In the July 2008 issue of Parenting magazine, there is an article titled, “Take Charge of Your Child’s Heath: 5 Common Conditions and How You can help Catch Them.” The article is written by William Sears, M.D., author of many books on childcare and parenting.

The number one issue that Dr. Sears says can be overlooked by a pediatrician is strabismus, which is a wandering or crossing of an eye. While the article is too brief to be complete, I am glad that Dr. Sears makes a point that strabismus can be missed during a routine appointment and that parents should trust themselves. Typically, if a mom sees something really wrong, there is.

I’d like to add a few additional comments to the article. First, it mentions that strabismus can be treated with glasses or surgery. This is true. But it may also be treated with vision therapy. Second, It is better to prevent a visual problem than fix one later. The American Optometric Association recommends eye exams at 6 months, 3 years, and each year during school. To help, the AOA created InfantSee, a program that provides no-cost eye exams for infants less than 12 months old.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

My Colleague Dr. Dan Fortenbacher maintains a blog called EXCELerated Vision that contains lots of great information on vision and visual development.

Recently, there have been some very useful posts on Infant Vision. The first contains an audio interview with Dr. Andrea Thau, one of the founding members of the InfantSee program. She discusses the importance of infant vision examinations.

There are also recent posts that contain detailed list of ways to encourage proper visual development for babies 0 to 3 months and 4 to 8 months of age. If you have a little one in your life, I encourage you to check this out.

From Contact Lens Today, a newsletter of Contact Lens Spectrum.

The Food and Drug Administration (FDA) Ophthalmic Devices Panel of the Medical Devices Advisory Committee met on June 10, 2008 to consider recommendations on contact lens care product development including preclinical testing and clinical performance measures, and labeling for contact lenses and lens care products.

Among the issues reviewed were:

• Changes from “no rub” to “rub and rinse” labeling
• Addition of “discard dates” on contact lenses to indicate when a product should be disposed of after it’s opened
• Expanding preclinical testing protocols to include testing solutions against more types of bacteria and fungi including Acanthamoeba
• Recommendations on frequent replacement of contact lens cases
• Stronger warnings against reuse of contact lens solutions

The panel also considered information offered by companies and others such a joint statement issued by The American Academy of Ophthalmology, the Contact Lens Association of Ophthalmologists, the Cornea Society and the American Society of Cataract and Refractive Surgery. A complete text of their recommendations is available at: http://aao.org/upload/joint_CL_recommendationsL.pdf. Representatives of the American Academy of Optometry Section on Cornea and Contact Lenses and the American Optometric Association Contact Lens and Cornea Section also addressed the panel.

I was just reading about babies that wear contact lenses. Is that really true? How do you know what lens to give them and how can they put them in?

Yes. It is true. But an infant doesn’t get contact lenses just because they don’t like their glasses. Infants as young as one week old may need contact lenses because that is the only way their eyes can get the best sight to ensure proper visual development. Infants might need contacts if they have had cataract surgery, have extremely high prescription glasses, or have very different prescriptions for the two eyes.

If an infant or very young child needs a contact lens, it can be a challenging  experience for everyone involved. For that reason, contact lenses are only recommended for infants in specific situations wear glasses will not work. After a comprehensive eye and vision exam, I will discuss contacts carefully with the parents and the process should only begin when they have a clear understanding of the risks and benefits of infant contact lens wear.

The benefits include:
· Improved vision with contacts
· Improved conditions for proper visual development
· Increased compliance when undergoing patching (occlusion) therapy

The risks are:
· Can be time consuming and stressful to insert and remove
· Possibility of irritation requiring removal of contact during the day
· Increased level of responsibility and care needed to monitor eyes
· Possibility of infection or ulcer of the eye, especially if proper lens hygiene not followed

Important information to know before we begin:
· Contact lenses must be removed every night for cleaning.
· It will be difficult at first to insert and remove the lens. This can be a two-person job.
· The contact lenses are custom made and may be expensive to replace if lost or damaged.

If you are a parent that has an infant or young children in contact lenses, the yahoo group Aphakic is a truly wonderful resource that I encourage you to check out. If you do need contacts for your child, inform yourself as much as possible and ask lots of questions of your eye doctor to make sure he or she is comfortable with the process.

See Well!

Here is a brief news video about a women who lost vision and needed several eye surgeries because she got a parasite called acanthamoeba . This exact scenario is why I tell patients not to swim in their contacts and not to sleep in their contacts unless I have specifically allowed them to do this.

Recently there has been an increase in contact lens related infections. There have also been some recalls of contact lens care solutions. I always recommend that patients use the proper solution and keep their contact lens case clean.

If you have any questions about this, please ask myself or the staff.

Be safe!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

A recent CNN story, found here, discusses advances in both technology and appeal of glasses, contacts, and patching for infants and kids. It has quotes from my colleague and fellow blogger, Dr. Justin Bazan, as well as Kelly Harmsen, creator of the “Eye Patch Kids” DVD, among others.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

While it is not exactly light reading, this article is one of the best at concretely summarizing some of the foundations of why we offer vision therapy. It covers not only the research about how effective vision therapy is for certain visual conditions, but how the visual system works.

I encourage everyone to at least check it out.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

Bright Eyes News has reached 10,000 hits. We must be doing something right. I hope all the readers find this information helpful. And don’t forget – I welcome feedback either in constructive criticism or questions to askDrB@brighteyestampa.com.

Now we’ll make it 100,000!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

At Bright Eyes, we pride ourselves in offering premium products and services. Each month we will highlight a particular product or service by making it our Feature of the Month.

The first Feature of the Month is Silhouette Eyewear. These frames are famous for being the lightest, most comfortable eyewear around, for both sunglasses and everyday glasses. Many claim that it is like not wearing glasses at all!

For the inaugural Feature of the Month, we are offering a special promotion. All throughout the Month of June, we’ll be offer $50 off on the purchase of Silhouette frames. Stop by for more details.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

Often parents will bring their children in for a comprehensive eye exam because they are concerned about the reading development of their child. They want to know, rightfully, if a visual problem is interfering with development of proper reading.

When evaluating an adult or child who has concerns about reading ability, there are several visual skills that I evaluate. These including clarity of sight, eye teaming, eye focusing, and eye movements. I have several ways to evaluate eye movements. Some of these tests rely on observation of eye movements. Some tests involve timing the accuracy of read material.

I now have an additional method that I am very excited about. The Visagraph III™ is a computer-based system for measuring eye movements while reading. Through the use of infrared sensors, an individual’s eye movements are recorded while he or she silently reads an appropriate text selection while wearing special goggles. Following the reading, a brief series of questions determines whether or not the subject reads with reasonable comprehension.

In addition to analysis of specific types of eye movements, I look at the overall path the the eyes take when the patient reads.

For example, a good reader will have a nice, even “stair-step” pattern from left to right with a smooth return to the left that is symmetrical for the right and left eye. The image below is from a real patient who reads well above grade-level:

But a person who has poor eye movement skills when reading will show lots of uneven movements both left and right as they go back to re-read certain words. They will also have irregular movements when the eye movements are not symmetrical.  This could occur due to eyestrain, focus problems, or problems using the eyes as a team. The image below is from a patient that reads well below grade-level.

This test is important to perform both during the initial evaluation and again at the end of therapy, if any has been provided. That way, I have a comparison to determine the level of progress that has been achieved and how much this mirrors the improvement that patients and parents report in reading skill.

If you or your child appears to have reading skill that is well below what you think it should be, a complete visual evaluation is in order. There may not be a vision issue impacting reading performance, but if there is, it should be corrected as early as possible.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care