Meet a Specialist: Jan Kylstra, M.D.
With nearly three decades of experience in clinical care and academic medicine, Dr. Jan Kylstra specializes in the medical and surgical management of retinal diseases, especially age-related macular degeneration (AMD) and diabetic retinopathy. As a member of Mass. Eye and Ear’s Retina Service, he not only repairs retinal tears, retinal detachments, and macular holes, but also has expertise in retinal infectious diseases, particularly in the context of HIV/AIDS.
“During my career as a retina specialist, I have witnessed two major transformations that have greatly improved patient care,” says Dr. Kylstra. “The first was the emergence of protease inhibitors in 1995 that helped many of my patients with AIDS-related infectious retinitis. The second was the development of anti-VEGF (vascular endothelial growth factor) therapies for neovascular or “wet” AMD, which offered new hope to thousands of individuals.”
By 2005, the injectable drug known as Avastin® became available. Shortly thereafter, two more medications – Lucentis® and Eylea® – were developed and “changed the game completely,” says Dr. Kylstra. “Many of the researchers and clinician scientists who made this sight-saving treatment possible are here at Mass. Eye and Ear and Harvard Medical School.”
Today, if wet AMD is diagnosed and treated in its early stages, 90 percent of patients will be able to keep reading and driving because of anti-VEGF therapies. When injected every four to six weeks, anti-VEGF drugs effectively control the disease. “By giving my patients these injections, I can preserve their remaining vision while also getting to know them in the process. I really enjoy that continuity of care.”
Dr. Kylstra also provides care for patients with diabetic retinopathy, which can develop when diabetes damages the retina’s capillaries. Resulting blood vessel leakage can cause retinal swelling, or diabetic macular edema. If not controlled, the ensuing damage to the retina can lead to permanent blindness.
Laser treatment or intraocular injections of Avastin®, Lucentis®, or Eylea® can prevent vision loss associated with diabetic retinopathy, but only if they are administered during the early stages of the disease. Because patients with advanced diabetic retinopathy can have completely normal vision, Dr. Kylstra stresses the importance of regular retina screenings.
“Anyone with diabetes should have an annual retina screening -- not just a vision check!” he says. “A retina screening includes a dilated eye exam. If we catch diabetic retinopathy before a critical point, we can prevent vision loss. Prevention is the best option because it is more difficult to restore vision once it’s lost.”
In addition to his clinical practice, Dr. Kylstra enjoys supervising residents and fellows in retina clinics and other clinical settings. “I’ve always loved teaching,” he explains. “Especially because it allows me to keep learning as well. And I really like that.”
Dr. Kylstra also makes time for clinical research. He hopes to move forward with two projects he began in South Carolina prior to joining Mass. Eye and Ear. One involves creation of an effective alternative to the Amsler grid, currently the standard early screening method for wet AMD. His other research project is aimed at predicting macular function and visual acuity after cataract surgery.
Dr. Kylstra completed both his residency and his clinical fellowship in Vitreoretinal Surgery at Mass. Eye and Ear/Harvard Medical School. He subsequently served as a member of the teaching faculty at the University of North Carolina and the Medical University of South Carolina for many years. When he and his wife, Etta Pisano (a radiologist and breast cancer detection specialist), were both offered Harvard teaching hospital posts, Boston beckoned.
“I’m so thrilled to be back here,” he says. “As a clinician educator, it feels great to be caring for patients and teaching in the place where I originally trained.”
Contact Dr. Kylstra’s office at 617-573-3202.
View Dr. Kylstra's online bio for more information.
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