Welcome to 2010, everyone!  I hope you are enjoying the start of a brand-new decade.

Readers of this blog know that it is a Bright Eyes News tradition to create an eye related Top Ten List of New Years Resolutions. For 2008, wrote about resolutions for eye health. For 2009, I wrote about resolutions for children’s vision.

Thinking back to 2009, I’ve talked to a number of patients who had lost – or were about to lose – their jobs.  It was an economically challenging year for many.  So I thought this year I would take this issue head-on and make a list for people who want to save money on eyecare. But, as a doctor, it wouldn’t be appropriate to just say, “Skip your exams, squint instead of updating your glasses, and wear your contacts until your eyes fall out.” First, it isn’t sound advice. Second, many of these actually cost more money in the long run.

So here is a list of New Years Resolutions to Save Money on Eyecare (Without Sacrificing Quality). I hope that you find it helpful.

1) Maintain a regular schedule for eye exams.

Many people feel that they are saving money by skipping their recommended eye exams.  Did you know that eye exams are primarily about eye health, not just clarity of sight?  There are some blinding conditions with no symptoms that can only be detected with a thorough eye exam. If caught early, they can often be treated early with much simpler treatments. This can save hundreds or thousands of dollars of complicated treatment, including ocular surgery. This doesn’t even factor in the lost income and quality of life that can come from the loss of vision.

2) Get the exam that you pay for.

This may seem very obvious, but you should be sure that you are getting a complete and thorough eye exam. After all, if you are paying for something, you should get it.  Sometimes people are reluctant to have their pupils dilated during an exam, but if they don’t, the doctor cannot look for signs of disease in the back of the eye. Find out if there is a charge to come back and finish the exam at a later date. If you bring your child to eye doctor because you have concerns that vision may be affecting school performance, ask beforehand what type of tests are included.  Not all vision plans will cover this specialized testing, so you should find out how much it costs.

3) Utilize InfantSEE.

As with all health issues, prevention is more cost effective than treatment. This is particularly true for infants. An eye early eye exam can detect potential problems such as extreme nearsightedness and farsightedness as well as strabismus and amblyopia. To assist in this, the American Optometric Association created the public health initiative called InfantSEE. Optometrists who participate in the program will provide one visual and eye health exam to infants between six and twelve months old at no charge.

4) Understand your Vision Plan, Medical Insurance, Flex and HSAs.

Some medical plans have coverage for eye exams. Some plans specifically cover medical problems such as eye infections and glaucoma. Other plans are specifically for vision and will have coverage for a vision exam, glasses, or contacts, but not medical visits. If you or your employer pays for these benefits, use them wisely. Find out what the annual benefits are. Ask the doctor’s staff to help you maximize your benefits. For example, you are getting both glasses and contact lenses and your plan only covers one of these, you may save more money applying the benefits to the glasses.  Also know that you cannot ask that the vision plan be billed on a different date than you actually received the service.  However, you CAN use your Flex and HSA accounts for eyecare and optical purchases.

5) Select your eyewear carefully.

When you are picking out eyewear, try on the styles and brands that you like. But keep in mind the purpose of each pair of glasses you buy. You might love the Tiffany & Co. frames with crystals, but if you work or play hard, it might make more sense to get some less expensive frames that are built to be durable. Costa Del Mar sunglasses are durable, but if you are prone to losing them(or dropping them in the gulf!) spend a extra few dollars on a glasses strap. And when shopping  around, be sure you compare apples to apples. A discount store or online retailer may be cheaper,  but consider material quality and customer service when making your choice.  Will your optical service remake lenses in the case of an error?  What happens if the coating flakes off within a few months?

6) Get the right lens materials and coatings.

Find out what the doctor or optician recommends for lens options, but don’t just assume that more expensive is better. Some lens options are worth a little extra: Crizal Alize or VisoXC will improve the clarity of your lenses, reduce glare, and resist scratches.  Some fabulously high-tech lens materials are essential for someone with a very high prescription but may be a waste of money if you have a low prescription. We always recommend UV protection for all general purpose glasses, but if you only use glasses for reading indoors, then it may not be needed. I encourage you to get glasses that meet your needs, but that doesn’t mean that every pair has to have all the bells and whistles. If the optical staff do not explain your options to your satisfaction – ask. They may be able to help you save money when they understand how the glasses are to be used.

7) Try multipurpose lenses.

Do you own just one pair of shoes? Not likely, because most people have different shoes for different purposes. Your eyes also have different needs and no one single pair of glasses will meet all those needs.  But you don’t need to own a baker’s dozen pairs of glasses either. If you have a different prescription for reading and distance (like most people over 45), save money with just one pair of bifocals or progressives. In Florida, it is best to have a dedicated pair of prescription sunglasses.  But eyewear with clip-on sunglasses or Transitions (that darken in the sun) are a cost-effective and protect your eyes from UV and bright sun.

Make use of your warranties.

If you are spending hard-earned money on glasses, you expect them to work well for you. Always inquire about what warranty is included in your purchase. At Bright Eyes, all of our eyewear frames come with a 2 year, unconditional breakage warranty. If you get premium scratch coating, it also includes 2 year scratch warranty. See if your optical offers similar coverage and if they do, make use of it.

9) Learn about your contacts.

Talking to your optometrist about your contact lens options.  Monthly lenses may be a cost-saving option for full-time wearers;  daily lenses are a good deal for occasional contact wearers, especially when you factor in the solution costs.  RGP (hard) contacts frequently outperform their soft counterparts and can be up to half as expensive.

10) Consider alternative financing options.

Many offices, including ours, accept Care Credit, a health care credit card with options for 6-months interest-free financing.  This is helpful for more expensive treatments not covered by insurances, such as Corneal Reshaping (orthokeratology), an method of providing glasses- free vision, or vision therapy, which allows people to overcome visual challenges to live life up to their potential.  Even eyeglasses and eye exams qualify for Care Credit purchases. Ask about Care Credit or similar programs at your doctor’s office.

I hope that this has been helpful in ensuring that you get best eyecare possible! Happy New Year!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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There is a framed poster that hangs in the exam room. It has pictures of some of the different kinds of things that can go wrong with your eyes. It shows images of eye infections, allergies, and reactions. It has some mild pictures and some that kind of freak people out.

When patients mention it, I say in a light-hearted, joking way, “That is what happens when people don’t take care of their contacts.”

Well, the US FDA and Department of Health and Human Services  has a similar idea, but definitely more education.  Watch this video:

This video explains some key points:

• Germs are found in water.
• Avoid water completely while in contact lenses (yes, no swimming)
• Use only fresh contact lens solution.
• Throw away your case regularly
• Contact your eye doctor if you are having any problems.

If you follow these guidelines, you will reduce the likelihood of having any serious complications from you contacts. If you have more questions, do not be afraid to call us at (813) 792-0637.

Be Well and stay healthy!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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It is that time of year again. Time for finishing off those holiday cookies and preparing for a happier, healthier, more prosperous new year. A year ago I posted the Ten New Year’s Resolutions for Your Eye Heath. This year I will turn my attention to children’s vision. So without further ado…

The Top Ten New Year’s Resolutions for Children Vision

1) Read up on children’s vision

There are some wonderfully informative websites about children’s vision and visual development. Check them out at Optometrist Network, College of Optometrists in Vision Development, Childrensvision.com, Parents Active in Vision Education, Optometric Extension Program Foundation, and many others.

2) Spend Some Quality Vision Time With Your Kids

One of the best things you can do is simply spend some time reading books and doing homework with your children. Watch them and talk to them about what they are seeing and what if feels like when they read. Compare what you find with this symptom checklist.

3) Have Their Eyes and Vision Examined

Have your children had an full eye exam?  (A simple screenings done at school or the pediatrician doesn’t count.)  If they haven’t, then make 2009 the year.  The American Optometric Association recommends the first eye exam at age six months, followed by age three years and then before entering school. This exam should be thorough and evaluate all aspects of vision. You can find additional useful information about this at the Vision First Foundation.

4) Bring Their Glasses in for Adjustment and Cleaning

All children who wear glasses -  especially boys – get them bent up a little bit. Sometimes a lot. Often the temples are crooked and the nosepads are flattened down. Don’t hesitate to come by Bright Eyes and have the staff adjust and clean their glasses. You might be amazed how much difference it can make!

5) Consider Contacts

Many parents think that their children are too young for contacts. Sometimes they are correct that the child and family simply are not ready for contacts. However,  contacts frequently provide better vision than glasses and is the best option for a child – if the parents are ready.  You can read my post about this here.

6) Consider the Need for Sports Eye Protection

Many of my young patients participate in organized supports such as baseball, football, or basketball. For these patients, prescription sports goggles are a good idea. First, their use will limit sports-related eye injuries. Second, the improved vision sports eyewear provide may significantly improve their performance on the field.

7) Ensure They are Using Good Visual Ergonomics

Most people are familiar with ergonomics to help them function more comfortable and efficiently. This also applies to vision. Ensure that your kids take frequent breaks from activities such as reading and video games. Watch to see if they hold books or video games very close, which can cause eye strain. When reading and writing a slant-board is helpful. Read more here.

Have them wear their sunglasses.

We live Florida. It is sunny, even in January. Most of my patients have sunglasses and most of their kids do, too. But parents often forget to have their kids wear them. They’ll go outside and put on the SPF 45 sunblock – which is a good idea – but then forget the eye protection. It is not too early to start preventing problems!

9) Myopia Progression

If you are concerned about your child’s rapid development of nearsightedness, there may be some options to consider. First, Precise Corneal Reshaping not only temporarily eliminates nearsightedness, but has been shown in studies to reduce progression of myopia. Additionally, some children may benefit from additional options such as bifocal glasses, bifocal contacts, or vision therapy. Only a comprehensive eye exam can indicate what is most appropriate.

10) Pass this along to anyone who has kids!

If you know a family member or has children, pass this info along. Especially if there are visual problems in the family.

I hope everyone has a fantastic 2009! If you have any questions about this list, or anything else eye-related, feel free to call 813-792-0637 or stop by the office.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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If you ever read a summary of a comprehensive exam, you may get a little confused by all the technical vision terms. To try to make it more easy to understand, I have listed a below a brief explanation of the testing done during a comprehensive eye and vision exam.

This does not cover every single test, but the majority of them. Because each patient is different, each exam uses different tests. You may find a Glossary of Vision Terms helpful, as well.

• MEDICAL HISTORY: Questions about past and current medical problems.
• VISUAL HISTORY: Questions about past and current vision problems.
• VISUAL ACUITY: Sharpness or clearness of eyesight at a specific distance.
• KERATOMETRY: Measures the shape of the front part of the eye (the cornea) where light enters.
• EXTRA OCULAR MUSCLES: Measures how accurately the eyes move while following an object and looking back and forth between targets.
• COVER TEST (NEAR): Measures the amount that the eyes are misaligned while looking at near.
• COVER TEST (DIST): Measures the amount that the eyes are misaligned while looking at distance.
• NEAR POINT CONVERGENCE: Measures the ability to converge – the eyes turning towards each other when looking at an object up close.
• STEREOPSIS: Measures the ability of the eyes to work together to see fine detail with depth perception “3D”.
• NEAR POINT ACCOMMODATION: Measures how close each eye is able to see clearly.
• PHORIA (NEAR): Measures the amount that the eyes are misaligned while looking at near.
• PHORIA (DISTANCE): Measures the amount that the eyes are misaligned while looking at distance.
• NEAR VERGENCE (BI): Measures the ability to converge – the eyes turning towards each other when looking at an object up close.
• NEAR VERGENCE (BO): Measures the ability to diverge – the eyes turning outwards at an object.
• ACA RATIO: Measures how much the eyes converge while focusing up close.
• NEGATIVE RELATIVE ACCOMMODATION: Measures the maximum ability to relax focusing while maintaining clear, single binocular vision.
• POSITIVE RELATIVE ACCOMMODATION: Measures the maximum ability to focus while maintaining clear, single binocular vision.
• MEM RETINOSCOPY: Measures the accuracy of focusing while looking at an object up close.
• REFRACTION: Measures the nearsightedness, farsightedness, or astigmatism of the eyes.
• EXTERNAL EXAM: Determines health of the eyes by observation.
• SLIT-LAMP EXAM: Determines the health of the eyes with a microscope.
• OPHTHALMOSCOPY: Uses special lenses to look inside the eye for diseases.
• TONOMETRY: Measures the pressure inside the eyes.
• DILATION ORDERS: Specifies the type of eye drops and method used to evaluate inside the eyes.
• CUP/DISC RATIO: A way of measuring the health of the optic nerve. Useful in glaucoma and other eye disease cases.
• ASSESSMENT: States what the known visual or eye health problems are.
• PLAN: Summarizes the recommendations for the treatment of the problems.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

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

About 30% of my patients wear contact lenses. Some are young children and some are great-grandparents. All of them want their contacts to feel comfortable all of the time. Well, as I tell patients, having comfortable contact lenses is partly my job (to recommend the best contacts and solutions) and partly the patient’s job (to take care of their contacts and their eyes).

Dr. Shelley Cutler, an optometrist practicing in Pennsylvania, has a lot of experience helping patients understand the proper ways to take care of their contacts… and their eyes. In fact, she has written an entire ebook on the subject called, “How To Be A SMARTER / MORE COMFORTABLE Contact Lens Wearer!!” 

After reading Dr. Cutler’s book, I asked her a few questions.

Dr. B: How did you get interested in contact lenses (CLs)? 
Dr: Cutler: I started wearing them myself at the age of15.  This was back in the days when there was ONLY PMMA’s  <gasp>  [Dr. B' s note: PMMA is older material of contact lenses that is almost never used now for health reasons.]

When I had to decide what I wanted to be when I grow up… (and it didnt happen all at once. I went to art school first…<grin>)  I then decided it would be somewhere in the health field as my father and brother were physicians and my mother was a nurse.  I felt that it would take too long to go through medical school.  I didn’t like dentistry or podiatry….  Aha… Optometry it would be!  (I really liked the optometrist that worked for the Ophthalmologist that my father referred to..and had many conversations with him as he took care of my CLs, I sort of fell into the contact lens field as I did my residency after Optometry school. My first position was at Wills Eye Hospital supervising the Contact Lens department.  I taught the Ophthalmology residents their CL education…and saw the clinic patients.   I saw more CL patients in a day than many practices saw in a month…. especially then  (mid 80’s) and all the difficult stuff.  I guess the rest is history.

What prompted you to write an ebook?
A couple of different reasons…….if I said financial wasn’t one of them, I’d be lying.  Researching different ways to accomplish this, it seemed to me that this would be a natural.   I’ve written a lot of articles, lectured, etc. through the years and consider myself an educator.  I seem to say the same thing to most patients throughout the day so why not educate patients via an ebook.  Hopefully it would eliminate some of the problems quickly if patients were better educated and could maximize their time with their docs in the minimal time that is now necessary because of all of the health insurance issues.

With young children and contact lenses, who is usually more nervous: patients or parents?
The parents…by far!   I’ve fit children from 1 week old on up.  (Aphakic lenses – for people who have had a lens removed due to cataract).

What are your thoughts on extended-wear contact lenses, the type that are approved to sleep in?
I dont love them….but there are patients that need this option. I give my patients the riot act…and they understand the rules. 

Your ebook is 60 pages. If you could give contact lens wearers just a little advice, what would it be?
Cleanliness is next to Godliness…  Well, I’m just quoting this phrase because it sounds good…but proper Hygiene and cleaning will solve many of the problems…or more important, prevent them.

1)  CLEAN/wash hands before you handle the lenses both before insertion as well as before removing them

2)  Keep the CL’s clean. definitely rub…. (I recommended this even during the era of “no rub”)

3)  Keep the CL case clean.  Wash it out with soap (be it CL cleaner…or a non moisturizer soap) regularly (2×3x/wk) rinse well with water and dry.  Even if there is some soap residue…(and believe it or not there’s not a whole lot when rinsed to that squeeky clean feel ) this is better than the bacterial biofilm that can harbor germs…in my opinion, especially because most soft lenses are frequent replacement these days.

4)  Keep the ocular environment clean.  Ladies (mostly) remove the make up around your eyes daily…and use my Optimum Lid Hygiene guide.  This will not only remove any make up …but for those who dont wear it, it can minimize oily residue from the lids….keep blepharitis and Meibomian Gland dyfunction, demodex and allergy contaminants to a minimum.

and of course, see your eye care practioner routinely at his/her recommended intervals.

Nate…again…thanks for your interest and support.
Shelley

You can learn more about contact lenses and read about Dr. Cutler’s book at http://www.mycontactsfeelgreat.com/

Macular Degeneration and other types of macular disease are very common, particular in older individuals. Fortunately, it is an exciting time because we are learning more about how these diseases progress and new treatments are being developed.

For people that have macular disease, it is important that they routinely check their vision to see if it has changed or worsened. Most typically, this is done at home with an Amsler Grid.

Dr. Richard Trevino, an Optometrist in Indiana, is currently developing an internet-based technique to monitor macular vision called myvisiontest.com. Not only does the site allow you to test and monitor your macular vision, but there is lots of useful and interesting information.

I recently had an opportunity to discuss My Vision Test with Dr. Trevino:

Dr. B: You have presented professional publications and papers on a variety of subjects during your career. What caused you to become interested in macular function testing?

Dr. Trevino: I have worked at a Veteran’s Administration clinic for the past 11 years, where most of my patients are elderly and macular degeneration is fairly common. Recently, some wonderful new therapies for macular degeneration have become available, making the early detection of choroidal neovascularization more important than ever. I became frustrated at the ineffectiveness of the Amsler grid for home monitoring. I felt there had to be something better. That was my original impetus.

I started researching the topic and encountered a number of technologies that were being investigated experimentally for macular function testing, and which seemed to show promise as an alternative to the Amsler grid for home use.

One technique that I found especially interesting was noise field campimetry. I read research papers that described how people could see their vision defects by staring at television static. I tried this out in our clinic by taking patients with macular degeneration out into the waiting room where we have a television. I would switch to a channel with just static, and ask the patient to tell me what they saw. In many cases they were able to see their defect quite clearly. That lead me to begin adding “monitor vision with television static” to my routine recommendations for patients with AMD.

Although patients could see their vision defects on the television screen, there was no good way for patients to record them for monitoring purposes. That is what lead me to write the computer program. To simulate television static and give people a way to record their defects.

Are you surprised that with the level of personal technology that exists today, the Amsler Grid is still the most common home testing of macular function?

Yes, it was surprising and disappointing to find that there was no good alternative to the Amsler grid. But as I delved more deeply into the topic, I began to recognize the substantial difficulties associated with coming up with a good, affordable home vision test for macular degeneration.

Nonetheless, I strongly believe that it is possible to construct such a test. There are some very smart people working on this problem, and I have been in contact with a few of them. MyVisionTest (MVT) may be the first, but it is definitely not the last word on the subject. Several technologies have been identified as potential candidates for replacing the Amsler grid. Noise field campimetry, the technology that MVT is based upon, is one of them. But more research is sorely needed in this area.

You clearly put a lot of work into MVT . How long have you been developing the site?

It was exactly one year ago, March 2007, that I posted the first version of MVT on the Internet. It has gone through 2 major revisions since that time, and I continue to actively work on it.

In November 2007, I began updating the site daily with news and information about macular degeneration, and information of interest to the low vision community in general. The hope is that this will encourage people to visit the site (and test their vision) more frequently.

One of the biggest problems with any home vision test scheme is getting people to use it regularly. We usually instruct our macular degeneration patients to check their vision daily, and we are lucky if they do it once in a blue moon. I hope that our users, who I believe are Internet-active people, will stop by myvisiontest.com daily as they surf the web to see what’s new, and test their vision while they are there.

Other changes are in the works. I have begun work on a second vision test for macular function testing, one that is not based upon noise field campimetry. Some people have difficulty seeing their vision defects using video static, find the test too complicated, or have problems with the test for other reasons. The new test would be an available as an alternative to the current vision test. I hope to begin beta-testing it within the next few months.

Are you computer savvy enough to do the programming?

Yes. I am a card-carrying computer geek. I have been very actively involved with computers since the mid-1980’s. I began teaching myself computer programming in the early 1990’s, but didn’t really do much with it until 1997, when I started getting involved with computer networking and web site development. Most of my programming experience is related to developing web sites for myself, friends and family, non-profit organizations, and small businesses.

When I decided to develop a vision test for macular degeneration, I consulted some friends that are computer professionals, and asked their advice about the project. But I have done all the programming myself.

Do you have forms of financial support fort or has it primarily been a personal project?

There are Google ads on the site, and I also accept donations to our “Java fund” to help pay the bills. My goal is to have the revenue from ads and donations offset the costs associated with running the site. We got pretty deep in the red last year, and I never expect to make that up. But so far in 2008 we have managed to break even. As long MVT is able to break even financially, then I can continue to offer this service to the public free of charge.

If there was just one thing you’d like all readers to know about macular disease, what would it be?

The single most important thing that I impress upon my patients is that smoking is a major risk factor for the development of macular degeneration. If you or a family member has macular degeneration and you smoke, you are significantly increasing your risk of losing vision to this disease.

Anything else you’d like to add?

This is a very exciting time in the field of macular degeneration research. Almost every day a new research paper is published telling us something new about the disease. There is growing hope that we can understand what causes macular degeneration and discover better treatments or perhaps even a cure for it.

Thanks for your time, Dr. Trevino. Good luck with myvisiontest.com. I’m sure many patients will benefit from the site.

Click here to visit My Vision Test.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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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

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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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