The ability to see clearly, even if we use glasses or contacts, is something nearly everyone takes for granted. But when our sight is threatened--by an accident, by age, by disease--our eyes need specialized help. And for a variety of vitreoretinal problems, the surgeons of Retina Vitreous Associates, Inc., can provide that help, using the latest technology to diagnose, repair, and improve their patients' vision.
Vitreoretinal disease is a subspecialty of ophthalmology, with fewer than 1,000 practices nationwide. The word "vitreoretinal" refers to the retina, a very thin, transparent tissue that lines the inner eye wall and corresponds to the film in a camera; and the vitreous body, a transparent jelly that fills the space between the lens at the front of the eye and the retina at the back. Physicians specializing in vitreoretinal disease are surgeons who have chosen to subspecialize within the special field of ophthalmology, completing a lengthy education process to be so designated. Sandra Chem, M.D., who practices at the Fort Wayne Retina Vitreous Associates office, completed her undergraduate work at Pennsylvania State University, and received her M.D. from Jefferson Medical College. She took her internship at the University of Pennsylvania and her residency at Indiana University Medical Center. Dr. Chern completed her fellowship in vitreoretinal disease at The Massachusetts Eye and Ear Infirmary of Harvard University, and is now using her extensive education to "keep patients from losing more vision."
According to Debra S. Seward, professional relations director, Retina Vitreous Associates is not a franchise, although the practice supports 13 offices in Ohio, Michigan, and Indiana. Dr. Jerald A. Bovino, who founded Retina Vitreous Associates 10 years ago in Toledo, Ohio, saw the need to bring this subspecialty to people in smaller cities and towns.
After establishing offices in other Ohio locations such as Sandusky, Mansfield, and Bryan, and a Michigan office in Monroe, the Fort Wayne office, located at 7305 West Jefferson Blvd. in Sleepy Hollow Professional Plaza, was opened in March 1994. A satellite office opened last summer in Muncie. Currently, 12 physicians provide care to patients in the three-state area.
Each regional office is completely staffed and equipped, with nurses, technicians, office staff, and physicians. There is also a designated outpatient surgery site for each region for procedures that can't be completed in-office. For the Fort Wayne office, outpatient surgery is performed at Dupont Surgery Center at 2510 Dupont Road.
The Fort Wayne office consists of a receptionist (actually two people who job-share), a photographer, two technicians, Seward, and Chern. The main office remains in Toledo, where billing and insurance filing services are based. Having insurance filing services centralized in the Toledo office means that doctors can spend more time seeing patients, and less on administrative matters, Seward says.
Although Chern, originally from the Washington, D.C. area, is the only physician who lives in Fort Wayne, four doctors practice in Indiana, making the commute from Toledo to see patients weekly: Charles K. Dabbs, Samuel R. Pesin, and Susan M. Malinowski.
Chern's day consists of a mix of seeing patients and performing surgery. One day a week she travels to Muncie (a doctor from Toledo staffs the Fort Wayne office that day).
Martin Kelly is the in-office photographer, but he's not there to take portraits of patients. Rather, he takes portraits of the inside of their eyes for diagnosis and monitoring purposes. The office has a darkroom, and Kelly draws on his former commercial photography experience and his continuing education in medical technology to aid the staff in their care of patients.
Education of the patient is important to the physicians and staff of Retina Vitreous, and each patient is provided with a wealth of clearly written, easily understandable information concerning his or her condition. According to Seward, each patient needs to understand his or her diagnosis, options for treatment, and how to monitor the condition at home. Videos are also available for patients to view in the office or at home.
Patient demographics are spread out more than one might think, Seward says. Although many patients are elderly, because of diseases like diabetic retinopathy (which can affect diabetic patients in early middle age), and sports injuries (often to teenagers), the doctors at Retina Vitreous treat patients of all ages.
"I do see more young people than you'd think," says Chem. Recently, she operated on a 6-year-old who had a hereditary retinal disease, and on a 10-year-old who had a retinal detachment caused by trauma.
Ninety-nine percent of patients seen by Retina Vitreous Associates are referred by another eye specialist such as an optometrist or ophthalmologist, says Seward. While all eye specialists are trained to diagnose and treat conditions such as cataracts and glaucoma, and to fit patients for corrective lens, retinal problems can be complicated and treatments are specialized, often involving microsurgery. Not all ophthalmologists are trained in this area, Chern says.
Most of the surgeries completed by Chern and her associates is outpatient. Besides being cost-effective, another benefit is that patients do well recuperating at home. The most common post-operative need is the administration of eye drops, and family members are instructed on how to do this. According to Chern, all the surgeons at Retina Vitreous are approachable and easy to work with, and strive to help educate patients. "We pride ourselves in patient education, and that starts with the surgeons," she says.
The cost of care varies greatly from patient-to-patient. Using the Dupont Surgical Center keeps surgery costs low. Medical insurance covers the cost for those patients who have it, but Retina Vitreous Associates won't turn anyone away who needs their services. They also work with city agencies to identify and help treat those in need. Vitreoretinal treatment is usually covered by insurance, Seward says.
Age-related macular degeneration (AMD) is the leading cause of poor vision in the United States, and is a current "hot topic" in the media because of recent coverage on ABC-TV's "20/20" news magazine, says Seward. The macula of our eye is the small, specialized area in the center of the retina which is responsible for our clearest vision. Age-related macular degeneration is very common and occurs in older people. As AMD progresses, the central vision begins to blur, although peripheral vision is unaffected. There are two types of AMD: "dry" and "wet." In dry AMD, which 90 percent of patients have, the decrease in central vision is mild and deteriorates slowly. The more severe, and rare, wet AMD is caused by abnormal growth of blood vessels underneath the retina, causing severe bleeding and scarring. The cause of either type of AMD has not been identified.
Unfortunately, there is no cure for either type of AMD. Laser surgery only improves vision in a small percentage of AMD patients who have certain types of the wet form; for most dry forms of AMD, laser surgery only stabilizes vision and sometimes helps prevent further deterioration. No medications have proven effective, and vitamin regimes containing zinc, vitamin E, and selenium, touted on TV and in magazines, are controversial at best.
"Nothing has been proven to be effective in reversing or slowing down macular degeneration," Chern says. "We do recommend [vitamins] for some patients, but we caution them that nothing has been proven. It's a frustrating problem."
The second most-common disease Chern treats is diabetic retinopathy. Diabetic retinopathy occurs due to changes in the blood vessels of the retina; the longer a person has diabetes, the greater the risk of developing diabetic retinopathy. Chern urges all diabetics to have regular examinations, for the damage is silent and may be preventable. Careful management of diabetes can prevent or postpone the development of diabetic retinopathy.
Of all the types of treatments she performs, most satisfying to Chern is performing surgery for retinal detachment, which responds well to surgical repair. "Patients regain a significant amount of vision," she says with a smile.
In retinal detachment, trauma to the body or head causes the retina to tear away from the wall of the eye. When that happens, vision is lost in that area. In many cases, surgical repair can restore vision and prevent blindness. The sooner surgery is done, the more vision can be saved, and she often finds herself in the operating room at all times of the day or night, weekends included.
Recovery is slow for retinal surgery, says Chem. It will probably be a minimum of six weeks before a patient notices a change in vision, and six months to a year before the full benefit is realized.
For some conditions, such as treatment of diabetic retinopathy, a laser treatment can be completed in the office. But Chern emphasizes that not every condition is treatable by lasers.
"Retinas can't be reattached (by lasers), they can't drain fluid, they can't remove scar tissue on the inside of an eye," she says. In some of these cases, microsurgery--surgery performed under microscopes using special instruments--is necessary.
The terms "laser surgery" and "microsurgery" have become commonplace our vocabulary, but Chern says if we could peek in an operating room, we'd be amazed at the equipment necessary. "There's lots of high-tech equipment set up for internal treatment and microscopic surgery," she says. The special equipment needed requires specially-trained staff, such as that at Retina Vitreous Associates, Seward adds.
Although some patients, such as those with diabetic retinopathy, are seen on a continuing basis, other patients are returned to their primary doctor's care once their treatment is completed. For all patients, their primary doctor is responsible for any corrective treatment a patient needs (glasses or contact lenses) and for conditions outside of the subspecialty of vitreoretinal (cataracts, glaucoma).
The future holds innovations in retinal work, says Chern. "Lasers are becoming more compact and portable," she says. Several years ago, a laser used in an office took up half a room; today, some fit in a suitcase. There are new surgical instruments for sub-macular surgery that allows a surgeon to remove blood clots and vessels from underneath the retina. New gases and liquids are being developed that can be injected into the eye and will improve surgical techniques. And the continuing development of microsurgery is exciting.
With education, the latest diagnostic and surgical techniques, the most up-to-date equipment, and a team of committed and caring physicians and staff ready to help them, the patients of Retina Vitreous Associates can take for granted the quality care their eyes will receive.
Company Retina Vitreous Associates of Indiana Inc.
Owner / Founder Jerald A. Bovino, M.D.
Address 7305 W. Jefferson Blvd. Sleepy Hollow Professional Plaza
Phone (219) 436-5050
Years in Business 20
Number of Employees 7 physicians
Products/Services The diagnosis, treatment, and continuing care of diseases and conditions of the retina and vitreal body, including laser and microsurgery
