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).

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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From National Eye Institute Press Release – May 18, 2009

National Eye Institute Celebrates Healthy Vision Month

Nearly 14 million Americans experience vision problems, ranging from the need for glasses to blindness. The National Eye Institute (NEI), part of the National Institutes of Health, supports vision research that leads to sight-saving treatments for these conditions. During Healthy Vision Month this May, NEI unveils three online resources for the public to get an inside look at the research process and its impact on public health.

Online Newsmagazine – www.nei.nih.gov/EYEonNEI

Eye on NEI will feature in-depth stories, interviews with researchers, vision science images, and answers to eye health questions. The first biweekly edition includes a profile of Erik Weihenmayer, the only blind man to reach the summit of Mount Everest. Weihenmayer recounts his experiences with testing a breakthrough vision device known as BrainPort. The device, developed with NEI support, allows visually impaired people to “see” objects and words by relaying electrical signals from the tongue to the brain.

Multimedia Timeline – www.nei.nih.gov/lca/nei_timeline

This interactive timeline details the research path toward gene therapy treatment for Leber congenital amaurosis (LCA), a blinding genetic condition that affects the eye’s retinal tissue. In a recent NEI-supported study, three young adults with LCA experienced improvements in day and night vision after undergoing gene therapy. The timeline incorporates video interviews with researchers, scientists, and medical experts to trace the scientific process from the laboratory bench to the patient’s bedside.

Vodcast and Podcast – www.nei.nih.gov/healthyeyes

Many vision problems can go undetected without regular, comprehensive dilated eye exams. In vodcast and podcast interviews for the new Healthy Eyes Web page, NEI’s Dr. Janine Austin Clayton explains that nearsightedness, farsightedness, astigmatism, and presbyopia are common vision problems that are easily corrected once diagnosed. Visitors can also use the Web page to send free e-cards to encourage family and friends to get their vision checked.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Full Press Release can be found here.

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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This is long, but worth looking at. This list of recent scientific support of vision therapy was compiled by my mentor, friend, and colleague, Dr. Dominick Maino and can be found on his blog, Maino’s Memos.

Be Well!

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

Optometric Vision Therapy (OVT) is not a new therapeutic intervention. It has been available for decades, but few have had the access needed. It usually includes the use of lenses, prism, bifocals, and structured therapeutic activities to facilitate the desired outcomes. This therapeutic approach has been successfully used for amblyopia (lazy eye), strabismus (eyes that turn in/out) and other binocular vision dysfunctions (convergence insufficiency/excess, divergence insufficiency/excess, accommodative dysfunctions (focusing), oculomotor anomalies (problems with saccades/pursuits/tracking).

Since these binocular vision dysfunctions have been linked to learning achievement, OVT is also used along with vision information processing therapy to not only improve vision function but academic performance.

Some say there is no research supporting what OVT offers…unfortunatley the majority of these skeptics never bother to seek out the research in the first place.

We have at least one excellent clinical trial to support OVT (see the many articles generated by this clinical trial) and several papers generated by another clinical trial demonstrating that you can treat amblyopia at just about any age…(see PEDIG papers below as well).

The research supporting OVT and learning is there, but not quite as strong as those papers noted above….(see listing below)…

Convergence Insufficiency Treatment Trial Papers

Effectiveness of Placebo Therapy for Maintaining Masking in a Clinical Trial of Vergence/Accommodative Therapy.
Kulp MT, Mitchell GL, Borsting E, Scheiman M, Cotter S, Rouse M, Tamkins S, Mohney BG, Toole A, Reuter K, Citt SG.
Invest Ophthalmol Vis Sci. 2009 Jan 17. [Epub ahead of print]

Randomized clinical trial of treatments for symptomatic convergence insufficiency in children.
Convergence Insufficiency Treatment Trial Study Group.
Arch Ophthalmol. 2008 Oct;126(10):1336-49.

Feasibility of using placebo vision therapy in a multicenter clinical trial.
Kulp MT, Borsting E, Mitchell GL, Scheiman M, Cotter S, Cooper J, Rouse M, London R, Wensveen J; Convergence Insufficiency Treatment Trial (CITT) Investigator Group.
Optom Vis Sci. 2008 Apr;85(4):255-61.

The convergence insufficiency treatment trial: design, methods, and baseline data.
Convergence Insufficiency Treatment Trial (CITT) Study Group.
Ophthalmic Epidemiol. 2008 Jan-Feb;15(1):24-36.

Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency.
Scheiman M, Mitchell GL, Cotter S, Rouse M, Borsting E, Kulp M, Cooper J, London R, Wensveen J; Convergence Insufficiency Treatment Trial (CITT) Study Group.
Optom Vis Sci. 2006 Nov;83(11):857-8; author reply 858-9. No abstract available.

Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children.
Scheiman M, Cotter S, Rouse M, Mitchell GL, Kulp M, Cooper J, Borsting E; Convergence Insufficiency Treatment Trial Study Group.
Br J Ophthalmol. 2005 Oct;89(10):1318-23.

A randomized clinical trial of treatments for convergence insufficiency in children.
Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J; Convergence Insufficiency Treatment Trial Study Group.
Arch Ophthalmol. 2005 Jan;123(1):14-24.

Validity and reliability of the revised convergence insufficiency symptom survey in adults.
Rouse MW, Borsting EJ, Mitchell GL, Scheiman M, Cotter SA, Cooper J, Kulp MT, London R, Wensveen J; Convergence Insufficiency Treatment Trial Group.
Ophthalmic Physiol Opt. 2004 Sep;24(5):384-90.

Validity and reliability of the revised convergence insufficiency symptom survey in children aged 9 to 18 years.
Borsting EJ, Rouse MW, Mitchell GL, Scheiman M, Cotter SA, Cooper J, Kulp MT, London R; Convergence Insufficiency Treatment Trial Group.
Optom Vis Sci. 2003 Dec;80(12):832-8.

Other research/vision and learning:

The efficacy of visual therapy: accommodative disorders and non-strabismic anomalies of binocular vision.
Suchoff IB, Petito GT.
J Am Optom Assoc. 1986 Feb;57(2):119-25.

Vision, learning, and dyslexia. A joint organizational policy statement. American Academy of Optometry. American Optometric Association.
Optom Vis Sci. 1997 Oct;74(10):868-70.

The association between vision quality of life and academics as measured by the College of Optometrists in Vision Development Quality of Life questionnaire.
Vaughn W, Maples WC, Hoenes R.
Optometry. 2006 Mar;77(3):116-23.

Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study.
Borsting E, Rouse M, Chu R.
Optometry. 2005 Oct;76(10):588-92.

Visual factors that significantly impact academic performance.
Maples WC.
Optometry. 2003 Jan;74(1):35-49.

Vertical fixation disparity in learning disabled.
Sucher DF, Stewart J.
Optom Vis Sci. 1993 Dec;70(12):1038-43.

Learning disabilities and vision problems: are they related?
Keys MP, Silver LB.
Pediatrician. 1990;17(3):194-201.

A pilot study. Depth perception and near stereoacuity: is it related to academic performance in young children?
Kulp MT, Schmidt PP.
Binocul Vis Strabismus Q. 2002;17(2):129-34.

Is visual memory predictive of below-average academic achievement in second through fourth graders?
Kulp MT, Edwards KE, Mitchell GL.
Optom Vis Sci. 2002 Jul;79(7):431-4.

Effect of oculomotor and other visual skills on reading performance: a literature review.
Kulp MT, Schmidt PP.
Optom Vis Sci. 1996 Apr;73(4):283-92. Review.

Several Pediatric Eye Disease Investigator Group Generated Papers on Amblyopia

Amblyopia treatment: 1998 versus 2004.
Khazaeni L, Quinn GE, Davidson SL, Forbes BJ.
J Pediatr Ophthalmol Strabismus. 2009 Jan-Feb;46(1):19-22; quiz 23-4.

Pharmacological plus optical penalization treatment for amblyopia: results of a randomized trial.
Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2009 Jan;127(1):22-30.

Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial.
Scheiman MM, Hertle RW, Kraker RT, Beck RW, Birch EE, Felius J, Holmes JM, Kundart J, Morrison DG, Repka MX, Tamkins SM; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2008 Dec;126(12):1634-42.

Further validation of the Amblyopia Treatment Index parental questionnaire.
Holmes JM, Strauber S, Quinn GE, Cole SR, Felius J, Kulp M; Pediatric Eye Disease Investigator Group.
J AAPOS. 2008 Dec;12(6):581-4. Epub 2008 Oct 30.

A randomized trial of near versus distance activities while patching for amblyopia in children aged 3 to less than 7 years.
Pediatric Eye Disease Investigator Group.
Ophthalmology. 2008 Nov;115(11):2071-8. Epub 2008 Sep 11.

Monocular oral reading performance after amblyopia treatment in children.
Repka MX, Kraker RT, Beck RW, Cotter SA, Holmes JM, Arnold RW, Astle WF, Sala NA, Tien DR; Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2008 Dec;146(6):942-7. Epub 2008 Aug 16.

A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years.
Pediatric Eye Disease Investigator Group, Repka MX, Kraker RT, Beck RW, Holmes JM, Cotter SA, Birch EE, Astle WF, Chandler DL, Felius J, Arnold RW, Tien DR, Glaser SR.
Arch Ophthalmol. 2008 Aug;126(8):1039-44.

Treatment of bilateral refractive amblyopia in children three to less than 10 years of age.
Wallace DK, Chandler DL, Beck RW, Arnold RW, Bacal DA, Birch EE, Felius J, Frazier M, Holmes JM, Hoover D, Klimek DA, Lorenzana I, Quinn GE, Repka MX, Suh DW, Tamkins S; Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2007 Oct;144(4):487-96. Epub 2007 Aug 20.

The effect on refractive error of unilateral atropine as compared with patching for the treatment of amblyopia.
Repka MX, Melia M, Eibschitz-Tsimhoni M, London R, Magoon E; Pediatric Eye Disease Investigator Group.
J AAPOS. 2007 Jun;11(3):300-2.

Treatment of strabismic amblyopia with refractive correction.
Cotter SA, Edwards AR, Arnold RW, Astle WF, Barnhardt CN, Beck RW, Birch EE, Donahue SP, Everett DF, Felius J, Holmes JM, Kraker RT, Melia BM, Repka MX, Wallace DK, Weise KK; Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2007 Jun;143(6):1060-3.

Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years.
Hertle RW, Scheiman MM, Beck RW, Chandler DL, Bacal DA, Birch E, Chu RH, Holmes JM, Klimek DL, Lee KA, Repka MX, Weakley DR Jr; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2007 May;125(5):655-9.

Factors associated with recurrence of amblyopia on cessation of patching.
Holmes JM, Melia M, Bradfield YS, Cruz OA, Forbes B; Pediatric Eye Disease Investigator Group.
Ophthalmology. 2007 Aug;114(8):1427-32. Epub 2007 Mar 23.

A symptom survey and quality of life questionnaire for nasolacrimal duct obstruction in children.
Holmes JM, Leske DA, Cole SR, Chandler DL, Repka MX; Nasolacrimal Duct Obstruction Questionnaire Study Group, Silbert DI, Tien DR, Bradley EA, Sala NA, Levin EM, Hoover DL, Klimek DL, Mohney BG, Laby DM, Lee KA, Enzenauer RW, Bacal DA, Mills MD, Beck RW; Pediatric Eye Disease Investigator Group.
Ophthalmology. 2006 Sep;113(9):1675-80. Epub 2006 Jul 7.

A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children.
Wallace DK; Pediatric Eye Disease Investigator Group, Edwards AR, Cotter SA, Beck RW, Arnold RW, Astle WF, Barnhardt CN, Birch EE, Donahue SP, Everett DF, Felius J, Holmes JM, Kraker RT, Melia M, Repka MX, Sala NA, Silbert DI, Weise KK.
Ophthalmology. 2006 Jun;113(6):904-12.

Treatment of anisometropic amblyopia in children with refractive correction.
Cotter SA; Pediatric Eye Disease Investigator Group, Edwards AR, Wallace DK, Beck RW, Arnold RW, Astle WF, Barnhardt CN, Birch EE, Donahue SP, Everett DF, Felius J, Holmes JM, Kraker RT, Melia M, Repka MX, Sala NA, Silbert DI, Weise KK.
Ophthalmology. 2006 Jun;113(6):895-903.

The effect of amblyopia therapy on ocular alignment.
Repka MX, Holmes JM, Melia BM, Beck RW, Gearinger MD, Tamkins SM, Wheeler DT; Pediatric Eye Disease Investigator Group.
J AAPOS. 2005 Dec;9(6):542-5.

A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia.
Holmes JM, Edwards AR, Beck RW, Arnold RW, Johnson DA, Klimek DL, Kraker RT, Lee KA, Lyon DW, Nosel ER, Repka MX, Sala NA, Silbert DI, Tamkins S; Pediatric Eye Disease Investigator Group.
J AAPOS. 2005 Apr;9(2):129-36.

Randomized trial of treatment of amblyopia in children aged 7 to 17 years.
Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, Crouch ER Jr, Cruz OA, Davitt BV, Donahue S, Holmes JM, Lyon DW, Repka MX, Sala NA, Silbert DI, Suh DW, Tamkins SM; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2005 Apr;123(4):437-47.

Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children.
Repka MX, Wallace DK, Beck RW, Kraker RT, Birch EE, Cotter SA, Donahue S, Everett DF, Hertle RW, Holmes JM, Quinn GE, Scheiman MM, Weakley DR; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2005 Feb;123(2):149-57.

A randomized trial of atropine regimens for treatment of moderate amblyopia in children.
Repka MX, Cotter SA, Beck RW, Kraker RT, Birch EE, Everett DF, Hertle RW, Holmes JM, Quinn GE, Sala NA, Scheiman MM, Stager DR Sr, Wallace DK; Pediatric Eye Disease Investigator Group.
Ophthalmology. 2004 Nov;111(11):2076-85.

Risk of amblyopia recurrence after cessation of treatment.
Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR, Cotter SA, Donahue S, Everett DF, Hertle RW, Keech RV, Paysse E, Quinn GF, Repka MX, Scheiman MM; Pediatric Eye Disease Investigator Group.
J AAPOS. 2004 Oct;8(5):420-8.

Recent advances in the treatment of amblyopia.
Quinn GE, Beck RW, Holmes JM, Repka MX; Pediatric Eye Disease Investigator Group.
Pediatrics. 2004 Jun;113(6):1800-2. No abstract available.

A prospective, pilot study of treatment of amblyopia in children 10 to <18>
Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2004 Mar;137(3):581-3.

Impact of patching and atropine treatment on the child and family in the amblyopia treatment study.
Holmes JM, Beck RW, Kraker RT, Cole SR, Repka MX, Birch EE, Felius J, Christiansen SP, Coats DK, Kulp MT; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2003 Nov;121(11):1625-32.

A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children.
Holmes JM, Kraker RT, Beck RW, Birch EE, Cotter SA, Everett DF, Hertle RW, Quinn GE, Repka MX, Scheiman MM, Wallace DK; Pediatric Eye Disease Investigator Group.
Ophthalmology. 2003 Nov;110(11):2075-87.

The course of moderate amblyopia treated with atropine in children: experience of the amblyopia treatment study.
Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2003 Oct;136(4):630-9.

The course of moderate amblyopia treated with patching in children: experience of the amblyopia treatment study.
Pediatric Eye Disease Investigator Group.
Am J Ophthalmol. 2003 Oct;136(4):620-9.

A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors.
Pediatric Eye Disease Investigator Group.
Ophthalmology. 2003 Aug;110(8):1632-7; discussion 1637-8.

A randomized trial of patching regimens for treatment of moderate amblyopia in children.
Repka MX, Beck RW, Holmes JM, Birch EE, Chandler DL, Cotter SA, Hertle RW, Kraker RT, Moke PS, Quinn GE, Scheiman MM; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2003 May;121(5):603-11.

Clinical research in pediatric ophthalmology: the Pediatric Eye Disease Investigator Group.
Beck RW.
Curr Opin Ophthalmol. 2002 Oct;13(5):337-40. Review.

The clinical profile of moderate amblyopia in children younger than 7 years.
Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2002 Mar;120(3):281-7.

A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children.
Pediatric Eye Disease Investigator Group..
Arch Ophthalmol. 2002 Mar;120(3):268-78.

The amblyopia treatment study visual acuity testing protocol.
Holmes JM, Beck RW, Repka MX, Leske DA, Kraker RT, Blair RC, Moke PS, Birch EE, Saunders RA, Hertle RW, Quinn GE, Simons KA, Miller JM; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2001 Sep;119(9):1345-53.

The Amblyopia Treatment Index.
Cole SR, Beck RW, Moke PS, Celano MP, Drews CD, Repka MX, Holmes JM, Birch EE, Kraker RT, Kip KE; Pediatric Eye Disease Investigator Group.
J AAPOS. 2001 Aug;5(4):250-4.

Academic Performance and Binocular Vision Dysfunctions/Vision Information Process

Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading Burkhart Fischer, Dipl Phys; Klaus Hartnegg, Dipl Phys
Optometry and Vision Development Volume 39, No. 4, 2008

Computerized Saccadic Eye Movement Therapy to Improve Oculomotor Control during Reading and Reading Rate in Adult Japanese Readersby Tomohito Okumura, MScOptom, MEd, FCOVD, FAAO, et. al.
Optometry and Vision Development Volume 39, No. 4, 2008

Filtered Text and Direction Discrimination Training Improved Reading Fluency for Both Dyslexic and Normal Readers Teri Lawton, PhD
Optometry and Vision Development Volume 39, No. 3, 2008

Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic Skills Burkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys., and Klaus Hartnegg, Dipl. Phys.
Optometry and Vision Development Volume 39, No. 1, 2008

Effects of Daily Practice on Subitizing, Visual Counting, and Basic Arithmetic Skills Burkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys., and Klaus Hartnegg, Dipl. Phys.
Optometry and Vision Development Volume 39, No. 1, 2008

The Impact of Vergence and Accommodative Therapy on Reading Eye Movements and Reading Speedby Michael Gallaway, OD, FCOVD and Mark B. Boas, OD, MS
Optometry and Vision Development Volume 38, No. 3, 2007

Evaluating Changes in Quality of Life After Vision Therapy Using the COVD Quality of Life Outcomes Assessment by Kelly M. Daugherty, OD, et. al.
Optometry and Vision Development Volume 38, No. 2, 2007

The Effects of HTS Vision Therapy Conducted in a School Setting on Reading Skills in Third and Fourth Grade Students David Goss, O.D., Ph.D., FAAO, FCOVD-A, et. al.
Optometry and Vision Development Volume 38, No. 1, 2007

A Study of the Effectiveness of Cognitive Skill Therapy Delivered in a Video Game Format Don Helms, O.D., and Sara M. Sawtelle, Ph.D.
Optometry and Vision Development Volume 38, No. 1, 2007

Training Direction-Discrimination Sensitivity Remediates a Wide Spectrum of Reading Skills Teri Lawton, Ph.D.
Optometry and Vision Development Volume 38, No. 1, 2007

Is there a common linkage among reading comprehension, visual attention, and magnocellular processing?
Solan HA, Shelley-Tremblay JF, Hansen PC, Larson S.
J Learn Disabil. 2007 May-Jun;40(3):270-8.

M-cell deficit and reading disability: a preliminary study of the effects of temporal vision-processing therapy.
Solan HA, Shelley-Tremblay J, Hansen PC, Silverman ME, Larson S, Ficarra A.
Optometry. 2004 Oct;75(10):640-50.

Visual deficits and dyslexia.
Solan HA.
J Learn Disabil. 1999 Jul-Aug;32(4):282-3. No abstract available.

Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities.
Solan HA, Larson S, Shelley-Tremblay J, Ficarra A, Silverman M.
J Learn Disabil. 2001 Mar-Apr;34(2):107-18.

Effect of attention therapy on reading comprehension.
Solan HA, Shelley-Tremblay J, Ficarra A, Silverman M, Larson S.
J Learn Disabil. 2003 Nov-Dec;36(6):556-63.

Coherent motion threshold measurements for M-cell deficit differ for above- and below-average readers.
Solan HA, Hansen PC, Shelley-Tremblay J, Ficarra A.
Optometry. 2003 Nov;74(11):727-34.

Eye movements and speed reading.
Solan HA.
J Am Optom Assoc. 1999 Jul;70(7):435. No abstract available.

Eye movement efficiency in normal and reading disabled elementary school children: effects of varying luminance and wavelength.
Solan HA, Ficarra A, Brannan JR, Rucker F.
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As an eye doctor who provides vision therapy to treat amblyopia and an avid NPR fan, I was heartened to hear this story in the shower this morning:

www.npr.org – Learning To See In Stereo

There has indeed been much progress in the visual sciences and specifically in the area of amblyopia. Rigorous, well-controlled clinical studies done at institutions such as UC Berkeley have shown us that amblyopia can be treated in ways that are less burdensome, can be treated at later ages than previously thought, and with far-reaching quality of life benefits.

Certainly it will take more effort for someone like Joe or Sue to see these benefits than it would for a 4 year old who has tremendous neuroplasticity.

One element that this story gets exactly right is that vision problems like amblyopia truly are issues of neurophysiology not ocular physiology. When we when treat a patient who has amblyopia, we really are changing how their brain functions.

I am so excited to get the word out on the science behind vision therapy!

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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This video is an interview of Mitchell Scheiman, OD, principle investigator of the Convergence Insufficiency Treatment Trial (CITT).

Dr. Mitchell Scheiman lead the  study that was funded by the National Eye Institute, to determine the most effective treatment for Convergence Insufficiency.  It was a collaborative study with both optometrists and ophthalmologists.

Click on the image to watch the video. You can read more about CITT here.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

On Monday, the National Institute of Health (NIH) released a study showing that there is a more effective treatment for children who have a common reading-related vision disorder. The new study concludes that office-based Vision Therapy along with at-home reinforcement activities is much more effective at treating convergence insufficiency that at-home activities alone or placebo treatment.

Convergence refers to the natural ability of the eyes to focus and align while viewing objects up close. Convergence insufficiency (CI) is a common childhood eye muscle coordination problem, which leads to some or all of the following: slow reading, eye strain, headaches, and blurred or double vision. Children with CI have corresponding issues in reading and concentrating, which ultimately impact learning. CI is often missed in many routine vision screenings because these screenings test distance vision, not the visual skills required for reading. For this reason many children can be misdiagnosed with learning disabilities when, in fact, they have a treatable eye condition.

The NIH study was a collaboration among both optometrists and ophthalmologists involved in 9 sites throughout the United States. Mayo Clinic researchers determined that in-office vision therapy combined with at-home activities was highly effective for treating convergence insufficiency (CI), compared with home-only therapy or placebo treatment. After 12 weeks, 75 percent of children who had weekly office-based and home-based therapy achieved either full correction or had significantly fewer symptoms of CI, compared to between 33-43 percent in the two home treatment groups and placebo group.

“As this study shows, once diagnosed, Convergence Insufficiency can be successfully treated with office-based vision therapy by a trained therapist along with at-home reinforcement,” said principal investigator Mitchell Scheiman, O.D., of Pennsylvania College of Optometry at Salus University. “This is very encouraging news for parents, educators, and anyone who may know a child diagnosed with CI.”

“We found decreases in the frequency and severity of symptoms that might make schoolwork more difficult. Parents reported that they saw a significant decrease in their child having difficulty completing schoolwork at school or at home, appearing inattentive or easily distracted when completing schoolwork, and avoiding schoolwork. In addition, parents reported that they worried less about their child’s school performance,” added Scheiman.

The researchers followed 221 children nationally, ages 9 to 17, divided into four study groups, two of which received only home-based therapies. One group did simple daily exercises for 15 minutes, trying to focus on a moving pencil. A second home-based group performed a shorter version of the pencil exercise and a series of computer-based exercises using special software. A third group did an hour of supervised therapy in a clinical office each week along with 15 minutes of prescribed exercises at home five days a week. The fourth group, the placebo or control group, did office and home exercises designed to look like real therapy but had no effect. Follow-up exams were held after the 4th and 8th weeks and at the end of the 12-week study. A 12-month follow-up study will be conducted to examine long-term effects of these CI treatments.

While there have been hundreds of optometric studies over the years, the CITT is the first scientific study to look at these treatment protocols. Children in all three treatment groups experienced improvement, though it’s not clear whether any improvement in the home groups was due to a placebo effect. About 75 percent of the children who had weekly office-based therapy coupled with at-home exercises experienced either full correction of their vision in 12 weeks or saw marked improvements, compared to 33-43 percent in the two home treatment groups and placebo group. Researchers say that the lower cost of home therapy may be a factor in its popularity, but they point to the high percentage of normalized vision in the office-based sample after 12 weeks as an indicator of quality outcome in the shortest period of time.

The study was published in the Oct. 13 issue of the journal Archives of Ophthalmology, and was funded by the National Eye Institute (NEI), part of the National Institutes of Health. Others involved in the research from Mayo Clinic were Jonathan Holmes, M.D.; Melissa Rice, O.D.; Virginia Karlsson; Becky Nielsen; Jan Sease; and Tracee Shevlin.

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

Optometrists have long been concerned with the fact that amount of eyestrain caused by reading can cause increased nearsightedness (myopia). This is now more true than ever with the increased use of computers and handheld video games. There is increasing research that shows that if the the near work is broken up by other activity, such as out door exercise, it can minimize the progression of myopia.

A new study supports this idea:

An association between physical activity and myopia was observed, suggesting a protective effect of physical activity on the development and progression of myopia in university students. The results confirm that intensive studying is a risk factor of myopia and that myopic progression or development is more likely in medical students in their early 20s than in their late 20s.

The summary of the the study is here. But instead of reading it, maybe you should go out and get some exercise!

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care