We don't just use the best technology. We helped develop it.
Dr. Jay Pepose is one of the foremost cornea-subspecialty trained surgeons in the region and across the country. He has done pioneering work on tissue rejection and has served as Medical Director of MidAmerica Tissuebank Services, located in St. Louis. Dr. Pepose has performed thousands of corneal procedures, restoring and preserving the vision of infants, athletes and patients from all walks of life. The key to his success, and that of his team of cornea-trained surgeons, has been an uncanny ability to use the results of sophisticated diagnostic technologies to determine the appropriate surgical treatment for each cornea patient. Moreover, our cornea-trained surgeons are on-call 24/7, 365 days a year, so that any concerns can be addressed before they become major complications that threaten the initial transplant.
Because outstanding vision outcomes depend upon high-quality, precise preoperative analysis of your eyes, as well as advanced treatments and surgical techniques, we encourage you to learn more about:
Our State-of-the-Art Diagnostic Tests
- Ultrasonic Pachymetry Accurately measures corneal thickness
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- Orbscan and Atlas Corneal Topography A 3-D Map of Your Eye
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- Specular Microscopy How much has your cornea deteriorated?
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Our Advanced Treatments and Procedures
- Corneal Transplants Out with the old. In with the new.
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- DSAEK A new technique for faster recovery
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- Amniotic Membrane Transplants - Nature's miracle procedure
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"Thank you for changing my life. I never realized how much I was missing." -- Lynn Felken
Our State-of-the-Art Diagnostic Tests
Ultrasonic Pachymetry Ultrasonic Pachymetry produces reliable and reproducible measurements of corneal thickness. While Pepose Vision Institute begins its eye examination with this standard test, it progresses rapidly to the latest state-of-the-art technologies that provide additional information and confirmation of your corneal damage or disease.
Orbscan and Atlas Corneal TopographyPVI is one of the few centers in the nation to evaluate all of its cornea patients using both the Orbscan and Atlas corneal topography instruments. Topography is a way to measure the shape of the cornea. We evaluate your cornea at over 8,000 points and the various elevations are then represented as color maps. Just as the height of land can be viewed from a helicopter circling above, the elevated peaks of the cornea can be printed in hot colors such as red and orange, and the valleys printed out in cool colors such as blue.
We measure both the front and back surfaces of the cornea. Its thickness at all locations can be plotted out, and a 3 dimensional reconstruction of the shape of the eye can be created that can be rotated and viewed by our surgeons at all angles. The Atlas topography device provides specialized computerized screening to evaluate the progression of a cornea condition called
keratoconus.
Both diagnostic instruments give an extremely detailed depiction of the state of your cornea, including surface defects, scarring and thinning.
Specular MicroscopyThis instrument is used to monitor the number, density, and quality of endothelial cells that line the back of the cornea. A specialized microscope magnifies the cells thousands of times and the image is captured with a still or video camera. The number of cells within one square millimeter are counted and recorded. The endothelium of a young, ten-year-old, healthy cornea has approximately 3,500 cells in each square millimeter. Normal aging causes the cells to gradually decrease over time. By age 60, most people have approximately 2,500 cells per square millimeter. Pepose Vision Institute is one of the very few eye practices in the region to have invested in this instrument in order to better diagnose the reason for initial corneal failure especially when due to genetically inherited diseases that affect the cornea - and to customize our cornea treatments to each patient's unique vision problem.
After We Accurately Diagnose Your Eye Problem, We Decide on the Best Treatment.
Corneal TransplantsCorneal transplants entail removal of your diseased or damaged tissue, and replacement with the donor tissue. After taking measurements of the amount of tissue to be removed, the diseased cornea is safely cut and lifted away from the eye. The donor tissue is cut to a matching size and placed on the patient's eye. It is held in place with very fine stitches that may be removed anytime from one month to a year after surgery. If there is also a cataract present, this can be removed at the same time and replaced with an intraocular lens. At the completion of your transplant surgery, a patch and a metal shield are placed over your eye to protect it.
Pepose Vision Institute performs most of its corneal transplants using local anesthesia, thereby enhancing the speed of recovery and avoiding complications inherent in the use of general anesthesia. As tissue banks have grown and distribution networks become more sophisticated, corneal transplants can now be "scheduled" most of the time. Only rarely must a transplant be delayed or rescheduled due to the lack of acceptable tissue. We perform most of our transplants at an outpatient surgery center, depending upon a patient's health status and surgical risk. The operation usually lasts between 1 and 2 hours, and most patients are discharged after a short stay in the recovery room. Your post-operative care will be intensive: our surgeons partner with you to ensure that very best vision outcome from your transplant. As soon as your vision stabilizes, we will fit you with glasses or contact lenses to maximize your vision potential.
Eye drops and ointment will be prescribed to avoid infection and minimize the risk of tissue rejection. The eye drops are required for at least a year and more often longer, to prevent rejection of the transplanted cornea. It is imperative that you comply with your medication schedule to assure the very best outcome from your corneal transplant.
DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty)DSAEK is the newest surgical technique for corneal transplantation. It permits our surgeons to transplant only the back layer of the cornea, when medically indicated. This procedure may lead to a faster visual recovery than the traditional "full thickness" transplant. It requires fewer sutures and may induce less astigmatism. In the DSAEK procedure, a thin piece of donor corneal tissue containing endothelial cells and posterior stroma is placed in the eye through a small incision on the side of the eye. This tissue adheres to the back surface of the old cornea and clears the corneal swelling. Since we use a smaller incision than in "full thickness" transplants, the eye is left stronger so that if it is inadvertently struck there is less likelihood of a serious injury.
In order to make the new tissue stick onto the back of the old cornea, an air bubble is used to completely fill the front part of the eye for an hour after surgery. After that time the air is partially released and left overnight. During the first twenty-four hours, patients must stay on their back as much as possible to keep the air bubble positioned correctly, anchoring the new tissue in place.
Like full thickness corneal transplantation, eye drops are required for at least a year and more often for the rest of your life to prevent graft rejection. Similarly, you will need to wear eyeglasses or contact lenses after the transplant, in order to maximize your vision potential.
Amniotic Membrane TransplantsDr. Jay Pepose was the first in the entire nation to perform an amniotic membrane transplant. This type of surgical intervention may be performed in situations in which spontaneous healing of the surface of the cornea fails to occur, such as in cases of chemical burns, or where the cornea is severely infected. It is not the procedure of choice when the cornea is severely damaged, such as when a perforation occurs. The amniotic membrane, which surrounds the fetus in the womb, is a unique source of 'biological dressing' that has been used in wound healing for decades. These membranes appear to contain large amounts of growth factors (which encourage tissue regeneration), as well as anti-bacterial and anti-scarring properties. They are especially useful as tissue grafts because they do not encourage autoimmune rejection (as happens in organ transplant, for example). Amniotic membrane transplants have also been successful in promoting the growth of corneal tissue and in preventing corneal scarring. Within two months, the amniotic membrane tissue "dissolves," leaving healed corneal tissue in its stead.
The amniotic membrane is "harvested" at the time that a baby is born, when it is no longer needed to sustain the baby. In this way, the miracle of birth can provide the miracle of sight to our cornea patients.
