A List of Major Procedures We Offer:

Lasik -- Laser Vision Correction:

LASIK is permanent vision correction that reduces or eliminates your dependence on glasses or contact lenses.

Dr. Pernoud has been performing refractive procedures for over 15 years and now offers one of the most advanced treatments for correcting nearsightedness, farsightedness, and astigmatism.

Studies have shown that 98% of patients who have nearsightedness achieve 20/40 uncorrected vision or better after the LASIK procedure. This is the level of vision necessary to pass a driver's test without glasses. Many patients achieve 20/20 vision or better. The Armed Forces are using this technology to improve the vision of its pilots.

Dr. Pernoud utilizes the latest Intralase laser to create a thin flap on the surface of the cornea without the need to use a cutting blade. The flap is lifted and laser energy is applied to the exposed surface. The latest VISX S-4 laser guided by wafefront technology creates a custom laser carved surface for each eye. An amazingly accurate pupil tracker instantly corrects for the tiny movements of the eye. Usually, in less than a minute, the laser corrects the vision.

Those choosing this procedure can walk out of the office an hour later with a new outlook on life. Call today to schedule a free personal assessment to find out whether you are a candidate for this amazing vision correction.

Cataract Removal:

When we are born, the lenses of our eyes, are usually perfectly clear. The lens of the eye is inside the eye behind the pupil. With age and sometimes from medications, radiation, or other factors, the lenses become cloudy. This process is usually very slow and may not be noticed until the vision is affected.

Most people first notice problems with their night driving. Lights at night have halos around them, street signs become difficult to read until the driver is close to them. The lines in the street may become hard to see. Eventually, driving during the day becomes a problem because of glare. Reading finally becomes more difficult. Because the decreased vision is caused by the clouding inside the eye, changing the eyeglasses prescription does not improve the vision.

To correct the vision, the cloudy lens must be removed surgically. There are no medications, eyedrops, vitamins, or diets that help. Contrary to what you may have heard, lasers cannot be used to remove cataracts.

Dr. Flavius Pernoud was the first surgeon in the St. Louis to perform No-Stitch, No-Shot, No-Patch cataract surgery. In modern cataract surgery, the eye is anesthetized with powerful eyedrops. No shots are needed. The eyelids are gently held open with a special lid holder. A 3 millimeter (about 1/8 inch) incision is made in the wall of the eye. By using a special computer driven instrument called a phacoemulsifier, the lens is pulverized and the pieces are removed. After the lens has been removed a small clear acrylic lens is implanted back into the eye where the original lens was positioned. The implant holds itself in place permanently and corrects the vision. The specially created tiny incision seals itself and stitches are not needed to close it.

Often, the vision is good enough that glasses are not needed all the time. Frequently, patients easily pass their driver's license test without glasses. Sometimes, only reading glasses are needed.

Multifocal implants, correcting both far and near vision are available and are very successful. Also, implants correcting astigmatism have been highly successful.

Cataract surgery is always done as an outpatient these days. The surgery itself takes about 15 minutes. Patients are sent home without an eye patch and there are no restrictions on activities except they are not allowed to swim for 2 weeks. The vision stabilizes very quickly, and most patients can see well enough to drive the next day after surgery.

If you have been told you have cataracts or if you have noticed that your vision seems to be deteriorating, call our office (314-351-0101) for an appointment to examine your eyes and discuss your situation.

Cosmetic and Reconstructive Surgery:

Have you noticed that your eyes are looking sleepy lately. The eyelids have the thinnest skin in the body and many times they show the signs of aging early. The droopy skin and brows come from gravity's effect on the skin as well as the weakening of the fibrous attachments to the muscles underneath.

Dr. Joan Pernoud has many years experience in rejuvenating the eyelid and eyebrows. She evaluates each patient in detail and discusses the goals of the treatment. Surgeries can be comfortably and painlessly performed in the fully equipped surgery suite in our office.

Many people think that there is swelling of their lower lids but, in most cases it is fat bulging beneath the thin skin. Baggy lower lids can also be rejuvenated by removing the fat causing the bulging. After the fat is removed, the excess skin is tightened to give a smooth youthful look.

Sometimes, the eyebrows become droopy and this adds to the sagging of the upper lids. This can also be corrected.

Often, the muscle that lifts the eyelid becomes partially detached and no longer has the strength to keep the lid open widely. In these cases, repair of the muscle can be combined with removal of extra skin producing a nicely lifted and youthfully contoured eyelid.

Most people are surprised that their Medicare or medical insurance covers many of these procedures. Why? Because many of these problems cause an obstruction of vision in the upper portion of the visual field.

BOTOX:

Wrinkling of the skin takes two different forms. There are permanent creases which we are born with such as those on the palms of the hands. Most wrinkles are developed later in life. Think about how smooth a baby's skin is. The baby hasn't had time enough to develop wrinkles. Sun damage causes some wrinkling but many wrinkles are caused by the action of the muscles under the skin. Look in the mirror and smile and frown noticing the different creases that appear. Facial expressions over time cause the creases to become permanent.

Botox is a protein which is approved by the FDA for the injection under the skin to weaken muscles. When small amounts of this protein is injected into specific areas of the face, the muscles under the skin become weak. This weakening in turn flattens out wrinkles. Allergan's BOTOX® product is the only one of its type with over 10 years of successful clinical experience in therapeutic conditions. BOTOX® has been used commercially for over 10 years in thousands of patients worldwide. The American Academy of Neurology, American Academy of Ophthalmology, and National Institutes of Health have endorsed BOTOX® as a valuable treatment.

It takes about 2 days for the full effects to be seen. People who have had the treatments say that they look younger, more relaxed, and less worried.

Botox does not cause permanent weakening. It lasts about 4 to 6 months and then must be repeated. The injections are done with a very tiny needle and Dr. Joan numbs the skin with a topical ointment. Treatments only take a few minutes and can be done on your lunch hour break. You can return to work immediately.

Glaucoma:

Glaucoma affects about 3% of the normal population. Most people are surprised to learn that there are NOsymptoms when you have glaucoma in the early stages. You notice no pain, no change in vision, and no redness.

The eye contains a fluid called aqueous humor which is produced inside the eye. This fluid has nothing to do with the tears which is the produced outside the eye. The aqueous is also drained away at a certain rate to keep the eye formed properly. In glaucoma, the plumbing inside the eye becomes inadequate to drain the fluid and the fluid pressure rises. If the fluid pressure rises too high for too long, the optic nerve becomes damaged.

It is necessary to diagnose glaucoma early before damage occurs in order to prevent permanent damage.

There are two main types of glaucoma, open angle and narrow angle. Open angle glaucoma constitutes about 96% of cases and the characteristic is that the pressure slowly rises and causes damage to the optic nerve very slowly over months and years. There is no pain or redness and the two million nerve fibers of the optic nerve are slowly damaged. The damage occurs so slowly that the patient does not notice the changes. Prompt diagnosis can be made in the office with a complete eye exam supplemented by a few simple painless tests. Once the diagnosis is established, treatment is begun. Usually, eyedrops are all that is necessary to control the pressure and keep it low so that no damage occurs. These drops must in most cases be continued throughout life. Pressure must be monitored in the office to be sure that they continue to be effective. Sometimes, laser treatment may be necessary to control the pressure and sometimes surgery must be performed to maintain low pressures.

Narrow angle surgery is caused by a sudden complete closure of the drainage mechanism resulting in a sudden very high rise in pressure. This becomes an emergency because the extreme pressure can completely destroy the optic nerve in a matter of hour. Laser treatment must be carried out promptly to avoid disaster. Diagnosis of the tendency for the eye to do this can be made during a complete eye exam as well and early laser treatment will prevent the sudden attack for the life of the patient.

Pernoud Vision Institute has all the equipment necessary to diagnose and treat all types of glaucoma.

Diabetic Retinopathy

The normal retina is made up of cells which are very sensitive to light. These photoreceptors are connected to each other and to the brain through about 2 million nerve fibers. All of these delicate tissues are supported by a network of millions of microscopic blood vessels.

In diabetes, some of these tiny blood vessels break down and begin to leak fluid and blood into the retina. This damages the photoreceptors and the nerves.

It is very important to follow your medical doctor's instructions to keep your diabetes under control however this does not guarantee that the retina will escape damage from the disease.

There may be no symptoms of diabetic retinopathy at first. A complete eye exam can reveal the earliest findings of leakage in the retina. As time goes on and the eye problem becomes more advanced, there is blurred vision which may appear to come and go. If the leakage continues there may be permanent damage which cannot be corrected.

Dr. Joan and Dr. Flavius Pernoud have over 30 years experience in examining patients for diabetes. Dr. Ishaq Chishti is a retinal specialist who has had over 35 years experience in treating diabetic retinopathy. Dr. Chishti frequently uses a technique called fluorescein angiography to locate the exact spots where the blood vessels are leaking.

This painless procedure is done right in our office. It involves injecting a yellow dye in a vein in the hand. About ten seconds after injection, the dye arrives in the retina and leaks from the damaged blood vessels. A special camera captures the images of the leakage and the doctor can tell whether the all-important central vision is threatened.

Dr. Chishti then may perform a laser treatment of the retina, sealing the leaking vessels. There are other modern treatments which have great promise that also may be used for diabetic retinopathy.

Macular Degeneration:

Macular Degeneration is an age-related disease which affects the central portion of the retina only. This very important part of the retina is called the macula and it is responsible for our most clear 20/20 vision. The side vision is not affected.

Patients usually first complain of difficulty reading small print. Changes in eyeglasses do not help and they find that they have to use a magnifying glass to read the newspaper or phone book.

As time goes on, reading road signs becomes impossible and people are surprised that they cannot pass their driver's license test because of their vision.

There are two types of macular degeneration, dry and wet. In the dry type, the photoreceptors of the retina slowly degenerate and die off. These cells are present when you are born and they never replace themselves. When they die, your vision deteriorates. The only treatment available now is taking anti-oxidant vitamins. We believe that this helps to stabilize the retina and may delay or halt the deterioration.

The wet type of macular degeneration occurs in about 10% of cases. In this type, there are new blood vessels which grow under the macula and begin to leak serum and blood destroying the photoreceptors. The damage occurs rapidly and likely will be permanent. There are new treatments which involve injections inside the eye of powerful medicines which cause the new blood vessels to shrivel and disappear, stopping the leakage. Sometimes laser treatments can be effective as well.

Dr. Joan Pernoud, Dr. Flavius Pernoud, and Dr. Cathy Phillips have many years of experience in diagnosing these problems. A good general eye exam is all that is necessary to keep track of your retina and to catch the early signs of this disease.

Dr. Ishaq Chishti has been involved in the treatment of all types of macular degeneration for many years. He has all the equipment necessary to diagnose and treat macular degeneration in the office.