Dr. B., If my child has trouble seeing the board at school, why does he need reading glasses?

This is a very good question. When parents bring their child to me for an exam, they frequently come in with knowledge that their child is having difficulty seeing at a distance. They may observe that their child squints to see the TV or is unable to see signs and buildings while in the car. After a comprehensive eye and vision exam I will often explain that, yes, I can improve their child’s distance vision with glasses. However, there may also be additional visual problems that need to be addressed to improve overall visual function. Sometimes the best way to treat these distance visual problems is with reading glasses. This diagnosis frequently confuses parents. Hopefully this post will help explain why it is necessary.

First, let me explain what types of lenses I am talking about. If a person needs a different lens power for distance viewing than near viewing, then he or she needs either multiple pairs of glasses or a single pair with multiple lens powers. If someone opts to have the all-in-one type, it can be either a bifocal lens (with a line separating the two lenses, distance on the top and reading on the bottom) or a progressive lens (where there is no visible line and the distance lens gradually blends into the near lens).

Which option a patient uses depends on the situation. For example, if a patient needs no distance lens, then one pair of reading glasses is sufficient. If a patient is too young to use a progressive lens, then a bifocal lens is best. (For the sake of simplicity, I am going to use the words “reading glasses” in the article to mean any of these options.)

Usually a child does not need reading glasses for the same reason that an adult does. When people reach about 40 years of age, they need reading glasses because printed matter has become blurry. Their eyes no longer have the focusing power to make the words clear. Children, on the other hand, usually do have enough focusing power to make words clear. But sometimes it may be difficult or uncomfortable for them to read without developing eyestrain, headaches, or blurry distance vision. (This is called accommodative insufficiency.) Although reading glasses help relax the eyes, making it easier to read without eyestrain, they usually do not solve the underlying problem. Often vision therapy is required to truly solve the focusing problem.

The other main reason that children need reading glasses is that their eyes tend to turn inward a little too much. This tendency to turn in can sometimes be controllable on the child’s part — a condition called esophoria, which doesn’t cause visible changes in the eye but can result in eyestrain or double vision. In other cases, the child cannot control the tendency, resulting in a visibly drifting inward eye (called accommodative esotropia). In both cases, reading glasses will reduce the eyes’ tendency to turn inward. This will relieve the strain on the eyes and may make reading more comfortable.

Also remember that these conditions do not just occur in children. Sometimes adults develop these types of problems and need reading glasses. Also, for both children and adults, sometimes multifocal contact lenses can be used, but patients still need to have appropriate backup glasses.

One final note: All children must have shatter-resistant lenses. These are made of Trivex or polycarbonate. We also recommend a sturdy, easily adjustable frame. All of our frames have a 2-year warranty against breakage, but it can be a good idea to have a backup pair in case of loss.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

In response to patient demand, we’ve added the ability to order contacts directly from the Bright Eyes website. Instead of calling or stopping by, you can just go to the online store and select the brand of contacts we have prescribed for you. We will verify the accuracy of your prescription and check to see if there are any problems with the order. Then, in a few days, you’ll receive the contacts at your home or office by mail. There are options for free shipping and handling.

You can also purchase contact lens cleaning and handling products as well. If you do not see the lenses or products you are looking for, be sure to let us know!

And, remember,  just because you can order online does not mean that you can’t drop in from time to time just to say “Hi.” We like that, too.

If you stop into Bright Eyes, you may notice a couple of new faces. To accommodate a growing and changing practice, we are excited to have two new staff members on board.

Sandra Krakowski

Sandra is our newest frame and lens specialist at Bright Eyes. She was born in Chicago, IL and moved to Florida when she was 13. She graduated from the University of South Florida with a Bachelor’s degree in Biomedical Sciences and minors in Biomedical Physics and Public Health. She has been working in the optical field for 2 years and next plans to attend the Nova Southeastern College of Optometry in Ft. Lauderdale, FL where she plans on pursuing a career as an Optometrist. In her free time when she’s not studying, Sandy likes to go to the beach, boating, shopping and just having fun.  

Renee Gregorio

Renee is a new administrative assistant for Bright Eyes Family Vision Care. She was born and raised in Tampa, FL. She is also currently pursuing a Bachelors degree in Criminology at the University of South Florida. Her career goal is to become an insurance fraud investigator.

Parents and patients alike often ask why therapy homework is such an important part of my vision therapy program. The following is a brief article by Paul Harris, O.D. that does a great job of explaining why we incorporate homework into our vision therapy program.

What’s so important about doing my homework?

Home activities have been an integral part of our vision therapy program. The pioneer clinicians in the field noticed that when home practice was done on a regular basis, more profound and lasting changes in behavior were noted. This was passed on to me through my education, but with little scientific backup. The old sages told us it would work and it matched my observations.

I ask my patients to do their home practice on the days that they do not come in for their in-office session, allowing one other day off per week. Thus, the plan for patients coming in once a week was for five days of home therapy to be done between in-office sessions. Over the years my observation has been that patients who regularly got at least three days of practice between their once-weekly in-office sessions made the progress as expected and in many cases did so towards the short end of my estimate of their length of treatment. The patient’s who worked less often than this, moved through the program more slowly and made fewer overall gains from the program. Some tried to compensate for missing several home sessions by practicing at one or two longer home practice sessions. I found that this was not as productive as the regularly spaced short practice sessions.

Once in a while a piece of good scientific work comes along that provides the proof to understand why such a thing is so. I recently ran across the article, “Adult Cortical Plasticity and Reorganization” by the Israeli neurologist Avi Karni. Traditional thought is that we become less plastic (changeable or moldable) as we get older and that in particular our cortices (the gray matter on the outside of the brain) is much less changeable than some other parts of our ‘higher’ brain functions. Without getting too technical, I relay the portions relative to regular home practice.

Karni found that there were two types of learning that he was able to measure at the level of changes in the cortexes of his subjects. His research was done primarily in areas of vision. He showed that “A fast improvement, occurring early in training, can be induced by a limited number of trials, on a time scale of a few minutes or less, but only if high- quality sensory input is provided.” This is what we are doing in your in-office session. Each activity we do in the office is programmed for 8-10 minutes. It is an intense, highly- controlled environment where we expose you to a specific aspect of vision that we want to help you improve. You perform that action several times in those few minutes. What he found, and which we find in the vision therapy room, is that people make very rapid improvement over a short period of time and then it levels out. It may actually be counter productive to push for more progress in that particular activity in the session in which the plateau was reached.

Then Karni found that the person would retain that new level of ability learned in the short practice session, for a period of about 8 hours. He continues, “After this latent period, large and long-lasting improvements in performance were found.” And here is the key that is relative to your vision therapy homework: “Performance continued to improve over days and was maximal after 5 to 10 consecutive training sessions spaced 1 to 3 days apart. Once a maximal level of performance was reached, most of the gain was retained over months and even years.”

The key to embedding the new behavior or skill is the 5-10 consecutive practice sessions with no more than 3 days between each of the practice sessions. You may note that during your vision therapy some activities are assigned for only one week. This is rare in the program. Most activities will be assigned for two or more weeks. Those activities that are done for much longer are modified as you proceed through your treatment.

In vision therapy we arrange conditions to provide you with the opportunity to have the necessary meaningful experiences to acquire the new skills you need to do the things you want to do. We hope that the activities are made meaningful to you and that you can see the reason why the activities are being done. With the proper support of regular home practice you can make huge changes which will last a very long time.

Reference: Karni, Avi, “Adult Cortical Plasticity and Reorganization”, Science & Medicine, January-February 1997, PP 24-33.

Last Revision July 19, 2001 written by Paul Harris (Paul.HarrisOD@gmail.com)

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
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Here at Bright Eyes Family Vision Care, we encourage our staff to become the best at what they do. We support them in becoming as educated as possible and reaching the highest level of certification and licensure.

I am proud to announce that Laura Huffman, one of our frame and lens specialists, has recently passed her certification exam of the American Board of Opticianry. Not only did she pass, but she passed with a whopping 92%!

If you stop by the office, be sure to congratulate Laura. (Then ask her how much prism is induced if your right lens is decentered 6 mms. She’ll know!)

Laura has worked hard and should be proud. Her next goal is to obtain her Optician’s License from the State of Florida. We are sure she’ll sail through that exam as well.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

I’ll let you in on a little secret: I hate going to the doctor. From scheduling the appointment, to filling out paperwork, to waiting in the small exam room, to trying to get to know my doc in the 7.5 minutes that we spend together, to getting the bill, I dislike it all. (I’ll admit that I dislike it less than buying a car, but I really hate that.)

And I know that I am not alone. Let’s face it: The health care system in this country is complex. Between the different types of doctors and the variability of insurance and vision plans, finding good care can be difficult. To get the best care, you’ve got to be organized. You’ve got to pay attention. And you’ve got to stick up for yourself because, really, no one else is going to do it for you (except maybe your mom).

But this guide can set you off in the right direction. It is an insider’s view that is written by two doctors, Michal Roizen, M.D. and Mehmet Oz, M.D., that present info in a light-hearted way that makes it easy to read. It has all kinds of useful references and places to start looking for information. And it can really help you feel confident about certain medical decision, such as second opinions.

I think that this is such a great book that I’m leaving my copy in the waiting area for people to read. You can click here to order your own copy of You, the Smart Patient: An Insider’s Handbook for Getting the Best Treatment.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

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

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

1. Select a point as far away as possible that you can easily see.
2. Hold your thumb directly in front of your eyes about a foot and a half in front of you.
3. Focus on details of your thumb for 20 to 30 seconds, while being aware that the original point you selected is now double and blurry.
4. Now focus on the distant point for an additional 20 to 30 seconds, being aware that your thumb is double and blurry.
5. As you focus back and forth, pay attention to how your eyes feel and what you notice about the act of focusing.

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

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

News Channel 8 has also covered the story of Kelly Harmsen and the “The EyePatch Kids” DVD. The USF students that produced the video came to Bright Eyes to videotape me and some patients for a the story. It was fun to be involved and help promote awareness of amblyopia treatment.

You can see the news segment here. (Works best with Internet Explorer).
Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

Happy New Year!

Now that the cookies have been eaten and the champagne has been toasted, many of us now turn our attention on how to improve our health. Some people will make resolutions to lose weight, others will think about exercising more and, others will try to make time for pleasure reading.

Because your eyes and vision are vital to most, if not all, of the resolutions that people make, I have compiled a list of New Year’s Resolutions for Your Eyes and Vision:

The Top Ten 2008 Eye and Vision New Year’s Resolutions:

1. Make sure that you have your eyes examined with dilation of the pupils as recommended by your doctor.

Vision changes can be gradual and you many not realize you are having a problem. Many conditions, such as glaucoma, start with no symptoms. Also, diseases such as diabetes and high blood pressure are frequently first detected with a dilated eye exam.

2. If you have children, make sure you have their eyes examined.

The recommended age for the first eye exam is 6 months. Children who are in school should have their eyes examined every year (and school and pediatrician vision screenings do not count).

3. If you should be wearing glasses for driving and you’re not, just do it.

This is especially true at night, when vision is more difficult and bright lights make it harder to see.

4. If you smoke, quit.

It has been clearly established that smoking can increase the risk of development of conditions such as cataracts and macular degeneration. Seek professional help to quit if needed.

5. Make sure your eyes have adequate UV protection.

Your regular glasses, sunglasses ,and contacts can all have UV protection. Limiting UV exposure reduces the risk of skin cancer of the eyelids, cataracts, and other conditions.

6. Wear your contact lenses no longer than recommended. If you are sleeping in your contacts and your eye doctor did not explicitly fit you in contacts for this purpose, stop.

If you abuse contact lenses, you put yourself at risk of eye infections that are not only painful but also have the potential to result in permanent vision loss.

7. Never “top off” contact lens solutions. Use only the solutions recommended for you.

Never save solution for the next day and add a little more to fill the case. Start each night with fresh solution. The majority of contact serious lens-related infections comes from not taking care of them as recommended. Contacts are medical devices that only work well if they are cleaned regularly and appropriately.

8. Change your contact lens case monthly.

Contact lens cases can contain micro-organisms that are very difficult to remove. The best remedy is to start fresh with a new case. If you need a new one, stop by our office for a free one.

9. When you work at the computer, read, or play handheld games, take visual breaks to limit eyestrain.

Remember the “20/20/20 Rule”: Look up from your work every 20 minutes to an object 20 feet away for 20 seconds. This is can keep you more comfortable and efficient. If you spend a significant amount of time on the computer, glasses specifically designed for the computer can reduce or eliminate eyestrain as well improve comfort of the neck.

10. Ask your eye doctor if nutritional supplements are a good idea for you and your eyes

There have been scientific studies that have shown that certain supplements can be appropriate for certain eye conditions, such as macular degeneration. They might be right for you, but they should only be of high quality and should be recommended by a doctor who knows about your overall health and the medications that you take.

After reading this list of New Years Resolutions, pass it onto a friend or family member you care about. If you need help with any of these, feel free to call 813-792-0637 or stop by the office.

Be Well in 2008!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care