Patient Questions

Yes. Nearsightedness (myopia) in children usually gets worse because the eye is growing too long, and several treatments can slow that growth. They slow it rather than reverse it, so starting early matters.

• Overnight ortho-k lenses, such as DreamSculpt™ Ortho-K, worn while your child sleeps
• Daily soft contact lenses made for myopia control
• Special glasses lenses designed to slow progression
• Low-dose atropine eye drops

Free habits help too: about 2 hours outdoors every day, and regular breaks from close-up screens and reading.

At your child's next exam, ask how much the prescription changed this year compared with what's normal for their age, and whether the eye's length (axial length) can be measured and tracked. That tells you how fast things are changing and which option fits your child and your budget.

Usually, yes, with the right timing. The concern is that drops put over a scleral lens can get trapped in the fluid against your eye for hours.

• Most allergy (antihistamine) drops contain preservatives, so use them before you put your lenses in (wait about 10 to 15 minutes) or after you take them out, not over the lens.
• Lubricating drops labeled preservative-free can generally be used while wearing sclerals. Preserved drops can irritate the eye or discolor the lens.
• Only fill the lens bowl with the solution your fitter recommended.

With keratoconus, controlling the itch matters extra, because eye rubbing is linked to keratoconus getting worse. Cool compresses help in the moment. Ask your fitter which drop and timing works best with your lenses, and if your eye becomes painful, very red or light-sensitive, take the lenses out and get seen promptly.

For many people, yes, but it depends on what's causing the halos. With small rigid (RGP) lenses, night glare often comes from the lens moving or sitting off-center on the cone, or from the edge of the lens's optical zone falling inside your pupil when it widens in the dark. Sclerals vault over the whole cornea, stay centered, and have a larger optical zone, so those causes often improve.

If the glare comes from corneal scarring, a scleral helps less. Some fitters can add customized optics to sclerals for leftover ghosting and glare.

Before you commit, ask whether you can try a diagnostic scleral in the office and look at lights in a dim room, what the fitting fee includes, and whether your plan covers medically necessary contact lenses. Keratoconus often qualifies.

This is called midday fogging, and it's common, especially in the first weeks. If drops on top of the lens don't clear it, the haze is in the fluid under the lens. It usually comes from debris, mucus or oils getting under the lens, a fit that lets tear fluid flow in under the edge, or oil from your fingers.

• Wash your hands with an oil-free soap before handling.
• Fill the lens bowl completely, with no bubbles.
• When it fogs, remove, rinse, refill with fresh preservative-free saline and reinsert.
• Warm compresses and lid hygiene help if you have dry eye or oily eyelids.

Thick drops added to the fill can bind with debris and make the haze worse, so ask your fitter before adding anything. Tell your fitter how many hours in the fog starts, because a fit adjustment often fixes it. If your eye becomes painful, red or light-sensitive, take the lens out and get seen promptly.

Many scleral fits take 2 to 4 lenses, and complex corneas can take more. What matters more than the count is whether each new lens clearly fixes the problem the last one had.

A scleral is supposed to vault completely over the cornea on a layer of fluid. If a lens touches the cornea on one side, that's a specific, fixable problem: the fitter can add depth, change the diameter, or use a design whose edge differs around the eye to match its shape. Touch shouldn't be left alone for long, because it can irritate the cornea.

Good questions for your fitter: what is changing in this lens, are custom or quadrant-specific designs available, and are refits included in the fee? If you're stuck on the same problem after several tries, a second opinion from a fitter who does many sclerals is reasonable.

Morning rubbing is very common, and because it happens half asleep, willpower rarely fixes it. What works is treating the itch and making the habit harder.

• Find out why your eyes itch when you wake. Allergies, dry eye and eyelid inflammation (blepharitis) are the usual causes, and all are treatable.
• Keep preservative-free artificial tears in the fridge by your bed and use them first thing instead of rubbing. A cold compress works too.
• A soft sleep mask or eye shields at night can stop rubbing before you're awake.
• Wash pillowcases often and keep pets out of the bedroom if you have allergies.
• If you must touch, press gently on the closed lid instead of rubbing.

Hard rubbing is linked to keratoconus getting worse, even after cross-linking. Tell your eye doctor about it, and get seen promptly for a sudden drop in vision, pain, or a very red, light-sensitive eye.

Hybrid lenses are a good next option when sclerals haven't worked. The center is a rigid gas permeable lens, so vision can be as crisp as a rigid lens, and the soft outer skirt makes them feel more like a soft lens.

• They're meant to be replaced on a schedule, often every 6 months. Ask what replacement plan and warranty come with the fit.
• The common wear problems are the soft skirt tearing where it meets the center, and protein buildup. Gentle handling and the cleaning system your fitter recommends help.
• They usually help ghosting and night glare a lot. How much glare is left depends on your cornea and pupil size.

If your eye gets red, painful or blurry after a few hours of wear, take the lens out and tell your fitter. That can mean the fit is too tight.

Cross-linking strengthens the cornea to slow or stop keratoconus. With the common "epi-off" method, plan for a few rough days.

• You can't drive yourself home that day, and most people don't drive for several days.
• The first 2 to 4 days are usually the hardest: light sensitivity, watering and a gritty pain, with a bandage contact lens on the eye.
• Expect a follow-up within the first few days, then more visits over the next few months. Vision is often blurry for a few weeks and can keep shifting for a few months.
• Many people return to desk work after about a week, but screens can be tiring at first.

Once the cornea settles, many people with keratoconus still need specialty lenses such as sclerals for their best vision, and that's something we fit.

Glasses can't fully correct irregular astigmatism, which is why ghosting and starbursts at night persist. The best fixes give your eye a new, smooth front surface.

• Scleral lenses are often the most effective option, and mild cases are usually simpler to fit than keratoconus.
• Smaller rigid gas permeable (RGP) or hybrid lenses also mask the irregularity and often cost less.
• Specialty soft lenses for irregular corneas can be more comfortable but usually help less with ghosting.
• A dry eye check matters, because a dry surface makes halos worse at night.

Ask whether your plan covers medically necessary contact lenses, since irregular corneas often qualify. Until you have a better option, avoiding night driving is the safe call.

Have it checked soon, ideally today or tomorrow. A feeling that lasts for days after a torn lens can mean a scratch on the cornea or a piece of the lens still stuck under the eyelid, and wearing a contact over either raises the risk of infection.

• Leave the lens out of that eye until it's checked, and never sleep in lenses.
• Call your eye doctor and ask for a medical visit for eye pain after a torn contact. Many offices fit these in the same day.
• Go in right away, or to urgent care, for real pain, light sensitivity, discharge, blurry vision that doesn't clear, or a white spot on the eye.

Once the eye is checked, ask whether a high-oxygen daily lens would suit you better, and give your eyes some lens-free hours each day.

A new floater should be checked with a dilated eye exam soon, ideally within a day. Most new floaters turn out to be the gel inside the eye pulling away from the retina with age (a posterior vitreous detachment). That's common and harmless by itself. The exam is to make sure it didn't cause a small retinal tear, which is treatable when caught early.

Flashes can happen with your eyes open or closed, and a retinal detachment doesn't always come with flashes. Go to an eye doctor or emergency room right away, the same day, if you notice:

• A sudden shower of many new floaters
• New flashes of light
• A shadow, curtain or veil over part of your vision
• A sudden drop in vision

Lattice degeneration is a pattern of thinning at the outer edge of the retina. It's much more common in nearsighted people, because a longer eye stretches the retina. It's mostly about genetics and the eye's length, not anything you did, and it's often first found at a routine dilated exam.

Barrier laser places a ring of small laser spots around a weak area so the retina holds down more firmly there. It's usually done in the office in a few minutes, to lower the chance of a retinal detachment later. Not every patch needs treatment, so it's fair to ask your doctor what about your area makes them recommend it, what recovery is like, and how often you should be checked.

Get seen the same day if you notice a sudden shower of new floaters, flashes of light, or a shadow or curtain over part of your vision.

Ongoing pain weeks after surgery deserves a specific look. The common causes are dry eye or irritation of the eye's surface, inflammation that's still active, and the pressure inside the eye. All of these are quick to check.

• Is my eye pressure normal?
• Is there still inflammation, and should my drops be adjusted? (Don't change or stop drops on your own.)
• Could dry eye be part of the pain and the blur later in the day?
• Is the lens implant centered where it should be?

A second opinion is a normal part of care if you still feel unsure; ask the second office to send its notes to your surgeon. Go in the same day if the pain gets worse, the eye gets redder, light starts to hurt, or your vision drops suddenly.

With monovision, one eye's lens implant is set for distance and the other for closer work, so you can see at more distances without glasses.

• A contact lens trial is a good preview of whether your brain is comfortable with the eyes set differently, though a cataract makes the trial less exact.
• Many people find monovision a little weaker at night and in dim light, with slightly less depth perception. Some keep glasses for night driving that set both eyes for distance.
• A smaller difference between the eyes (mini-monovision) usually gives good computer and phone vision and is easier to adapt to, with readers for fine print.

To compare targets, a prescription with astigmatism can be turned into one number: the sphere plus half the cylinder. Your surgeon can tell you which target fits your eyes.

LASIK is an adult procedure. It's FDA-approved from age 18, and most surgeons want the prescription to be stable for at least a year or two first, which for many nearsighted people means the early-to-mid 20s.

The reason is that LASIK reshapes the front of the eye to correct the prescription you have that day. It doesn't stop the eye from growing longer, and that growth is what makes nearsightedness get worse in children and teens. If surgery is done while the eye is still changing, vision can drift again afterward.

In the meantime, the part you can influence is how fast your child's eyes are changing now. Ask about myopia control at their next exam.

Most people's nearsightedness slows down and levels off in their 20s, but high prescriptions can keep creeping up through the teen years. Two or three stable exams in a row tell you much more than one, and measuring the eye's length (axial length) is the most precise way to track it.

At very high prescriptions, many people are not good LASIK candidates, because correcting that much means removing a lot of corneal tissue. An implantable lens (ICL), which is placed inside the eye without removing corneal tissue, is often the better fit. In the US, ICL is approved starting at age 21, and surgeons also want the prescription to be stable first.

High myopia stretches the retina, so yearly dilated exams matter. Get seen the same day if you notice a sudden shower of new floaters, flashes of light, or a shadow or curtain over part of your vision.