James Ball joined Bowcliffe’s impressive tenant roster just last month, opening up his state of the art Custom Vision Clinic to the world. From academic days at Cambridge to studying groundbreaking refractive surgery at the prestigious Lions Eye Institute in Australia, James is officially one of ophthalmology’s great minds. We took time out to speak to him about de-busting the myths about laser eye surgery and his passion for changing his clients’ lives through improving their vision…
Name: James Ball
Position: Founder, Custom Vision Clinic
Your CV and career history are fairly impressive, from Cambridge to Australia and London and all that’s in between. What was it that made you settle in glorious Yorkshire?
It was a ‘who’ rather than a ‘what’! My beautiful wife, who is Yorkshire born and bred.
Why did you choose ophthalmology rather than any other medical profession?
It’s just awesome! The impact eye surgery can have on improving a person’s quality of life is astonishing. I saw this for the first time when I was a medical student at Cambridge. I was sitting in on an eye clinic when a professor of Egyptology attended for a routine follow-up and brought along the book he had just written, which he had dedicated to his eye surgeon and the team at Addenbrookes. They’d saved the sight in his only eye and so he’d been able to continue working and writing and could see his grandchildren.
When did you found Custom Vision Clinic and what made you decide to branch out with your own business?
The Custom Vision Clinic opened its doors last month after our inspection by the Care Quality Commission who described our new facility as excellent. The idea for my own clinic was born out of a desire to improve the customer service and outcomes for my patients. The private hospitals I was working with just weren’t investing in the latest equipment for accurate diagnosis and surgical planning. So, I sat down and wrote a business plan, secured finance and when Lucinda showed me The Coach House at Bowcliffe Hall, I knew that I’d found the perfect location for my clinic.
What does a day in the life of James Ball look like?
Up at six and out the door before seven in order to get to the hospital in time for the pre-operative ward round at 7:45 am. Although I’ve sub-specialised in cornea and lens surgery, my operating list can be quite varied. From corneal transplants, cataract surgery, lens implantation or laser eye surgery. The clinic runs from 1:30 pm to 5:30 pm (sometimes later) and then home. The Drivers’ Club inspired me to change my car from an all-electric Tesla to a convertible with a normally aspirated engine, so this time of year if the sun is shining I put the roof down. Most evenings I play cricket with my son and before dinner, I head to the gym for half an hour. Later in the evening, I catch up on emails and clinic work before bed.
Tell us a little about your team, how many people do you have working alongside you?
I’m supported by Angela West (personal assistant and patient liaison). Angela has worked with me for seven years and is one of the very few people who can read my writing and understand my dictation. She is fantastic with our patients and able to offer a patient perspective because I performed lens replacement surgery for her five years ago. Caroline Thacker is our optometrist who works with us on a Monday and Wednesday. She has a wonderfully calming presence in the clinic and runs our programme of educational events for local optometrists. I have a plan for the team to expand over the next six months as we grow.
During your time at Cambridge, you won the Fawcett prize – what was that for?
It was awarded in the final exams to the student judged to have the best communication skills. It was a lovely surprise to be awarded this prize at the post-finals black tie dinner. My friends gave me a big cheer!
We’re told that you moved to Australia to undertake specialist training in and work on the development of new techniques in refractive surgery at the prestigious Lions Eye Institute. Can you explain to us what refractive eye surgery is and have those techniques made it back to the UK yet?
My family and I had a wonderful time in Australia. As a clinical fellow, I had a bit more time to spend with them and more time to think. I went primarily to work with a genius called Graham Barrett. Has our work made it over here? Absolutely! The new Lenstar biometry machine, which I’ve purchased for the Custom Vision Clinic contains the Barrett formula for lens calculation. It allows us to take our cataract surgery outcomes to another level. Refractive surgery is any surgery performed to decrease dependence on spectacles and contact lenses. This includes LASIK, SMILE keyhole laser eye surgery, ICL implantation and Refractive Lens Replacement. The cataract surgery we can offer at Custom Vision is so accurate that it can be considered refractive surgery.
What should people consider and what questions should they ask a consultant if they are planning on having laser eye surgery?
The first issue is that, in most clinics, people don’t meet the consultant until the day of surgery. The initial assessment is undertaken by an optician and a counsellor, who has received basic training in what to say to people who are interested in laser eye surgery. It’s often more about sales rather than a balanced discussion of the risks and benefits of treatment for that particular patient.
A lot of the key questions should have been answered by information available on the clinic website or pre-operative information and brochure: Who is the surgeon? Does he or she hold the Royal College of Ophthalmologists Certificate in Laser and Refractive surgery (CertLRS)? Do they offer all the available means of surgical correction of refractive error? Do they practice according to the new standards published by the Royal College of Ophthalmologists? I am on the committee which wrote these standards, so at the Custom Vision Clinic, we follow them.
Talk us through one of your more common laser eye surgery procedures…
We are one of only four clinics in the country which can offer Zeiss Presbyond LASIK laser eye surgery. LASIK is the go-to laser eye surgery treatment in most clinics. It’s provided excellent correction of short-sightedness and long-sightedness for the last two decades. What’s new with Presbyond is that we can now help people who are in their mid-forties and older to keep their reading vision with laser eye surgery.
What are some of the most common misconceptions about laser eye surgery?
- That it hurts
- That it’s risky
- That it doesn’t last!
Point 1: Laser eye surgery is incredibly gentle on the eye. There is no pain or soreness during the procedure. The eye is a bit sore for a few hours after the treatment but we give patients anaesthetic eye drops to use for that short period. The following morning, the vision is 95% recovered and the eyes feel completely comfortable.
Point 2: Modern laser eye surgery is extremely safe. The entire procedure is performed using lasers with accuracy to within a few microns. With our system, the only complication, which could cause a significant reduction in vision is infection. The recovery is so rapid after laser eye surgery that the surface of the eye has healed within a few hours. Everything which touches the eye during the procedure is sterile, single use, disposable. So the window of opportunity for bugs to get in and cause infection is incredibly small. In contrast, infection as a result of contact lens wear is a common problem presenting to the NHS eye casualty departments. So when people tell me that they wouldn’t consider laser eye surgery but they already wear contact lenses, I tell them that they have already embraced the concept of taking a small risk for an improvement in quality of life.
Point 3: We now have a wealth of evidence that the shape change we induce in the cornea with laser eye surgery remains stable over time (decades). Some short-sighted people show an increase in myopia through their twenties because their eye elongates. This is why we want the patient’s prescription to be stable for two years before we proceed with treatment. If they don’t have laser eye surgery, their optician just keeps prescribing stronger spectacles.
For all of us in our forties, there is a gradual loss of flexibility in the crystalline lens inside our eyes. This causes a gradual loss of the ability to pull focus from distance to near and back out again. So if someone has had laser eye surgery in their early thirties to give them excellent unaided distance vision, they will find in their late forties a gradually increasing need for reading glasses. They will, however, keep their excellent distance vision until they develop cataracts. If they hadn’t had laser eye surgery, they would need to move into varifocal or bifocal spectacles. We now have Presbyond laser eye surgery, which can help people in their late forties and early fifties regain a range of focus from distance through to near, without spectacles.
Do you see and treat more people with Myopia (short-sightedness) or Hyperopia (long-sightedness)?
Myopia is much more common, so we treat more short-sightedness. And people understandably want to both read and admire the view. We can achieve this for them now.
What age group and gender do you see most of? Do people tend to live with eye conditions for a significant amount of time before deciding to undergo laser eye surgery?
It is very common for people to come for help when they begin to experience problems with the comfort of their contact lenses. In all of us, the tear film quality decreases with age and contact lens wear causes dry eye. This can ultimately lead to difficulties with decreased wear time and discomfort in contact lenses. The other problems that trigger people over 45 seeking help are frustration with having to put glasses on and off, and needing lots of different pairs of glasses; for reading, computer work, driving, etc.
When did you move your offices to Bowcliffe and where on the Estate are you based?
We moved into the wing of The Coach House at the end of last year and our clinic opened last month.
On average, how many eye surgeries are you likely to complete each month?
I perform on average twenty procedures a week, so on average, eighty procedures per month.
What is the aftercare procedure and how long should patients expect to take to recover?
What’s extraordinary about the recovery after laser eye surgery is the fact that the vision is 95% there within 24 hours after treatment. The final 5% of recovery then takes six months on average. In the first few months, there is commonly some mild dryness and fluctuation of vision, which we manage with eye drops.
Can laser eye surgery now treat astigmatism (a common eye condition that causes blurred or distorted vision)?
Yes (up to six diopters, which covers the vast majority of people)
What would you say to someone who is considering eye surgery?
Stop considering and start taking steps to improve your quality of life. This calendar year, we are offering free consultations at the Custom Vision Clinic. The consultation allows us to determine if laser eye surgery, lens implantation or lens replacement will be safe and effective for you. It also happens to be the most comprehensive assessment of the health of your eyes
When you’re not helping to fix people’s eyesight, where are we most likely to find you and doing what?
Spending time with my family. These days that involves a lot of time spent watching my son play sport and my daughters perform in concerts.
What is your biggest achievement both in a work capacity and a personal one?
In a work capacity, it’s a tie between setting up my new clinic here at Bowcliffe Hall and setting up the laser eye surgery service at St James’s Hospital In Leeds ten years ago. This has not only generated money for the NHS trust but has allowed us to develop new treatments for NHS patients in Yorkshire, which are now being performed in other units in the country
In a personal capacity, I’m sure my wife and I would both agree that our three children are our biggest achievement.
Favourite part of the Bowcliffe Estate, why?
My clinic – it’s beautiful.
Favourite dish on the Drivers’ Club menu…
It’s all delicious – I just rotate around the menu and pounce on the specials.
Tell us three things that we would never know about you…
- I’m allergic to peanuts, pine nuts, chickpeas, lentils and kiwi fruit -I’m not going to become a vegetarian
- I support Coventry City Football Club (I was born there and so it’s my cross to bear)
- At Cambridge I became friends with Sacha Baron-Cohen whilst performing together in a Footlights production – I think he went on to do quite well
Share your social channels so others can follow and connect with you…
Twitter: twitter.com/customvisionuk
Facebook: facebook.com/customvisionclinics
Website: customvisionclinic.com