Pepose Vision Blogs » Jay Pepose

Eye Can Hear

Jay Pepose — Mon, 16 Apr 2012 20:28:37 +0000

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.

How Dry I Am!

Jay Pepose — Fri, 02 Sep 2011 17:56:56 +0000

Do you know of someone who has gritty, sandy, irritated eyes, with fluctuating vision that gets worse as the day goes on? If this sounds familiar, then you or a loved one may be suffering from dry eyes—one of the most prevalent ocular conditions.
Dry eyes are ten times more common in women than men, and are more common following the onset of menopause. It can be made worse by taking hormone replacement therapy, as it is the male rather than female hormones that support tear production by the lacrimal gland above the upper lid. Patients with both dry eye and dry mouth may have a very severe form called Sjögren’s syndrome. Dry eye can also also be exacerbated by common medications, such as diuretics, antihistamines and anti-depressants.
At Pepose Vision Institute, we are involved in clinical research to better diagnose dry eye syndromes and monitor treatment. This includes evaluating new devices that measure the lipid layer of the tears and the tear osmolarity. The first step towards relief is always the correct diagnosis, as dry eye can mimic some of the signs of allergy or other conditions and be easily missed.
If you suffer from dry eyes, what can be done? There are 3 steps to therapy. The first is the use of artificial tear supplements and night time gels. There are differences in artificial tears, regarding their thickness, viscosity and components, and so do not give up if you have tried one product. The second step is a prescription drop called Restasis that actually increases tear production. It also has an anti-inflammatory effect, which can be supplemented with short time use of other topical medications. Oral omega-3 supplements using fish oil and flaxseed also help.
However, one of the most immediate and effective treatment for dry eye is the one least utilized. Punctal plugs are microscopic (about the size of the tip of a ball point pen) and are molded to exactly fit into the tiny holes in the lids that drain away the tears. This is not where the tears come from, but rather how they drain away. The tears go down these 4 ducts, one in each lid, into the bony tissue and then to the back of our throat. We actually are drinking our tears all day long, which is why some people can taste their eye medicines! Punctal plugs can be painlessly placed in the office, not the operating room, with just the use of numbing drops. You do not feel the plugs and there is no maintenance required. They work instantly, just like putting a stopper in the drain when the faucet is dripping.
If you have chronically red, irritated eyes, with fluctuating vision and feel eye strain by the end of the day, please consider making an appointment with Pepose Vision Institute to have an evaluation for dry eyes and other conditions that could affect your sight. We are here to help you protect the most precious of our 5 senses.

I talked to 94.1 KPVR about Williams and Sjögren’s, click the play button below to hear the audio:

Oh Say Can You See?

Jay Pepose — Fri, 01 Jul 2011 09:03:51 +0000

With summer officially here and temperatures in the nineties, July fourth cannot be far away. And what would Independence Day be without a breathtaking fireworks display?

Unfortunately, around 12,000 people a year are treated in Emergencies rooms for fireworks-related injuries, including a handful of fatalities. Well over half of these injuries occur between June 18 And July 18.

Of those injured, roughly one in four involve the eyes, often resulting in blindness, third degree burns to the lids and face and permanent scarring. Close to half of those injured are 14 years of age and younger, boys twice and frequently as girls, with the 10 to 14 years old group at highest risk.

Firecrackers, sparklers and rockets were the cause of most of the injuries and burns. Sparklers often ignited clothing, as they burn at over 1000 degrees. Rockets fly into faces and firecracker explode in peoples hands, causing injury to the victim and to bystanders.

What is the solution? LEAVE FIREWORKS DISPLAYS TO TRAINED PROFESSIONALS.

Celebrate our nation’s independence and have a wonderful time with your loved ones and family. Please remember to make it a safe July fourth and protect your most precious sense and your children’s, as well.

Dr. Pepose Talks about St. Louis Cardinals Manager Tony La Russa’s condition

Jay Pepose — Thu, 12 May 2011 20:55:32 +0000

Women and Eye Health

Jay Pepose — Thu, 12 May 2011 18:38:18 +0000

Did you know that each year, more women than men are diagnosed with vision threatening conditions? For example, of over 2 million Americans over age 50 with macular degeneration, over 1.3 million are women. Women account for 2.3 million of the 4 million Americans age 40 or older with diabetic retinopathy. Overall, women comprise 2.3 of the 3.6 million Americans age 40 or older who are visually impaired to the point where they do not qualify for a driver’s license.

Another common example is the finding that dry eyes are twice as common in women than in men. Underlying theories for these observations vary. For example, some have postulated that decreasing levels of androgens around the time of menopause may play a role in the development of dry eye syndrome.

Women are so involved in caring for their families, that often they may ignore their own health issues. I strongly encourage women to make eye health a priority both for themselves and their families, as many of these conditions can be effectively treated if detected early.

Are You Suffering From Computer-Vision Syndrome?

Jay Pepose — Mon, 25 Oct 2010 14:31:53 +0000

A recent article in The Wall Street Journal asks whether we are becoming a “squinter nation”. Computer screens, I-Pads, smart phones, and a litany of other hand held devices are all typically viewed between 18 to 40 inches away. This intermediate distance is often the “black hole” in between the clear distance and near focus of typical bifocal glasses. The National Institute of Occupational Safety and Health says that 30% of people who spend 3 or more hours a day on computer experience the symptoms of computer-vision syndrome or “CVS”.

The symptoms of CVS include headaches, fatigue, blurred vision and neck pain. The blink rate drops when we stare at computers, contributing to dry eye and blurry vision. (Lowering the screen and using artificial tears may help). For those of us experiencing the loss of near (presbyopia), the eyes may fatigue from trying to accommodate for long periods of time, just as muscles would fatigue during an isometric exercise. Looking off to the distance every few minutes to relax the muscle and applying heat or a warm washcloth to the eyes may reduce these findings. Neck strain often relates to trying to utilize the near segment of the bifocal glasses by tilting the head back in an unnatural position when looking at the computer.

Some people resort to multiple powers of reading glasses for computer or closer objects, but it becomes evident that these blur distance vision if you look across the room. Others have tried multifocal contacts or trifocals or specialized occupational progressive glasses with a large upper portion for intermediate (i.e. computer range vision) and a lower area for close-up, with no correction for distance.

For patients with cataract, a new life-style enhancing intraocular lens implant called Crystalens has been shown to deliver good distance and intermediate vision in the same eye. This may be a good solution for patients who want to maintain good uncorrected distance vision and also to be able to see their computer and Kindle. If you are suffering from computer-vision syndrome, I recommend seeing what options may be available for you by making an appointment online or calling us at 636-728-0111.

Clinical Studies at Pepose Vision

Jay Pepose — Tue, 12 Oct 2010 13:43:45 +0000

Part of our mission at Pepose Vision Institute is to advance the field of ophthalmology by performing clinical studies. These may be the evaluation of a new surgical device or technique or the development of a better diagnostic instrument. We are excited to work together with our patients to see the future of ophthalmology.

Currently, we are evaluating a new eye drop for the treatment of dry eye syndrome. Patients will be evaluated free of charge, obtain study medication and are reimbursed for their time. We are also participating in a randomized trial of 3 FDA approved intraocular lens implants for the correction of near, intermediate and far vision in patients with cataract. Patients enrolled in this study are able to obtain these premium lens implants for half of the standard fee.

If you are interested in participating in one of our ongoing clinical trials, please visit our web page at

http://peposevision.com/studies/current-studies or call us at 636-534-5130. Thank you for your trust and confidence and in working together with us to advance eye care and eye health.

Ways You Can Reduce Your Chances of Getting Macular Degeneration

Jay Pepose — Fri, 29 Jan 2010 17:38:35 +0000

As the baby boomers are getting older and living longer, we may be seeing more and more age-related eye problems—one of which is age-related macular degeneration. This conditions affects the part of the retina called the macula, which, like the film of a camera, “develops” the central visual image and sends the signal onto the brain where we perceive sight. Many of my patients who have members of their immediate family with macular degeneration become concerned with their own risk and have asked me what they can do to reduce their chances of acquiring this condition.

While we cannot alter our genes, there are a number of things that can do in an effort to modify and reduce the risk of macular degeneration or having mild forms of the disease progress to more advanced forms.

Stop smoking or, if not possible, cut back on cigarettes
Eat more fish per week
Take vitamin supplements which contain lutein, zeaxanthin, zinc and/or omega-3
Reduce your Body Mass Index: try to lose weight
Protect your eyes from sunlight: wear UV-protecting sunglasses when outdoors
Control your cholesterol level
Control your blood pressure level
Increase your macular pigment level, which may be possible through consumption of egg yolks

Bausch and Lomb has a useful website, where you can estimate your own personal risk of macular degeneration and also the impact of changes in diet or lifestyle that may reduce the risk. It is available at www.bauschjoyofsight.com. There are new treatment options for the wet form of macular degeneration and many potential drugs in the pipeline. It is important to do everything we can in regard to diet and lifestyle modifications to reduce the risk of macular degeneration as much as possible. Further information about macular degeneration is available on our website at http://www.peposevision.com/3deye.php. While there is no substitute for a thorough eye examination, some patients monitor for changes in their central vision at home by the use of Amsler grid testing. The Amsler chart can be printed out for home use, and is available at http://www.macular.org/chart.html.

Alternatives to LASIK?

Jay Pepose — Tue, 24 Mar 2009 13:53:05 +0000

Many patients don’t realize that there are alternatives to LASIK surgery. LASIK works well for low to moderate degrees of nearsighted, but there are alternatives when treating very high prescriptions. One of these is the Visian ICL, which is like an intraocular contact lens that never needs cleaning. Visit our website to obtain more information or call to see if you are a candidate for this new technology.

Spring is coming and with spring comes allergies. Contact lenses can act like a sponge and absorb pollen. That is one reason why many patients with allergies consider LASIK surgery or Visian ICL.

If you do wear contact lenses, wear them safely. Overnight use of a contact lens increases the risk of an eye infection. Smoking compounds this further. Do not wear contact lenses in a swimming pool or shower. Always disinfect your lenses and periodically get a fresh lens case. Follow the recommended schedule for contact lens replacement.

To learn more about Visian ICL, you can visit our website at www.peposevision.com

Update from Hawaii

Jay Pepose — Sun, 18 Jan 2009 08:38:45 +0000

This week, I have been invited to lecture at the Hawaii Ophthalmological Society Annual meeting in Honolulu. I am teaching the local doctors on the mechanism of action of the Crystalens lens implant for patients with cataracts, who desire both near and far vision. In addition, I have brought surgical tapes that demonstrate important points in achieving good success with this lens.

From there, I have been invited to speak at the Royal Hawaiian Eye meeting in Maui. This meeting has over 1000 ophthalmologists from both the US and abroad. Among the 3 lectures that I am giving at this meeting, is a presentation on new accommodating lens implants, to give the audience a snapshot of what may be on the horizon over the next 10 years. Since Pepose Vision Institute is involved in many clinical trials, we are very aware of technology under development. We are excited about participating this year in a clinical trial of a new lens implant that can change power postoperatively by application of a special wavelength of light. This allows the surgeon to fine tune the power of the lens after it has been implanted and wound healing changes have already occurred—similar to going to a tailor to have a suit or dress custom-fit.

In addition, we will be participating in a trial of a new infrared laser system, in the initial studies on a bifocal treatment of the cornea, which will not require creation of a LASIK flap. I will be going to Bogata this spring to meet with engineers, scientists and clinicians to further study this new technology.