By month six of a well-run optometry account, the Search campaigns have done their job. Isolation holds the exam searches you know, Exploration finds the long tail, and the account has months of real booked exams behind it. That history is what Performance Max needs, and it's why we wait for it.
Performance Max works differently from everything before it. There are no keywords to choose. You give it goals, assets and hints about who your patients are, and Google decides where to show the ads. The quality of those hints decides whether it finds new patients or wanders. For an eye care practice, one of the best hints is sitting in plain sight: the websites of the optical chains your future patients are browsing right now.
Performance Max Runs Everywhere Google Sells Ads
A single Performance Max campaign draws on every place Google sells ad space, from the search results page to YouTube, Gmail, Maps, Discover and Display sites. Google's own summary says it can be used to complement keyword-based Search campaigns and find more conversions.
That reach is the appeal and the risk. A Search campaign shows up when someone types a search you chose. Performance Max shows up wherever Google predicts a conversion, and it learns what a conversion looks like from your account's history. An account with clean booked-exam data (Chapter 1) teaches it to find people who book exams. An account counting page views teaches it to find people who browse. That's why Performance Max waits until months six or seven in our rollout.
Audience Signals Speed Up Learning. They Don't Pick Who Sees the Ad
Audience signals are the hints. Google describes them as a way to share who your customers are so the campaign learns faster, starting from high-intent audiences instead of from scratch.
What they aren't is a targeting boundary. Signals are optional, and Google is open that the campaign will reach past them whenever it predicts someone outside them is likely to book. So a signal doesn't need to be perfect. It needs to point the campaign in the right direction on day one, so the first weeks of spending teach it about likely patients rather than random browsers.
The Optical Chains' Websites Make Your Best Audience Signal
The strongest signal most practices can build is a custom segment. Google lets you describe the people you want with keywords, website addresses and apps, and it then looks for people with those interests or purchase intentions.
For an optometry practice, the website list writes itself. Enter the sites of the optical chains people in your area are comparing. In our example market, Chicago, every national chain we checked was advertising on Google Search, and their sites make a natural list: LensCrafters, Warby Parker, America's Best, MyEyeDr., Visionworks and Pearle Vision. Your market's list will overlap and add local names. Then add a second part, search terms, such as "eye exam near me," "optometrist near me" and "contact lens exam." Google's help center explains that search terms in a custom segment reach people who searched for those and similar terms on Google.
This isn't remarketing. You're not reaching anyone's website visitors. Google uses the list to understand what kind of person browses those sites and searches those terms, and finds more people like them. Think of it as telling Google, "My patients look like people shopping for an eye exam and a new pair of glasses."
Keep Medical Eye Care Pages Out of the Campaign
There's one limit specific to health care, and optometry sits partly inside it. Google's personalized advertising policy treats health as a sensitive category, and it's direct about what that means for custom segments. When the ads or landing pages are health-sensitive, a custom segment can only be used with Display campaigns, reaching people without sensitive interests or placed by context. Every other campaign type using that custom segment won't be eligible to serve at all.
Google's health category covers physical conditions and treatments, and it doesn't list eyes by name. Our reading: pages about a condition, such as glaucoma, dry eye disease or macular degeneration, likely fall inside it. Pages about a routine eye exam, a contact lens exam or eyewear likely don't. Build the Performance Max campaign around the routine pages, where your chain-based segment can actually run. Keep medical eye care in Search, where keyword targeting isn't affected by this rule. Chapter 16 covers advertising medical eye care in full.
Your Patient List Stays in Your Office
Many Performance Max guides tell you to upload a customer list as a signal. For an optometry practice, don't.
Google's health policy excludes Customer Match and your own data segments for health-sensitive advertising. And under HIPAA, a practice that bills insurance electronically is a covered entity, which makes its patient list protected health information. Sending patient names or emails to an ad platform needs a HIPAA-permitted basis, and a marketing signal isn't one. (This isn't legal advice; have counsel review before any patient data leaves the office.)
In practice, first-party audiences in eye care start at close to zero. That's fine. The chain-site segment and search terms carry the load, and your booked-exam conversions teach the campaign the rest.
Performance Max Chases Whatever Goal You Give It. Give It Booked Exams.
Performance Max optimizes toward the conversion goals you give it. Give it the booked exam, with the same primary conversions from Chapter 1: confirmed online bookings, request forms and qualifying calls. Don't add eyewear or contact lens purchases as goals in this campaign, or it will drift toward the cheapest thing to sell.
Launch with Maximize Conversions and no target cost per booking. Let the campaign spend its first weeks learning, and add a target once it has a stable cost per booking of its own.
If your practice runs an online frame or contact lens store, keep the campaign away from it. Final URL expansion (Chapter 9) lets Google pick landing pages, and a shop page will attract shoppers. Exclude the store's URLs, and any lens-reorder pages, from the campaign.
Each Kind of Eye Exam Deserves Its Own Asset Group
Inside a Performance Max campaign, asset groups hold the images, videos, text and landing page for one theme. Build them the way Chapter 4 built ad groups: by what the patient came for. A routine eye exam group points at the exam page, with photos of the exam room and doctors and headlines about time with the doctor. A contact lens exam group points at the contact lens page. If children's exams matter to you, give them a group of their own, with photos that show a child in the chair and headlines written for parents.
Each group can carry its own signal. The chain-site segment suits the routine exam group well. For the contact lens group, add search terms about contact lens exams and fittings. Keep every group on routine pages, for the health-policy reason above.
After the first four to six weeks, read what the campaign found. Performance Max reports insights on which searches and audiences drove conversions. Compare them against your Search campaigns: a search theme that books exams cheaply in Performance Max may deserve an exact-match keyword in Isolation, and one that only drives clicks deserves a negative.
A Budget-Limited Search Campaign Hands Its Best Searches to Performance Max
Performance Max can compete with your own Search campaigns, and Google sets the rules for who wins. If someone's search lines up with an exact keyword in one of your Search campaigns, Google hands it to that campaign first. The search themes inside Performance Max sit a rung lower, level with phrase and broad keywords.
There's a catch that ties back to Chapter 7. Google notes that when a Search campaign is limited by budget, Performance Max may occasionally serve on its exact-match terms. A January budget that runs dry by noon hands your best searches to a campaign you have less control over. Before anything else, make sure Isolation's budget holds.
Two more controls keep the lines clean:
- Brand exclusions: exclude your practice name and doctors' names, so your brand campaign keeps them.
- Search themes: add a few exam-focused themes, and drop any Google flags or declines.
Stock Photos Waste the One Asset Chains Can't Copy: Your Doctors
Performance Max needs images, videos, headlines and descriptions to build ads for every surface. If you don't supply them, Google's tools will generate images and videos from what it has. For a practice whose best asset is its doctors, that's a missed chance.
Supply your own:
- Photos: the doctors, the team, the exam room, the optical shop, the front of the building. No stock photos of models in glasses; patients can tell.
- Video: even a 30-second phone video of a doctor explaining what happens at an exam beats an auto-generated slideshow.
- Text: the headlines and descriptions that won in Search (Chapter 8), including the patient phrases and the doctor lines, written within your state's rules.
Next: Parents Before the School Year
Performance Max reaches people who are already close to booking. The next campaign type reaches people before they search: parents who haven't booked a child's eye exam. Chapter 11 covers Demand Gen, and why back-to-school season is the time to use it.
Every chapter is listed on the guide's home page.
For eye care practices under our Google Ads management, Performance Max waits until the Search data earns it, and the first signal is always built from the chains' websites. Setting it up yourself? Write your list of competitor sites before you open the campaign builder.
