I am a 36 year old male and have struggled with mild to moderate amblyopia most of my life. I am able to fuse close up and have very good hand eye coordination but at distance, such as driving, I am unable to fuse and the resulting strain worsens the eye turn. Is vision therapy still a viable option at my age?

This is an impossible question to answer without the benefit for a full, thorough vision exam. This would show the cause and severity of the amblyopia, eye turn,  and other visual problems that you may have and identify areas of possible improvement.

But even without the particulars in your case, I can say a few things generally. Because the purpose of vision therapy is to help you develop visual skills that may be lacking, there is not point in life when it is not possible to receive some benefit from vision therapy. The real question is this: Are you bothered enough by your visual problem that you would like to take the steps to improve the situation. (Case in point, this video of a 101 year old vision therapy patient.)

But I don’t want to paint vision therapy as a panacea either, because some conditions are very complicated and can take a significant amount of time, effort, and expense to improve. Some conditions are best treated with a combination of vision therapy and other methods, such as special glasses or surgery. Yet other conditions are better left untreated.

I would recommend against any of the “improve your vision” ads on TV or the internet. Many of these have elements of legitimate therapy, but they tend to over-promise and do not match the person with the appropriate therapy. Instead, only pursue therapy from a doctor with specialized training in visual function and vision therapy.

Have you read Susan Barry’s book, “Fixing My Gaze“? I very highly recommend it. You may also find this blog interesting: http://seeing3d.blogspot.com/.

If you would like more information about the evaluation or vision therapy, please do not hesitate to call and speak to Edna or myself.

Best Wishes.

-Dr. Nate

Bright Eyes Family Vision Care

Connect: Facebook Twitter Foursquare LS1 Yelp

Question via a email: I’ve had strabismus all of my life. However, I am now soon-to-be 55 years of age, and the strabismus is becoming an issue. Other than when very tired, I’ve never had to consciously bring the double vision together. Now it has become a conscious effort. Any advice you can provide is greatly appreciated.

As I am sure you can understand, I can’t give you any specific medical advice without examining you. However, I can give you some general opinions on cases similar to yours. First, if you have not read Susan Barry’s Fixing My Gaze, I recommend that you do so. It is excellent and will provide you with a great deal of information about a case similar to your own that has been successfully treated with vision therapy. That is not to say that you could have the same result, but you would have a better understanding of your condition and options.  If you’d like to come by the office, I will give you a copy.

It is very common for individuals with vision problems to experience a worsening of comfort and control in their 40s and 50s that occurs along with the natural change of reduced ability to see up close. Sometimes this reveals longstanding problems or sometimes it creates new problems. An evaluation is needed to determine the extent.

Generally, in these cases there are many treatment options. One could do nothing, which is what you have been doing previously. One could wear specific glasses or glasses with prism in them to help improve the ability to keep the eyes aligned. One could undertake vision therapy, not to strengthen the eye muscles, but to help coordinate and control them. Finally, in extreme cases, eye muscle surgery is an option.

Elaine, I hope this is helpful. If you have more questions or would like to schedule an exam, feel free to call the office at 813-792-0637.

-Dr. Nate
Bright Eyes Family Vision Care
Connect: Facebook Twitter Foursquare LocalShops1.com

As I have explained in this post, I have an extremely long, poly-ethnic last name. During my residency, optometry students started calling me “Dr. B”, because there were many doctors to refer to and Dr. Bonilla-Warford just takes too much time to say.

I have kept up “Dr. B.” out of convenience. But have noticed something: Nobody really spontaneously calls me “Dr. B.” any more. They will if I ask them to, but they don’t do it on their own. Instead,  they call me “Dr. Nate.” In fact,  I now have more people that call me “Dr. Nate” than “Dr. B.”

So I am formally announcing that my new nickname is “Dr. Nate.” Accordingly, I’ll be changing the Ask B. category to “Ask Dr. Nate.”

I hope every is sufficiently confused now.

See Well!!

-Dr. Nate

Bright Eyes Family Vision Care
Connect with Us: Facebook Twitter Foursquare Yelp

My daughter just had academic testing done. She is in 2^nd grade.  She is a great reader and has no problem writing.  Her struggle is with visual perception and long term retrieval.  She has difficulty with math; specifically with shapes, graphs and tables.  She does not seem to understand or can not see the relevance to the math problems presented.   Can you tell me if you have heard of this math issue having to do with a vision problem?

Well, without being too technical, math does involve complex visual perceptual skill. It is certainly possible that a challenge in specific visual processing can result in difficulty with math. The relationships that are involved in math are typically rooted in tangible concepts that are readily processed visually.  (Here is a simple example). This can even be the case even if your daughter is a good reader – it is also possible that her language verbal skills are so very high that they compensate for visual difficulty, or that the visual processes may not be the same used primarily in reading.

Has your daughter and a complete vision evaluation? I would start there, followed by an optometric visual information processing evaluation. After these are completed, it would be possible to tell you if  some form of intervention (glasses, contact lenses, vision therapy)  may benefit her.

And, of course, she should continue to receive the needed instruction and any tutoring/remediation/addition instruction that is appropriate.

I hope this information has been helpful. If you have further questions, you can call the office at 813-792-0637 or email me directly.

Be Well!

Nathan Bonilla-Warford, OD, FAAO
Bright Eyes Family Vision Care
Westchase, Tampa, FL
P 813-792-0637 F813-792-0657
Connect with Us:Facebook Twitter Foursquare Yelp

Dr. B: I love my contact lenses. Do you think my son is old enough to wear them safely?

The definitive answer is: Probably. Regarding children and contacts, there is one thing that matters most: is the entire family is motivated?

There are some instances where contact lenses are necessary for children (and even babies) for proper visual development. These parents need lots of training, especially if they do not wear contact lenses themselves, but they are very motivated to do what is best for their child.

The most common reason children might benefit from contacts is that they are beginning to play sports or other activity and they find their glasses get in the way. This can be a motivating factor. (Teens often want contacts for cosmetic reasons, but that is less common for pre-teens.)

Because contact lenses require patience and consistency in caring for contacts, everyone in the house needs to be determined to help the child succeed. If either parent, or a sibling, has bad contact lens habits, these will be quickly picked up by children.

It has been thought in the past that children should be 13 years old (i.e. teenagers) before they were allowed to use contact lenses. I feel that if motivation is there, children much younger can safely wear contact lenses.

This has been shown to be true by a scientific study called the Contact Lenses in Pediatrics (CLIP) Study. The study found that children age 8 to 11 can safely wear contact lenses. The study compared 84 children and 85 teens in how long it took to teach them contact lens to use contacts and if there was any difference in safety. The CLIP study concludes, “neither children nor teens experienced problems related to contact lens wear during the study. Eye care practitioners should consider routinely offering contact lenses as a treatment option, even for children 8 years old.”

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

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!

How successful are people with multifocal rgp lenses. My doc was not too encouraging even tho I am motivated. I know the articles are favorable,sharper vision more accurate prescription. I really would like to hear what a REAL person has experienced.

I am glad you asked because this is one of the most exciting areas of contact lenses today. These lenses do take some extra effort and equipment to get right, so not every doctor enjoys fitting them. I have found them to be very rewarding for myself and patients.

People over 40 years old commonly have presbyopia (difficulty seeing up close) and wear reading glasses. Many people would like the freedom to be able to see both near and far without glasses, yet remember 20 or 30 years ago when they wore “hard lenses” and hated them.

I am happy to report that these lenses are better than ever. Rigid Gas Permeable (RGP) lenses are truly high-tech. While gas permeable contacts will not be as comfortable at first as soft contacts, newer materials and lens coatings make them much more comfortable to wear than they used to be.

Also, there are many new RGP multifocal designs that allow for extremely good vision both distance and near. They may not work in every situation, but they can allow you to be much less dependent on your reading glasses.

Just the other day I designed some multifocal RGP for a woman who wanted to not have to wear glasses to her son’s wedding. The contacts fit great and she was able to be in the photos without her glasses. After she came back for a modification of the design, she said they were even better.

Also, there is a brand-new option. This just came out this month, but I have been lucky enough to work with it since January. It is the SynergEyes multifocal. It is a hybrid design, meaning it has the optics of a RGP lens, but the comfort of a soft lens. I have been having tremendous success with this lens and am very excited about it.

If you are motivated, we can almost always find a contact lens to make you happy. If you are interested in any of the new contact lens designs, call the office for more information. If you come in for an evaluation, we will discuss the options fully before you are committed to any of them.

Thanks for the great question!

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

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

This is probably the most common non-vision-related question that I get asked. People who haven’t met me sometimes think that I am a woman, due to the hyphenated name. Those who have met me might wonder just how much Hispanic heritage I have, since Bonilla is a Hispanic name and I do not look Hispanic.
So here is the story: Before Cristina and I got married, I was Nathan James Warford and she was Cristina Michelle Bonilla. I am of mixed Anglo background and Cristina is 100% Puerto Rican. When we got engaged, we took each other’s name and we are now both “Bonilla-Warford”

In some ways this is nice. The idea was have the name represent that we were equals in the marriage. And Bonilla-Warford has a better “flow” than “Warford-Bonilla.” Also, while neither Bonilla or Warford is particularly rare, I am confident that we are the only “Bonilla-Warfords” around.

However, there are downsides. Nobody can pronounce it. (It is proncounced: Bo NEE Ya WAR ford.) Nobody knows whether to file my info under B or W. (It is B.) And it really is hard to remember. So I just have people call me Dr. B.

So that is the answer. Be well!

Dr. B.
Bright Eyes Family Vision Care
Westchase, Tampa, FL
Connect with Us: Facebook Twitter Foursquare

A patient recently asked me:
“I read something on the internet about Precise Corneal Reshaping lenses being uncomfortable. Is this true? How uncomfortable are they?”

Well, there isn’t any way to sugar-coat this. The reshaping lenses can initally be uncomfortable for some patients. One study showed that 31% of patients experienced initial discomfort. Understandably, some patients are concerned about this. But this alone need not be a reason to dismiss PCR. Here are some reasons why:

1. You may be able to feel the lenses, but they should not be painful. If they are painful, then there is something wrong. Possibly the lens has debris on it. Possibly you inadvertly scratched your eye. No matter what, if the lens is painful, then you should take the lens out, examine it and call the office.
2. These lenses are specifically selected and designed for your eyes. The reshaping lenses that you are given are carefully chosen to be the healthiest, be the most comfortable, and, of course, provide the best vision possible.
3. The procedure for utilizing the lenses is designed to minimize discomfort. In fact, a particular type of lubrication drop is recommended each night to both keep the eyes moist, but also keep the eyes comfortable.
4. Remember, the central goal of PCR is to reshape your cornea. The lens will fit better and be more comfortable after your cornea takes on the new shape. This does take a few days to occur. After two or three days, your lenses will feel much more comfortable.

Does all this mean that you do not feel the lenses when you wear them the first time? No. Lens awareness is very normal. This awareness may cause your eyes to water in the beginning. But after your eyes adapt to the lenses, they will return to their usual comfort level.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
Connect with Us:  YelpFacebookTwitter