Seeing Eye To Eye

Contact Lens Intolerance and Dry Eyes
Written By: | November 9, 2012

Dry eye conditions are the primary reason people become contact lens intolerant. A properly fit contact lens should ride or float on the eye in a thin tear film. With each blink, this tear film of fluid between the contact lens and the eye is replaced with fresh fluid, allowing debris to be washed away and fresh oxygen that is dissolved in the fluid to reach the cornea. If this film is compromised in quantity or quality, the contact lens may become uncomfortable or even unhealthy to wear.

Most people, who have been successfully wearing contact lenses for years and then find that their wearing time or comfort decreases, are probably suffering from a dry eye condition. Our tear film is not constant over our life time. The quality and quantity of our tears do decrease over our life time. During our examination we will evaluate the fit of the contact lens and look for signs of early damage to the cornea that may be a result of a compromised tear film. If the contact lens itself is the problem, changing the lens curvature, diameter, or material may correct the problem. Sometimes the chemicals in multipurpose storage solutions for contact lenses can cause changes to the eye’s surface that mimic chronic dry eye, and this can be eliminated by switching to a hydrogen-peroxide based cleansing system. Other causes of compromise include exposure to chronic wind and dust, and incomplete or infrequent blinking, such as when staring at a computer for long periods without resting the eyes.

If we suspect that a patient may be suffering from dry eyes, the next step is to determine the cause so treatment can be tailored appropriately. The eye’s tear film is actually composed of three separate layers, and a deficiency in any one of the three layers will result in an inadequate tear film. Various treatments for dry eyes are available from artificial tears, prescription eye drops, Omega 3, oral medications, punctual plugs and LipiFlow treatments. There are many tests to identify why the tear film is deficient and this will guide our treatment plan. The majority of dry eye conditions are evaporative in nature. One of the newest treatments available to improve evaporative dry eye is LipiFlow. This 12 minute treatment heats up the eye lids, while gently messaging them, to produce a better lipid layer which decreases evaporation.

Once the dry eye problem is treated and the quality of the tear film is improved, wearing contact lenses becomes both safer and more comfortable.

James C. Rieger OD.



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Written By: | October 19, 2012

The fall season brings us beautiful changing colors and a crisp feel to the air as we savor our first sip of hot chocolate and remember the familiar smells of hayrides and bonfires and that first cool night when you need a nice warm sweater.

Fall is also a reminder that the holiday season is fast approaching, and with that the end of the year!  Hard to believe but a new year is at our doorstep.  After the election and the holidays hit then we’ll find ourselves singing “Auld Lang Syne” before we can shout Happy New Y. . . .!

But before December 31st arrives many of us have two hugely important financial tasks to complete.  Properly executed, these two simple steps can save us thousands of dollars in taxes!  What am I talking about?  ENROLL and UTILIZE!

ENROLL in your company’s Flexible Spending Account (or Health Savings Account) for 2013

UTILIZE the funds you have been saving up during 2012 – December 31st is the deadline!

Over the past decade, Flexible Spending Account (FSA) and Health Savings Account (HSA) plans became the “in vogue” workplace benefit.  Thousands of employers offer these plans and millions of employees nationwide participate.

These plans allow you to set aside pre-tax dollars to pay for a whole host of health care expenses (from major procedures all the way down to aspirin and bandages).  The net effect is that you receive medical goods and services that you would have paid for during the year anyway while in turn reducing your taxable income.

Why doesn’t everyone participate?  One reason why some people are hesitant to ENROLL and UTILIZE this benefit is that your saved-up funds must be used by December 31st of each year.  If not, you can actually lose the money you set aside.  Most plans have a grace period through March of the next year, but it’s wise to consider December 31st as the cutoff.  No one wants to lose that money.  However, as long as you plan accordingly then these tax-savings are easy to obtain and easy to manage!


You need to have a plan because both the ENROLL and UTILIZE steps have deadlines.  We can help whether you are considering enrolling or have funds to utilize.  For instance, we offer a completely free consultation to help you determine if you are a candidate for laser vision correction.  This helps provide peace of mind before you ENROLL in your 2013 plan.

Need to UTILIZE your 2012 funds?  We can provide the full comprehensive pre-surgical exam (Dr. Pepose will personally examine you) and schedule your procedure before the end of the year.

Contact me personally at 636-534-5112.  We can set up the completely FREE consultation to discuss how laser vision correction can change your life.  On a deadline for 2013 enrollment?  We will squeeze you in, give me a call.

Act soon, as the fall/winter seasons are always extremely busy here.  Now is the time!  ENROLL and UTILIZE!


Adrian Beck

Patient Consultant


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Written By: | October 12, 2012

October is Eye Injury Prevention Month. October is also the month where we have fun dressing up in fun and crazy costumes for Halloween. Some of those crazy costumes are even complete with contact lenses that look like bleeding eyes, stars, or cat eyes. In this blog post, I want to remind everyone that although contacts are safe when properly cared for and prescribed by an eye care professional, they can cause serious eye injury if abused.

I recently did a Google search for Halloween contact lenses. Boy, did I find a lot of options. Some were pretty scary too!

However, what I found most scary was that a lot of the sites didn’t require a doctor’s prescription to buy the contact lenses. Contact lenses come in different shapes and sizes to fit different eyes. When contacts fit too tight or too loose, or if the material does not allow enough oxygen to the cornea, corneal damage may ensue. When you have a contact lens evaluation with an eye care professional, we make sure that the lens is just right for your eye.

Here are some good things to remember with contact lenses, whether they are clear or make you look like a cat:

-Always wash your hands before inserting and removing your lenses

-Never use tap water on contacts—there are lots of little microbes that live in the water that you do not want in your eye

-Always disinfect your lenses nightly in the solution that your eye care provider recommends for

-Never share contact lenses with a friend or wear contact lenses that were not prescribed especially for you

Remember, contacts can be a great way to help you see, and can add fun pizzaz to your Halloween costume. Just remember to be safe and responsible with your contact lenses. At Pepose Vision Institute, we are here to help you see your very best—even in contacts.

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November is Diabetic Eye Disease Awareness Month
Written By: | October 5, 2012

Do you or someone you love have diabetes?  If so, did you know that every diabetic individual needs a yearly dilated retinal examination?  This is true even if you have no vision problems.

The retinal hemorrhaging associated with diabetes has no symptoms at first, but once vision is affected it becomes much more difficult to treat.  In fact, diabetes is the leading cause of legal blindness in this country for people under age 65.  It is the second leading cause of legal blindness in this country for people over age 65.

However, if you take good care of your blood sugars and see an eye doctor on a regular basis there is no reason to lose any vision to diabetes.

Dr. Nancy Holekamp at the Pepose Vision Institute specializes in the diagnosis and treatment of diabetic retinopathy.  The Pepose Vision Institute has the latest diagnostic, medical, and surgical technology for taking care of diabetic retinopathy.

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Do you know the most common cause of vision loss for individuals over the age of 40?
Written By: | September 17, 2012

According to Prevent Blindness America, there are more cases worldwide of cataracts in people over the age of 40 years than glaucoma, macular degeneration, and diabetic retinopathy combined.  This is partly because cataracts, or clouding of the natural lens, develop as a result of natural aging.

Nevertheless, there are measures you can take to help prevent cataracts or slow their development, such as stopping smoking, wearing UV protective sunglasses, controlling diabetes, and avoiding steroid medications such as nasal sprays if there are alternative therapies that can be recommended by your doctor.  To reduce your UV exposure, wear a wide brimmed hat and sunglasses when outdoors.  Also, even if your vision is clear and healthy, make it a priority to schedule yearly exams with your eye doctor in order to screen for cataracts, glaucoma, macular degeneration, and other vision disorders.  Early detection just may save your sight!

Eating foods high in antioxidants, such as beta-carotene beta-carotene, (dark green and orange-yellow vegetables, such as carrots, sweet potatoes, squash, spinach, broccoli, lettuce, and green peppers), selenium (crab, liver, fish, and poultry), and vitamins C and E (all citrus fruits, strawberries, cauliflower, kale, mustard greens, kiwi fruit, cantaloupe, fortified cereals, sunflower seeds, nuts, pine nuts, peanut butter and avocados) may also help ward off cataract development.  Your eyes can benefit from the leafy vegetables, citrus fruits, and berries you add to your daily diet.  It is easy and delicious!

Cataracts generally do not cause eye pain or redness.  Some of the symptoms associated with early cataract formation include blurriness, double vision, ghosting, difficulty with night driving, needing more light to read, and frequent changes of glasses prescriptions.

The definitive treatment for cataracts, regardless of age, is cataract surgery.  Cataract surgery is a generally painless and quick outpatient procedure where the cloudy, natural lens is replaced by a miniature, clear artificial lens or implant.  Cataract surgery is vision correction surgery because intraocular lens implants (IOLs) have a prescription built into them to improve focusing, so that cataract surgery patients can become less dependent on glasses.  The surgeons at Pepose Vision Institute can implant distance-focusing, near-focusing, astigmatism-correcting (AcrySof Toric), accommodating (Crystalens), and multifocal (Tecnis and ReSTOR) implants.  Our goal is to customize cataract surgery for our patient’s individual needs.  Since cataract surgery is a medically necessary procedure, some or all of this vision correction surgery can be covered by medical insurance.

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Make Eye Exams Part of the Back to School Routine
Written By: | August 9, 2012

“As children head back to school, parents can become so consumed with supply lists that they often forget the one thing that can make or break a school year for a child-good vision”, stated Pepose Vision Institute Optometrist Dr. James Rieger. Eighty percent of what children learn is through vision. and among school-aged children, 6-11 years old, an estimated 5.3 million have vision problems.

Eyesight plays an essential role in learning, yet many children have a vision problem and aren’t aware of it. They simply don’t recognize that their eyesight isn’t optimal or is changing. Comprehensive eye exams are necessary to detect problems that a simple screening can miss, such as eye coordination, lazy eye, and near and farsightedness.

A child’s vision may change frequently, so regular eye and vision care is crucial to a student’s classroom success and overall development. Studies indicate that 60 percent of children identified as “problem learners” actually suffer from undetected vision problems. and in some cases have been inaccurately diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

A comprehensive eye exam includes tests to determine nearsightedness, farsightedness, astigmatism, eye coordination and eye muscle function, eye focusing abilities and an overall eye health exam. Eye exams are also especially important in diagnosing diseases and disorders.

There are several essential elements checked during a comprehensive eye examination to help ensure learning is maximized through good vision. For example:

  • Visual acuity is measured at several distances so students can comfortably and efficiently read, work on the computer or see the blackboard.
  • Focusing or accommodation is an important skill that is tested. Eyes must be able to focus on a specific object, and to easily shift focus from one object to another. This allows a child to move attention from a book to the chalkboard and back.
  • Visual alignment and ocular motility is evaluated. Ideally, the muscles that aim each eye converge so that both eyes are aimed at the same object, refining depth perception.
  • Binocular fusion (eye teaming) skills are assessed. These skills are critical to coordinating and aligning the eyes precisely so the brain can fuse the pictures it receives from each eye into a single image.
  • Eye tracking skills are tested to determine whether the child can track across a page accurately and efficiently while reading, and can copy material quickly and easily from the chalkboard or another piece of paper.
  • Color vision is important because a large part of the early educational process involves the use of color identification.
  • Eye-hand-body coordination, critical for handwriting, throwing a ball or playing an instrument, and visual perception, used to interpret and understand visual information like form, size, orientation, texture and color perception, is another important visual function that is tested.
  • Overall eye health is determined by examining the structures of the eye.

“As a doctor, I look for a variety of indicators through various test and instruments during a comprehensive eye exam,” said Dr. Rieger. “But parents can play an important role in looking out for certain behaviors and warning signs that could indicate a problem that may have developed in between eye exams.”

Warning signs parents should watch for include:

  • Loses place while reading
  • Avoids close work
  • Tends to rub eyes
  • Has headaches
  • Turns or tilts head
  • Makes frequent reversals when reading or writing
  • Omits or confuses small words when reading
  • Consistently performs below potential
  • Struggles to complete homework
  • Squints while reading or watching television
  • Has behavioral problems
  • Holds reading material closer than normal

If parents notice these kinds of symptoms, they should schedule an appointment for their child to see their eye doctor. The ramifications of poor eyesight in children can be far-reaching, and it is crucial that any vision problems are diagnosed and treated promptly., Dr. Rieger says.

It is especially important to monitor the signs and symptoms of vision problems as a student progresses in school due to increasing visual demands resulting from smaller print in textbooks, the use of smart boards, an increase in computer work or additional homework in general.

“A child with undetected vision problems can be frustrated or bored in school because he or she can’t see the board or read a book easily,” said Dr. Rieger. “Vision problems can be frequently misdiagnosed as behavioral problems, and if left untreated, almost always result in diminished academic performance and self-esteem problems.”  ”Students who see well are more engaged, more empowered and more involved in academic life.”

The bottom line is while you’re making your list of items for back to school, make the call to set up an eye appointment. Schedule an appointment and get a good start to the new school year.


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Cataract Surgery May Reduce Hip Fractures
Written By: | August 2, 2012

This large retrospective review evaluated the incidence of hip fractures within a year of cataract surgery in a random sample of Medicare beneficiaries age 65 and older diagnosed with a cataract from 2002 to 2009. Overall, those who had cataracts removed had 16 percent fewer hip fractures than those who declined surgery. Older patients (aged 80 to 84) and those with significant comorbidities experienced the most significant benefit, with 28 percent fewer hip fractures compared to equally sick patients who did not have surgery. And those who had severe cataracts removed had 23 percent fewer hip fractures than those with severe cataracts who declined surgery.

Journal of the American Medical Association, August 1, 2012.

See more info by clicking here.

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Computer Vision Syndrome (CVS)
Written By: | April 23, 2012

More than 50% of Americans spend 2 hours or more on a computer.  Computer Vision Syndrome (CVS) describes a group of eye and vision-related problems that arise from extended periods of computer use.

Many of us who spend a great deal of time on the computer recognize and experience many of these symptoms:

  • Difficulty focusing and blurred vision
  • Headaches
  • Dry, itchy, watery eyes
  • Pain or muscle spasms in the neck and shoulders

Minor vision problems such as uncorrected nearsightedness, farsightedness or presbyopia can contribute to the development of CVS.  Poor eye coordination and focusing skills can contribute as well.

Steps to manage CVS:
  • Adjust text size so that it is three times the smallest text you can read from your normal working distance.
  • Experiment with color choice.  Black text on a white background works well for most but a light text on a dark background or other color combinations may work better.
  • Adjust the brightness to match the room brightness.  Then, increase the contrast to the highest comfortable level.
  • Reduce  glare:
    • Position your monitor so that windows are to the side of the monitor.
    • Do not shine a desk lamp on the screen.
    • Consider using a glare filter over the monitor or a monitor hood.
  • Use lubricating eye drops.   And, remember to blink.
  • Make sure to use proper “computer ergonomics”
    • Position your monitor 20 to 26 inches away.
    • Make sure your monitor is 4-9 inches below straight ahead gaze.
    • Position your chair and monitor so that your arms are parallel to the floor while typing and your feet are flat on the floor.
    • Use a document holder close to the screen.
    • Finally, take a break.  Either look away from the computer and even stand up or stretch.
  • Take time to make your computer use as comfortable as possible.
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Eye Can Hear
Written By: | April 16, 2012

The next time you are seen at Pepose Vision Institute, you may be surprised when the technician offers to perform a hearing screening test using a 5 tone screening device held up to each ear. If hearing loss is detected, the doctor will offer you an opportunity to have a free audiology evaluation with a licensed audiologist in our office. If needed, the audiologist will dispense hearing aids. If the evaluation suggests the possibility of more serious disease, then you will be referred to an ENT specialist.

Why would an ophthalmology practice find it important to offer hearing testing services? For a number of very important reasons, outlined below.




Hearing Loss is a Risk Factor for Macular Degeneration

Numerous studies have shown a higher prevalence of hearing loss in patients with macular degeneration. A recent study suggested that hearing loss was significantly greater (in decibels) in the dry kind than the wet. Surprisingly, hearing loss in patients 55 years of age or younger was associated with an even higher (4.3X) increase in odds ratio of developing macular degeneration compared to those older, so we screen both younger and older patients.

When a group of patients living in Beaver Dam, Wisconsin between age 48 and 92 were examined, 45.9% had hearing loss. It was more common in men and the risk increased with every 5 years of life. Of note, of those that needed it, only 14.7% of patients wore hearing aids. Patients visit an ophthalmologist with far greater frequency than an ENT specialist, which provides us a unique opportunity to help.

A study published last year in the Archives of Ophthalmology showed that the overall increased risk of developing macular degeneration in a patient with hearing loss was 2.28 times those without. Put into perspective, that is a 36% larger increase in the odds of developing macular degeneration compared to the impact of smoking more than 11 years. Patients with hearing loss may need to be monitored more closely by us for the development of macular disease, so it is important for us to know your hearing status.


We are in the Business of Enhancing Quality of Life

I think you can now appreciate why screening for hearing loss is good medicine for those of us in eye care. Patients who have both sensory hearing loss and vision loss more often become isolated, dependent and have problems communicating. They are more prone to depression, falls, and accidents. We want to take advantage of the unique opportunity we have to make a positive impact in your quality of life. Please contact us at 636-728-0111 or by clicking here  to schedule free hearing testing at Pepose Vision Institute, which can often be provided the same day as your next eye examination.

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Why Cataract Surgery in the 58 year old?
Written By: | April 2, 2012

Most of us think that one has to be older to develop a cataract.  This makes sense as cataract formation is generally age-related.  A cataract is a cloudy natural lens inside the eye that distorts light entering the eye.  However, a number of factors may accelerate cataract formation.  Cataracts can develop at an earlier age due to trauma to the eyes, from medical conditions such as diabetes, or from spending more time outdoors without wearing sunglasses to block UV light.  Earlier cataracts are also seen in patients who use steroids chronically, such as with Prednisone pills, asthma inhalers, allergy nasal sprays, or steroid eye drops.

During the early phase of cataract formation, patients will note subtle changes in their vision.  They will report that their vision with their present glasses or contacts is not as sharp as when they first received the glasses.  They will need more light to read.  Street signs at night will be more difficult to see until they are very close to the signs.  There may be more glare from oncoming car headlights.

These symptoms are initially treated by updating the glasses or contact lens prescriptions.  As the cataract clouds, a different glasses prescription is needed to bend the light around the new cloudy areas that have developed since the previous glasses prescription,  In a sense, this means that patients with early cataracts face the challenge of trying to catch up the progressing clouding.  Hence, patients wonder if a more permanent solution to their vision problems makes more sense than updating their glasses every 6 – 12 months while struggling in between.

An alternative treatment for symptoms related to early cataract formation is consideration of cataract surgery.  The advantages of cataract surgery in these patients are that surgery: (1) permanently removes the clouded natural lens; (2) is generally a 1 time procedure; (3) replaces the cataract with an artificial, clear lens or implant that further improves the vision because glasses prescriptions can be built into the implant (as if the glasses were permanently placed inside the eye); and (4) provides long-term stable vision as the artificial implant does not change over time, as long as the health of the remainder of the eye remains the same.  For these reasons, patient even in their 50s and 60s are considering cataract surgery as a safe, effective, long-term treatment to improve their ability to drive and read without “filmy,” “hazy,” “ghosting,” or “glary” vision.


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