Seeing Eye To Eye

A New Treatment for Wet AMD: Only at Pepose Vision
Written By: | 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.

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A New Breakthrough Treatment For Endstage AMD: Only at Pepose Vision Institute
Written By: | January 23, 2012

The doctors at the Pepose Vision Institute are pleased to bring to St. Louis a new advancement in the treatment of age-related macular degeneration (AMD).  A new FDA-approved telescope implant is now available at Pepose Vision Institute to treat the most advanced form of AMD, or End-Stage AMD, in which both eyes have central vision loss. End-Stage AMD can develop from either the dry or the wet form of AMD and is not curable with drugs.  The telescope implant helps by using healthy areas of the retina to see instead of the area affected by the macular degeneration.

The telescope implant is used in a comprehensive patient treatment program called CentraSight.  The CentraSight treatment program includes several steps, including proper diagnosis, candidate screening/evaluation, possible surgery and visual rehabilitation.  Candidate patients will have the opportunity to look through an external telescope to help understand what it could be like to have the telescope implant in the eye.  The doctors at Pepose Vision Institute  are a CentraSight Center of Excellence and comprise a team that helps you decide if you are a candidate for the telescope implant and whether it may be the right choice for you.

We are pleased to make you aware of this new treatment option for advanced AMD.  It is covered by medicare.  If you or a loved one have the following:

  • Over age 75
  • Endstage AMD
  • No prior cataract surgery in at least one eye

Please call the Pepose Vision Institute today at 636-728-0111 for an evaluation by the Pepose Vision retina specialist, Dr. Nancy Holekamp.

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Confidence in the Care Delivered at Pepose Vision
Written By: | 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.

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A Second Opinion is Always a Good Idea
Written By: | 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.

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Quality Eye Care Does Not Take Place in a Factory
Written By: | 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.

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Making the “Un-Diagnosis”
Written By: | 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.

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Blog from London/Euretina Meeting
Written By: | 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!

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Women and Eye Health
Written By: | May 12, 2011

Did you know that each year, more women than men are diagnosed with vision threatening conditions? For example, of over 2 million Americans over age 50 with macular degeneration, over 1.3 million are women. Women account for 2.3 million of the 4 million Americans age 40 or older with diabetic retinopathy. Overall, women comprise 2.3 of the 3.6 million Americans age 40 or older who are visually impaired to the point where they do not qualify for a driver’s license.

Another common example is the finding that dry eyes are twice as common in women than in men. Underlying theories for these observations vary. For example, some have postulated that decreasing levels of androgens around the time of menopause may play a role in the development of dry eye syndrome.

Women are so involved in caring for their families, that often they may ignore their own health issues. I strongly encourage women to make eye health a priority both for themselves and their families, as many of these conditions can be effectively treated if detected early.

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Quantel Suprascan Laser
Written By: | January 18, 2011

On Wednesday January 12, 2011 a new era in laser surgery arrived at the Pepose Vision Institute.  The Quantel Suprascan laser for treating diabetic retinopathy, retinal tears, and retinal edema was installed. It is the only laser of its kind in the Saint Louis area.

What makes the Quantel Suprascan Laser special? A classic laser delivers a single spot at a time to the retina with a single action of the trigger mechanism, in this case, a foot pedal operated by the laser surgeon.  The Quantel Suprascan Laser delivers multiple bursts of laser spots in a pre-determined pattern with each action of the foot pedal.

What are the advantages to the patient? The use of the Quantel Multispot Laser allows the surgeon to place multiple laser spots simultaneously.  For a patient with proliferative diabetic retinopathy receiving 1000 laser spots, each session of laser will last less than 10 minutes compared to the15 to 20 minutes needed with the classical laser.  Also, the laser energy required to treat the retina is lower than that used by the classic laser, resulting in less pain for the patient.  Thus, the Quantel laser offers the patient an equally effective but shorter, more comfortable treatment.

The Quantel Suprascan Laser is used widely throughout Europe and is just beginning to be used here in the United States.  We are pleased to have a scanning pattern laser at the Pepose Vision Institute.

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