BMC: Who or what drew you to ophthalmology?

Jason J. Jones, MD: My father is an ophthalmologist, and that was a large part of my inspiration for going into the field. He demonstrated what it’s like to live the lifestyle that we live as surgeons. Growing up, I got a lot of exposure to ophthalmology, not just in his office and with his patients, but in traveling, going to meetings, and visiting other doctors’ offices. Visiting other doctors has been lost nowadays because we have so much better electronic communication, such as through sharing videos. But those were important solidifying elements in my decision to become an ophthalmologist.

BMC: When you visited other practices with your father, what was his reasoning for going and also for bringing you along?

Jones: I was quite young when I first started accompanying him on these visits, and it continued through high school and even when I was in college. When we took family trips, we would decide on a location, and he would say, “I met this guy at a meeting this past year, and he’s just down the road from where we’ll be staying. I’m going to see if I can visit him.”

I think part of the benefit for him was to see the lay of the land in that office. This was an early time in terms of ambulatory surgery centers (ASCs). People were building ASCs in the mid to late 1980s, and the ASC I work in now was opened in 1987—a fairly early one.

There was also an element of spontaneity because you didn’t know what you would learn, so he always kept an open mind toward seeing what’s happening at that location, with that doctor, and how things work. There’s less of that nowadays. We’re interested in others’ surgical techniques, and you can see such good video that a site visit doesn’t have the same level of importance. So we probably lose some of those serendipitous findings that we would get in the past.

BMC: You went to undergraduate and medical school on the East Coast, and then did your residency in Utah, and now you’re practicing in the Midwest. Has experiencing life and practicing medicine across various parts of the United States helped shape you as a physician?

Jones: Yes, certainly. There are differences of lifestyle in all of these locations, and people interact differently with each other. I will never forget, when I was interested in leaving New York City to go to the University of Utah, and I asked one of the residents at my medical center what he’d heard about the University of Utah, he told me he really didn’t know much about it other than it was in Utah.

I kept an open mind, and I got to experience different elements of lifestyles living in a very urban environment, and then a more rural, suburban type of environment in the Salt Lake City area. And then I came back to my hometown. Growing up, I didn’t have aspirations of coming back here, but it was an opportunity for me. And that opportunity was and is still good, in terms of my practice and the lifestyle. I really appreciate what it has offered me, both professionally and personally.

BMC: When you returned to the Midwest, you joined your father’s practice, correct?

Jones: Yes. My dad was still practicing for a few years, and we were concurrent. He still likes to poke his head in the door and see what’s going on occasionally. The transition between us was interesting for me. We have sometimes hearty folks here in the Midwest, and many of the patients in this area are farmers and very salt-of-the-earth. There’s a lot of Northern European ancestry as well. My father and I would be in the examination lanes together, and if he saw a patient who seemed challenging for some reason—pseudoexfoliation, a small pupil, cornea guttata, a dense cataract, or if the patient was wheelchair-bound or monocular, or all of the above—he would talk with and examine the patient, and then he’d say, “My son will be in here in a few minutes, and he’ll take a look at you. He’ll be doing your surgery.”

Essentially, for the first 2 or 3 years, I got all of the difficult cases. I was well-equipped due to my experience from residency, but I also had to evolve from there. That was a good challenge. Now I take care of all of the patients, and I still find plenty of challenges. But that was something that really tested my abilities at the early stage of my career.

BMC: What are your biggest passions inside your profession?

Jones: Moving the ball forward, whatever that entails, in terms of technology, and understanding a new technique better or maybe revisiting old techniques. For example, I still find the nuances of hydrodissection interesting, and I continually try to refine that process, to make it more dependable, and more consistent.

Video can play a role in terms of understanding those sorts of things. This is why I love video: It’s an excellent means of communication, especially communicating things that you cannot describe verbally.

Moving the ball forward also applies to participating in clinical trials. I brought clinical trial participation into this practice after I was here for several years. Working with industry people, different companies, and different technologies helps to push that boundary forward.

It all goes back to not accepting what we have as good enough. Although it’s also valid to recognize that what we have already is quite good—excellent, really. But there is still room to make cataract surgery and IOL technology better. We’re in a bit of a renaissance now, in that phaco and IOL technologies have really been pushing forward. It’s exciting to see. I did not foresee that I’d be changing my practices and evolving as quickly as we have.

BMC: With regard to IOL and phaco technologies, what are some of the things that you are currently excited about?

Jones: I’ve used a variety of different technologies. I still like the phaco ultrasound technology, and I think that there’s room to grow. It’s become a much more refined technology in many ways, including ways that are sometimes surprising. But, if the attitude is to grow this space and push our boundaries forward, I think something as simple and as basic as the miLoop (Iantech) can offer a particular advantage in selected cases, and that’s exciting. I think it has great promise for advanced cataracts, in particular—patients who might not be good candidates for phaco because of the density of the cataract. This would allow us to manually extract the lens through a relatively small scleral tunnel incision. It could also be a step forward in manual small-incision cataract surgery, performed often in developing nations.

I have also used the femtosecond laser for cataract surgery. That experience taught me a lot, and I am still fascinated by that technology, but I have moved away from it. My main reason was that I found I was still doing a significant portion of the cataract surgery procedure with a traditional approach, and the combination of the technologies was an expensive way of doing surgery. This was true not only in terms of financial outlay for the practice and the patient, but also in terms of time efficiency.

I think the other capsulotomy cutting technologies, the Zepto Precision Pulse Capsulotomy device (Mynosys), and the CapsuLaser (CapsuLaser), are interesting. I have tried Zepto, and I’m going to do more work with it, but the financial barrier to these technologies being well accepted is quite high.

Can these devices perform better than we can manually? The argument is that maybe they can, but they have to prove to be worth the cost, and I’m not sure they’re there yet. It’s good to be skeptical. I think the jury’s still out on some of these things, but let’s see where they take us. The market will dictate whether they really have a place.

BMC: You make a lot of surgical videos, and you were among the first to dive into concentrating on surgical videos. What were and are your motivations to create videos?

Jones: Actually, the person I think of as the pioneer of surgical video is Howard V. Gimbel, MD, MPH, FRCSC, AOE, FACS. And there are many others: I. Howard Fine, MD, is another excellent resource in terms of early surgical video.

Back in the day, I remember my father watching surgical videos. That was an inspiration to me that carried forward to my residency with Alan S. Crandall, MD. The entire surgical experience included not just doing the surgery, but also watching the video afterward so you could understand better what happened, especially if there was a complication.

I still watch my surgery cases. I record essentially every one of them, but I don’t keep them as part of the patient record. Rather, I use it as a learning tool for myself. It’s a considerable investment of time and money to create and watch them, but I find it cathartic and somewhat relaxing.

There are specific surgeries that were watershed moments for me that actually changed the way I did surgery. The video helped me to not just recall the event, but to have a window into what the experience was like—reliving it, but in a more dispassionate manner. I can look at that video time and again if I need to understand it better. Video doesn’t tell you everything about what happened, especially if things go wrong, but it can certainly help you understand. I look at it as an investment in myself.

BMC: You have quite a few elegant and complex surgical cases that you’ve posted to Eyetube and YouTube. Have you heard stories about how one of your videos has helped somebody during a tough case?

Jones: I certainly have. I’ve published some videos on posterior capsulorrhexis. We all break a posterior capsule at times. A person came up to me at a meeting and said, “I had that happen, and then I remembered your videos, and I created a posterior capsulorrhexis and put the lens in. There was a company rep there in the OR with me, and he couldn’t believe I did that.”

The reality is, posterior capsulorrhexis is an old technique. It’s just that there were not a lot of videos available. When I first wanted to do posterior capsulorrhexis, I hunted far and wide for information and especially videos. I found little information and very few videos. There are some great articles in which people talk about their techniques, but language is sometimes limiting. The moving image can be so much more understandable.

Sharing experiences makes a big difference to me because it allows other people to pick up those ideas. This is how I’ve learned some of my techniques. Surgeons who publish their videos on Eyetube or YouTube can be fantastic resources to understand how others confronted a problem, how they accomplished a successful outcome.

I still search for videos all the time and pull up Eyetube every day or so to see if there is a new posting. I don’t just search cataract and IOL, I watch retina, for example, because I have patients who need retina care as well. Understanding how those issues can be approached helps me talk to patients about what to expect when I need to refer them.

Another thing that’s interesting is the number of patients from around the world who have contacted me. I’ve had patients call me from Australia, Germany, England, and all across the United States saying they saw a video on YouTube and they want to know if they can come to my office. I’m flattered that people want to come and potentially be a patient of mine, but I find it more satisfying and appropriate for most of these patients to find an excellent surgeon in their own area, and usually that’s what I encourage them to do. I help direct them toward someone with the expertise to handle the problem they’ve described.

BMC: What is one thing you love about your home life, and one thing that you wish you could change?

Jones: My family is my bedrock. My wife is a fantastic partner in life; she’s also an ophthalmologist in our office. We have two lovely kids. Having them as a part of my life is a counterbalance to the craziness of practice, and a respite from the overwhelming activity that can be a part of a career.

As far as what I would change, I’d like to get more time for my personal life. Finding adequate time to spend with the people you love is challenging when other things can be so consuming. I still want to live up to the challenge of what my practice brings to me, but as I’ve gotten older, I want to give up less of my personal life if I can. Trying to strike that balance is a challenge that we all face.

For me, practice is beyond just seeing the next patient and doing the next surgery. It’s sharing with other people what I do surgically through videos, books, and articles. That’s something I learned early on: Having multiple things in your life is reassuring because not everything is going to work well in every facet of your life. If you have more things in your life, there’s a better chance that some of them will go well and generate satisfaction and happiness.

BMC: On your days off, what would we likely find you doing?

Jones: Believe it or not, editing or watching my videos. I’d be at home with my kids and wife. I’ve taken up flying a drone; I’ve got one that I travel with, a small foldable one. Travel is another part of my personal life that I’ve come to enjoy. I’ve been fortunate to travel many different places and enjoy different aspects of different cultures. That goes back to what we talked about earlier, living and working in different places.

BMC: I saw on your website that you speak Spanish and that you are learning Chinese. What drew you to these two languages?

Jones: We were required to learn a foreign language in school. I chose Spanish. At one point in my life, I would dream in Spanish. I am not fluent, but I do speak it with the significant number of Hispanic patients in my practice. The fact that I can greet these patients in their language and have some level of conversation with them helps me to relate to them, and vice versa.

As for Chinese, my wife grew up in Beijing, and I tried to learn Mandarin. I was speaking some Chinese with my wife, and my older daughter, who was 3 years old at the time, said to me in English, “Daddy, you can’t speak Chinese.” The subtleties of the words are quite difficult for me. I would still like to learn the language, I just don’t have enough time. Sometimes, when I am around my in-laws with my wife and they are speaking Chinese, I amaze them because I understand more of what they’re saying than they think.

BMC: If you had to nominate one creative mind in ophthalmology, whom would it be and why?

Jones: It’s hard to nominate just one. There are many pioneers from my father’s generation, who introduced phacoemulsification and IOLs and developed the techniques we still use today, in some ways.

But if I had to choose someone who’s younger, and whose legacy is already being built, I’d choose Iqbal Ike K. Ahmed, MD, FRCSC.

Ike has done a lot for ophthalmology, for glaucoma, for ophthalmology in Canada, and for people of color, and I really appreciate that about him. He’s also a good friend of mine. I’ve known him since my residency, when he was a fellow.

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BMC: Who or what drew you to ophthalmology?

William F. Wiley, MD: I grew up in an ophthalmology family. My father was an ophthalmologist, and living in a household with that exposure to the field was a big influence. There are several legacy ophthalmologists in practice now. Part of this is that ophthalmology provides a nice lifestyle, and the other part is that it’s an innovative field with constant introduction of new technologies. Ophthalmologists tend to be happy with their career choices, and that satisfaction trickles down to their children.

In medical school, you get little exposure to ophthalmology. Unless they are exposed to it, most medical students don’t think about this field as a career—it’s sort of an outlier specialty. It’s hard to study for, the exams are complicated, and the equipment is hard to use. Many people rotating through ophthalmology are turned off by those things. If you grow up with it, you have a baseline understanding that allows you to catch on quickly in med school and residency. Often, people gravitate toward things that they understand or excel at, so that was part of it, too, for me.

BMC: How did your father’s career influence yours?

Wiley: The way he practiced ophthalmology was reflective of my own interests. He was early into refractive surgery, a field that gained popularity in the late 1980s into the ‘90s. He was the first in our region to do RK. Actually, I’m a patient of RK: I had it done on my eyes, by my father, when I was in college.

Being able to see that gift of sight from a personal standpoint was great. Today, we may tend to take refractive surgery for granted, but back then, it was truly amazing to understand that you could go from needing glasses to not needing them. Seeing my father do that was transformative to me. His excitement trickled down, and as a patient myself I was also able to partake in the excitement.

My father was also a pioneer in optometric comanagement at a time when there was a huge divide between optometry and ophthalmology. There still is some, but it’s more collegial now. Back then, it was unusual for ophthalmologists to work closely with optometry. I remember him talking about how his relationship with optometry was frowned upon among his colleagues, and thinking, “They’re just people. What do you mean you shouldn’t be working with them? They know eyes just like you do.” At the time, I didn’t understand the traditional ophthalmology point of view. Having been exposed to the other alternative at an early age helped guide my own choices later. Now I’m partnered with optometry within our practice, and I work with community optometrists as well.

Lastly, my father’s innovative spirit influenced me. When I was in high school, we worked on some patents together. He had a patent for an adjustable-focus IOL. He and I would brainstorm and try to figure out, “What kind of technology could allow a lens to be adjusted inside the eye?” We looked at electronic- and light-adjustable methods. This was years before that type of technology became reality. But through that experience, I was able to see that a solo private practitioner could help guide the field or innovate technology in the field. So that also guided my career path.

BMC: Regarding the concept of the adjustable IOL, what are your thoughts now that it is closer to becoming a reality?

Wiley: Our practice was chosen to be a study site for the FDA clinical trials for the RxLAL. The first time I implanted one and then adjusted it, I thought to myself, “This is something my dad and I talked about 20 years ago in the kitchen, brainstorming how we might be able to do it.” To see that technology come to fruition was a great moment, and I was so excited to go home that evening and tell my father.

Unfortunately, my father let his patents for the adjustable-focus IOL expire. At that time, it just didn’t seem possible to do. I asked if he was upset about not holding onto them. He said, “Well, at least I helped put the idea out there, and somebody else was able to capitalize on those thoughts and run with them.”

BMC: Your father was heavily involved with the Society for Excellence in Eyecare (SEE), and now you are involved with the Caribbean Eye Meeting. How much of that is because of your father, and how have you made it your own undertaking?

Wiley: The Island Ophthalmology Meeting, which later merged into the Caribbean Eye Meeting, was started by my dad. Our family went on vacation to Jamaica with another ophthalmologist’s family, and all my dad and this other doctor talked about was ophthalmology. The next year, they invited another family, and so for the first few years it was just a few docs and their families. The docs talked shop, and the families had fun on the beach. Then they began to invite people from industry. It grew organically. Initially it was just a small meeting, and then they merged it with SEE. Then that group partnered with the American College of Eye Surgeons (ACES) to cosupport Caribbean Eye.

I knew it from childhood as a great family vacation, but in my first few years of practice, I wasn’t involved. I think there was sort of a generation gap, as the organizers and attendees were mainly of my dad’s generation.

The people I credit for modernizing the meeting and the society are James C. Loden, MD, of Nashville, whose father is also an ophthalmologist and colleague of my father’s, and P. Dee G. Stephenson, MD. Jim started going to the meetings, and he brought in younger doctors. Jim and Dee helped it transition from a legacy doctor’s club to a true, modern day, cutting-edge meeting.

BMC: You practice at Clear Choice Custom LASIK Center, the Cleveland Eye Clinic, and Toledo LASIK Center, and you’re also on the faculty at Case Western Reserve University. How do you divide your time, and what are the benefits of practicing across multiple institutions?

Wiley: Practicing with a number of organizations can be complex. The way our private practices were formed, there was an independent refractive surgery company, Clear Choice, focusing on refractive surgery. Separate from that was Cleveland Eye Clinic, an anterior segment/cataract practice. Those were on their own paths of revenue. When the Centers for Medicare and Medicaid Services, in the preceding decade, changed the rules to allow billing the patient for premium IOLs, we started seeing Clear Choice and Cleveland Eye Clinic more closely align, with Cleveland Eye Clinic providing upgraded or refractive services along with cataract surgery.

At that point, we built a new structure that now houses both entities under one roof, so that Clear Choice and Cleveland Eye Clinic could share technologies. They still operate independently, but they are becoming more complimentary, as they combine cataract surgery, refractive surgery, and more comprehensive ophthalmology under one roof. We now also have a dry eye center of excellence and an oculoplastic surgery practice. So we’re melding refractive and cataract surgery into a modern, all-encompassing comprehensive practice.

But I also teach at Case Western because I enjoy working with residents. When I think back to my training, I’m indebted to the doctors who spent their time with me through residency. In the program where I trained, Rush Presbyterian St. Luke’s Hospital in Chicago, many of the doctors had their own private practices, and they taught from that perspective. It was nice to be able to get that firsthand experience from the private practice world. This was different from the traditional academic center that might offer little exposure to private practices.

I thought it would be good to work with residents here in Cleveland, to show them a different side of ophthalmology than what they might be exposed to in the academic institution. Postgraduate residents who are looking to go into refractive surgery or refractive cataract surgery might get a better perspective in our practice than they would in a traditional, pathology-based academic setting. It’s a way for me to give back and teach residents the way I was taught.

BMC: You’ve taken on a fellow this year. Is this your first time sponsoring a fellowship?

Wiley: Yes. Through working with Case Western’s residency program, I got to meet people who were interested in following a path of learning that dove a little deeper into refractive surgery. We realized that it would be a great way for us to help invest in the field of refractive surgery. There are a number of corneal fellowships out there, but traditionally they’re more pathology-based and not as much about refractive surgery. Refractive surgery is expanding and changing, and it’s becoming harder, I think, to truly learn the skill set required to be a comprehensive refractive surgeon.

Right out of residency, when I started working with my dad, I didn’t have a formal fellowship. The only refractive surgery I learned was LASIK. We had a microkerotome, an excimer laser, and a corneal topographer, and that was it. Now look at the procedures we’re providing: We have SMILE, multifocal IOLs, corneal inlays, phakic IOLs, and CXL.

What was once a relatively simple thing that you might learn with a weekend keratome or excimer laser course is now much more complicated.

BMC: I follow @clearchoicelaser on Instagram. From the posts, it looks like a fun and family-like corporate culture. As medical director, how do you promote this positive energy and keep your employees happy?

Wiley: Clear Choice has a great culture, and it does have a family atmosphere. We have had nontraditional marketing since almost day 1. Two of the partners in Clear Choice are not physicians; they are marketers by trade, and they helped create that culture. Sometimes physicians have one way of looking at things that’s different from what a business or a marketing person may see.

When I look back to some of the early marketing things I wanted to pursue, it was a picture of doctors and text saying how great doctors are. That goes only so far. Initially, some of the posts our team wanted to put out there, I said, “I don’t know, that doesn’t look very medical to me.” I had to step back and let the team run with their thoughts and ideas, and it has been extremely effective.

Even the waiting room is different from what I might have designed as a physician. My partners did not want the space to look like the typical, sterile, cold medical facility. They made it look like a local coffee shop with a warm-and-fuzzy sort of feeling. The picture I had in my mind was traditional and academic. They pushed to make it comfortable. So we have a fireplace in the lobby. We make fresh cookies and have a coffee machine making fresh Starbucks coffee. It is a totally different atmosphere that was driven by the staff and the team.

One day my business partner said, “We should get an ice cream truck.” I was like, “Why would we want an ice cream truck?” He said, “Well, who doesn’t like ice cream?” And I said, “Okay, but how will this benefit our patients, how will it help to get our name out?” We ended up buying not one but two vintage 1950s ice cream trucks, and we offer access to them for any of our past or present patients. They can reserve a truck for a kid’s birthday party or special event. We offer it as a free service, and we take donations that go to a local low-vision center.

The benefit to the practice is that, when the truck shows up at the birthday party, all of the parents say, “Wait a minute, how did you get this ice cream truck?” And the patients can say, “Oh, Clear Choice. We’re patients. It’s a great place to have your LASIK or refractive surgery done.” It helps get the name out there in a nontraditional way. It’s a fun thing that the staff gets into. I drove it to our town when we had a local festival—I was a hero to my kids and the neighborhood kids.

Listening to a partner with a nontraditional marketing idea and taking your ego out of the way can lead to interesting developments. Letting somebody else run with an idea to create a better atmosphere was initially hard for me to do, but I can see that has paid off and has produced a great culture to work in.

BMC: You’ve performed surgery on more than 100 physicians or their family members. What is it about you and your practice that attracts other physicians to entrust their eyes to you?

Wiley: Medical communities tend to be pretty close-knit. By treating everybody on your team or at your hospital or surgery center with respect and care, and trying to be a center of excellence, the word gets out. Likewise, if I needed knee surgery, I might ask my scrub tech, “You work at the hospital. Who’s the best knee surgeon, and what is he like?” When you’re approachable, when you’re there for your patients, they will talk about where they had their eyes done when they see other professionals. I’ve always given my cell phone number to all of my patients. We treat a lot of patients, so you’d think that my phone would be ringing off the hook, but it’s not. I think that for patients, knowing they can reach me if needed is nice, but they don’t take advantage.

We’re also leading innovation, and we strive to always have the latest technology to try to get that next-level result. We work with industry through studies and partner with industry for new technologies. All those things have helped raise the level of care that we deliver.

BMC: Outside of ophthalmology, what keeps you fulfilled?

Wiley: I enjoy skiing in the winter. Living in Cleveland, winters can be rough, with subfreezing temperatures. My family made a decision to have skiing as our family hobby, and that’s one outlet I’ve enjoyed over the past few years. Almost every weekend in the winter, we drive to Western New York and ski as a family. My kids have gotten involved in the racing programs.

We’re in the car together, on the mountain together. It’s a great family atmosphere. It’s a nice break from eye care because I work pretty hard, and I’m often away from the family, but that’s one time when we’re together.

I enjoy doing triathlons. I have always enjoyed running and biking, but I thought there’s no way I could ever swim a mile or more. I just felt like I wouldn’t have it in me. So that is something, to be able to do a half Ironman or multiple triathlons, to work through that weakness in the swimming section. That was rewarding.

BMC: A little birdie told me that you’re a Dave Matthews Band fan. Tell me about when and why you started following them.

Wiley: I went to the University of Virginia, and that’s where Dave Matthews got started, at a bar called Trax. He would play every Tuesday night with a $5 cover charge. Even when he first started, he was pretty good, and he drew a crowd. I was in a fraternity, and we had an annual fall festival. We had a band every year, and it was usually a cover band, but somebody suggested Dave Matthews. And we found out he would charge $500 to play, whereas the cover band would be $800.

Looking back, it’s wild to think I saw Dave Matthews play in front of 40 people at a fraternity party. As they got bigger, we all started to adjust our class schedule—you did not want to have an 8 am class on Wednesday. He started building a local following.

BMC: If you had to nominate one creative mind in ophthalmology, whom would it be and why?

Wiley: Anybody who is a member of the Vanguard Ophthalmology Society (http://www.vanguardeye.org/), a group that was started in 2009 by like-minded physicians, and the innovation that comes out of this group is inspiring. For example, Malik Y. Kahook, MD, has innovated a number of products, most recently the Harmoni IOL, which was bought by Alcon. John P. Berdahl, MD, started Equinox, which is looking into the role of intracranial pressure in glaucoma. (Editor’s Note: The Chief Medical Editors of MillennialEYE have selected Dr. Kahook as one of its creative minds and the Chief Medical Editors of CollaborativeEYE have selected Dr. Thompson.) Gary Wörtz, MD, has the Omega lens (Omega Ophthalmics), which is a new upgradable IOL that is interesting. Damien F. Goldberg, MD, has the company Ocular Science, developing topical formulations for postoperative care. And Rob Sambursky, MD, started RPS Diagnostics.

Those are just a few members of Vanguard who have great ideas. Some members may not have invented anything yet, but the society has a collegial atmosphere of bouncing ideas off each other. Over the past 10 years, it’s been great to see such a concentration of creative minds come together and help change or shape the field.