With an Eye to the Future

Dr. Jay Pepose, M.D., Ph.D.

One of the many things that differentiates Pepose Vision Institute is that we are never satisfied with the status quo. We believe that the only thing that we can count on is change, and we have created an environment that embraces change.

When we look ahead to the future of eye care, what do we see? We see that the largest growing segment of the population is the post- World War II baby  boomers born between 1945 and 1964, who began to reach age 60 in 2005. If you look back to the year 1900, the average life expectancy was age 46 for a man and 48 for a woman. Today a child born in the U.S. can expect to live on average to age 74 for a man and 79 for a woman. What does this mean in terms of the future of eye care?

Since we are living much longer than our grandparents did, we must protect our eyes from trauma and UV-irradiation by wearing UV-protecting sunglasses. We must also be vigilant in having agerelated eye conditions detected as early as possible through annual eye examinations. The conditions that are most prevalent with age include cataract, glaucoma, dry eye (particularly in post-menopausal women), and macular degeneration.

Let’s consider cataract first, as this is the leading cause of diminished vision throughout the world. In the past, cataract surgery was performed exclusively as a hospital in-patient procedure and reserved for dense ‘ripe’ cataracts. It required large incisions and sutures, and bed rest with sandbags around the head. Then, cataract surgery evolved into an outpatient procedure with small incisions and rapid recovery, allowing treatment of earlier, less dense cataracts that affected daily visual functions. Realizing and anticipating this trend, we have built our own Medicare approved Ambulatory Surgery Center in our new facility. We have the latest equipment to ultrasonically liquefy cataracts and new operating microscopes that give unparalleled surgical views on a large flat-screen television, so the entire operating room staff knows exactly where we are in the surgery. In fact, if you wish to see your loved one’s cataract surgery, it can be viewed live through any computer in our building (with password access). Having our own Ambulatory Surgery Center gives our patients the convenience of cataract surgery in the same building where pre- and post-operative care is delivered.

Today, we have the first multifocal and accommodating lens implants designed to allow a greater depth of focus than the older monofocal lens implants, just as autofocus cameras replaced the old “browinie” distance-focus only cameras. New lens designs can correct the eye’s astigmatism and be inserted through smaller, self-healing incisions. Our reputation as careful innovators is why the eye care industry partners with Pepose Vision Institute in the design and clinical evaluation of new  intraocular lenses and diagnostic devices.

With regard to glaucoma, we have worked with the eye industry to develop and evaluate new  devices to more accurately measure intraocular pressure- a main culprit in causing the loss of side vision.

Older instruments were influenced by corneal thickness and stiffness and could give falsely high or low readings, thereby compromising treatment plans. We now perform outpatient glaucoma laser treatments in our new Ambulatory Surgery Center, allowing many patients to reduce their dependency on daily glaucoma drops.

At Pepose Vision Institute, we remain at the forefront of clinical research, so that our patients can benefit from the latest innovations. If you are interested in learning more about our clinical studies and have internet access, you can log into the National Institute of Health’s Library of  Medicine for free at the National Institute for Health. Type in peposevision.com/pubmed to see a list of our peer-reviewed publications or type in any eye condition to learn more about the latest discoveries, such as new treatments for the wet form of macular degeneration. We are living at a time of the greatest advances in medical technology and we will continue to bring them here to St. Louis for you and your family

Dr. Jay Pepose, M.D., Ph.D.
www.peposevision.com
636.728.0111

How Dry I Am!

Dr. Jay Pepose, M.D., Ph.D

Do you know someone who has gritty, sandy, irritated eyes, with fluctuating vision that gets worse as the day goes on? He or she 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. The condition 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 Siogren’s syndrome. Dry eye also can 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 allergies or other conditions that can be easily missed.If you suffer from dry eyes, what can be done? There are three therapy options. The first is to use artificial tear supplements and night time gels. There are differences in artificial tears, in terms of their thickness, viscosity and components, so do not give up if you have tried only one product. The second option is a prescription drop called Restasis that actually increases tear production. It also has an anti-inflammatory effect, which can be supplemented with short-term use of other topical medications.

One of the most immediate and effective treatments for dry eye is the one least utilized. This third option is punctal plugs which are microscopic (about the size of the tip of a pen) and are molded to exactly fit into the tiny holes in the lids that drain away tears. The tears go down these four ducts, one in each lid, into the bony tissue and then to the back of your 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 during an office visit, using just 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 bathtub is filling.

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 to have an evaluation for dry eyes. There is no reason for you to suffer when treatment is at hand!

Dr. Jay S. Pepose, M.D., Ph.D.
www.peposevision.com
636.728.0111

Training Tomorrow’s Eye Surgeons:

An Important Part of Our Mission

We are committed to a tripartite mission consisting of interrelated goals: training, research and clinical practice. In this regard, PVI offers one-year and two-year Cornea/Vision Correction clinical and research Fellowships for doctors who have completed an accredited U.S. residency program in ophthalmology. The Fellowship program is rigorous and competitive, attracting the best and the brightest graduates of the top ophthalmology programs. The Ophthalmology Fellowship Match that we participate in is sponsored by the Association of University Professors of Ophthalmology. Our Fellows are involved in all aspects of the Practice. They participate in the only cooperative program nationwide with the School of Optometry at UMSL, which provides pre- and post-operative co-management training to optometry students. Fellows perform vision correction surgery for patients in this specific program, under the direct supervision of PVI surgeons.

Fellows actively participate in clinical trials and research, leading to presentations at major scientific meetings and publication of findings. Having surgeons who are also PhD scientists makes our practice an ideal setting for training in clinical research.

In addition to our clinical fellows, we also offer an International Eye Bank Fellowship Program, in collaboration with other U.S. eye banking groups. The second most prevalent cause of blindness in the world is corneal disease. The goal of this Fellowship program is to promote indigenous eye banks and corneal transplantation in poorer nations.

As Dr. Pepose notes, “It is far more satisfying, efficient and effective to teach medical personnel in foreign countries to provide corneal tissue transplantation services themselves within their own communities.”

www.peposevision.com

 

 

Teddi Bryant

“I couldn’t believe how well I could see again after my cataract surgery.”

At 42, Teddi Bryant is not your typical cataract patient. The owner of Hot Mamas Exercise Studio in Denver, she spends her days keeping pregnant and post-partum women in good shape and her evenings keeping up with her own children, ages 5 and 10.

So when her vision became blurry and she began experiencing difficulty seeing out of her left side mirror while driving, she immediately scheduled an eye exam in Colorado. “I knew I might be at risk for cataracts because of both heredity and environment,” says Bryant. “My father developed a cataract in his 40s and one of my sisters was diagnosed with one in her 30s. Growing up on the ski slopes of Colorado, with all that bright sunshine, probably didn’t help either.”

Her initial check-up confirmed what she already suspected– a cataract in her left eye. It showed the beginnings of one in her right eye as well.”My job is teaching people how to take care of themselves, so I take my physical condition seriously,” says Bryant. “I wanted to go to an ophthalmologist with a great reputation to have my surgery.” Her Denver boyfriend, one of Dr. Pepose’s former LASIK patients, highly recommended Pepose Vision Institute to Bryant for cataract surgery. So flying to St. Louis for a consultation was a “no brainer,” Bryant says. At her first visit, Dr. Pepose determined the extent of her cataract and scheduled surgery shortly thereafter.

Bryant describes the procedure as a “surreal experience,” where she could hear voices around her but couldn’t see anything. “I was a little nervous, but everyone was very caring, and it was so quick and painless that it was done before I knew it,” she adds. Her post-operative check-up was “just astounding,” Bryant says. “I couldn’t believe how well I could see again.”

Back in Denver, Bryant says the operation did more than allow her to read and drive more easily. “My posture and my self-confidence changed, all because I could see people clearly when I talked to them,” she says. These days, Bryant is back to her hectic schedule. She ‘s leading stroller classes–boot camps for new mothers–and has just completed a DVD for prenatal and postnatal women called “Hot Mamas Exercise.”

And when it comes time to remove the cataract in her right eye, Bryant knows exactly what she’ll do. “I’ll jump back on a plane and head to Pepose Vision Institute, of course,” she says.

Vince and Judy Koehr

“The Koehrs, with their new Crystalens implants, will really see Alaska.”

 

 

 

 

 

 

 

 

 

Travel enthusiasts Vince and Judy Koehr of Lake St. Louis were planning to book an Alaskan cruise as a mutual Christmas present two years ago. Since their retirement, they had enjoyed several other cruises, as well as touring Germany, Switzerland, Austria and the Czech Republic.

But when Vince was diagnosed with cataracts, the couple decided to give each other a holiday gift of intraocular lens implants instead. “We figured we’d rather see the glaciers without having to wear our glasses,” says Judy.

As an artist who had served as art director for several St. Louis advertising agencies before establishing his own graphic design firm, Vince, 72, felt good vision was of the utmost importance. And Judy, 68, an avid reader who had been wearing bifocals for more than 25 years, couldn’t wait to be able to pick up a book without hunting for her glasses. That’s why the Koehrs carefully researched their options regarding monofocal, bifocal and multifocal lens implants. “I was interested in Crystalens because it seemed like it had the least limitations,” says Vince. “The PVI staff was extremely professional and did a terrific job of explaining the pros and cons of each lens to us,” says Judy. “And Dr. Pepose’s expertise with Crystalens sold us on the procedure.”

“They learned that Crystalens, a new, custom intraocular lens, can provide a continuous range of near, immediate and distance vision by mimicking the way in which the natural lens accommodates, for distance and near. Many times, it can eliminate the need for bifocals or reading glasses completely.

“The procedure was quick and entirely painless,” says Judy. “By the next day, there was a dramatic difference in my vision–colors were so much brighter!” “I couldn’t have asked for a better experience or outcome,” adds Vince. “Dr. Pepose is so competent and compassionate — and he has a great sense of humor, too! And my vision today is 20/20.”

Now the couple is planning a trip to Alaska in earnest–and the only glasses Judy says she will have to pack are fashion sunglasses to help take the glare off of all that bright, white snow.

Liz and Charley Schmitz

They gave each other the gift of LASIK – the gift of clear, quality vision.

As co-authors of “Seven Golden Anniversaries,” Liz and Charley Schmitz pride themselves on knowing the secrets to successful marriages. So on their 40th anniversary, they decided to take Rule #4 in their book- “Your body is your castle”- to heart and focus on improving their joint health by giving each other the gift of LASIK surgery.

“We were both frustrated by our poor eyesight; we were constantly adjusting our glasses up and down on our faces. It really interfered with our writing process,” says Charley, 62, dean of the College of Education at the University of Missouri-St. Louis and a professor of counseling and family therapy there. “Contacts were never an option for me because of severe allergies,” adds Liz, 60, a longtime public school educator and administrator who now heads up a business venture called “Successful Marriage Reflections.”

Years of academic training had taught the pair to research decisions thoroughly. After a great deal of reading and talking to friends and colleagues, they called Pepose Vision Institute for LASIK consultations. “I had never spent a minute of my life in a hospital, and I dreaded the notion of having surgery. So I wanted to make sure I had the best doctor possible to perform such a delicate operation,” says Charley. By the end of their initial visit–a three-hour, state-ofthe- art testing process to create a precise, personalized treatment plan–both Charley and Liz had embraced the idea of LASIK enthusiastically, and scheduled their surgeries three days apart.

Charley chivalrously chose to go first. “It was quick, easy and completely painless,” he recalls. “Dr. Pepose is so pleasant and thorough–he just has such a great bedside manner. I was so impressed that he took the time to explain each step of the procedure.” The following day, Charley had his post-operative check-up. “It was an amazing transformation. I could read the eye chart with 20/15 vision!” he says. That was all it took to empower Liz to follow suit. “Charley came through the operation like such a champ that I never had a second thought about it,” she says.

Today, the couple calls their LASIK experience “a miracle.” “It’s completely transformed my ability to write. I can look at a printed page on my left, then focus on the computer screen in front of me, and go back and forth without a problem,” says Liz. “It has also made technology so much more useful,” says Charley. “I can actually use my iPhone to access the internet and keep a calendar because I can read the finest print.”

Beyond work, the two say their enhanced eyesight has “made the whole world a discovery again.” Liz, a master gardener, appreciates the colors and brightness of the floral displays at the Missouri Botanical
Gardens. Charley, a huge Cardinals baseball fan, revels in the fact that he can follow a pitch in Busch Stadium. And traveling–a shared passion–has become much more enjoyable. “When we sightsee, we actually see the sights,” Charley chuckles. Best of all, say the marriage doctors, “We get to see each other better, which is lovely.”

Eye Health Tips for Women

Mujtaba Qazi, M.D.

Vision can be affected by medical conditions and health problems that are more commonly found in women. Being aware of these and getting timely testing can save your sight.

Of course, you know that your eyes are an important part of your body and that your eyesight is your most valuable sense. Deterioration of eyesight can profoundly impact everyday activities such as driving and reading. In seniors, poor vision often leads to poor health through susceptibility to accidents such as falls. In addition, impaired vision can impede social interactions and can contribute to the onset of depression.

There are many medical conditions that can lead to serious eye diseases in women. Diabetes can cause bleeding (retinopathy) in the retina (the lining of the back of the eye that captures light energy and converts it to an electrical signal that is transmitted to the brain) and cataracts (clouding of the natural lens). Autoimmune diseases – such as lupus and rheumatoid arthritis, among others – can cause inflammation in the eye (iritis) and dry eyes (Sjogren’s syndrome).

Another autoimmune disease, multiple sclerosis, is also more common in women and can lead to vision loss when the optic nerve becomes inflamed. High blood pressure can cause hypertensive retinopathy. Finally, there is evidence that a poor lipid profile (high LDL- cholesterol and triglycerides) may be associated with age-related macular degeneration (AMD, where the center of the back of the eye or retina atrophies and scars, leading to a blind spot in the central vision). The point is that, as far as the health of your eyes are concerned, taking care of these and other medical conditions will help you take care of your eyes. Taking care of your eyes, through annual vision exams, also can make your body healthier and happier.

Lifestyle Changes

There are several lifestyle choices you can make for yourself and for your family to reduce the risk of developing eye diseases. One of the most important lifestyle changes, if applicable, is to stop smoking. A recent study has shown that, on average, smoking shortens a person’s life by ten years due to heart disease and cancer. Smoking is also a significant risk factor for AMD and cataract formation. Furthermore, eating a well-balanced diet not only protects against heart disease, but can maintain the heath of certain eye structures. Several studies have suggested that eating foods with antioxidants can help to protect against AMD and cataracts. In particular, carotenoids — such as lutein and zeaxanthin that are found in leafy, green vegetables, fruits, and dietary supplements — are present in the retina. A recent National Eye Institute study showed that giving AMD patients a supplement of antioxidant vitamins and minerals slowed down disease progression. Omega 3 fatty acid and flax seed oil supplements can promote healthy tear production. Lastly, another “toxin” to the eye is ultraviolet light from the sun. Exposure to UV light can increase the risk for skin cancers on the eyelid, earlier cataract formation, and AMD. UV protective sunglasses are an essential part of eye health care.

Knowledge is the Key

As women in the U.S., on average, live longer than men, they have a much greater prevalence of common, age-related eye diseases, such as dry eye syndrome (which is common in postmenopausal women), AMD, glaucoma, and cataracts. Knowledge is the key to saving your sight. Be aware of the symptoms (blurriness, dryness, scratchiness, difficulty with night driving, blind spots in the vision when reading, among others) of the major eye diseases and that many eye conditions run in families. Keep in mind that perhaps three-quarters of vision loss is either preventable or treatable if the disease is diagnosed in a timely manner. These treatments can range from readily accomplished measures such as getting new eyeglasses, wearing sunglasses, maintaining a healthy diet, or, in some cases, prescription eye drops or even laser treatmentsand surgery. Regular, comprehensive eye examinations for you and your family members at Pepose Vision Institute is the best place to start.

Dr. Mujtaba Qazi, M.D.
www.peposevision.com
636.728.0111

We have corrected your vision, but only you can protect your vision.

Dr. James C. Rieger, O.D.

Due to patient requests for a one-stop facility to see their physician and get their glasses and contact lenses at the same time, Precision Optix has been incorporated into our practice.

Precision Optix is a full-service optical that relies on state-of-the-art technology and highly trained staff to ensure that customers receive the very best sunglasses and prescription glasses to meet their vision needs. It offers a wide array of the newest frame designs for the most discerning buyer, and will fit each person’s budget needs. Our doctors are skilled in contact lenses and welcome those “hard to fit” patients. Contact lenses can be ordered directly through Precision Optix.

We offer the very best in sunglasses including Maui Jim’s, which have UV protection and are polarized. At PVI, we understand the importance of taking precautions to keep your eyes healthy. Wearing sunglasses with UV protection safeguards your eyes and eyelids, which are at highest risk for skin cancer on the face. Whether in cloudy or bright sunshine, ultraviolet radiation can also play a contributory role in the development of various eye disorders, including cataracts and cornea degeneration. Polarized lenses eliminate glare or reflected light, increase comfort, and visual acuity.

You can use your “FSA” – flex spending account money- to purchase eyeglasses and contact lenses and sunglasses. You, your family, and friends are welcome to shop at our optical during regular Practice hours. Come visit Precision Optix between 8:00am to 5:30pm Monday through Friday.

Dr. James C. Rieger, O.D.
www.peposevision.com
636.728.0111

Our Doctors

Pepose Vision Institute Doctors

Jay S. Pepose, M.D., Ph.D., Medical Director of Pepose Vision Institute and Professor of Clinical Ophthalmology at Washington University and Barnes- Jewish Hospital, specializes in laser vision correction, cataract and cornea surgery.

Dr. Pepose earned his medical degree and Ph.D. from UCLA and completed his residency in ophthalmology at the Johns Hopkins Medical Institutions. He completed his cornea subspecialty training at Georgetown University Medical Center. Dr. Pepose is a pioneer in LASIK vision correction and accommodating lens implants.

Dr. Pepose is the only St. Louis area cornea and vision correction specialist recognized again by Best Doctors in America – 2008 and America’s Top Doctors. Patients benefit from the world class research that he performs at PVI.

Mujtaba A. Qazi, M.D. is Instructor of Ophthalmology at Washington University and Barnes-Jewish Hospital, as well as a cornea and vision correction surgery Instructor at the University of Missouri-St. Louis School of Optometry. He specializes in the areas of cornea, cataract and vision correction surgery.

Dr. Qazi earned his medical degree from NYU and completed his residency in ophthalmology at Boston University School of Medicine. He completed his subspecialty training in cornea and vision correction at Pepose Vision Institute, where he was personally trained by Dr. Pepose. Dr. Qazi is recognized by “Who’s Who in Medicine and Healthcare” and in Best Doctors in America – 2008.

James C. Rieger, O.D. is a licensed optometrist in both Missouri and Illinois, with subspecialty certifications in the diagnosis and treatment of ocular conditions, including glaucoma. He earned his O.D. from the University of Missouri-St. Louis College of Optometry. Following graduation, Dr. Rieger trained with eye surgeons Our Doctors in the pre- and post-operative care of LASIK and cataract patients.

Michael P. Steele, O.D. is a licensed optometrist in both Missouri and Louisiana, with subspecialty certifications in the diagnosis and treatment of ocular disease. Dr. Steele earned his O.D. from Illinois College of Optometry in Chicago. He served his residency in primary care at Ochsner Hospital and Clinic in New Orleans, focusing on pre- and post-operative care of cornea patients as well as the treatment of glaucoma, contact lens fitting and low vision rehabilitation.

“The Times They Are A Changing”

Dr. Jay S. Pepose, M.D., Ph.D.

One of the few things you can count on in life is change. When I attended medical school at UCLA thirty years ago, I remember one of my instructors saying that 90% of what we knew about medical science had been discovered only one decade before! Today, the Internet offers virtually instantaneous information transfer, further accelerating the creation and dissemination of medical knowledge.

No other field in medicine changes as quickly as ophthalmology, which has developed and rapidly embraced new technologies to protect, preserve and enhance vision. Many of you may remember grandparents lying in the hospital after cataract surgery with sandbags stacked around their head; afterwards, they required thick glasses to see because lens implants had not yet become available. This was to change when, during World War II, a British ophthalmic surgeon by the name of Harold Ridley treated a fighter pilot with a piece of plexiglass from the windshield of his plane embedded in his eye. He noted that the plexiglass had not resulted in any inflammation in the eye. This young surgeon’s seminal observation led him to fashion the first intraocular lens implant which he first implanted in a patient in 1949.

This new approach was ridiculed by many ophthalmologists at the time; Dr. Ridley was threatened with revocation of his medical license. Nevertheless, he persevered, and, with further development, the lens implant has restored sight to hundreds of millions of people throughout the world. Dr. Ridley, once ridiculed by his colleagues, was later awarded knighthood by the Queen of England for his important contribution, having made one of the most significant medical discoveries in history.

In 1988, I came to St Louis to join the faculty of Washington University School of Medicine. I remember my discussions with the head of Barnes Hospital, who encouraged me to focus on areas that would change the way ophthalmology was practiced over the next decade. One of the areas I chose to work in was the use of the excimer laser to sculpt the cornea to treat nearsightedness, farsightedness and astigmatism. At that time, we had only incisional surgery called “RK,” performed with a diamond-tipped knife. I remember giving grand rounds about our early results with the excimer laser and having one ophthalmologist stand up and call me a “charlatan” because he believed that only incisions could accomplish permanent changes in corneal shape. Several years later, when I gave the first certification course in excimer laser surgery, this same ophthalmologist was eagerly in attendance in the front row. So, in the face of constant change, some things apparently remain unchanged from Sir Harold Ridley’s time to today!

Who would have even dreamt ten years ago about the innovations that are available to us today, such as bifocal lens implants for cataract surgery that allow both near and far vision; intraocular contact lenses for treatment of high nearsightedness; new laser treatments for glaucoma and new therapies for the wet form of macular degeneration? What are the next ten years likely to bring? I predict that we will have new corneal treatments for presbyopia (the “reading glasses problem”)  and procedures that, in combination, can address a whole host of ocular conditions.

As a practice, we have also seen tremendous change and growth. When Pepose Vision Institute was first founded in 1999 with 6 employees, I would never have dreamt that 8 years later we would be moving into a state-of-the art eye building with two operating suites and two laser rooms; a facility that permits us to offer in-house a full range of ophthalmic services from LASIK to cataract surgery to glaucoma treatment to contact lens fitting and glasses. This now permits us to offer our patients a lifetime of eye care, as the natural process of aging results in new threats to their vision. Our facility was built with our patients in mind; to not only make their visits more comfortable, but to provide them with the information necessary to become informed patients.

Above all, we are dedicated to providing the most advanced eye care available, within a patient-centered environment. To achieve this goal, we are involved in a number of on-going clinical studies in cooperation with eye industry leaders. Simply put, world-class research leads to world-class treatments.

To be able to see the world around us, and the people whom we love, is a precious gift. We appreciate the confidence you put in us to protect, preserve and enhance your vision throughout your lifetime