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SEEING LIFE CLEARLY

Drs. Kristopher and Jessica Pugh

BY LAURA ROSS | PHOTOS BY CHRISTIAN WATSON

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IN THE SPACE of a few moments, Dr. Jessica Pugh is a blur. She checks in with front desk staff on patient details, takes a ‘mom’ phone call on arranging transportation to her children’s evening school and sports activities, talks briefly with her husband, surgeon Dr. Kristopher Pugh, and cheerfully, if not somewhat reluctantly, takes a few minutes for a photo shoot and a media interview. It’s all in a day’s work for the busy physician, who along with her husband, owns and runs Dr. Black’s Eye Associates, specializing in ophthalmology and optometry, and vision correction surgery for patients in Southern Indiana and Louisville.

“Believe it or not, I don’t do caffeine,” she laughed. 

“I get up and exercise early and get our four kids (Emma, 14; Hadley, 13; Callum, 9; and Boden, 7) out the door, then I see patients. My husband and I are passionate about our work and we want to set that example for our kids to work hard and treat people correctly. Do I feel balanced all the time? No, but you give yourself grace and just have fun and do the best you can.”

That passion for patient care and good vision runs in the family. More than 30 years ago, Dr. Brad Black established his Southern Indiana practice, which evolved to become Dr. Black’s Eye Associates, serving Southern Indiana, and eventually expanding into Louisville. Dr. Black retired in 2017 and under the leadership of his daughter and son-in law – Drs. Jessica and Kristopher Pugh – the practice continues to expand and currently has 12 office locations, plus a surgery center (Vision Surgical Center) and a LASIK Center. Dr. Black’s Eye Associates now includes 21 doctors and 180 staff, along with a seven-vehicle fleet transportation department that provides complimentary transportation for cataract surgery patients. 

“I grew up in the business, peeking in at eye exams and watching everything,” Dr. Jessica Pugh said. “My dad started the business here in Jeffersonville when I was in first grade, and it feels like home to me.”

When she was in high school, a mission trip through VOSH (Volunteer Optometric Services To Humanity) with her father changed her life. “We went to Honduras and that stuck with me,” she explained. “My dad would spend hours operating, and I’d work in the dispensary, giving out glasses.” 

She made her way to Butler University, where she kicked around studying genetics and childhood education, but when a sorority sister went into optometry, it all clicked. “I realized I’d been preparing for that my whole life,” she said. 

As she focused on optometry, she also made another fateful connection. 

“Jessica and I met at Butler when several friends piled into a minivan for a short trip,” laughed Dr. Kristopher Pugh. “I got to know her then.” As they dated, they discussed their medical studies and naturally, Jessica talked a lot about her dad. 

“We went to different cities for medical school,” explained Kristopher, who had a goal of becoming a hospitalist. “I was influenced by her dad, who is really gregarious and fun to be around, and that combo and a surgery rotation my 3rd year made me decide to switch from medicine to surgery.” 

The couple was married shortly after graduation and moved to South Carolina for Kristopher’s surgery residency. While they were there, they welcomed their first two children. But, the tug of returning home to Indiana always remained. In 2007, with other job prospects on the table, the couple moved home. 

“We had offers to consider and it didn’t take us long to realize we had an opportunity you just can’t recreate – both our families are in Indiana,” said Kristopher. “Dr. Black is so well-known and has such a great reputation that the chance to come back here and learn from him, and for me to rev up as a surgeon and Jessica as an eye doctor, was as good as any fellowship or job that existed elsewhere.” 

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VISION AND GROWTH 

“We didn’t come here thinking my dad was on his way out,” said Jessica. “We’d love it if he’d work forever.” 

But retirement called by 2017, and Dr. Brad Black stepped away to become a full-time active grandparent. Kristopher and Jessica took over the family business. 

“Dr. Black was so helpful and set lofty expectations that allowed me the space and time it takes to be the best surgeon,” said Kristopher. “I have respect for him as a father in law, but also as a colleague and mentor and boss. I was lucky to work with him.” 

The Pughs soon learned that growing a business was just as much work as providing patient care. “We were just being the best doctors we could be,” said Kristopher. “But I’m fascinated by the opportunity to run a healthcare business. There’s a parallel between meeting a patient and putting together the puzzle on what their best vision is, and there’s also a puzzle piece in determining the eye care needs of Southern Indiana.” 

They realized that the area was a changing marketplace, with many of Dr. Black’s long-time colleagues retiring. “Dr. Black saw patients in rural communities,” said Kristopher. “He didn’t own practices there, but he worked alongside local, rural doctors and performed surgeries in their hometown hospitals.” 

The Pughs built upon those long-time relationships and began acquiring those practices as the doctors retired. “In just six or so years, we now have a comprehensive practice that has pediatric eye care and surgery, refractive surgery, glasses, contact lenses, and we are taking care of the aging population,” said Kristopher. “We’ve added new doctors and staffs, but while many of our competitors are selling out, we are locally, family-owned.” 

As their practice has grown, the Pughs actively empower their doctors in satellite offices to make their own decisions and keep their local feel. “Being locally owned sets us apart. It’s becoming a rarity,” said Jessica. “We’re one of the last free-standing optometric practices in the area.” 

“Like all of our doctors here, ethically, I’d have a hard time looking at a patient and recommending a treatment or surgery that I didn’t feel 100 percent behind,” she added. “I think the culture and work environment is so important. I want this to be a place where employees want to come in and I want them to have a smile on their face. When you can cultivate that within the practice, it is passed along to the patients.” 

“The concept of a family business is something we’re learning constantly,” said Kristopher. “It changes every day. If done correctly, you can create a workplace where everyone feels connected and involved in something that is bigger.” 

GIVING BACK 

The Pugh family and their extended family of physicians and staff are all actively involved in their communities. Dr. Jessica Pugh is on the board of the New Albany Education Foundation and supports many other organizations. “I grew up here and we are all firmly rooted in Southern Indiana,” she said. “There’s a big part of me that feels if someone asks for help, we should try to give back.” 

Dr. Black’s Eye Associates also sponsors many organizations across Southern Indiana, including Impact 100 Southern Indiana, New Albany and Floyd Central High Schools’ theatre arts programs, and the New Albany track program, among others. Doctors and staff are regular participants in many school career days and the practice provides complimentary vision screenings for more than 2,000 elementary students in Floyd, Harrison, Washington, Scott, and Ripley counties. The practice also takes the complimentary vision screenings on the road to county health fairs across Indiana. 

Eventually, the Pughs hope to develop a free clinic to provide necessary visual exams, frames, and lenses for families in need. “It’s so important to us to be a visible part of our community and continue the legacy of giving back that Jessica’s dad instilled in us,” said Kristopher. 

Reflecting on her own mission trips with her father, Jessica saw her past mesh with her future last year when she and her daughter, Hadley, traveled on a mission trip to the Dominican Republic. “It’s like I came full circle,” she mused. “Several doctors from this area ran a full clinic, with medical, dental and optometric services. I ran the optometric clinic and we handed out 650 glasses in one week. It left a huge impression on my daughter. It was so special to serve others with her by my side, and I know my dad was proud of both of us.” 

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COMMITMENT TO QUALITY 

When Dr. Brad Black established his practice, he made a commitment to treat each patient as he would a family member. Respect and compassion were – and are – as important as providing medical care. 

“It can be hard to prioritize your eye health, especially when you have kids, a busy job, and things going on constantly,” said Jessica. “And, for a patient, it can be very scary, after all, it’s their eyes. I don’t treat that very lightly. I’m sympathetic and like to talk you through the appointment,” 

“When I see patients, I don’t look at the clock. I look at them,” she said. “People like to have things explained and feel that they are heard. Everything we do here, we do 100 percent for every patient.” 

“In most medical practices, the art of personal service has been sacrificed for efficiency,” said patient William Hardy. “Eye Associates has created the perfect balance of medical practices and procedures, while giving personalized treatment.” 

“Every person I came in contact with at Dr. Black’s Eye Associates treated me with extreme respect,” agreed patient Jean Arden Haub. “Even though this was my first visit, they treated me like they had known me all my life.” 

“A good day for me is executing a plan to help people see better,” said Kristopher. “The outcomes are impactful and measurable, and I get quiet satisfaction from seeing patients respond so well. I enjoy meeting a patient, getting to know as much about them as I can, putting together a puzzle on how they’ve seen their whole life, how they see now, and how they want to see in the next decades.” 

“What I love most is that our family has cared for generations of area families,” said Jessica. “It’s fun. My friends come in. Their parents come in. It’s rewarding to carry on that tradition of service. My dad, Dr. Black, is the most jovial person you’ll ever meet, but he stood for nothing less than perfection in the operating room. We are proud to carry on that same quality.” 


ARE YOU A GOOD CANDIDATE FOR LASIK SURGERY? 

Since the early 1990s, LASIK (which stands for laser-assisted in-situ keratomileusis) vision correction surgery has changed the lives of thousands of patients who now enjoy greatly improved vision. LASIK surgery helps correct vision in people who are farsighted, nearsighted or have astigmatism. Newer, recent technology advances have made the procedure safer and more precise than ever before. Dr. Black’s Eye Associates’ Jeffersonville Vision Surgery Center offers advanced laser technology, using a femtosecond laser that provides outstanding precision and speed in the vision correction surgery. 

“Laser vision correction is one of several tools we can utilize to correct vision and let people live the life they want to live,” said surgeon Dr. Kristopher Pugh. “This is the only location in Southern Indiana where LASIK can be done.” 

Doctors first evaluate a patient’s vision, their age, and the shape and thickness of their corneas before performing LASIK. According to Dr. Pugh, the best age range for LASIK patients is between their mid-20s to mid-50s. 

The LASIK procedure performed by Dr. Black’s Eye Associates surgeons utilizes a bladeless WaveLight® EX500 laser system, which maps the unique characteristics of the patient’s eye. This computer-controlled, tiny beam of light prepares the cornea for treatment by a second, excimer laser. Computer-guided technology pin-points the precise topography of the eye to allow for precision and accuracy in reshaping the cornea, which is the clear front part of the eye, so that light traveling through it is properly focused on the retina, located in the back of the eye. 

Once the patient undergoes the surgery, vision can be significantly improved by the second or third day after the procedure. Many patients experience 20/20 vision. 

“It’s a pretty amazing procedure,” said Dr. Pugh. “The recovery is so quick, and that wow factor is so hard to replicate. Patients tell me stories that they’ve had glasses since they were six years old, and then they get up after surgery and see so clearly. It’s exciting to watch that reaction.” 

Unlike some LASIK vision correction surgery centers, Dr. Black’s Eye Associates provides a lifetime LASIK guarantee. If an enhancement or re-treatment is needed later, qualified patients will receive the treatment without charge. 

For a complementary consultation on LASIK surgery options, call Dr. Black’s Eye Associates at 812.284.0660. 

Have Headaches? Here’s How To Find Relief

By Dr. Michael Cassaro

Headaches! What a headache! While most people never get headaches, most people do get occasional headaches, though they usually are not severe. Treatment, if necessary, is successful with over-the-counter medications as needed.

Yet, there are a lot of people with frequent headaches, recurrent headaches, headaches that last for days at a time and even what are referred to as chronic daily headaches. Despite their name, chronic daily headaches don’t have to actually occur every day. But for people who deal with fear of a headache on those few days without actually experiencing one, they probably still have chronic daily headaches. Headaches are also characterized by other attributes, such as where the pain is located, what it feels like, what aggravates the headaches or what relieves the headaches.

All of this makes very little difference to the person who has the headache. That person just wants relief, which comes in stages.

Self-help usually comes first. Basic treatments like correcting dehydration and taking over-the-counter medications help almost everybody with occasional headaches, regardless of the cause or type of headache.

For people with frequent headaches, recurring headaches and chronic daily headaches, the basic treatments just don’t bring enough relief. Sometimes, even when there is pain relief, the fear of the headache coming back, or a new headache starting, can be almost as debilitating as the headache pain. Those types of headaches require an accurate diagnosis of the cause and require different treatments.

The causes of chronic daily headaches are usually a combination of things that all come together. A component that is almost always present is a toxic environment. The toxins can be coming from outside your body or from inside your body. If you have chronic daily headaches, look at your environment at home, at work, in your car and in your yard. Get rid of all the chemicals. This includes things like lawn treatments, bug sprays those plug-in air fresheners, as well as air fresheners in aerosol cans. (I’ve got news for you, there is not a real pine forest or a real meadow in those cans. The can is potentially full of headache starters.)

In addition to cleaning up your external environment, you have to take a close look at your internal environment. The toxic component of your headache trigger can be something you put in your body or something you aren’t properly eliminating from your body.

When I first learned to treat people with headaches, I was taught to have individuals keep a headache diary. I no longer make that recommendation to my patients. There is usually so much information that it is just confusing. The cause of this afternoon’s headache may not be what you ate for lunch. It may be that something you ate two days ago reacting with something you ate two days before that and turned into a headache today, tomorrow or next week.

And, it may not be the food you see that triggers the headache. It’s more likely that some chemical food additive, or combination of additives, is causing your headaches. You will never find out what most of these additives are. They are not required to be listed on any food labels.

There are several thousand manmade chemicals that can be added to our foods and listed collectively as spices, colors or flavors (both artificial and natural flavors are mostly manmade chemicals). The only way to get away from these hidden headache triggers is to prepare your meals at home from ingredients you buy in the produce department or the butcher department of the grocery store. Bring your lunch to work.

I’ve been a physician for thirty years. In that time, I can’t remember a single patient whom I treated for chronic daily headaches who didn’t have irritable bowel problems. If the colon isn’t working right, the rest of the body is toxic. Until the colon function returns to normal, the chronic daily headaches are likely to continue. It doesn’t matter if the predominant symptom is constipation, diarrhea or both alternating back and forth.

Irritable bowel problems are caused by what you eat. It’s that simple – and it’s not genetic. If it runs in your family, it’s because everybody in your family eats at the same table. Eat what you can buy in the produce department or the butcher department of the grocery store. Leave the rest of the store alone. The deli is not the butcher department! Also, cereal is not in the produce department or the butcher department. Don’t worry about fiber.

Everything in the produce department is loaded with high quality, natural fiber. Another likely trigger for headaches is arthritis. More specifically, arthritis in the neck is one of the most common causes of headaches. This arthritis can be the result of an old injury, decades in the past. The headaches also can start immediately after a neck injury. This is common with a whiplash injury. Sometimes the headaches start right after the injury, go away after a short time and return years later. Sometimes, the arthritis is there for years without causing any pain. Then, a sneezing fit, or stepping wrong off of a curb can jar your neck just enough to start relentless headaches.

When there is arthritis in the neck, a new injury can cause the joints between two of the neck bones to become unstable. This is a common cause of very severe headaches, including migraine headaches that can last for many days at a time. This type of instability is a very common cause of headaches that awaken you or headaches with which you awaken. This is also a frequent cause of headaches brought on by looking down for prolonged periods of time, like when reading (or looking at your phone), studying or working at a desk.

Successful treatment of chronic daily headaches begins with an accurate diagnosis of the cause. That starts with a physical examination. A hands-on physical examination is step one. It can pick up many things that will not show up on any test or X-ray. When getting neck X-rays, the most valuable views are the flexion and extension views. The doctor has to specifically order these views, they are not done as part of a routine neck X-ray. Even better is a video motion X-ray.

Unfortunately, most insurance does not pay for video motion X-rays. An MRI has only limited value in finding the cause of headaches, unless it is looking at the neck. An MRI of the head will show things like brain tumors or aneurisms, but for the other 99 percent of people who have headaches, it adds no useful information.

Treating chronic daily headaches can sometimes be accomplished with just medications. For some people, a combination of medications that decrease frequency and severity of the headaches is combined with medications to treat a headache that still happens. However, for most people with chronic daily headaches, additional treatment is required and it is usually minimally invasive.

They may include injections. There are many types of injections used successfully to treat chronic daily headaches. Some of the common injections are Botox and nerve blocks. The nerve blocks can also be used to help specifically identify which nerves are involved. Once those nerves have been identified, other, more permanent treatments, are possible.

There are two main treatments used for chronic daily headaches to provide long-term, frequently permanent, relief. Those treatments are radiofrequency neurolysis and occipital nerve stimulation.

Radiofrequency neurolysis is performed with special needles that are placed so the tips are adjacent to the nerves identified as the culprits in headache generation. The nerves are then burned using the same technology that is used by a microwave oven. Those nerves can no longer carry the headache pain signals. Headache gone!

Radiofrequency neurolysis cannot be used on all nerves that might carry headache pain signals. For people who cannot get relief of their chronic daily headaches using radiofrequency neurolysis, occipital nerve stimulation can be used. Occipital nerve stimulation is more invasive than a procedure using needles. It involves a permanently-implanted device. With the implanted occipital stimulator, a headache can be “turned off” as easily as “flipping a switch.”

There is almost always a way to stop chronic daily headaches. If you are still suffering with chronic daily headaches, look for information on more effective ways to treat your headaches. Medications are most commonly managed by neurologists specializing in headache treatment. Invasive therapies like injections, radiofrequency neurolysis or occipital nerve stimulation are usually provided by pain management doctors specializing in headache treatment.

An ounce of prevention is worth a pound of cure. Radiofrequency neurolysis and occipital stimulation prevent headaches. Most people who have opted for one of these treatments, love the results. They no longer have to take a combination of medications, and don’t have to deal with the medication side effects.

Get a good headache examination. Find out if more can be done to eliminate your headaches so you can lead a pain free life.

Michael Cassaro, M.D. is one of the top pain treatment experts in the country. You can learn more about his Jeffersonville-based practice at www.painlessliving.net.