Pernoud Eye Institute: Where Skill and Technology Meet Family Values:

By Jane D. Palisch

For a large metropolitan area, St. Louis certainly awards a great deal of merit to family businesses. That’s because in our big-city lifestyles, with small-town ethics and ideals, St. Louis residents know there are family names you can trust for quality services. St. Louis is home to families of brew masters, restaurateurs, auto dealers, ophthalmologists—ophthalmologists? Yes, ophthalmologists—who maintain their reputations for excellence through generations by upholding the family’s values and expectations.

Here, in the midst of Missouri’s largest concentration of excellent medical care, you’ll find big-city clinical expertise provided with the pride and dedication that comes with upholding those family values and expectations. Pernoud Eye Institute gives its patients high quality care with compassion—that with which the Pernoud family name has become synonymous.

In 1978, Drs. Flavius and Joan Pernoud, the founders of Pernoud Eye Institute, made a commitment—to their specialty, their patients, their staff, their families, to their hometown and to each other—to provide leading-edge eye care. And, for nearly three decades, they’ve held fast to that commitment…and more. From routine eye exams to corneal and retinal surgeries, and oculoplastic surgery procedures, this husband-and-wife team remains dedicated to the cause. The Drs. Pernoud are passionate about their work, their patients, and their family; and, it all works synergistically to reveal a nearly 30-year practice filled with satisfied patients.

Today, Pernoud Eye Institute is known for effectively melding expert (years of experience using the latest techniques and technology) yet compassionate (patients are treated like family) care for virtually every ophthalmologic need their patients have. If you want to talk numbers, Pernoud Eye Institute currently has four doctors—each with his or her own specialty—eight exam rooms, a laser room, a surgical suite, a comprehensive diagnostic center and, as if that weren’t enough, a full-service optical shop. Add to all that a continually growing patient base. For this level of personal and professional success, the doctors credit the St. Louis family name and reputation component. “Many of our referrals come from other doctors, but we also receive referrals from (current) patients. There’s no better reference than a completely satisfied patient,” Dr. Flavius Pernoud says. And, in St. Louis’ big-city yet small-town atmosphere, word travels quickly.

Although they spent their South St. Louis childhood days living within six blocks of each other, the Drs. Pernoud did not meet until Flavius was a second-year undergraduate student and Joan Hutchins was a freshman at St. Louis University. The two commuter students began a relationship and career path that stayed the course through their undergraduate degrees, their completion of St. Louis University Medical School in consecutive years and ophthalmology residency programs at University of Texas.

As Flavius G. Pernoud III graduated from St. Louis University, he entered medical school as a third-generation Pernoud family medical student, a legacy of which he is proud. With his grandfather Flavius Pernoud (Flavius III refers to him as a “horse and buggy” doctor), who began the family tradition as a general surgeon and practitioner, and then his father (Flavius G. Pernoud Jr.) and uncle who specialized in ophthalmology, the path may appear to have been clear-cut.

However, ophthalmology, he confesses, was not always Flavius III’s goal with regards to specialty. “I was somewhat anti-ophthalmology and not interested in that field for awhile,” he says. Although he had interest in obstetrics-gynecology and orthopedics throughout medical school, Pernoud says he had made up his mind by the time he was a senior. “I liked ophthalmology because you get to see all age groups from infants to centenarians. I also like it because it’s very definitive. Most of the problems you can just look at, diagnose, and do something to help or alleviate the problem,” he explains.  “Eye surgery is intricate and interesting.  Above all the surgery is highly rewarding because restoring vision is giving back one of our most precious gifts.”

Midway along Flavius and Joan Pernoud’s mutual academic/career path the couple decided that, not only would they make effective partners in an ophthalmology private practice, but also a well-matched married couple. In 1970, with Flavius in his second year of medical school and Joan in her first year, the two married and officially became the third generation of St. Louis Pernoud physicians.

After both doctors completed their residency programs in ophthalmology, Dr. Flavius concluded fellowship training in corneal surgery and  Dr. Joan conducted research for the ophthalmology department on melanomas, the Pernouds returned to St. Louis. “Our whole focus was to continue the family tradition. While my father and I had separate practices, I practiced in his office part-time and, gradually, I did more and more of his surgeries,” Pernoud says.

The Drs. Pernoud first opened their St. Louis practice at Lutheran Hospital, later moved to a location on Hampton Avenue and, in 1990, moved “back home” to their present South St. Louis location on Chippewa. Throughout those transitions, the practice has grown in scope, staff and in the sub-specialty areas of ophthalmology to become the area’s leading full-service medical and surgical ophthalmologic practice. “We’ve been in a growth mode for 28 or 29 years now. We do so many different things here and truly can care for almost any (ophthalmologic) need our patients may have,” Pernoud says.

The Pernouds are proud to claim a practice with patients who feel like family—many who have “grown up” with them. “We love the atmosphere of ophthalmology because we sometimes treat entire families. It’s not uncommon for us to have a 95-year-old grandmother, a mom in her 60s, the granddaughter in her 40s and maybe even her kids who are around 16 or so. They all have their own set of problems, but our practice is geared to address the problems of everyone, regardless of age,” Pernoud says.

Although the diseases with young children are so different from those of adults and the elderly, Flavius says that ophthalmologists receive training for the problems people experience at any age. “We did a lot of pediatric ophthalmology in our residency and training.” Most young children and infants are referred to the practice by pediatricians who have identified a symptom of an ophthalmologic disorder. As a rule, Pernoud recommends that children have an ophthalmologic exam before age five. “If there is any history of eye problems in the family—like ‘lazy’ or crossed eyes (even if they are not evident in the early childhood years)—if it’s in the family, they should be seen by one year of age to rule out early or developing symptoms,” he advises. 

Thanks to the year he spent in a corneal surgery fellowship (beyond his residency training), Dr. Flavius began to develop his sub-specialty in corneal and external diseases of the eye. In this area of specialty, as one would expect, Pernoud developed expertise in a common ophthalmologic surgical procedure: cataract removal. As he began his practice in July 1978, the ophthalmology field had just begun to embrace the “new” technology for cataract surgery—intraocular lens implants—a procedure in which the surgeon replaces the natural lens of the eye with an intraocular lens (IOL) or artificial lens to replicate the function of the eye’s natural crystalline lens. Over the years, he further honed his skill in the procedure and gained experience, and in 1990, Pernoud established a career milestone as he was first in the St. Louis area to perform a significant advancement in this procedure called the “no stitch” surgery.”

In addition to the obvious (stated) benefits of the procedure, patients could resume normal activities almost immediately after surgery. Specifically, the procedure offered a reduction in the incision size (from 11 or 12mm in the traditional procedure to 3mm in his advanced method), softer IOL implants, and much less traumatic pre-surgical prep (no shot) and post-surgical recovery (no patch) issues. “The old procedure took about eight weeks to heal; you wore a patch afterwards. In the old days, you couldn’t bend over (for fear of rupturing the sutures). This incision is so small, it seals itself tightly,” he says.

“With a corneal subspecialty, the procedure I do most is cataract surgery,” Pernoud says. That is not too surprising because, according to National Eye Institute statistics, cataract affects nearly 20.5 million Americans age 40 and older. By age 80, more than half of all Americans develop the condition. The improvements in the procedure and ease of recovery have boosted the frequency with which the procedure is performed. “Cataract surgery is the number one surgical procedure performed in this country today,” he says.

In keeping with Pernoud’s corneal subspecialty, his surgical expertise also includes corneal transplants and refractive surgical procedures that reduce refractive error and offer permanent vision correction for myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. These procedures include laser assisted in-situ keratomileusis (LASIK), designed to minimize a patient’s dependence on glasses or contact lenses. LASIK and similar refractive correction procedures have grown in popularity due to their overall success including near-immediate results and little-to-no recovery time or restrictions.

Although a common (and elective) surgery for many of Pernoud’s patients, the procedure is nothing short of a small miracle that ends the day-in, day-out routine of misplaced eyeglasses, scratched lenses or daily contact lens maintenance. “Many patients say LASIK changes their lives so dramatically. They’re so grateful to be less dependent upon and typically free from glasses and contact lenses for many tasks.  I recall one patient saying, ‘Dr. Pernoud!  Thank you so much!  I can’t believe I could see the alarm clock and even drove here without my glasses!’!” Pernoud says.

Flavius Pernoud’s wife and professional partner, Dr. Joan Pernoud, shares in the opportunity to offer many vision-improving and sometimes life-changing procedures. In 1990, when she and husband Flavius moved their practice to the current location, Dr. Joan Pernoud found her broad spectrum of ophthalmologic skills leaning toward and growing in the direction of an oculoplastics subspecialty. The specialty, which merges the techniques and skills of ophthalmology and plastic surgery, includes the treatment of eyelid disorders, tear system dysfunctions and reconstructive surgical procedures.

Procedures in this subspecialty include repairing external defects or conditions such as removing tumors from the eyelids and surrounding tissue, blepharoplasty (upper and lower eyelid lifts) and Botox™ cosmetic wrinkle injections. Oculoplastics, Dr. Flavius says, is a subspecialty of ophthalmology and is routinely taught in ophthalmology residency. The area surrounding the eye requires extreme precision and expertise, which Dr. Joan’s surgical skills reflect. “When removing tumors from the eyelid or surrounding tissue, one must be aware of eyelid function—like tearing and blinking. If those are disrupted, it can cause significant problems,” Dr. Flavius Pernoud says. Skin cancers that occur on the eyelids, nose or eyebrow area also may invade the eye socket. Depending upon the size and depth, the cancerous lesions or nodules must be removed, and reconstructive surgery may be necessary to restore the function and appearance of the surrounding area.

Some oculoplastic procedures are performed for reasons of both function and aesthetics. Blepharoplasty, a procedure to repair droopy upper eyelid skin and puffy bags below the eye in the lower lid, can improve peripheral vision (in severe cases), and also serves to enhance facial appearance. Dr. Joan Pernoud often uses Botox™—again, for both function and aesthetic purposes—to treat eyelid spasms and other conditions as well as facial wrinkles (like “crow’s feet”) surrounding the eyes. When used for facial wrinkles adjacent to the eyes and forehead, Botox™ can serve as an alternative for patients who do not wish to have more invasive cosmetic surgical procedures to address or alleviate these signs of aging.

In addition to her skills in oculoplastics, Dr. Joan has earned professional distinction serving as an expert in rating levels of disability due to eye injury. “In addition to her oculoplastics work, Joan also does workers compensation evaluations for the state. There are guidelines for eye injuries to determine an individual’s level of disability based on the rating system established by the state of Missouri. She has developed a reputation for being able to do these assessments and ratings accurately,” Dr. Flavius says. Her expertise in this area makes her a sought-after resource for attorneys and insurance companies that require accurate clinical assessment regarding vision loss.

In addition to the Drs. Pernoud, the Pernoud Eye Institute’s professional family includes Ishaq Chishti, MD, FACS, whose four-year ophthalmology residency and fellowship in diseases and surgery of the retina at Harvard Medical School, and nearly 35 years experience provide patients with another important dimension of expert ophthalmologic care. His subspecialty area encompasses the diagnosis and treatment of retinal diseases and disorders including diabetic retinopathy, macular degeneration, macular holes, retinal tears and retinal detachment. “Dr. Chishti adds an important component to our practice for our patients with retinal disorders. Many of these problems, if diagnosed early, are treatable. Dr. Chishti’s expertise in this area completes the spectrum of surgical eye services offered at Pernoud Eye Institute,” Flavius says.

Cathy L. Phillips, OD, rounds out the clinical family at Pernoud Eye Institute. Since May 2006, Dr. Phillips has served as optometrist for the practice, providing comprehensive eye exams and vision services. She specializes in specialty contact lens fittings as well as general eye care. Her excellent optometric services, coupled with the Eye Institute’s on-site optical shop, make vision correction a one-stop convenience for patients—even those who require unique or hard-to-fit contact lens solutions.

Pernoud Eye Institute, perhaps because of its staying power as a St. Louis family business and reputation for excellence also has become a go-to resource for glaucoma treatment. The disorder, which results from elevated pressure in the eye, causes damage to the optic nerve, resulting in vision loss. While the disease affects millions of Americans, only about half of them are aware they have the disease. That’s why, Dr. Flavius Pernoud says, screening for glaucoma is so important for everyone and even more so if older relatives are diagnosed with the disease. He explains that glaucoma affects about 3 percent of the general population. If an immediate family member—mother, father, sister, brother—has it, other family members have a 30 percent chance of developing the condition.

“Statistically,” Pernoud says, “anyone with a family member with glaucoma is 10 times as likely to have it as the average person. You should be screened for glaucoma by the age of 50…before that, if it’s in your family.” The practice, Pernoud says, has developed a reputation for diagnosing and treating glaucoma. “We’re known in the community as glaucoma specialists. As is necessary with this disease, we follow patients along to make sure we maintain control over the pressure level. It’s a complicated disease. As a result, we’ve accumulated many patients whom we’ve been treating and monitoring for years,” he says.  “This is one of the reasons having a full-scale diagnostic center on site is so important.”

And that, as you can imagine, is just what this family-based practice is all about: staff that works comfortably together like family, treating patients as if they were family. “When people come in, we treat them as we would want to be treated. We’re here to help them overcome their problems. A patient’s time is important, so we work to get them in and get them out promptly. Most of all, we want people to feel comfortable here,” Pernoud says.

Although ophthalmology is a just one portion of a patient’s medical care, Pernoud feels that the specialty has “an element of general health.” Symptoms of many general medical problems, like stroke or diabetes, he says, often appear in the eyes. While patients may have no other noticeable symptoms, the ophthalmologic effects of other illness may be the first warning sign of a general illness. “We take good care of our patients,” he says.

Although marketing experts may profess that businesses should not try to be all things to all people, when it comes to family and eye care, it works…and it works well. “We’ve tried to be all things to all people. We have a lot of the bases covered,” Pernoud says.

Family treating patients like family—that’s what you’ll find along-side the latest techniques and the cutting edge technology. In the St. Louis tradition, the Pernoud Eye Institute is a family name you can trust for big-city quality in services with small-town family values and expectations.