EFTA Document EFTA01970587

To: Boris Nikolic From: Jeffrey Epstein Sent Mon 5/20/2013 12:26:46 AM Subject Re: FW: Yesterday I thanks , i sincerely appreciate the trust, I have no idea of the facts. But I am aware that you are emotionally fragile at the moment. so while your worry might be fully justified there is a possiblity that you need to rest and recharge . working so hard , to block out the tough issues , can only sap your strength, . whatever happens we will deal with, it. . On Sun, May 19, 2013 at 7:47 PM, Boris Nikolic e > wrote: Please keep this confidential. Mark is great but I do think that he is trying his best to calm me down. It is the best if you read from my mail at the bottom first. Re his email: Snellen numbers — is a test that show that I will most likely not have much improvement after cataract surgery. He is explaining why it might His worry is something that I did not mention at all — his worry is that he will need to continue killing my retina by laser (laser burns it my a heat), that he will need to continue to go in rounds and rounds. Essentially my blood vessels of retina are slowly collapsing. This ischemia is what is producing Vascular growth factor hormone which as a result has a growth of new fragile blood vessels growing where they should not be growing. As they are where they should not be — they are fragile and result in bleeding. As a consequence of bleeding you get scaring an retinal detachments. Laser acts to burn these ischemic parts of retina so they stop producing vascular growth factor (and by each treatment I am losing a part of my vision). Lucetis acts to block vascular growth factors but it needs repeat injections and has side effect. Neither of these stop underling problem that my small blood vessels are collapsing. Sorry to bother you with details but just in case you wondered. EFTA_R1_00452668 EFTA01970587 Now really I need back to work. B From: Mark Blumenkranz (mailto Sent: Sunday, May 19, 2013 11:56 AM To: Boris Nikolic Subject: Re: Yesterday Boris It is no worry at all. I enjoy all our interactions and trying to be of help. First of all I do think you notice significant improvement in the right eye, even if the Suellen numbers ( is 20/60...20/50 etc) don't change that much because the amount of brightness, lack of glare, improved colors etc should be dramatic. And there is a possibility the Snellen acuity could improved by 2-3 lines up to 20/40 or better too. We just have to wait and sec. As to the lucentis, if it were me I would wait for several reasons. First of all, the clinical appearance of the ncovascularization is relatively benign, it is in fact hard to find without the angiogram and looks mostly if not totally regressed. We should give the laser time to work and see if it does the trick. If not we can always add lucentis, but wouldn't it be better to know whether we need it or not before injecting. Even if you were to have a very minor amount of bleeding we could inject then and then it would clear rapidly. The only issue in my mind is whether to prophylactically the areas that are non perfused now but without neovascularization. That is probably the hardest question but if you are being examined regularly with periodic angiograms then we should be able to pick anything starting up very quickly so I think it is reasonable just to watch. If you want to speak directly today I am just around the house working and would be happy to do so. best Mark EFTA_R1_00452669 EFTA01970588 Mark S. Blumcnkranz MD Hi Smead Professor and Chairman Department of Ophthalmology Director, Byers Eye Institute at Stanford 2452 Watson Court Palo • -5353 Tel: Fax: 650-494-1524 On Sat, May 18, 2013 at 10:17 PM, Boris Nikolic > wrote: Hi Mark! Thank you so much for Yesterday's visit. I am so sorry of I scared you (that I am fainting or something) but I was very distressed after learning that I have two new neovascularization in my "healthy" eye. As that came after I heard from your cataract surgeon that a cataract surgery will probably not lead to a significant (some but not too much) improvement in my vision on my right eye, I was somewhat shaken. THANK YOU AGAIN for you care. My only question to you is whether I still need a Lucentis injection. I am afraid that a) these neovascularizations have progressed somewhat fast (these were not there at all in February). If we count that my last Lucentis was given on January 28th and perhaps has worked for 3 months or so would indicate that these two neovascularizations are only month old or so. b) As it takes some time for laser treatment to start working (6 weeks and more I think), I am afraid that there might be a chance for these neovascularization to grow and bleed — something that I can't afford in this eye. Do you think that it is worth having a Lucentis injection in this laser treated eye? Lucentis would start working immediately and might synergize with laser for neovascularization to dries off. On the other hand, there is a risk with every Lucentis injection. Last time 2 weeks after Lucentis and a laser in this same eye, I developed new long floaters and OCT was indicative of begging of PVD. EFTA_R1_00452670 EFTA01970589 What would you do in my shoes? I am so sorry to bother you but I am scared and confused. Thank you Boris The information contained in this communication is confidential, may be attorney-client privileged, may constitute inside information, and is intended only for the use of the addressee. It is the property of Jeffrey Epstein Unauthorized use, disclosure or copying of this communication or any part thereof is strictly prohibited and may be unlawful. If you have received this communication in error, please notify us immediately by return e-mail or by e-mail to [email protected], and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved EFTA_R1_00452671 EFTA01970590