Does this look the same in every market?

No. Across the 6 markets measured, the share of businesses no AI engine named ranged from 74.4% to 89.5%. Google rank counts for more in some markets than others. Every market's own numbers are published on its own page rather than folded into the average.

The Local AI Visibility Index

Ophthalmology (Refractive / Cosmetic) across 6 US markets

We measured every Ophthalmology (Refractive / Cosmetic) practice Google Maps returns in 6 markets — 288 businesses in total — then asked 5 AI answer engines the same 10 patient questions in each one and recorded who got named.

Practices: 288
Markets: 6
Questions: 10 per market
Engines: 5
Measured: July 2026

75%

of the best-reviewed Ophthalmology (Refractive / Cosmetic) practices across 6 markets were named by no AI answer engine at all.

Finding 01

How often do the best-ranked local businesses show up in AI answers?

The businesses ranked highest on Google Maps still show up in only 11.8% of AI answers. Measured across 288 eye doctors in 6 markets: across the best-ranked 10% by map position, an AI engine named them in 11.8% of the answers about their own category.

Ranking well clearly helps. It is also clearly not the thing that decides it — most of the best-ranked businesses across these 6 markets still never came up. And this is an average of markets that do not agree with each other: rank counted for more in the smaller markets we measured than in the larger ones.

Google Maps rank vs getting named — all 6 markets combined
Where they rank on Google Maps	Named by AI	Share
The 1st third — best ranked on Maps	38 of 96	39.6%
The middle third	6 of 96	6.2%
The bottom third	4 of 96	4.2%

Finding 02

How much of the AI answers do a handful of businesses take?

In the average local market, three businesses take 67.3% of everything AI answer engines say. Measured across 288 eye doctors in 6 markets: the three most-named businesses in each market got 67.3% of all the mentions, and everyone else split what was left.

Finding 03

Are the best-reviewed local businesses named by AI answer engines?

75.0% of the best-reviewed local businesses are never named by an AI answer engine. Measured across 288 eye doctors in 6 markets: among the top half by Google rank, star rating and review count combined, 75.0% show up in Google Maps but were named in none of the AI answers about their own category.

Finding 04

Do Google reviews decide whether AI names a business?

Google reviews do not decide whether AI answer engines name a business. Measured across 288 eye doctors in 6 markets: neither the number of reviews nor the star rating tracked with getting named — both came out close enough to zero to mean nothing (review count -0.006, star rating +0.000, on a scale where 1.0 would be a perfect match).

Finding 05

Do different AI answer engines recommend the same businesses?

No two AI answer engines recommend the same local businesses. Measured across 288 eye doctors in 6 markets: asked the same questions, any two engines agreed on somewhere between 25.6% and 65.0% of the businesses they named — so being named by one is no guarantee of being named by the others.

Across every market combined, each engine named a different share of the businesses measured: Perplexity named 86, Gemini named 79, Google AI Overview named 61, ChatGPT named 27, Claude named 27.

Of the 102 practices named by any of the three, all three agreed on 21.

How often two engines named the same business
Engine pair	Agreed on
Gemini & Perplexity	65.0%
Gemini & Google AI Overview	64.7%
Perplexity & Google AI Overview	61.5%
Claude & Google AI Overview	37.5%
ChatGPT & Google AI Overview	33.3%
Claude & Gemini	29.3%
ChatGPT & Perplexity	27.0%
Claude & Perplexity	27.0%
ChatGPT & Gemini	26.2%
ChatGPT & Claude	25.6%

How much does this vary between markets?

Substantially. The share of practices no engine named ranged from 74.4% to 89.5% across the 6 markets measured. These markets do not agree with each other, and a combined average would hide that, so every market’s own figures are published on its own page, computed from that market alone.

Per-market results — 288 businesses across 6 markets
Market	Practices	Never named	Top 3 took
Phoenix, AZ	57	89.5%	81.4%
Bend, OR	52	82.7%	59.2%
Philadelphia, PA	48	85.4%	71.9%
Mansfield, OH	44	86.4%	70.9%
Savannah, GA	44	79.5%	66.9%
Peoria, IL	43	74.4%	53.4%

How we measured it

In each of 6 markets we pulled every Ophthalmology (Refractive / Cosmetic) practice Google Maps returns, then asked 5 AI answer engines the same 10 patient questions and recorded which ones each engine named. The questions were held identical across ChatGPT, Claude, Gemini, Perplexity and Google’s AI Overview, and a practice with more than one listing is counted once per market.

Sample: 288 practices across 6 markets: Bend, OR; Mansfield, OH; Peoria, IL; Philadelphia, PA; Phoenix, AZ; Savannah, GA. A practice with more than one listing is counted once per market. 218 listings that share the websites of 59 organizations are counted as those organizations, because AI engines cite an organization's site rather than any individual listing.
Market selection: The 6 markets were picked before any measuring started — deliberately spread across large, medium and small cities and across the country — and every market we opened is reported here, including the ones that came back less interesting.
Collection: 10 patient questions per market, held identical across ChatGPT, Claude, Gemini, Perplexity and Google's AI Overview. 50 answers per market, July 2026.
Visibility: Share of answers naming or citing a practice, weighted by the reach of the engine that named it.
What we will and will not publish: A combined number only goes up when it covers at least 3 markets and 150 practices, with a usable reading for at least half of them. Where markets disagree with each other, we publish the range as well as the average rather than hiding it.
Scope: One category, 6 US markets. Practices are never named. Answer engines change over time; these figures describe July 2026.

For anyone who wants the statistics

The findings above are counts, which is how most people want to read them. Here are the same relationships as correlations, across all 288 businesses.

Reputation signals vs getting named — 288 practices
What we measured	How closely it tracked	What that means
Google Maps rank	−0.315	A slight connection
Review count	−0.006	No connection
Star rating	+0	No connection

Reading the middle column: 0.0 means the two things had nothing to do with each other. 1.0 would mean they moved together perfectly. A minus sign means they moved in opposite directions. Anything under about 0.2 either way is noise.