, which put a hearing solution inside an ordinary-looking pair of glasses. This is not a lens company dabbling in health. This is a deliberate build-out of a medical technology pillar.
And third — the one closest to my heart — oculomics and data. Connect the dots between the acquisitions and the picture resolves: imaging hardware, clinical settings, retail touchpoints in the tens of thousands, and sensor-laden eyewear. That is a data acquisition network of a scale no startup, and frankly no health system, can easily replicate.
The iconic eyewear, med-tech, and wearables all working synergistically together into a beautifully crafted, intelligent, data-gathering device that people love to wear and use.
The hinge maker
Swings like this take a particular kind of vision, and this company has it in its founding DNA. Leonardo Del Vecchio, orphaned young and trained as a metalworker, started Luxottica in the mountain town of Agordo in 1961 making component parts for other people's eyeglasses — hinges, temples, the small unglamorous pieces of the trade. By 1967 he was selling complete frames. In 1974 he bought his distributor. Then came retail, then the brands — LensCrafters, Ray-Ban, Oakley — and finally, in 2018, the merger with Essilor that unified lens and frame under one roof.
We talked about this on the Real Talk episode with Carl Spear, who shared his many stories with the late Mr. Del Vecchio on our to facilities in Agordo (LINK TO CARL SPEAR PODCAST): Del Vecchio never stopped moving up the value chain. He just kept climbing, decade after decade, from hinges to a vertically integrated empire. Analysts will tell you vertical integration is EssilorLuxottica's ultimate competitive advantage, and they're right. But integration at that scale wasn't a strategy sprint. It was sixty years of compounding, and Del Vecchio didn't live to see all of what he set in motion. Neither did the architects of the Duomo. That's rather the point.
Beyond one company
Here is the bigger thesis, and it extends well past Milan. In the AI era, incumbents with scale, proprietary data,
and vertical integration hold structural advantages that are easy to underestimate. Models are becoming commodities; the moats are shifting to what feeds them and where they deploy. An incumbent that owns the imaging device, the clinical (and now surgical) workflow, the retail channel, and the patient relationship controls both the data that trains the algorithms and the distribution that delivers them.
Whether incumbents can move nimbly enough is a separate question, and an honest one. Cathedral builders had centuries; AI cycles are measured in quarters, and the market has already shown flashes of impatience and discomfort with the smart-glasses story (Link to the NY Smart Glasses story). Big organizations can mistake motion for progress, and integration can calcify into bureaucracy and stagnation where it would have better to just leave things alone.
It is also exceptionally difficult to scale service, especially in something as intimate as eye surgery. Oculomics has no obvious business model that has yet been proven. And there will be missteps in rolling services out from a political, organizational, and social lens. The question is if organizations have the patience and financial capacity to learn from those mistakes, adjust, and move forward.
But standing under the Duomo's fifty-two columns, I found myself thinking that we chronically overestimate what can be built in a year and underestimate what can be built in a decade. The builders of 1386 had no idea how the spires would be engineered. They started anyway, and they built an institution designed to outlast any individual — which is, in the end, what a durable vision requires.
Big swings take time to materialize. The people and companies willing to take them — and patient enough to see them through — are the ones that end up defining what the rest of us walk past in awe.