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What is dry eye & why does it matter

What is dry eyes and why does that happen?

Dry eye occurs when the tear film doesn’t properly moisturize the eyes and there’s two main types of dry eyes.

The first type is what we call aqueous deficiency. And that is just a fancy way of saying your eyes don’t produce enough tears.

This typically happens if you have some kind of underlying auto-immune condition.

Now, the more common type is what we call evaporative dry eye.

And that’s when you produce enough tears, but the tear quality that you produced is, not the right balance and your tears evaporate too fast.

So a lot of my patients, they actually complain of watery eyes.

And this is not super intuitive because you know, the body’s reflex is actually telling you that the eyes are dry and that’s why you’re producing more tears.

And then in terms of dry eye itself, it’s not very simple. It’s quite complex.

There’s a lot of factors that play into what makes it people symptomatic or not.

Some factors include age, uf you’re a female or male, the medications you’re taking, your work environment and the environment you live in,

If you’re a contact lens wear and a lot of different things that as physicians, we need to take into account and kind of personalize and tailor our treatments towards each individual.

Does additional screen time affect our children’s eyesight?

Patients of all ages are staring at screenings at an all time high.

What kind of impact do you think this is going to have on a children’s eyesight, their prescriptions and their eye health long term.

And unfortunately, everything that we do these days has to do with some kind of a digital device. And it starts very early in life.

When I see a toddler installer looking at an iPad, it’s very likely to distort, maybe issues later in life is the eyes and myopia.

There is a direct correlation between how much time is spent outdoors and rate of progression.

So accommodation is time outdoors on the plate out, less time in front of any digital device.

Silicon Valley Eye Physicians Sunnyvale – 80-Year old Keratoconus patient discovers scleral lenses

So how did you come to worst scleral lens?

Yes, I was diagnosed with Keratoconus in 1976 when I was 36 years old.

I’ve been wearing contact lenses for at least 10, 15 years before them.

When I was diagnosed and I originally went to the Institute for Sight Foundation in Boston, with Dr. Perry Rosenthal, who was a great, great, research guy.

Anyway, make a long story short. He diagnosed me with a deficit, diagnosed with keratoconus and started fitting me with whatever the most current contact lens was at some time, because he was in the process of developing that.

But after a number of years, it still just got worse and more difficult for me to find the lens that would fit. It was either too shallow. So it would rub and irritate the cornea, or it was too had too much curvature that it would just fall off.

I couldn’t keep it in. And my vision is so dependent upon that contact lens cause I only had one eye with vision and it was just a frustration year after year pain, a lot of pain, but so forth. And so on.

Then I heard about the scleral and I moved to this part of California and I started doing some research and I saw that you were, Dr. Mendelson, actually prescribing sclerals. (I) came here. He did. It’s been a miracle for however many, five, four or five years for the first time in my adult life. And I’m 80 years old for the first time. I’ve been able to just really enjoy being out and seeing things without pain.

Blepharospasm of the eyes & dry eye. What’s the connection?

Dr Wu: Are there any concerns with dry eyes and spasming of the eyelids? Blepharospasms that you do that you’re familiar with?

Blepharospasms can cause some dry eyes because of the unusual eyelid to ocular surface interactions.

I think some patients experience some relief of Botox that’s been explored recently. Definitely, if you have blepharospasm that does take into account and we do come up with a certain treatment plan, that can be a little bit more beneficial towards the blepharospasm.

Dr Lau: So, just anecdotally, from what I see in patients that oftentimes it’s stress-related or whether it’s increased work at taking homework. But some simple home remedies that you may want to try, obviously reducing stress, caffeine, getting better sleep, and you can try tonic water. There’s a chemical in there that might reduce the amount of spasms that you may be receiving.

Dr Wu: I like to add there’s some eyelid twitching is probably mainly what you’re getting at, but there’s different types of that. And so, you know, I think the most common type is what Dr. Lau alluded to where you can try these easy home remedies and just limiting your caffeine intake and more sleep. Trying to reduce stress levels. And then the previous statement I made about the Botox is for a more serious condition, that’s actually called blepharospasm.

Scleral Lenses for Keratoconus & Corneal Irregularity

At our office. Keratoconus is one of those common corneal conditions that we encounter. It is believed that it can be founded up to one of 250 people. Whereas in the past, we used to think it used to be one to 2000 or 3000 people. During your consultation, we may do corneal topography, which basically creates a map of the front surface of your eyes. This allows us to determine the shape, the size, the curvature of your condition, and whether you’re progressing.

If we determined that your eyes are progressing, we may recommend a treatment called corneal collagen cross-linking. Basically, this is the only way to stabilize and stop the cornea from progressing further and further.

Once we’ve determined that your eyes are stable and you’re not progressing, we can recommend the best visual treatment options. And this can include the most advanced contact lenses, including large diameter size scleral contact lenses.

That includes hybrid lenses, which is a fusion of a hard lens and a soft lens.

We can also do custom soft lenses, which may work for certain types of mild cases of keratoconus.

And lastly, we have the traditional gas permeable contact lenses, which we used to use for many decades in the past. If this is something you want to learn more about, please schedule a consultation at Silicon Valley Eye Physicians. Thank you.

How do you know you have dry eye disease?

Dr Wu: A lot of patients, you know, aren’t really aware that what they’re experiencing is dry eyes.

So at the end of the day, you may feel like your eyes, you’re having a hard time keeping your eyes open.

You may feel like your eyes feel a little sticky or just not, not quite right.

And these are early signs of dry eye symptoms.

And so with dry eyes, we definitely want to treat it at the early stages before it gets progresses to a more serious condition. And that can start to affect your quality of life, your vision, and your ability to wear contact lenses, et cetera,

Dr Mendelson: Any patients consider any surgical intervention whether its cataract surgery or LASIK surgery will benefit from better outcomes once they have a nice pristine tear layer.

So this needs to be determined and others before any surgical intervention, because patients are going to benefit from much, much better vision post surgery.

So again, very important if anyone considers any surgery such as LASIK or cataract, make sure that the dry eyes, even if you don’t feel dry, that you’re doctor inspects the glands of the eye, and take any steps that are necessary to ensure a good outcome.

Why do parents not view Myopia (nearsightedness) as a problem?

Parents start myopia management for their child once they understand how a higher prescription leads to a high risk for eye disease. Our own Dr. Moshe Mendelson published an article on Review of Myopia Management regarding this. Plus, parents are able to talk to our doctors remotely, from their own, about myopia management.

There’s a lot to learn how myopia management is necessary for protecting your child’s future. Click here to learn about myopia management and schedule your myopia management consultation.

How Sleep Apnea Affects The Eyes

Did you know that some eye conditions are associated with sleep apnea? According to the National Sleep Foundation, more than 18 million Americans have sleep apnea, and Health Canada reports similar prevalence. It’s a sleep disorder where people stop breathing — often multiple times per night — while sleeping.

If you have sleep apnea: it tends to take longer for your tears to be replenished, you’re more likely to have ocular irritation, you have a higher chance of developing floppy eyelids, and you’re at increased risk for glaucoma.

What Is Obstructive Sleep Apnea?

There are different types of sleep apnea. The most common one is obstructive sleep apnea (OSA). During OSA, your airway becomes partially blocked due to relaxed muscles in your nose and throat. This causes apnea (the absence of breathing) or hypopnea (abnormally shallow, slow breathing). It’s twice as common in men, and is more likely to affect people with obesity, hypertension, diabetes or heart disease.

What are the common symptoms of sleep apnea?

Sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These temporary breathing lapses cause lower-quality sleep and affect the body’s oxygen supply, which can lead to potentially serious health consequences.

While snoring is a common symptom, not everyone who snores has sleep apnea. Interrupted sleep can cause excessive daytime sleepiness, fatigue, irritability or depression, headaches in the morning, difficulty concentrating and thinking, and a sore throat.

Which Eye Conditions Are Associated With Sleep Apnea?


Glaucoma occurs when increased pressure within the eye damages the optic nerve, which connects the eye to the brain, leading to vision loss and sometimes blindness. In some cases, it might be due to a drop in blood oxygen levels, which happens when you stop breathing. However, CPAP machines, one of the most common treatments for sleep apnea, can also cause glaucoma.

So, people with sleep apnea — even if it’s being treated — need to get their eyes checked on a regular basis for glaucoma.

Floppy Eyelid Syndrome

Floppy Eyelid Syndrome (FES) is an eye condition where a person has an unusually large and floppy upper eyelid. It can cause eye redness, irritation, discharge, or blurry vision — and over 90% of people with FES also have sleep apnea.

Non-Arteritic Anterior Ischemic Optic Neuropathy

Non-arteritic anterior ischemic optic neuropathy (NAION) is an eye condition that occurs when there is a loss of blood flow to the optic nerve. Patients typically complain of significant vision loss in one eye without any major pain. Approximately 70-80% of patients with NAION have been found to have OSA.

Retinal Vein Occlusion

Also referred to as an ‘eye stroke,’ retinal vein occlusion (RVO) is a blockage of the small veins that carry blood away from the retina. A recent study of 114 RVO patients found that sleep apnea was suspected in 74% of the patients that had previously been diagnosed with RVO.

Other Eye Health Issues Associated With Sleep Apnea

Some other ocular conditions that are more common in patients with sleep apnea include: papilledema, keratoconus, and central serous chorioretinopathy. Furthermore, in addition to glaucoma mentioned above, CPAP machines are associated with dry eye syndrome and bacterial conjunctivitis.

Talk To Your Doc

Get eye exams regularly to rule out eye disorders and prevent potential vision loss, especially if you have been diagnosed with sleep apnea. At Silicon Valley Eye Physicians in Sunnyvale we encourage you to share your medical history with us so we can better diagnose and treat any eye conditions or ocular diseases you may have, and help you keep your eyes nice and healthy.

Frequently Asked Questions with Dr. David Mark

Q: What Causes Sleep Apnea?

  • A: Sleep apnea occurs when in-part or completely stop breathing when sleeping. This causes your lungs to strain harder for oxygen, and makes the brain send signals that jerk your body awake to resume proper breathing.

Q: What are the Warning Signs of Sleep Apnea?

  • A: A common sign of sleep apnea is loud snoring. Snoring that is loud enough to disturb the sleep of the patient as well as others around, even across the walls. That said, not everyone who snores suffers from obstructive sleep apnea.

Quality Frames For Prescription Eyeglasses & Computer Glasses In Sunnyvale, California. Visit Silicon Valley Eye Physicians for an eye exam and eyeglasses that match your style.

Why vision therapy comes before tutoring or a learning center

Teacher eyeglasses 1280 x 853Our parental instinct naturally wants to find the fastest solution & often the first options for a child who struggles in the classroom are either a tutor or a learning center. However, not every solution to a learning problem can be solved by forcing extra hours of the same material.

One of the foundations of vision therapy is how we educate parents to recognize that when their child has a tantrum, gets easily frustrated, and can’t continue with homework, maybe very bright and intelligent in other areas. The issue might not have anything to do with the child’s intelligence. In fact, many parents who find out about vision therapy have already enrolled their child in various programs only to discover that something a lot more basic was the source of the child’s setbacks – their vision.

Why aren’t parents brought to vision therapy from the beginning?

There are various reasons why vision therapy may not have been recommended to you initially or perhaps have never heard about it until now.

  1. Vision therapy is a unique program that only some optometrists specialize in and offer at their clinics. Therefore, not all eye doctors when performing their eye exam will be on the lookout for a vision problem in your child.
  2. There’s a lot of competition in this field. Tutoring and learning centers offer a lot of value, and they’re often large institutions trying to win over your business.
  3. Other practitioners may not have had the education or years of training to specialize in vision therapy, but they will attempt ‘eye exercises” on their own to solve the problem. While there may be some benefits from this, without having the necessary training you’re not going to solve the problem appropriately.
  4. Because vision therapy is an out-of-pocket expense, parents try to turn to cheaper means or hope the problems will simply go away as the child grows older.

With factors like the ones shared, many children continue their years at school without ever treating their vision problem until the problem becomes too severe to cope or they reach adulthood & discover what was holding them back the entire time.

Plus, some parents consider their child in 1st or 2nd grade too early to start vision therapy. The child is starting to read & pronounce the words now, so who says it’s a vision problem that won’t go away? Unfortunately, in scenarios like this, a child with a vision problem who reaches 3rd, 4th, or even 5th grade falls behind the class as the foundational visual skills were never developed. The child may be able to pronounce words & run through sentences, but they will lack comprehension. For people with normal vision, it’s difficult to understand how someone can read through a page & not remember what they read. Children end up learning to read but never reading to learn.

Why Vision Therapy Should Be Your 1st Priority

Fortunately, vision therapy is well researched & supported with multitudes of success stories over the years. Plus, a developmental optometrist who specializes in vision therapy has ways to accurately test your child’s various visual skills & identify whether vision therapy is needed. There’s no guesswork involved. This means that your child will achieve normal, functional vision at the end of therapy, and in many cases, they become amazing readers, sports players, and happy to learn.

Frequently Asked Questions with Silicon Valley Eye Physicians

Q: Can you request lenses made from glass? Is glass still used for lenses?

  • A: Opticians still sometimes use glass for lenses. However, glass is not used very often because they aren’t as safe. If these glass lenses breaks, they can shatters into many pieces and can injure the eye. Glass lenses are much heavier than plastic lenses, so they can make your eyeglasses less comfortable to wear.

Q: Can a coating be added to eyeglasses to protect them from further scratches?

  • A: A protective coating can’t be added to a lens after it’s scratched. The coating is applied when the lens is manufactured and can’t be put on later.

Quality Frames For Prescription Eyeglasses & Computer Glasses In Sunnyvale, California. Visit Silicon Valley Eye Physicians for an eye exam and eyeglasses that match your style.

3 Benefits of Anti-Glare Coating

Glare refers to the excessive brightness caused by direct or reflected light. It can cause eye strain, digital eye strain (when using a computer, for example), halos, and headaches. Glare can also reduce visibility, making it unsafe to drive.

Anti-glare coating, also known as anti-reflective (AR) coating, is a thin layer applied to the surface of your eyeglass lenses that allows more light to pass through your lenses. By reducing the amount of glare that reflects off of your lenses, you can see more clearly and experience more comfortable vision. You can request anti-glare coating for lenses when you buy eyeglasses.

AR Coating Offers 3 Major Advantages

Better Appearance

Without an anti-glare coating on your glasses, camera flashes and bright lights can reflect off your lenses. This can hinder your appearance when speaking to people or in meetings, cause flash reflections when picture-taking, and make it difficult to find the right angle for video calls. Anti-reflective coating eliminates the harsh reflections and allows others to clearly see your eyes and face.

Reduced Digital Eye Strain

You know that tired, irritated feeling you get after staring at a digital screen for several hours? That’s digital eye strain. Anti-glare coating helps reduce digital eye strain by lowering exposure to excessive glare from digital devices and lighting.

Safe Driving at Night

The bright headlights from cars driving in the opposite direction can pose a serious danger when driving at night. These sudden glares can lead you to momentarily lose focus of the view ahead. AR coating on your prescription eyewear effectively reduces reflections from headlights at night, allowing you to enjoy a better view of the road and safer driving at night.

Let your eyes look and feel better every day with anti-glare coated lenses. Contact us to book your appointment today!

Frequently Asked Questions with Silicon Valley Eye Physicians

Q: Can you request lenses made from glass? Is glass still used for lenses?

  • A: Opticians still sometimes use glass for lenses. However, glass is not used very often because they aren’t as safe. If these glass lenses breaks, they can shatters into many pieces and can injure the eye. Glass lenses are much heavier than plastic lenses, so they can make your eyeglasses less comfortable to wear.

Q: Can a coating be added to eyeglasses to protect them from further scratches?

  • A: A protective coating can’t be added to a lens after it’s scratched. The coating is applied when the lens is manufactured and can’t be put on later.

Quality Frames For Prescription Eyeglasses & Computer Glasses In Sunnyvale, California. Visit Silicon Valley Eye Physicians for an eye exam and eyeglasses that match your style.