Volume 1, Issue 1 Fall 2014 Dr. DeCroos Joins Southeastern .

FUNDUS Fall 2014FPage 5Bristol Office Offers Convenience,Comfort for Tri Cities Patientsor Southeastern RetinaAssociates patients living inand near Bristol, Virginia,the November 2013 openingof the new office location wasa welcomed addition to thegrowing number of SoutheasternRetina locations across the region.Providing much more convenientaccess, the office has significantlycut down travel time for Tri Citiespatients.in the area the proper care theyneed without the burden of a longcommute.”As do the other SoutheasternRetina locations, a wide range ofservices are offered to patients withmacular degeneration, diabeticretinopathy, retinal vasculardiseases, retinal detachments,retina surgery, and all diseases ofthe retina and vitreous.Tri Cities VitreoretinalSpecialists who see patients at thenew Bristol office and other TriCities locations include Joseph M.Gunn, MD, Howard L. Cummings,MD, Allan Couch, MD, and CrisLarzo, MD.According to SERA’s Tri CitiesAdministrator, Maxine Stonecipher,the office, located at 1701 EuclidAve., Suite A, was completelyremodeled and offers a beautiful,calming atmosphere.“Our patients were travelinglong distances to our other officelocations,” said Stonecipher. “Withour new location, however, we areable to offer the patients who liveDeCroos JoinsSoutheastern RetinaLocated at 1701 Euclid Ave., the new Bristol, Va., office should significantlyimprove travel time for patients living in and around Bristol.Anderson, who assisted Dr.DeCroos with joining SERA.“I really liked the values andpriorities of the group,” said Dr.the top groups for clinical trials andresearch in the country.”Dr. DeCroos actively participates in Southeastern RetinaAssociates ongoing clinical“This group has a long sense trials program. He just finishedof integrity, of doing theenrollment in a macular degenright thing for their patients eration trial and is beginningenrollment for a diabetes trial“We received data from alland their employees.”soon. Dr. DeCroos believesover the world, and I was ablethat participation in trials canto see what groups were particisignificantly improve the lives ofpating in research studies. SouthDeCroos. “This group has a longhis patients, as well as patients alleastern Retina Associates was onesense of integrity, of doing the right over the world.of the top groups in the country.”thing for their patients and theirDr. DeCroos and his wife Emily,employees. Integrity is a core valueAfter making inquiries, heof the group. They are also one ofwas put in touch with Dr. Nickcontinued on page 11continued from page 1“When I was in my residency,I had a Research Fellowshipat the Duke Reading Center inDurham reading images.

Diseases and Surgery of the Retina and VitreousPage 6Improving Patient Outcomes forAge-related Macular DegenerationAbeneath the center of the macula,they leak fluid or blood, causingcentral vision loss with blurringand distortion of vision. Untreated,these abnormal blood vessels typically will grow relatively large andeventually cause scarring withpermanent, often severe, centralvision loss.When the pupils are dilated, acomplete examination of the frontand back of the eye is conducted,and if diagnosed, individuals withAMD may have several typesof tests to assess the condition,including color photography ofthe macula to document drusen,pigment changes, and other characteristics of AMD.the American Academy of Ophthalmology regarding the frequency ofeye exams and referrals to eye careproviders for patients of variousages and risk factors,” Andersonsaid. “In short, most patients overthe age of 65 should have a dilatedeye exam every year.”TREATMENTcommon ophthalmicDIAGNOSIScondition affecting peopleFluorescein angiography isBecause of the lack of visualage 50 years and older isanother common diagnostic testsymptoms, diagnosing the diseaseage-related macular degenerationthat can aid in determining thecan be difficult to diagnosis in(AMD). AMD may be associatedextent of macular degeneration andthe primary care setting. Nickwith central vision loss, a devashelps distinguish betweentating condition affecting anthe dry and wet forms ofindividual’s ability to read,“In the past, patients with Wet the condition. By injectingto drive a car, or even toAMD would almost inevitably sodium fluorescein dye intosee someone’s face if in itsa peripheral vein, choroidalgo blind. Now, most patientsadvanced stages. AMD canneovasculation in the maculawith Wet AMD retain highlydevelop so slowly that it’scan be visualized as a leakingnot until the vision is gettingfunctional vision.”blood vessel complex underseverely bad that the patientthe retina.will notice.Optical Coherence TomographyAnderson, MD, a retina surgeonThe two major types of AMD(OCT) a non-invasive, imagingwith Southeastern Retina Associare “dry” (non-neovascular) andtechnique that uses low energyatesrecommendsthatpatientsa “wet” (neovascular). The drylaser to scan the macula and deterovertheageof65shouldhaveanform—the most common—is themine whether there is fluid in theannualeyeexamwiththeireyeearly stage of the condition. Typimacula, potentially signifyingcareprovidertodetectAMDandcally, there is little or no vision lossWet AMD. Commonly used as another conditions such as glaucomaadjunct to fluorescein angiographyduring this stage, although thereandcataracts.to help diagnose Wet AMD, it canare a few exceptions of a moreadvanced “dry” degeneration. Wet“Primary care providers should also be used to assess the responseto treatment for Wet AMD.AMD is the late stage of the condifollow the guidelines set forth bytion, affecting about 10 percent ofall people with AMD. The majorityof central vision loss stems fromWet AMD, which implies leakageand bleeding in the macula dueto abnormal blood vessels knownas choroidal neovascularization. As the vessels start to growTreatment for AMD variesaccording to type. Currently, thereare no FDA-approved treatmentsfor Dry AMD, but as Andersonpointed out, many patients withDry AMD should take a vitamincontinued on page 11

FUNDUS Fall 2014Page 7In the News.Spotlight on Joseph Gunn, M.D.For those who know him, Dr.Joseph M. Gunn’s tendencyto bleed orange would comeas no surprise. Originally fromMemphis, TN, Gunn, who practiceswith Southeastern Retina Associates, received a good portion of hiseducation on each of the University of Tennessee campuses. Gunnknew from a very early age that hewanted to study medicine, but itwasn’t until college that he decidedit was people that he wanted totake care of instead of animals.“I still love animals, and teaseabout going back to school to be aveterinary ophthalmologist, but Iguess I’m a little old for that now,”Gunn laughed. “I feel lucky thatI knew early on what I wanted todo, and pretty much knew how Ineeded to get there. I was fortunateto figure that out early on.”After double majoring inbiology and zoology at theUT-Knoxville campus, Gunnheaded back home to westTennessee for medical school at theUniversity of Tennessee Center forthe Health Sciences in Memphis.After graduating in 1985, he cameright back to the other end ofthe state for his ophthalmologyresidency at the UT-Chattanoogacampus.His interest in ophthalmologywas also something he developedearly on, namely out of personalexperience. “I started wearingglasses when I was 15, after I didn’tget to take the written test for mydriver’s permit because I failedthe vision test,” he recalled. “Amoment that really stands out tome is the day I got my glasses, andI was driving up our street withmy mom. We passed a huge oaktree, and I said to her, ‘Wow, I cansee the leaves on that tree now.’I thought my mom was going tostart crying,” he recalled.His fellowship training in retinaand vitreous was completed inChicago at the Illinois Eye andEar Infirmary, after which he wentto Florida to practice and then toCharlotte, N.C., for seven years.Gunn started working in theTri Cities in January 1997, when hejoined Southeastern Retina Associates.A quick look at Gunn’sCV reveals his keen interestin academic work and clinicalresearch, and he said his grouphas been very fortunate to beincluded in their speciality’s majorclinical trials. “We were one of thecenters nationally included in theSubmacular Surgery Trials andthat really helped us be included inthe other clinical trials,” he said.“These studies help keep us on thecutting edge of things.”Although Gunn sees patientsfor retinal detachment and otherretinal macular diseases, one areaof interest for Gunn is diabetes,primarily because of the largenumber of patients he sees withdiabetes and macular degeneration.“So many people in this area areaffected by diabetes,” said Gunn.“Some of the medicines that weare usingtreat bothconditions. Wemight useslightly different doses or a slightlydifferent timing regime, but someof the medicines used to treatdiabetes were spun off of medicines used to treat macular degeneration.“We are getting better resultsnow, but not because we aredoing a better job—we’ve alwaysdone the best job we can—but thevisual results for our patients havegotten better as our treatmentshave gotten better,” he shared.“It’s really nice to be able to eitherstabilize a patient’s vision or makeit better. Previously, the only wayto treat patients with maculardegeneration was to use the laser.We could treat the leaks, but thepatient’s vision didn’t get better.We did the best we could at thetime, but some of the treatmentswe are developing are making usbetter at what we do.”As Gunn explained, diabetesin general is a chronic diseaseand very frustrating for patientscontinued on page 10

FUNDUS Fall 2014Page 8In the News.Spotlight on John C. Hoskins, M.D.After a conversation withretina surgeon John C.Hoskins, MD, “community-centered” might top the listof his many attributes. Hoskins,who founded Southeastern RetinaAssociates (SERA) in 1980, grewup in Knoxville and returned homeafter finishing his education so thathe could give back to the patientsof East Tennessee.“I really want to emphasize how great it is to practice medicine here in EastTennessee,” Hoskins shared.“I watched my dad practicehere in Knoxville and EastTennessee. I could see howgratifying it was for him, so itwas easy for me to see myselfdoing that.”chusetts Eye and Ear Infirmary,Harvard University, in Boston.“There were not a lot ofprograms at the time, so I wasfortunate to get to do that,” hesaid. “I could see that the retinawas going to be an important fieldof study, as age-related maculardegeneration in older people wasmore commonplace, as well as thegrowth of diabetic problems. Nogreat place to live. We are a prettyunique practice in that regard. Fourof them even attended BeardenHigh School, imagine that.”“We really have been fortunateall the way down the line.“East Tennessee is a great place We have great partnersand great patients whoto practice, and we are ableappreciate what we do,” heto do something here that thecontinued.people would really benefit from,and they are really grateful forwhat we do.”Hoskins, who received anundergraduate degree in Englishfrom Vanderbilt University in1966, went on to receive hismedical degree from the University of Tennessee, Memphis, andcompleted his ophthalmologyresidency at Brooke Army MedicalCenter in San Antonio, Texas.Hoskins’ father, an ophthalmologist, was a role model for Hoskins’career path. “Ophthalmology was abig part of my background. I reallyliked ophthalmology like my fatherdid, so it just came naturally afterthat,” he said.However, Hoskins saw that, atthe time, ophthalmic subspecialtieswere growing and tremendouslyneeded, so he decided to pursuea retina fellowship at the Massa-one in Knoxville was doing it, soI was very fortunate to bring mytraining back to East Tennessee.”As the first retina surgeon inEast Tennessee, Hoskins has helpedgrow SERA into what it is today.Currently, fourteen providers seepatients in Knoxville, Chattanooga,and the Tri Cities, and as Hoskinspointed out, all of them are asgrateful as he is to be practicing inEast Tennessee.“East Tennessee is a great placeto practice, and we are able to dosomething here that the peoplewould really benefit from, and theyare really grateful for what we do,”he said. “Five of our physiciansgrew up in Knoxville and all ofthem came back here because it’s aAn important part of hispractice, Hoskins shared,is the group’s involvementin clinical trials, includinghistorically significantsubretinal surgery trials (e.g. CATT,AREDS, DRCR).“Our practice as a whole hasbeen involved in a number oftrials sponsored by the NationalEye Institute, such as for diabeticretinopathy and macular degeneration. Trials have always been asignificant focal point of our practice,” he said. “We like to be tiedinto academic centers and remainat the forefront of things, and thatis certainly one way of doing that.“Participation is very beneficial to our patients, as well. Theycan receive cutting edge therapies through trials that may notbe available for a few years,” hepointed out.continued on page 9

FUNDUS Fall 2014Page 9ForeseeHome ASignificantly Improving Patient Caren exciting opportunityfor Southeastern Retinapatients with Dry AMD isthe ForeSeeHome monitoringdevice, on which The National EyeInstitute (NEI) recently completeda study.“This study was actuallystopped early because patientsusing the ForeseeHome deviceshowed significantly better resultsthan those patients not using thedevice,” said Keith Shuler, MD. “Ihave only seen the NEI halt a studyearly a handful of times in mycareer due to positive results.”The ForeseeHome AMD Monitoring Program is a prescriptionbased, comprehensive telemoni-toring and data managementsystem that extends the management of AMD to patients’ homesbetween office visits. The testresults are transmitted to a centralmonitoring center that will alertphysicians to immediate, significant visual field changes in theirpatients, so that patients can berecalled for timely follow-up, andnecessary treatment may be initiated.The ForeseeHome AMD Monitoring Program utilizes a simpleto use device based on preferentialhyperacuity perimetry, a form ofvisual-field testing, to identifyminute visual distortions, or metamorphopsia, for the detection ofearly CNV development.In the News.Spotlight on John C. Hoskins, M.D.continued from page 8Many of these trials have ledto great advances in the specialty,some of the most significantadvancements in pharmacologictreatments.“For patients with what we call‘wet’ age-related macular degeneration [AMD], the only treatment in years past was to seal offthe bleeding with a laser, and wedidn’t have very good outcomeswith these patients. They wouldoften get to where they couldn’tread or drive, and AMD can significantly change their lifestyle,” heexplained. “Now we have anti-VEGF drugs, such as Lucentis andAvastin that we use a lot. Whenpatients come in with bleeding inthe back of the eye, we can treatthem with intravitreal injections.They receive the injections everymonth for varied periods of timedepending on the eye’s response,but so many people can keepreading and driving, but in theearly part of my career, we couldn’tdo that. It’s pretty standard treatment we do in the office, and it’s ahugely significant advancement.”For Hoskins, community ismore than the patient population; itThe patient above is pictured using theForeseeHome device, which allowsher physician to monitor her DryAMD from home, extending the timebetween office visits.includes his healthcare colleaguesas well. Hoskins has been influential in bringing ophthalmologistsand optometrists together in thecommunity to provide top-qualityeye care to East Tennesseans.“SERA has tried to play a partin bringing the community ofophthalmologists and optometriststogether to better serve our region,”he said. “With the new healthcarelaws, we feel it is even more important to work together.”At home, Hoskins, who ismarried and has three grown children, is an avid golfer and University of Tennessee football fan.Provided courtesy of EastTennessee Medical News.

Diseases and Surgery of the Retina and VitreousPage 10In the News.Southeastern Retina Recognized Nationallyfor Clinical ExcellenceSoutheastern Retina Associates recently received a prestigious industry award for itscontributions to advancing medicalresearch of diabetes-induced retinaldisorders. Southeastern RetinaAssociates was awarded the TopSite for 2013 Award by the DiabeticRetinopathy Clinical Research(DRCR) Network for demonstrating outstanding performancein the DRCR Network.“We are honored to be acknowledged at this level for our clinicalexcellence,” said Dr. Joseph M.Googe, Jr. of Southeastern RetinaAssociates. “Our entire staffhas always been committed toproviding the finest care possibleand offering our patients thenewest and best treatments ofvision-threatening diseases.”The DRCR is a collaborativenetwork funded by the NationalEye Institute (NIH) and is dedi-cated to clinical research of diabeticretinopathy, diabetic macularedema and associated conditions.The DRCR includes over 113participating sites (offices) withover 320 physicians throughout theUnited States.“If you are diabetic and havevision issues, as a patient of Southeastern Retina Associates, youcan be assured you have the mostexperienced medical team in theregion working to preserve youreyesight,” said Googe. “We havebeen leading clinical trials formore than 15 years and continueto advance leading edge researchto stay abreast of the latest refinements in surgical techniqueand scientific discovery for ourpatients.”For patients who would likemore information on enrolling in aclinical trial, please contact one ofthe Southeastern Retina AssociatesIn the News.Spotlight on Joseph Gunn, M.D.continued from page 7because it changes everything thatthey do, especially for those withtype 1 who have had it from a veryyoung age.“Denial is probably a big factorin younger patients,” Gunn said.“But with the better treatmentsavailable, there is a good chancethey can completely avoid developing retinopathy.”A good illustration Gunn sharedwas the outcomes of a brotherand sister seen in clinic who bothhad type 1 diabetes. The brothercompletely neglected his diseaseand hadn’t seen an eye doctor untilhe was 18. Even though the clinicwas aggressive in taking care ofhim, he went downhill quickly,and by the time he was 20, he wascompletely blind in both eyes.Dr. Joseph M. Googe, Jr. and KristinaOliver accepting the DRCR Top Sitefor 2013 awardclinical trials coordinators:ChattanoogaSteve McBee, (423) 756-1002KnoxvilleKristina Oliver, Lisa Lovelady(865) 588-0811Tri C

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