There’s a sign on the office wall of Johnny L. Gayton, MD, that displays a Bible verse: “Do all things heartily as unto the Lord (Colossians 3:23).” Dr. Gayton points to it as the philosophy that guides his entire practice, including its ASC.

“It means that you should do the absolute best that you can in all you do to honor [God],” he says. “That’s our overall philosophy right there. It means you should take care of people just as you would like to be taken care of.”

An ophthalmologist who opened his practice, Eyesight Associates, in 1983, just after finishing his residency at age 27, Dr. Gayton opened the doors of his ASC 17 years later in 2001. Based in Warner Robins, GA, about 100 miles south of Atlanta, Eyesight Associates comprises eight locations covering a predominantly rural area. But don’t let this small practice’s remote location fool you.

Expertise Builds Business

The ASC draws patients from all over the U.S. and many countries in Europe, Asia, and Africa, drawn in by Dr. Gayton’s expertise in the temporal and “piggyback” approaches to cataract surgery—both of which he pioneered in the 1980s. While the piggyback approach has fallen by the wayside in this country, it is still popular in Europe. The temporal approach, meanwhile, is the most widely used technique in the world in cataract surgery.

“I remember having dinner a couple of years ago with Mike McFarland [MD, an ophthalmologist in Arkansas], who developed suture-less cataract surgery. He and I were talking about how cool it was that two guys from rural areas in the South wound up changing ophthalmology.”

Today, Eyesight Associates’ ASC boasts almost 4,000 procedures a year, an annual patient volume of more than 2,000, and more than $3.2 million in annual revenues. The practice employs three surgeons, as well as 125 support staff across all eight locations. Dr. Gayton specializes in cataract, glaucoma, and a “smattering” of oculoplastic cases, while the ASC’s other two surgeons, Jack Johnson, MD, and Henry Schneider, MD, focus on cataract, MIGS, and laser procedures.

A Cautious Approach

Dr. Gayton is understandably proud of his practice, but he strives to maintain a sober perspective. For example, he does little to market the practice, preferring word-of-mouth and social media to mass media, such as print and TV advertising.

“We used to do outside marketing. We even had our own TV show, ‘Eyesight’s Insights,’” he says. “The thing is, we noted over time that we were spending a significant amount of money, but the majority of new people said they were coming in because of recommendations or reputation.”

Dr. Gayton takes a similarly conservative approach to technology acquisition: “Our criteria for technology comes down to: ‘Does it work, and does it improve our outcomes without making our patient flow go significantly awry?’”

By way of example, he cites the Ellex Tango Reflex laser which, he says, “has proven to be one of our best investments. It’s much more comfortable for patients undergoing SLT procedures, which we can frequently do in 2 minutes or less. Our volume has more than doubled since we added it to our practice. We were doing about 150 SLTs a year; now we’re doing 300. It also does YAG capsulotomies more accurately, and even treats floaters.”

Dr. Gayton cites similar reasons for acquiring the ARGOS biometer (Movu, Alcon), the NGenuity 3D (Alcon) heads-up imaging system, and the Optos ultra-widefield imaging system. “If [the technology] doesn’t interfere with patient flows and it significantly improves outcomes, we typically get it,” he says.

Perseverance Through Tough Times

Eyesight Associates and its ASC have faced several challenges. Like many practices, the early phases of the COVID-19 pandemic, when elective procedures, such as LASIK and SLT, were prohibited, were among the harshest.

“Our procedure volume dropped 90% per week,” Dr. Gayton says, who had to temporarily lay off some staff. “One thing that kept us going is that we were still allowed to do glaucoma and emergency cases,” he says, adding that he was able to leverage federal and state assistance to keep paying a portion of his staff’s salaries. “They appreciated how hard we worked ensure they had some income.”

Eyesight Associates was also significantly challenged by a major case of embezzlement by two trusted administrators, just as the center was being built in 2000. The embezzlement was so significant that it almost closed the practice. Community and banking support allowed it to continue, says Dr. Gayton.

Performance Metrics

With respect to measuring practice performance, Dr. Gayton looks very closely at patient outcomes, costs, and efficiency.

“If we see anything jump out, we address it very quickly. I used to do cases in my head before I went to sleep at night. I’d come up with ways to be more efficient, because time is money, and utilization of equipment and supplies is money as well. I’d come up with ways to transition instruments as little as possible, and more efficiently remove the cataract, or do the glaucoma procedure. That’s one of our measures of success as well, for we want to be as efficient as we can.”

He also relies on patient reviews, noting that every surgical patient receives a follow-up call, and online reviews are also scrutinized. “A big part of deciding whether we’re doing a good job is, ‘Do I usually have a patient ready to operate on?’ and ‘How do our patients feel about how we treated them?’”

‘We Can Always Care’

All of the success comes back to the philosophy that guides Eyesight Associates and its ASC: “Dr. Spencer Thornton, one of my mentors, used to say, ‘People don’t care how much you know until they know how much you care.’ We try to take care of people the way we would want to be cared for, and that goes for our staff as well. We can’t always cure, but we can always care.” ■