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FAQs with Dr Holland


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Here are the most frequently asked questions, we hope you find this helpful.

Please call the office if you wish for more information or to schedule an appointment.

Dry Eyes:

1. What is dry eye and what are the main causes?

Dry eye disease is multifactorial, but often is inflammation related.

The signs and symptoms of dry eye stem from tear film instability – your tears evaporate off of your eye faster than they can be replaced. The most common cause of dry eye results from poor production of the oil layer of tears.

This oil layer is produced by glands in your eyelids called meibomian glands. These oils gradually thicken and may reduce the amount of secretions over time due to inflammation. A thick, clogged, and infected meibomian gland causes “a stye”.

2. What are the main signs and symptoms of dry eyes?

The most common symptoms include dry, irritated, red, or watery eyes.

As dry eye progresses, eye fatigue, light sensitivity, blurry or unstable vision, or a sensation that something is in the eye may be experienced.

Very few patients have all of these symptoms. Even patients with moderate dry eye disease may only experience 1 or 2 of these symptoms. In my practice, the most common complaints I hear from my dry eye patients are:

  • “My vision goes in and out of focus.”
  • “My eyes feel fatigued, especially when working on a computer.”
  • “My eyes feel tired.”
  • “I’ve had a stye in the past.”
  • “It feels good to take my contact lenses out when I get home.”

3. How does IPL treat dry eyes?

Intense pulsed light (IPL) is a revolutionary UV light treatment that was originally developed in dermatology clinics.

This specifically calibrated light is delivered to the facial structures around your eyes to minimize inflammatory factors that reduce tear production.

Not all patients are great candidates for IPL dry eye treatment; so you should consult your optometrist if IPL treatment is an option for you. Generally, patients with rosacea or vascularization on their cheeks and nose see the largest improvement in their dry eye symptoms.

4. How does Mibo ThermoFlo treat dry eyes?

Miboflow treatment is aimed at liquifying thickened meibomian gland secretions. When these secretions are too thick, they cannot be secreted, or do not evenly distribute onto the front of the eye.

This is often the main cause of dry eye symptoms. If your eye doctor ever told you that you need to do warm compresses, Miboflow treatment is “warm compresses on steroids,” and is a much more successful and effective treatment than at-home-remedies.

This treatment is aimed at preserving and improving the function of the meibomian glands.

I have seen Miboflow treatment improve current dry eye symptoms with many patients. With prescribed Miboflow treatments, the risk of dry eye becoming more severe is minimized.


Scleral Lenses:

1. How are scleral lenses different from regular hard lenses?

Scleral lenses are larger diameter rigid gas permeable (hard) contact lenses that fit under your eyelids and onto the white part of your eye.

A larger diameter lens leads to significantly increased comfort and more stability because it vaults over the cornea, leaving the cornea untouched, which allows for clearer optics.

The fitting philosophy is different with sclerals than with smaller hard contact lenses because the smaller lenses rest on the front of the cornea. Scleral lenses are the newest technology and provide advanced customizable contact lens optics for the most unique and difficult to fit eyes.

2. Who are the best candidates for scleral lenses?

While scleral lenses have been historically reserved for irregular corneas and continue to give excellent benefits for these patients, it is becoming more commonplace to use scleral lenses for higher prescription eyes or unique scenarios (such as dry eye).

Scleral lens candidates are often patients who have failed or tried multiple contact lenses that do not work. Generally, if you want better or more consistent vision than your soft contact lenses offer, scleral lenses could be for you.

If you have been told “you can’t wear contact lenses” or “your prescription doesn’t come in contact lenses,” likely you can wear a scleral lens!

3. What is keratoconus and why are scleral lenses a good option?

Keratoconus is a progressive thinning disorder of the cornea that results in a change in the curvature of the front surface of the eye.

Halos, glare, blurred vision, and double vision are common symptoms associated with keratoconus. As keratoconus progresses, the patient’s astigmatism will change quickly causing glasses remakes and reducing how well you can see with glasses. There are genetic correlations with keratoconus, as wellas physical correlations such as eye rubbing.


Myopia Management

1. What is myopia and why is it becoming a major health issue?

Myopia is an official diagnosis equivalent to “nearsightedness.”

Myopia means the up-close vision is clearer than the distance vision. Its cause is multifactorial, but there is a large correlation between excessive near work and increasing prescriptions among pediatrics and teenagers.

I have seen significant increases in glasses prescriptions due to a surge in computer/tablet use in these age groups compared to prior years. The length of the eye, known as “axial length” is measured by an instrument called an A-Scan.

As the eye grows longer, the glasses Rx increases. We also know that increasing axial length is correlated with increased incidence of other ocular diseases like cataracts, glaucoma, myopic degeneration, and retinal detachments.

If there are ways to lower your child’s risks for these potentially blinding eye diseases, it is appropriate to discuss the risks and benefits of such treatment with your child’s optometrist.

2. Why is Myopia management important?

Myopia management, also known as “myopia control”, is the practice of treating children for their progressive myopia by correcting their changing prescription as needed.

Myopia management’s aim is to minimize the length that the eye grows in an attempt to lower the likelihood of increasing prescriptions, as well as the negative side effects that accompany a higher axial length.

3. Which children are good candidates for Myopia Management?

Most children are excellent candidates for myopia management in the early and middle stages of myopia.

There are limits to each treatment option, so if you are considering myopia management for your child, it is best to see a qualified professional sooner than later to minimize progressive myopia.

4. Briefly describe each of your treatment options:

Ortho-K, MiSight and Atropine.

In the US there are currently three accepted forms of “myopia control” that show significant evidence of slowing the progression of myopia and axial length.

In no particular order, those treatment options are;

  • Orthokeratology (Ortho-k),
  • MiSight Lenses and
  • Atropine drops.

Orthokeratology is the practice of fitting a rigid lens for the patient to wear at night.

This custom-made lens acts like a retainer to gently mold the front surface of the eye toa specific shape and power. This pattern both corrects the patient’s vision and alters the light rays that are sent to the retina to slow the lengthening process (myopic progression) of the eye.

Ultimately, the patient no longer needs to wear glasses or contact lenses during the day as long as they wear the orthokeratology lens every night.

MiSight lenses were FDA approved in 2019. MiSight lenses are daily disposable contact lenses that have custom optics built into the lenses to aid in slowing myopic progression.

These lenses look, feel, and are worn like any other daily contact lens, except they have specialized myopia control optics built into the lens design.

As long as your child wears the lenses, they are working to slow their myopic progression.

Atropine is an eye drop that we use in a very low concentration for myopia control.

While there is a lot of debate on what is the ideal concentration for each individual, it is well documented that low-dose atropine minimizes axial length and myopic progression.

This treatment can be used alone, in which case glasses will correct your child’s vision, or can be used in combination with orthokeratology or MiSight lenses.