Up Close with Josh Johnston, OD, FAAO

Were you always interested in a career in optometry?

I didn’t have my first eye exam until the first couple of weeks of optometry school. I was not always interested in optometry specifically, but I was always interested in health care. When I was in junior high, in the 1990s, there were all those medical shows on TV like ER, and also others that showed real-life surgical cases being done. They interested me and sparked my curiosity.

I went through college as premed but didn’t know what direction I would take. After graduating, I moved back home to Austin, Texas, and worked for an optometrist for a year to see if I liked it. I enjoyed the idea of running a business in a private practice setting and providing health care.

When did you know you wanted to become an optometrist? Was there a particular person who influenced you?

The father of my high school girlfriend was the first physician to perform a heart transplant in Texas. He let us come watch him do heart transplants and I fell in love with hospitals and health care.

In my senior year, I got into a program that gave me exposure to every medical specialty in a hospital. For 2 or 3 hours a day our class was at the hospital in various capacities, and that experience led me to become premed. In college, an older friend who was pre-optometry sparked my interest in that field.

You oversee a dry eye center of excellence. How did you come to be interested in dry eye and ocular surface disease?

I was at Georgia Eye Partners from 2004 to 2009, and at that time we were pretty small, just myself and a couple of ophthalmologists. I primarily worked at our Emory Midtown Hospital location, an inner-city hospital, and we would see a ton of pathology, glaucoma, trauma patients—every specialty in that 20-floor building was referring patients to us.

I then moved to California, where I joined a large group. I was doing more bread-and-butter optometry with optical, some medical management, and postoperative patients, but primarily annual eye exams, contact lenses, and glasses. I missed medical optometry and realized after attending a lecture that I wasn’t doing anything about dry eye or asking patients about dry eye symptoms.

I moved back to Atlanta in 2011 and started the dry eye clinic. There’s no silver bullet or one drop that we have to give or one cure per se. I think that’s why I love dry eye. It’s unique and challenging.

What, in your opinion, are the best aspects of working in an OD-MD practice?

The biggest opportunity for me in an OD/MD practice is the wide variety of pathology. We see everything here except surgical retina and pediatrics—we have oculoplastics, neuro-ophthalmology, three surgical glaucoma specialists, and five cornea specialists, as well as our optometrists. Every day is different. Every patient is different. We see such a variety of challenging and interesting cases.

What is your impression of the latest generation of optometrists? How are they different from your generation?

I’m 44. Most of my career has been spent as a clinical director and a residency director. A lot of that is maintaining business development relationships in the community, talking to referring doctors, engaging them as customers, and helping their patients get good care at our practice. For us, it’s all about treating patients well so they have good outcomes, and then maintaining good communication with the referring doctors. Some younger doctors aren’t familiar with the history of battles between ophthalmology and optometry, and they may take comanagement and the improved scope-of-practice laws for granted.

Some of the doctors before us had to fight for the ability to prescribe many treatments such as dilating drops, therapeutics, and oral steroids. I’m now calling on the younger generation to further develop our referral management opportunities. They’re mainly focused on good outcomes and good communication. They all are getting good training now, but they may not know how long it took us to get to where we are today.

You used to do triathlons. As a father of three, what keeps you busy now, outside of work?

Triathlons were fun, and there was a period of my life where that was something I really enjoyed, but it’s hard to do with my schedule these days. I do miss the thrill of competing, though, so I’m signed up for an event in Vermont in October where I will be climbing the equivalent of Mount Everest (29,000 feet) in a day and a half. As a dad, I get to coach some flag football and soccer. I get a little bit of the competitive bug from these opportunities.