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 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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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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