Archive for the ‘Myopia’ Category

Orthokeratology goes by many names…. Ortho-k, corneal refractive therapy, Gentle Vision Shaping, corneal molding, and others. At Bright Eyes Family Vision Care, we tend to call it corneal reshaping or Orthokeratology. But regardless of whatever terms we choose to call it, our patients call it “awesome!”

Watch for yourself:

(Click here to watch on Youtube).

This last weekend I was fortunate enough to  attend and speak at  the Orthokeratology Academy of America (OAA) educational conference. The OAA is an international organization of orthokeratologists who provide a nonsurgical alternative to refractive surgery for nearsightedness, astigmatism and hyperopia. Current research also shows that Ortho-K can slow myopic progression in children.

The international faculty of presenters covered topics including myopia control (including soft lens technology), corneal reshaping research, safety of corneal reshaping, progressive/hyperopic Ortho-K lens designs, new corneal reshaping techniques. I heard speakers from Australia, Japan, China, Italy, Spain, and from all over the US.

President Dr. Cary Herzberg had the pleasure of announcing the inception of the new International Academy of Orthokeratology(IAO). The IAO brings together ortho-K organizations from the America (OAA) as well and Europe and Asia. This international organization will support, promote and advance corneal reshaping worldwide thru quality education and research presentations at meetings held around the world.  For more information about the OAA click here.

At Bright Eyes, we have successfully treated patients from 7 to 59 years old with orthokeratology. This includes pilots, lawyers, retirees, and lots of kids like Christopher (above). If you would like more information about Orthokeratology, call our office in Westchase at 813-792-0637 or visit http://BrightEyesOrthoK.com

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

My colleagues and I think and talk about myopia (nearsightedness) every day. We talk about the drawbacks (and rewards) of being myopic. We talk about the causes and treatment options for myopia, both short and long term.

But I have never seen a day like today, with myopia in all the papers and on every major TV news program. Given how quickly news travels today, the total number of people thinking and re-thinking about their eyes and vision is probably higher today than it has ever been!

Yesterday morning, I received an email about a newly released study, “Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999-2004.” While I take it as common knowledge that nearsightedness is increasing in much of the world, including the United States, even I was stunned to see this headline about the study: “Myopia Prevalence Rose 66% over 30-Year Period” There is no way around it, a 66% increase is a lot!

So I posted the link on Twitter and Facebook, but I didn’t really have the time to dedicate to the study until today. And then the really big news hit. There are stories on myopia on  NPR, Discover,  the LA Times, and video segments on Good Morning America and local affiliates such as these and these.

So since this is such a hot topic today, I’ll share what I tell patients almost every day at the office.  But first let me say this:  while vision science has advanced tremendously, and we have a better understanding than ever, there still is a lot that we do not know about the details of nearsightedness and its development. And, although this may shock you to read, there are some less-than-ethical people who will claim to have all the answers and will say with a straight face that they have THE ONLY WAY to either prevent or eliminate nearsightedness or glasses. The truth is that we don’t know exactly how this works and we can never make promises because what may work for 1000 people may not work for you.

But we can say some things about myopia more generally. There is a genetic component for sure, but just because you and your spouse are nearsighted is not a guarantee that your children will be . In fact, there may be more commonly a genetic susceptibility than an actual myopia “gene.” And clearly there are other factors involved because while the population is changing (due to aging and immigration) our US genes haven’t changed that much in 30 years, but our eyes have!

So, as many of the links above point out, our lifestyle can have an impact on vision. Our eyes are inherently best-suited for looking off into the distance. This is easy and natural. Yet today we spend an increasing amount of time and effort focusing within arms-length and in some cases just a few inches. And while we have always had (and will continue to have, I hope) kids and adults with their noses buried in bound books, the truth is that intensely playing tiny video games or texting does require more visual effort. And I can attest from seeing patients at Bright Eyes that children are engaged in these activities at younger and younger ages.

So – if a patient has increasing nearsightedness, or seems predisposed to be nearsighted what are the options? Here  are the refractive options from least to most aggressive.

• Do nothing. Some people prefer to not take any action because they do not have need to see better at a distance and they prefer the vision up close. This is totally reasonable, as long as it is an educated choice and not just by default or neglect. However, this is not itself a treatment for myopia and in fact may promote myopia in the long run.
• Traditional glasses or contacts. This will help a patient see clearly in the distance which is necessary for things like driving or going to school which are important. But it will not address any underlying problems leading to increasing myopia.
• Bifocal Glasses. This method was more popular in prior decades to slow down myopia progression. The scientific studies have not shown it to be as helpful generally, but may be for a  subset of people with specific visual problems.
• Multifocal soft contact. There is small but growing evidence that multifical contacts, like Proclear EP, can provide clear distance vision and limit the progression of nearsightedness.
• Orthokeratology (Corneal Reshaping). There is several scientific studies that have shown that this can provide safe, clear daytime vision, and slow or stop progression of myopia. You can read more about this here. And I have written more about this here.
• Atropine drops. This method of myopia control involved the use of prescription eye drops to keep the eyes dilated. This has been used for years and is more popular in Asia, but has not caught on in the US, due to side effects.

But regardless of which method is employed above, it is wise to take frequent, brief breaks from near work. Looking up and away every 15 minutes or so is a good idea, because there is some evidence that it is not the total time during near work, but the length of the individual periods of work that make a bigger difference. Getting outside more is a good idea, but it is not clear if it is the distance vision, sunlight, or some other benefit. Of course, this is true not just for your eyes, but for your body and mind, too!

As vision professionals, we clearly have much work to do in understanding more about why and how myopia occurs. But it is exciting to know that there are treatment options that can reduce the likelihood of progression.

If you have concerns about your vision or if your children have not been thoroughly evaluated, call us at 813-792-0637 to schedule an appointment. After reviewing the examination findings, we can discuss concerns and treatment options that may be right for you.

Be well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

(Edited to fix a few typos and add some info left out).

There can be no doubt that all of us, especially children, are doing hand held work more frequently and more intently than ever before.   All you have to do is look around any restaurant, doctor’s waiting room, or mini-van, and you will see people of all ages do this.  They are reading, playing hand held video games such as the Nintendo 3DS or the PSP, or using their iPhone or Blackberry to watch videos and keep in touch with others.

All of this technology is great, but it can come with a cost – visual discomfort that can interfere with proper vision.

In addition to using proper posture and taking frequent visual breaks from intensely focusing up closely, another important element is how close  a person is to the object they are looking at in their hands.  A good way to tell if it is the right distance is by using the “Elbow Distance” rule.

Research on human ergonomics has determined that the optimal  visual distance for reading and other close work is the Harmon Distance or “Elbow Distance”.  This distance is measured by placing a closed fist at the eyes. The point at the end of the elbow represents the closest distance a person should be from their near work.

The beauty of applying Elbow Distance is that as we grow, so do our arms. You would expect a child to hold objects closer to his face than  an adult.  So instead of a “one size fits some” rule of a certain number of inches, the “Elbow Distance” can apply to almost everyone.  Go ahead and try it on yourself now and see if you hold a magazine or cellphone at your Elbow Distance or a little further.

Some people get so absorbed in their games or reading that when they get very close to their work, they are placing undue stress on their vision.  I am also very guilty of this.  When I get 4 to 5 inches from what I’m writing, my eyes have to work harder to keep the words clear because of the close distance.  But if I keep the right distance, the visual system relaxes and performs more efficiently – and I can really tell a difference.

If children or adults frequently get extremely close to their books or games, this may just be a bad habit.  But it can also be sign of a visual problem. Either way, it is best to get an exam performed by an eye doctor who specializes in visual efficiency.  They can determine if there is a problem and if glasses or vision therapy might be needed.

Be well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

In 2003 I completed my contact lens externship. It was a chance to see how contact lenses helped a variety of patients in different settings. The majority of these patient encounters were relatively routine in that I was determining the contact lens that provided the patient with clear vision. Some people simply needed a modification of their current contact lens prescription, some were having difficulty with their contacts for astigmatism, and others were experiencing multi-focal contact lenses for the first time.

But there were also some special patients that were trying something that at the time was new and exciting: Precise Corneal Reshaping (PCR). Although it goes by many names, including orthokeratology, PCR is the wearing of a reshaping lens (similar to rigid gas permeable contact lens) during sleeping hours to mold the cornea and eliminate the need for daytime glasses and contacts.

When orthokeratology was first created in 1962, it was rather crude and unpredictable. The process was refined over time but it has only been in the last 5 years that we have seen a tremenedous increase in both scientific studies and utilization of PCR. In 2002, Corneal Refractive Therapy ™ (CRT) by Paragon was the first modern system to receive FDA approval. In those days there were very few practitioners doing CRT and I was lucky enough to have this expereince early on.

In the last year I have been asked several times if I am still providing this service. Well, after some work and investment in equipment, I am happy to announce that Bright Eyes Family Vision care is now offering PCR for eligible candidates! We are the only eye care office in Westchase and one of the few in Tampa to offer this service.

Who is an eligible candidate? Well, the procedure can correct myopia (nearsightedness) with or without some astigmatism. It is approved for all ages and is reversible, so it can be prescribed for kids and teens as well as adults. Since PCR changes the shape of the cornea, candidates must have healthy eyes and corneas that will respond to the treatment. Through a series of tests, such as computerized corneal topography, I can determine whether or not a patient will be a good candidate. Because not everyone is a candidate, we are offering the PCR Pre-Evaluation at no charge. This also gives patients (and parents) a chance to ask questions before deciding on the procedure.

PCR will be a great vision correction option for active adults – no worries about contacts while swimming, biking, playing sports, etc. It will be great for kids and teens – no worries about breaking glasses or losing contacts, since the reshaping lenses stay at home and are only worn at night.

In time, I will write about some of the latest research about PCR slowing the progression of myopia, but if you have any questions, you can always call the office for a patient information packet. You can also attend one of the seminars that I will be offering on November 8th, and 15th. Call 813-792-0637 for more information.

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.