TBO.com recently posted a story called “Patching Up a Problem.” It features the DVD ”The Eye Patch Kids” that aims to help children understand  eye patching therapy for amblyopia, also known as “lazy eye.” The story also has some video and pictures of the DVD and eye patching.

You can read the interview that that I did with Kelly Harmsen, the creator of the DVD here.

My daughter’s name is Nora. She is, of course, adorable. And since I am an eye doctor, I have been watching with interest how her eyes and vision develop since she was just minutes old. First she opened her eyes. Then she got better at moving them (but not necessarily together.) Finally, she developed a wide-eyed inquisitive way of looking at things that has not faded.

Since before she was born, my wife Cristina and I have done our very best to take care of her and made sure that she received all the care and attention that she needed. We have a wonderful pediatrician who has seen her many times. Fortunately, Nora has always been healthy (except for that first ear infection). She is a happy baby girl and she appears to be growing fast without any problems. But there still are some aspects of her eyes and vision that have not been checked fully.

Nora recently turned 7 months old. That means it is time for her first comprehensive eye and vision assessment. For the average baby, all the visual skills should be significantly developed by six months old. The American Optometric Association recommends the first eye exam at six months of age, then at three years of age and every year while in school. So with the help of my father and Cristina, Nora received her first eye exam.

Like I do with all infants, I first checked that she can see well out of each eye. I then made sure her eyes are straight and not drifting inward or outward. I checked to see if her eyes can turn inward the proper amount when she looks at an object or toy up close. I shined some bright lights in her eyes to make sure that her pupils react properly to light. They did.

By using a special flashlight called a retinoscope, I was able to determine if Nora had any refractive error (nearsightedness, farsightedness, or astigmatism). It turns out that she has a small amount of farsightedness, which is perfectly normal. Most commonly, the large amounts of refractive error that a baby may have tend to diminish over time (a process called emmetropization), but it is good to have a baseline measurement to see if the error is increasing, staying the same, or decreasing.

After I was convinced that Nora was seeing well and her eyes moved well for her age, it was time to check out the health of her eyes. I looked closely at all the parts of her eyes on the outside to make sure everything was healthy and working well. Then I sprayed eyedrops onto her eyes to enlarge her pupils to allow me to see inside. This is the same type of drop that we use for adults when we dilate their pupils, but the spray makes sure we get it in their tiny eyes without too much fuss.

The drops take 15 minutes or so to take effect, so we all went out in the waiting area. We passed the time by trying on some baby sunglasses, which were very cute on her. After the spray worked its magic, I had Cristina hold Nora and I examined very carefully all around the inside of Nora’s eye to make sure all the nerves, blood vessels, and other parts were healthy.

So now that Nora’s eyes have a clean bill of health, I don’t need to examine her again until she’s three years old. And, really, she did great. She a had a good time playing with the toys, and I can sleep at night knowing that she’s been thoroughly checked out.

If you have an infant at home between the ages of 6 and 12 months, the InfantSEE program will provide one evaluation like Nora’s at no change. Call the office or visit InfantSEE.org for more information.

Merry Christmas!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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As any parent knows, it is fascinating to watch infants acquire knowledge and skills during the first year. Here is some new research that suggests that as this process occurs in infants, what may superficially appear to be a regression may actually be a refinement that improves efficiency.

This is the second of three posts on Eye Yoga. You can find the first post here.

Head Swings

Set-up: Stand up straight with feet shoulder-width apart and bearing equal weight. Your hands should be comfortably at your side.

1. You should fix your eyes on a non-moving target at least five feet away.
2. Turn your head as far to the left as possible, keeping your eyes fixed forward on the target ahead. With this exercise your eyes stay steady on the target in front, and your head and neck are moving. As with the Eye Stretches in Part One, try to be aware of how your head and eyes feel as you do this.
3. Now turn your head to the right, keeping your eyes fixed forward on the target ahead.
4. Continue in this manner until all the head has been moved in all 8 gazes: up, down, left, right, upper right, lower left, upper left and lower right.
5. Proceed to moving head in a slow circle, first clockwise and then counter clockwise.
6. Next simulate figure 8’s and also random movements.

As with any new activity or exercise program, start slowly at first. If you experience significant pain, double vision, or other visual problems, consult your Optometrist.

Recently, I have discovered a wonderful new book entitled, “All Children Have Different Eyes.” The story features children who have significant visual problems such as nystagmus, and strabismus, low vision, and how they can deal with day-to-day social situations. It is written by author Edie Glaser, who has lived with visual disabilties her entire life along with child-psychologist Dr. Maria Burgio. It contains vibrant and inviting illustrations by Doina Paraschiv.

I was lucky enough to interview Edie Glaser:

Dr. B: “All Children Have Different Eyes” is filled with many positive ways for children with vision problems to handle social situations. As a child with nystagmus, strabismus, and low vision, how much of the book came from your own experiences?

Edie: Almost every scene from Tommy and Wendy’s story represents a common occurrence in my own childhood and that of most children with low vision, such as not being able to share a book with a classmate or being asked questions like why I don’t get better glasses. However, I did not handle these situations as confidently or competently as Tommy and Wendy do. Like many kids with low vision, I tried to fake not being able to see things and I didn’t understand my condition, so I often stayed quiet. Because of my silence, teachers and other kids often misunderstood me and teased me. I felt very alienated. Tommy and Wendy are my heroes for how they handle themselves.

Yes, Tommy and Wendy are tremendous role-models. And their stories are good for children with and without visual disabilities. As a child with visual problems, you surely went to many eye doctors throughout your life. What were the best eye doctors like?

My favorite eye doctors have been the ones who have clinical training and experience treating my own particular condition known as “nystagmus”. I only met these doctors a few years ago. Before that, I went to general ophthalmologists who knew very little about nystagmus. They were so excited to see my eyes wobble that they showed me to all of their interns and staff and the result was always the same. They’d say nothing could be done for me. When I met the specialists in the field, that’s when I discovered treatment options.

I agree that it is important for patients of all ages to educate themselves as much as they can about their health and find the very best doctors. People should feel comfortable questioning how much experience their doctor has with their type of case or condition. With books such as yours and information available via the internet, do you think it is easier for children with visual disabilities and their parents than it was when you were a little girl?

Yes and no. With the internet, it’s definitely easier to find competent medical care for a particular condition or to get help advocating for special services in the classroom, but most parents and teachers are still in the dark about how low vision affects a child’s social development. Accommodations need to be made in this area, too; but unfortunately, social competency is not an educational standard and so it often gets ignored and overlooked. Kids are still fending for themselves in this most important aspect of development.

You should be very proud of this book. How is the book being used to work with children with vision problems?

I am very proud and very fortunate to be the co-author of this book. Every time I hear a success story about how it has helped a parent or child to better deal with their condition, it gives my life a sense of deeper fulfillment. In addition to parents buying the book for their child, it is being used by teachers of the visually impaired with their low-vision students to help develop their social competency. It’s also being read to whole classes to make all students aware of how a classmate with low vision sees and plays in different ways. This is a crucial step to helping the low-vision child become accepted among his or her peers.

What else are you working on?

I have another book recently published that explains the medical condition of nystagmus to the lay reader, especially the new parent who is desperate to understand what is happening with their child’s vision and what can be done about it. I am also in the process of writing a book about what it’s like to live with wobbly eyes and low vision from early school days to driving/not driving to dating to interviewing for a job.

How long did it take to write and publish “All Children Have Different Eyes”?

It took four hours to write the story and several months of editing the text and adding/removing scenes to ensure that the language and social situations were both engaging and appropriate for ages 4-8. Then it took several more months for the professional illustrator to do her magic. I’m very proud of how we made such a complex and emotional subject so accessible and useful to this age group in both words and pictures.

Well all of that work has truly paid off. Now that you have published this book, are you surprised that there haven’t been more books like yours?

Yes, I am very surprised at how many books exist for blind children and children who have perfect vision when they wear glasses, yet there is nothing for the child in-between–until now.

Thank you for this opportunity to share the message of All Children Have Different Eyes with your readers.

You are welcome! Thanks so much for sharing your time and message.

If you are interested in “All Children Have Different Eyes,” go to the website www.lowvisionkids.com. You can order copies of the book, access the free teachers-guide, and find many, many resources (including a great hand-eye coordination game) that are not just for parents of children with visual disabilities.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

An alert parent of one of my patient’s emailed me the link to another news story about the potential benefits of vision therapy.  This a great short clip that discusses some of the issues that people with visual problems can have. It also shows some of the techniques that we use in vision therapy.  You can watch the video here.

If you have concerns that you or someone you know has a visual problem that might be treated with vision therapy, be sure to call or email the office. You can also find lots of information by clicking on the links section on the right of this page.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

I think this is very good demonstration of what it is like to examine someone’s eyes. This simulates my view when I do a procedure called, “Indirect Ophthalmoscopy.” If you move your mouse over the image, you can look around for blood vessels, the yellowish nerve that leads from your eyes to your brain, and the small, darkish-colored macula that provides your sharp central vision.

If you’d like to know more about the retina and how it works you can check out this article.

[vodpod id=ExternalVideo.444739&w=425&h=350&fv=] from www.ophthalmixonline posted with vodpod

Here is another great story about how vision problems can be overlooked in children – by parents and professionals alike. This one takes place outside of Chicago, and involves Dr. Neil Margolis, a wonderfully talented Optometrist.

This is the first of three posts. Here are links to the second and third posts.

Have you ever taken a Yoga class? Yoga is amazing for relaxing, strengthening, and listening to your body and mind. Well, your eyes can benefit from the same type of activity. Better yet, it is simple, can be performed anywhere, and is free.

The purpose of Eye Yoga is to stretch and relax your eye muscles, to develop an awareness of how the eyes move, and to control that movement in a coordinated and efficient manner.

Eye stretches

Set-up: Stand up straight with feet shoulder-width apart and bearing equal weight. Your hands should be comfortably at your side.

1. Start with your eyes open and looking straight ahead. Move your eyes to the 4 primary positions of gaze (up, down, left and right), forming a + with the eye movement.
2. Hold the stretch for 5 seconds in each direction. Become aware of how your eyes feel and what they see.
3. Then move your eyes to the 4 diagonal positions of gaze (upper right, upper left, lower right, lower left), forming an x with the eye movement.
4. Encourage the eyes to stretch to the maximum distance without causing extreme discomfort. The goal is to perform the task with eye movement only (no head movement) and while maintaining good balance.
5. Repeat with eyes closed.

As with any new activity or exercise program, start slowly at first. If you experience significant pain, double vision, or other visual problems, consult your Optometrist.

I recently discovered another article about binocular vision that is worth reading. It concerns one young patient who has been suspected to have several conditions, including autism and ADHD, before an Optometrist discovered that she actually had convergence insufficiency.

Unfortunately, because the symptoms of disorders such as attention problems and autism are very similar to those of binocular vision disorders, it can be very difficult to determine what the true problem is. Not only that, but many children have multiple conditions, but not all of them are discovered.

This is why a thorough evalution of visual skills is recommended for every child, especially those who are struggling or are suspected of having behavioral or other problems. If there is a visual problem it may or may not be the primary source, but eliminating it can go a long way to helping other problems…

 Click here to read the article.