Written by: Dr. Joel Hunter

Posted on May 10, 2013

Welcome back for the rest of the story that I started yesterday. I promise this is headed somewhere good.

There is another type of surgery called clear lens exchange (or refractive lensectomy or natural lens replacement or refractive lens exchange) that is the exact same procedure as cataract surgery except is performed before the lens is cloudy and obstructing the vision. The reason people do this is so that they can be free of glasses and contacts even if they are (a) not a good LASIK candidate (b) very close to developing cataracts over the next few years. The other difference between this refractive lens exchange and cataract surgery is pretty significant. Insurance covers cataract surgery. It does not cover the elective clear lens surgery.

We did this clear lens exchange at Hunter Vision for a few months when we opened. We never accepted insurance so it was the only lens surgery that we could do. All of the patients did wonderfully and are happy, but I gave it up to focus on just LASIK because some simple math made it pretty clear that as long as we weren’t accepting insurance we could help a lot more people with LASIK than we could with clear lens exchange.

At some point over the last few years, I got tired of sending people with cataracts away to other doctors because we don’t accept insurance. “Why am I doing this?” I thought. The original plan was to stay away from the headache that is health insurance (mainly because I didn’t want people to have a bad experience because of an unpleasant insurance company we couldn’t control), but the more I thought about it, the more I realized that we could figure it out. We have learned over the years that making people super happy is much more about loving them and working with them, rather than avoiding problems altogether. As Josh and I talked over all this, a momentous decision became a lot easier to make.

Hunter Vision is going to start accepting insurance.

We realize that sentence means that there is going to be a lot more work on our side (did you know there are whole departments in doctor’s offices that just deal with filling out insurance paperwork? My lands, it is really something), but we also realize that there is going to be a lot of joy for a lot of people on the other side of that work. I went from annoyed with having to relearn insurance coding, to completely freed and elated over a couple of days, because I realize how great it is going to be to help people with cataracts see again.

Long story, slightly shorter, we’re going to start accepting insurance at Hunter Vision because we want to help people with cataracts that we can’t help right now. And we figured, “If we can love people the way Jesus would as they walk through an insurance-free process like LASIK, then how much more of a chance will there be to show care for folks as we become an insurance provider?” My guess is, the room for improvement in people’s experience with insurance and their providers is oftentimes pretty great. We’re really looking forward to providing care for those folks.

Written by: Dr. Joel Hunter

Posted on May 2, 2013

If there is anywhere the word beautiful can be used to describe a medical procedure, it is cataract surgery. There is almost no other procedure on the eye, or anywhere else for that matter, where a patient can undergo such a complete transformation from nonfunctional to perfect in such a dramatic way. It is hard to imagine what it is like unless you haven’t been able to see anything clear, even with glasses, for so long that you can’t remember how it once felt. Many years ago in training, one of the greatest joys I’ve ever had was performing cataract surgery at the VA Hospital. It was life-changing to watch peoples lives change. I’ve had patients that haven’t been able to read their Bible in years, that now can pick it up and read for themselves what had to be read for all those years. I’m going to get emotional. Let me balance it out to say we also had a veteran that thought he owned a brown car for a year until his cataracts got removed and he realized it was cherry red.

We’re going to start doing cataracts at Hunter Vision. “What was the delay?” you say? It is an excellent question, and this blog should give you an answer. To get there, first I need to briefly explain what cataract surgery is. There is a lens inside the eye that you cannot see, but that you look through from the time you are born until, well, it gets too cloudy to see through. The lens is made of protein and living tissue just like everything else in your body. And just like everything else, it ages right along with you.

Eventually, this beautiful clear lens actually becomes a hindrance because it is blocking and blurring light as though it were a cloud inside your eye. It oftentimes turns the dark brown color of an old beer bottle. It is at this point that people stop calling it a clear lens and start calling it a cataract. Cataract surgery just means swapping that cloudy lens out for an artificial one that is perfectly clear. There are even artificial lenses now that can allow you to have good reading vision AND good distance vision. It is amazing.

The world of cataract surgery is more exciting than ever, not because of what we as surgeons get to do to fix eyes, but because the new technology in lenses is letting people see in a way that was science fiction a few years ago. People can now have permanent glasses- free vision. To get to what that means for Hunter Vision and our patients, read on with Part 2, which we’ll post tomorrow, because no one should have to read a blog longer than 500 words.

Written by: Dr. Joel Hunter

Posted on Apr 25, 2013

As I sat in a very long and tedious brain surgery case, I pondered the pros and cons of the other surgical subspecialties I might choose. Reproductive medicine, vascular surgery, or ophthalmology. Reproductive Endocrinology and Infertility (REI for short, this is not where the outdoor equipment company gets its name) falls into the field of the seemingly miraculous. It is a subspecialty of OB/GYN that medically and surgically helps women who cannot have a baby, to have a baby. What a gift! I really enjoyed my two-month OB/GYN rotation. Sadly, I was no longer attracted to women after it. I’m pretty sure that’s offensive to somebody, and for that I apologize. Just trying to be real here. REI was out because I’d have to be an OB/GYN first and it turns out that would make me asexual (again, sorry). Some of the best doctors and husbands I know are OB/GYNs but I couldn’t do both (husband and doctor).

Vascular surgery is basically sewing blood vessels together. It is like being a seamster who wears latex gloves. A big part of why I didn’t feel like I’d like it is because you have to do a five-year general surgery residency. This is almost entirely abdominal surgery on stomachs and livers and colons and gallbladders. There are great men and women that live for general surgery, as a medical student, that world was more about surviving than thriving. I made it through fine, but the residency is even more brutal. Legislation was passed to protect patients by only allowing residents to work 80 hours a week. However, in practice the 80- hour work week law is obeyed kind of like the speed limit. Everyone knows what it is and then does whatever they can get away with. To say to a surgery attending, “I’ve worked my 80 hours already this week,” would be equivalent to saying, “I’m wearing footy pajamas to work tomorrow.” On top of all this, I didn’t want to sew blood vessels together for the rest of my life.
That left ophthalmology. However, for unknown reasons, the Internal Medicine and General Surgery types that
run med schools don’t hold ophthalmology as a priority. So I knew only slightly more about ophthalmology than I
would have if I wasn’t in medical school. I had one half-day of it a year previous. Optometry, optical technician, and ophthalmology were separated by very fuzzy lines. But, the more I researched into it, the more I got hooked. Not only was it microsurgical, it was beautiful. I have a journal entry from my first elective month-long rotation in ophthalmology that thankfully I’ve lost, but I do remember it describing seeing all these eye parts under a microscope in oddly romantic terms. Then I found out, wonder of wonders, the attending physicians in ophthalmology were happy! The patients were happy. And most astonishing of all, the residents were happy. I had stumbled into Eden. It took exactly one month for the push factor out of neurosurgery to be dwarfed by the pull factor into eye surgery.

My only concern before becoming an ophthalmologist, and I am ashamed to admit this, was that I wouldn’t get to
tell people I was a brain surgeon. As it turns out, it is way, way better to love what you do than to love telling people what you do. So to this day, if someone asks what I do, I look them in the eye and say, “I’m a
brain surgeon.” Because how are they gonna know?

Written by: Elizabeth Hunter

Posted on Apr 10, 2013

When I was 13 years old, my parents sat me down and told me that they had signed me up to join them and my older brother on a mission trip to Trinidad. Our church was coordinating the trip and my parents had volunteered the four of us to go serve.

Calling my response “lack-luster” would be charitable to my 13-year-old self. My reaction was exactly what one may expect of an adolescent girl who was just told she would spend part of her summer away from her friends and pets (who were the “friends” to whom I referred). To be honest, I wasn’t popular (at all) but Cocoa’s and Giacomo’s love was unconditional. That being said, my parents put their foot down and said, “You are going. This is important to your character.”

I did and they were right. The experience was life changing. And not because I did something so profound that the island of Trinidad would never be the same. I know I wasn’t nearly the blessing to those whom I served as they were to me. My life was imprinted by those I met and by the culture that embraced me. That first trip led me to go on two more to Trinidad. To this day, I am thankful that my parents twisted my awkward and belligerent 13-year-old arm. It taught me to understand what an honor it is to serve.

As we are preparing for our trip to the Dominican Republic this year, what I find so exciting is the group of volunteers that has been brought together for this common mission. Among our sixteen team members are three elementary-age students. They are enthusiastic and eager to jump into this adventure. When I watch them scrubbing away at eyeglasses with smiles on their faces, I think of how this world will be different because their parents introduced them to missions at an early age.

Written by: Elizabeth Hunter

Posted on Mar 27, 2013

When we began THE EYEGLASS PROJECT last year,  we had no idea what it would look like. We didn’t know how many people we would be able to help and we didn’t know what the future held for the project. We simply knew that from the inception of Hunter Vision, we have always recognized a call to serve.

We started small by beginning to allow our patients, who have had LASIK, to leave their eyeglasses behind in hopes that they would be repurposed. With a handful of prescription glasses in tow and inspiration drawn from several locals who went before us, we decided to begin a campaign to collect glasses throughout the Central Florida community. We built partnerships with Northland Church and TIME Ministries in Santo Domingo and launched a donation campaign in December of 2011.

The community rallied and several organizations jumped on board to carry the banner of bringing sight to those in need. Track Shack, Downtown Credo, Hard Rock, Summit Church, Lenscrafters, and the RDV Sportsplex contributed hugely to our campaign.

By spring of 2012, we had collected 1,500 pairs of usable glasses. Those glasses were then sent to Santo Domingo, Dominican Republic to be distributed by our team of ten volunteers. In May of 2012, we saw 400 patients in three days of clinic and were able to fit them with donated eyeglasses.

We were so grateful to have the opportunity to serve in May last year that we decided to continue THE EYEGLASS PROJECT in 2013.

Our trip is scheduled for May of this year and we are again overwhelmed by the response of this community. The collections began in December of 2012 for this year’s trip and the project continues to expand as we build new, exciting partnerships throughout Central Florida.

We plunged into a call to serve and the scope of those who are serving, and who are being reached, has superseded our hopes for it. We didn’t know what it would look like when it began and we don’t know exactly where the mission will lead, but what we do know is that this community has begun to make a lasting difference in the lives of others. THE EYEGLASS PROJECT may have begun in the office at Hunter Vision but many throughout the community have picked up the mission. Our hope is that this becomes our community’s project, not just our own. We are excited to learn what that looks like and are enjoying this eyeglasses thrill ride we are on.

Written by: Dr. Joel Hunter

Posted on Mar 20, 2013

Today, to continue this endeavor to answer Hunter Vision staff questions, we start with our wonderful, kind Surgery Counselor, Marylee. She tells people about 3D LASIK and laser eye surgery in general. She also manages the surgery schedule. She said maybe people would want to know why I chose to do eyes.

It wasn’t always that way. I wanted to be a doctor from time immemorial (age 13) and wallpapered my middle school room with anatomy posters and studied anatomy in the evenings sometimes to prepare for medical school. (A quick aside, if any burgeoning pre-medical students are reading this and think it sounds like a good idea, it is not. The years of occasional anatomy study leading to medical school saved me a total of three minutes in medical school anatomy. Turns out it was a little more in depth than I had imagined it would be.) More specifically, I wanted to be a neurosurgeon. Why, you ask? One, because it was the most impressive to say when people casually ask what you do. And two, I thought it would be very fun.

I was sure for the first two and a half years of medical school that I would do brain surgery. I would move to the front of the class when our neuroscience professor would teach. He was a man with a great handlebar mustache and an unopened umbrella he used both as a walking stick and to point to the screen behind him. I revered Dr. Nolan, and became the neuroscience course liaison. A job with a purpose as inscrutable as its title. After learning the academic part of it all, I was more sure than ever about neurosurgery. I lobbied to have a new, solo, two-week neurosurgical specialty added to my surgery rotation. And then something remarkable and unexpected happened.

It was very miserable. The residents were miserable. The attending physicians were miserable. The nurses were miserable. The only outliers in this unbroken chain of misery were the patients, who were all asleep. For a week, I persevered, trying to counter their unhappiness with my own enthusiasm. But that was all I could muster, a week. It took one week to undo 10 years of unbroken momentum towards one goal. One week in, I was sitting in a routine eight hour (!) case, a sub thalamic stimulator placement for Parkinson’s, and I had a completely novel thought, “I don’t have to do this.” And that was it, I spent the next seven hours thinking of what other microsurgical speciality I might like. I came down to three: reproductive endocrinology and infertility, vascular surgery, or ophthalmology.

Ophthalmology ended up being the clear winner. And since it turns out I write even more than I talk, I’ll have to save that story for another day.

Written by: Dr. Joel Hunter

Posted on Feb 28, 2013

Our clinic director, Kate — a recurring character in these blogs — has informed me that I need to blog if I want people to see our website. “Why should that matter?” I asked. And then she told me a lot more about SEO than I ever wanted to know, which in this case, was more than just what the letters stand for (Search Engine Optimization). In summary, she said, “Dr. Hunter, if blogs were logs, you need to become a blumber jack.” At least in this version of the story she did.

In an effort to aid me with topics — I usually end up wanting to write about what my 3-year-old is up to — the Hunter Vision staff each wrote me with a topic or two that they thought might be interesting. This SEO is helped when I write about medical things, apparently, and about LASIK, specifically. I am on board with this plan for two reasons. One, I am fully in support of anything that can get people to come to Hunter Vision. Laser eye surgery at this place adds joy to the world, and the world always needs joy. Two, if someone happens to be interested in eyes or medicine in general, it might be helpful.

With no further ado, I’ll start with an easy and anonymous (maybe because it wasn’t really an A effort question) staff question. “What is your favorite day of the work week?” Friday. Friday is laser day. People come in nervous and walk out really happy and I get to watch it all day long. I still remember the day I had my LASIK 10 years ago and it was one of the craziest days of my life. I just kept noticing that I could see things farther and farther away every hour. Having spent my life as Mr. Magoo, it was a miraculous event. That’s what Friday is to me. Getting to watch a modern day miracle happen over and over. It never stops being wondrous. If that language seems too lofty, then you probably don’t know what it is like living as a blind man without glasses. Or you’ve never seen Mr. Magoo. If it is the former, I am genuinely happy for you. If it is the latter, then I am sorry for you.

Written by: Dr. Joel Hunter

Posted on Feb 25, 2012

Today we’ll answer another of the “50 Tough Questions for your LASIK Doctor.” As I looked through the list again, I feel like maybe it should be named “50 Tough Questions for a Bad LASIK Doctor.” These questions, as it is in many other areas in life, are only tough if you’re wanting to hide something. “What did you do after work?” is an easy question for a husband that went to the florist to pick up flowers for his wife. It is a tough question for a husband that went to the dog track and lost all the money in their savings account. So with that clarification, here’s another of the 50 questions.

“What percentage of your previous patients have had enhancement surgery?”

I get a version of this question a lot. Most people are concerned that if they do this, they want it to be permanent and not have to worry about more surgery over the next year or two. To clarify, an enhancement is a “touch up” laser procedure to get someone to 20/20 if they didn’t quite do perfect the first time. There are a lot of factors at play in how often this happens. An enhancement rate will never be zero because whenever there is living tissue involved, there is the potential for unpredictability.

Here’s my answer up front. Our enhancement rate is about 1% and as far as I know, it is the lowest one in the galaxy. Here’s how we got it there:

First off, we spend a lot of energy on the front end trying to separate out good candidates from so-so candidates. Much of the reason for that is that good candidates have a much lower risk for having problems or needing enhancements (see this blog for more on that). After a whole host of 3D images of a candidate’s eyes show that we can help them, we can then proceed with 3D LASIK.

Secondly, not all lasers that perform LASIK are created equal. It is important to know that there are different makes and models that have different results in clinical studies. When we decided what lasers to get, we said, “Let’s get the absolute newest, most expensive, fastest, most technologically advanced lasers available.” And we did. And they were expensive! But wow, has it made a difference.

Lastly, I am neurotic about the drops that we give patients to use after surgery. Post-operative care is almost as important as the pre-op and intra-op. We spent a lot of time working out the perfect post-operative plan, and it helps deliver amazing results time after time. I have been called the “The Dwight Howard of Eye Drop Instructions” more than once—not really, but I’d like to get that started.

There are other factors that go into making an enhancement rate very low, but these are the main three. You should feel free to talk about enhancement rates at your consult. It is an important question to ask a LASIK doctor, but it shouldn’t be a tough one.

Written by: Dr. Joel Hunter

Posted on Feb 11, 2012

Kate, our Clinic Director, found a website with “50 Tough Questions for your LASIK Doctor.” She sent it on to me and thought it would be a good idea if I answered some of them for our blog. I said, “You don’t think people just want to hear about what I did for Thanksgiving or my son’s latest toddler escapades?” She has a point. For a LASIK practice’s blog, there is not a ton of LASIK focused writing. So I’m going to try to answer a few of the questions from the “Tough Questions” website. There are several good questions on there (and some ridiculous ones), but also, they have this amazing picture.

Here we go.

What percentage of refractive surgery candidates do you decline?

Great question! First off, you wouldn’t believe the variability, found clinic to clinic, in the testing that determines if someone is a candidate for LASIK. There are some places that do the bare minimum (check your prescription, and check to make sure your cornea isn’t too thin), and there are some places that do much more (things like corneal topography, dilated eye exam, cycloplegic refraction, etc.). Now that I come around to what we do at Hunter Vision, I am embarrassed to realize that I have to talk about how much more thorough a 3D LASIK evaluation is than what is done pretty much anywhere else. And I randomly picked this question! (maybe)

The average candidacy rate at many LASIK clinics is in the 85% range. At Hunter Vision, depending on the month, it ranges around 60%. We screen a lot of people out that have LASIK as an option, but not as their best option. The truth is, some people just will do better in glasses for now. On the flip side, some people will have way, way happier lives without glasses and contacts. The 3D candidacy exam is our way of sorting out these people. Kind of like sorting the sheep from the goats, but more like sorting the goats that should wear glasses or shouldn’t wear glasses. (Our editors strongly recommended I remove that terrible joke.) With 3D scans of the retina inside the eye, 3D scans of the cornea and lens at the front of the eye, and everything in between, it starts to become clear who should move toward LASIK and who should not.

But there is one thing that matters as much or more than that. Time. I spend about 20 minutes or so with each person that comes to Hunter Vision for their first (and only) evaluation, in that visit, we work together and figure out what would be best for their eye health and vision needs. My goal is not to get people under a laser, my goal is to provide results that will make people happy. That makes the decision making process more involved, but immeasurably more fun because it means that even with a low candidacy rate, there is a really, really high happiness rate.

Written by: Elizabeth Hunter

Posted on Jan 13, 2012

Happy New Year!

It is the time of year to make our resolutions and to decide how to better our lives. As we are testing will power and perseverance in our own lives, why not, in one more simple act, make someone else’s better.

THE EYEGLASS PROJECT is well underway and we’ve experienced an amazing outpouring of generosity from the community. We have accumulated about 700 pairs of glasses between drop locations in Hunter Vision, the RDV Sportsplex, and Northland Church. 

As we continue on this venture, we are adding some drop locations through Track Shack. If you are a runner as I am not, you can drop off any eyeglass donations at packet pick-up for all Track Shack races. As Hunter Vision proudly sponsors Track Shack, we will also have a Hunter Vision booth at all Track Shack races. If you are running or cheering or just staring in amazement that people can run so far and fast without being chased by a tiger (That’s me. I do that. While eating a churro.), bring your used eyeglasses and drop them off at our booth.

700 pairs donated and more to come! Isn’t this fun?