Seeing Eye To Eye

March is AMD Awareness Month

Written By: Nancy Holekamp | March 19, 2012

Age-related macular degeneration is now a disease in plain sight.  Thanks to public service announcements, increased news coverage, and Academy Award winning actresses coming forward to speak about their disease, AMD awareness has never been higher.   However, I would like to use this blog to educate patients on the 4 latest developments in managing and treating patients with AMD.  #1:  Genetic testing for AMD.  A simple swab of saliva from the inside of the cheek can reveal whether or not an individual carries the “bad” genes for developing wet AMD after age 60.  #2:  Early detection with the Foresee Home Device.  For patients genetically at risk for wet AMD, an FDA-approved, sophisticated home monitoring device (not unlike a computerized Amsler grid) can be used to detect conversion from dry to wet AMD and allow for early treatment with anti-VEGF injections.  #3:  Eylea injections.  This is the newest FDA-approved treatment for exudative AMD.  In clinical trials Eylea was shown to be effective when given every 8 weeks compared to Lucentis given every 4 weeks.  This ushers in the possibility of half as many office visits and injections for patients.  #4:  The implantable miniature telescope.  For select patients with untreatable dry AMD and select patients with advanced wet AMD who never received or failed anti-VEGF injections, the implantable miniature telescope offers the chance to regain reading vision.  These four advances represent state-of-the-art management in AMD.  The Retina Service at the Pepose Vision Institute is currently the only place in St. Louis where all of them are being used on a daily basis to help patients.

A New Treatment for Wet AMD: Only at Pepose Vision

Written By: Nancy Holekamp | January 26, 2012

The standard of care for wet age-related macular degeneration consists of injections into the eye of an anti-blood vessel, anti-leakage protein known as anti-VEGF therapy.  These injections are highly effective at preventing blindness from this devastating disease, but often they must be given on a monthly basis for a year or more.  Now, there is a new FDA approved anti-VEGF drug that can be given every two months – effectively cutting in half the number of doctor’s visits and the number a injections a patient might require over the course of a year.  The new drug is called Eylea and it is manufactured by Regeneron.  Eylea costs $1,850 per shot which seems like a lot of money except that it is $100 less expensive than the other FDA approved anti-VEGF drug on the market, Lucentis.  Eylea was FDA approved on November 18, 2011.  Within a week the drug was being offered to AMD patients at the Pepose Vision Institute.  The Retina Service at Pepose Vision Institute has been the only ophthalmology practice offering Eylea to patients with wet AMD in the St. Louis area since FDA approval.

Come to the Best Doctors at Pepose Vision Institute

Written By: Nancy Holekamp | December 28, 2011

Have you heard the old joke, “What do you call the person who graduates last in their medical school class?”  Of course, the punch line is “Doctor!”  Although funny at first, this joke is revealing a stark truth:  Not all doctors are created equally.  The doctors at Pepose Vision Institute have the very best training – and graduated at the top of their class from prestigious medical schools such as UCLA (Dr. Jay Pepose), Johns Hopkins (Dr. Nancy Holekamp), and  NYU  Medical School (Dr. Mujtaba Qazi).  All of the physicians at Pepose Vision are listed in America’s Best for their specialty.  For your eyes you undoubtedly want the very best care from the top docs.  You will find it at Pepose Vision Institute.

Confidence in the Care Delivered at Pepose Vision

Written By: Nancy Holekamp | December 5, 2011

Recently, a 47 year-old man presented to the Retina Service of the Pepose Vision Institute with a 3-day history of distortion in the left eye.  I diagnosed a rare condition called Angioid Streaks with choroidal neovascularization.  Untreated, it would lead to legal blindness.  Fortunately, sight-saving treatment was given that same day and the patient, relieved, was asked to return in one month.  During the month interval, the patient sought a second opinion from another retina specialist in the area who agreed with both the diagnosis and the treatment given.  The second physician commented on the fact that I was one of only 15 physicians in the area who could expertly diagnose and treat this uncommon condition.  Upon return to Pepose Vision, the patient sheepishly acknowledged he had gotten a second opinion.  My response startled him.  I said, “Good, I am so glad you did.  I want you to feel comfortable in the care you are receiving”.  The patient’s response back startled me.  He said, “I am very glad to be sitting here with you”.  The patient-physician relationship was solidified.

A Second Opinion is Always a Good Idea

Written By: Nancy Holekamp | November 1, 2011

A 57 year-old African American man presented to the Pepose Vision Institute seeking a second opinion regarding the slow, progressive loss of vision he had been experiencing over many years.  This patient had been seeing numerous ophthalmologists and no one had been able to give him a satisfactory diagnosis or explanation for his vision loss.  He had even seen “super-specialists” at academic institutions.  Vision was 20/40 in the right eye, which is good enough for reading and driving, but vision was only light perception in the left eye.  Simple questioning revealed that this gentleman had lost night vision and peripheral vision slowly over many years.  A dilated retinal examination displayed classic bone spicule formation in the retinal periphery diagnostic of retinitis pigmentosa.  Subsequent testing confirmed the diagnosis.  This patient was alarmed that the diagnosis had been missed by numerous ophthalmologists, some even specialists in hereditary retinal degenerations, over many years.  He had been sure he was seeing “the very best doctors”.   The moral of the story, if there is one, may be that a second opinion is always a good idea.  And, if you didn’t get your first opinion at Pepose Vision Institute, perhaps your second opinion should be from the doctors at Pepose Vision.

Aspirin Use and Advanced AMD

Written By: Nancy Holekamp | October 11, 2011

Recently in the press there was an article warning of the “dangers” of taking aspirin daily if you have age-related macular degeneration.  Before we stop a practice that has been validated over and over again in large clinical trials with thousands and thousands of patients (ie. Elderly individuals minimizing their risk of heart disease by taking aspirin on a daily basis) because of a single 839 patient epidemiologic study, let us look at the facts.

Researchers led by Paulus de Jong in the Netherlands collected health from nearly 4,700 people over age 65.  Of the 839 people who took aspirin each day, 36 had an advanced form of the disease called wet macular degeneration — or about four out of every 100 daily aspirin users.  In comparison, roughly two out of every 100 people who took aspirin less frequently had wet macular degeneration.  So…..we are comparing 4% of people to 2% of people.  Perhaps we should call for a larger study.  Actually, that is what Paulus de Jong has said:  “Larger studies that follow people over time and document their aspirin use and vision will help resolve aspirin’s role in macular degeneration.  He then added, “For people with cardiovascular disease who take aspirin to prevent the condition from worsening, the benefits of the drug outweigh the risks to visual health.  A healthy eye with full visual capacities is of no use in a dead body.”  I agree with Dr. de Jong.  Actually, he and I are members of the same international research society called the Macula Society and I hold Dr. de Jong in high regard.  I think his advice is worth taking on a daily basis.

Quality Eye Care Does Not Take Place in a Factory

Written By: Nancy Holekamp | September 27, 2011

Have you ever waited one, two, even three hours to see your eye doctor? Was the waiting room packed with not enough chairs for all the people? Were the technician’s who saw you before the doctor rushed? Then, once you were finally in the examination room did you receive less than 10 minutes of the doctor’s attention? Did you leave the office not really knowing your diagnosis or why the tests were ordered? If the answer to any of these questions is yes, you may need a new ophthalmologist or retina specialist. High quality, compassionate, patient-centered care doesn’t look like this. Pepose Vision Institute care does not look like this. At the Pepose Vision Institute, each patient is given individual attention from being walked back to the ophthalmic technician room, to getting state-of the art diagnostic testing from skilled staff, to seeing the doctor in a timely, professional manner, and finally to be walked to the front office for check-out. At Pepose Vision Institute, we believe that personalized healthcare is possible – and it doesn’t take place in a factory.

Making the “Un-Diagnosis”

Written By: Nancy Holekamp | August 4, 2011

A doctor offers each patient 3 things: diagnosis, prognosis, and treatment. If the diagnosis is incorrect, it follows that the prognosis and treatment will also be wrong. Recently, a 78 year-old man presented to Pepose Vision Institute seeking a second opinion regarding his diagnosis of age-related macular degeneration or AMD. As the leading cause of legal blindness in this country for people over the age of 65 AMD is a scary diagnosis, and one that should not be made without certainty. This patient was diagnosed 9 years ago, had been taking eye vitamins, and lived in fear of losing vision. I examined the patient carefully, noting the absence of any “drusen”, yellow spots on the retina required for the diagnosis of AMD. This patient, in fact, had a different non-blinding condition. Quite relieved by the good news, the patient was grateful for the correct diagnosis. It gave him new hope and a new outlook. At Pepose Vision Institute, the doctors will make sure every patient receives the correct diagnosis, something that should not be taken for granted.

Blog from London/Euretina Meeting

Written By: Nancy Holekamp | June 6, 2011

“Euretina” represents the European Society of Retina Specialists. Over 3,000 retina specialists from predominantly Europe but all over the world are meeting in London this week. The conference center is in the shadow of Parliament and Westminster Abbey. I was asked to participate in an international research symposium on the vitreous gel, the clear jelly inside the eye that occupies the large space within the eye behind the lens. Most people, including many vitreoretinal surgeons, consider the vitreous gel as unimportant. A small group of us researchers from around the world believe otherwise. In fact, I was asked to speak at this symposium because the research team at Washington University with whom I collaborate recently discovered that the vitreous gel metabolizes oxygen and protects the eye from oxidative damage. We all live in 21% oxygen and we are all slowly oxidizing all the time. The vitreous gel protects the inside of the eye from oxidation, and protects us from age-related cataract and some forms of glaucoma. Thus, the vitreous gel may represent more than meets the eye!

Avastin & Lucentis Clinical Study Results

Written By: Nancy Holekamp | May 6, 2011

CATT Trial Injections for Treatment of
Wet Age-Related Macular Degeneration
Reported in the New England Journal of Medicine

On Friday April 29, 2011 the results of the head-to-head trial comparing Avastin injections to Lucentis injections for treatment of wet age-related macular degeneration or AMD were reported in the New England Journal of Medicine. The study was a large, randomized, prospective clinical trial. In other words, it met the gold standard for research. The study found that Avastin and Lucentis were essentially equivalent. This is big news because the cost of Avastin is about $50 and the cost of Lucentis is about $2,000. We are all concerned with cutting healthcare costs. The study also found that monthly monitoring and receiving injections only as needed was essentially equivalent to receiving routine monthly injections. However, it is important that patients with wet AMD keep to a monthly schedule of visits with their retina specialist for the best results.