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!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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(Edited to fix a few typos and add some info left out).

I’ve been a big fan of Susan Barry ever since I first read about her in The New Yorker several years ago. I was an even bigger fan after her book “Fixing My Gaze” was published this year. As a neuroscientist and educator, she has written a very accessible book about her remarkable experience with vision therapy as an adult.

I’ve become so enamored with “Fixing My Gaze” that I have shared many copies with friends, held an online contest to give a the book as a prize, and even interviewed Dr. Barry. So I was delighted to see this morning that the book has been selected as the #4 top science book by Amazon.com for 2009. This is very fitting, due to the easy-reading style of a very complex and fascinating subject.

Congrats to Dr. Barry for the well-deserved praise for a fine piece of work!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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It isn’t too late to late to get the back to school exams in. If you have a family eye doctor, schedule an appointment with them. If you don’t have an eye doctor, or one that doesn’t see children, you can call 813-792-0637 and we can schedule an appointment for you at Bright Eyes or recommend a doctor in your area for the country.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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We’ve had a lot of videos lately, but that is what happens during back to National Children’s Vision and Learning month. More on that later.

Remember that with your child’s physical and dentist visit, they should have their eyes examined before school!

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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For those that follow vision therapy, you likely have read about this Joint Plicy Statement by the American Academy of Pediatrics, Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus;  and American Association of Certified Orthoptists.

Well, this has created a stir, not so much for the policy that essentially has not changed in decades, but rather the tactics that were used to arrive that the policy statement. This is from the American Optometric Associatio Newsblog:

The policy statement …  sheds doubt on the claim that vision therapy treats dyslexia – a claim that vision researchers and clinicians have not made for decades.

It also ignores the evidence of the proven benefits of vision therapy, such as in well-designed studies, most notably the Convergence Insufficiency Treatment Trial (CITT), which was funded by the National Eye Institute. This study showed that vision therapy administered in an eye care provider’s office is the best course of treatment for that condition.

Unfortunately, this is not new.  As Leonard Press, O.D., writes in A flawed statement on vision therapy, learning and dyslexia is reissued:

The American Optometric Association in a joint policy statement with the American Academy of Optometry has previously pointed out the flaws with the joint policy statement of the organizations above (1997, at www.aoa.org/x5420.xml ).  A point-by-point rebuttal of the misleading information intended to discredit optometric vision therapy was published by the American Optometric Association in its journal, Optometry.  (Bowan MD, 2002).  This latest iteration in the form of the Pediatrics article unfortunately recycles the same straw man arguments as the prior joint statements.

The issues of reading and learning are highly complex and multifactorial. I do honestly believe that all profressionals involved feel they are acting in the best interest of children. Unfortunately, some organzzations are slow to change, even in the face of highly credible evidence.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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Ahah! I was scooped on this story by one of my favorite bloggers, Ann Z. from LittleFourEyes. I was going to write a post about this exciting news today, but since she already has. Check it out here.

I Will leave you with a quote from yesterday’s press release:

According to Dr. S. Barry Eiden the trial will also investigate why these special lenses may be effective in slowing myopia.

“Current thinking suggests that these CRT lenses flatten the cornea but other evidence suggests that these lenses may influence the growth in eyeball length (termed axial length). A major contributor to progressive nearsightedness is axial length elongation. Corneal reshaping may actually result in decreased axial length growth. The exact mechanism by which this happens is still being investigated” said Dr. Eiden.

“The results of the SMART Study so far are very exciting,” said Dr. Davis. “The outcomes of this study may revolutionize how we manage young nearsighted patients from this point forward”.

You can go to the SMART study facebook page to find more information.You can also watch a news report on the study here.

It should also be noted that the SMART study is building on additional recent studies that have also found that Orthokeratology has been successful in slowly the progression of myopia.

To find orthokeratology doctors in Tampa and elsewhere: go to the Orthokeratology Academy of America. If you are curious, feel free to call or come in for our no-cost consultation to determine if you are candidate.

Be Well.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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This is very exciting news. It is one of those stories that is so beautiful in its utter simplicity.

Researchers from Australia’s University of New South Wales “have used contact lenses coated in stem cells to restore sight to patients suffering a blinding disease,” with the “groundbreaking operation” bringing “significant improvements in vision within a matter of weeks.” The new “procedure uses a person’s own cells to heal damage to the cornea — the transparent outermost layer of the eye,” and is “carried out under local anesthetic, with patients returning home within two hours of surgery, removing the need for expensive hospital stays.”

The three patients who have been “treated so far had very poor vision caused by corneal disease — the fourth most common form of blindness, affecting around 10 million worldwide.” Corneal blindness “is caused by genetics, surgery, burns, infection or chemotherapy, and treatments usually include grafts and transplants, and drugs, such as steroids.”(Via AOA’s First Look)

You can read more in the Mail Online, here.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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Like many Optometrists, I provide visual care to infants. I support the effort in Michigan to get the word out about this important program

“(Dr. Daniel) Mosser, Dr. Robert Barnett II, Dr. Carolyn Ormes and Dr. Barry Morrisson are Martinsburg-based optometrists who will be participating in the clinic program, which was set in motion after Gov. Joe Manchin declared May 4 through May 16 InfantSEE Week.

This week, more than 50 eye doctors statewide will be providing free comprehensive eye and vision assessments for babies between 6 and 12 months of age, by appointments only.

Br. Bonilla-Warford participates in InfantSEE. If you have a little one who is 6 to 12 months of age, bring her or him to Bright Eyes for a no-cost visual assessment. Because it is easier to prevent a visual problem than treat one!

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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I have been telling my patients for quite some time that omega-3 fatty acids are good for the eyes. These essential fatty acids can help people with dry eye disease.

A recent study also shows that it can reduce the risk of sight-stealing macular degeneration, too:

Two studies released this week in the Archives of Ophthalmology show adults who followed a Mediterranean-style diet high in omega-3 fatty acids found in fish, nuts, and olive oil and low in the trans fats found in baked and processed foods have a much lower risk of developing the sight-robbing disease.

This is one more reason to pay attention to your diet and talking to your doctors about omega-3 supplements if you think you don’t get enough.

Eat well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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There is increasing clinical evidence that orthokeratology is an effective method of reduce myopic progression. The latest study,  the SMART (Stabilization of Myopia by Accelerated Reshaping Technique) Trial, a national study led by Chicago researchers Drs. S. Barry Eiden and Robert Davis, adds additional evidence:

“At the end of one year, the test group was absolutely rock solid, no progression (of nearsightedness) at all,” Eiden said. “The control group had two power steps of progression on average.”  One power step equals a change of .25 diopters in prescription strength.

If the study’s hypothesis holds up, children with mild nearsightedness could have healthier eyes as adults, with a greater chance of successful LASIK, vision-correcting surgery and less risk of retinal complications later in life, Eiden said.

This is exciting because many parents ask me about methods to reduce or eliminate the development of nearsightedness. This study is far from over, but it appears to be supporting the efficacy of orthokeratology as a means to control myopia.

Bright Eyes is one of the few offices in Tampa and the only in Westchase to offer orthokeratology. If you have any questions about orthokeratology, or whether or not you or your children are candidates, contact the office at 813-792-0637.

Be Well!

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