Archive for the ‘Vision Therapy’ Category

A new study, about amblyopia, has been published and it is really getting attention. From CBS news to Huffington Post to CNET, everyone is covering it, probably because they get to use the word “Tetris” in the title. Tetris, of course, is the hugely addictive block-stack game that, at least in my memory, was the first hand-held videogame blockbuster.

I am extremely glad to see this study and I do have some thoughts on it:
First, do not get too excited about the Tetris part. While I really have no doubt that Tetris and similar games stimulate visual planning and cognitive development, I suspect that the main benefit of using Tetris in this study is that it is very engaging, requires attention to visual detail, and requires the  player to make decisions based on visual information. Basically this is true for most video games (and real world games, for that matter). So Tetris is not the magic here.

What IS a big deal about this study is the goggles – they required the eyes to work together to play the game. If you play, you can’t just shut off the amblyopic eye, or you’ll lose because you won’t see the falling blocks. And that isn’t motivating or good therapy.  It isn’t patching or covering the good eye because you won’t see the blocks on the bottom. You still won’t win. This is like conventional patching. You can stimulate the amblyopic eye (upgrading the modem), but that alone only helps somewhat.

What this study shows is that only when both eyes can see and are given the opportunity to work together to achieve a common visual goal is there significant improvement in the amblyopic eye. In my internet analogy, this is not only giving the amblyopic eye a 4G smartphone but making sure it is net savvy. Both eyes are now friends on Facebook and Twitter so they can work together in real time to solve visual-spatial problems efficiently. (Just to be clear: the eyes do not use Facebook, and they do not communicate directly – all that happens in the brain).

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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The entire staff and I want to extend a special congratulations to DS, our newest vision therapy graduate!  She has worked very hard and has done extremely well. She should be quite proud of herself!

DS was referred by her excellent tutor who I have known for several years and is skilled at suspecting vision problems when they are interfering with learning activities like reading and writing. When DS came in our office,  she was struggling with words that appeared to run together while reading, skipping lines while reading and generally avoiding activities like homework. Her COVD Quality of Life Survey score was 39, indicating that visual problems were likely causing her symptoms. (A lower score is better, and anything over 20 is raises suspicion of a vision problem).

DS’s symptoms were explained by her convergence insufficiency (difficulty turning eyes inward when looking up close), accommodative insufficiency (difficulty focusing) and pursuit dysfunction (difficulty with tracking).

Now after completing vision therapy, all of that has changed! As her mom said, “It is like she’s a different child. She understands  more of her reading because of her eyes tracking better. Homework is not a struggle anymore. In fact, she has it done before she gets home most of the time. ”

And what I love to hear from parents:  ”She is more excited about reading than ever before!”

Recently report cards came out, and her mom was so excited at the improvement that she emailed us a copy. There has been improvement not just in reading but improvement in many areas (especially in science) as you can see in this little section of the grade report:

I’m quite happy that through vision therapy, DS has overcome her visual problems, and this is reflected in her COVD Quality of Life score that dropped from 39 to 8! As DS lives quite a long distance from our office, I’m sure they will not miss the weekly drive. But we will miss seeing her in the office! We are very proud of her. If she works as hard at everything else as she has in VT, we have no doubt she will succeed beyond her wildest dreams!

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

If you have tried to get an appointment recently, you may have noticed that August is a very busy month for us. And rightfully so. August is National Children’s Vision & Learning Month. I spend much of this month – and every month – helping children develop the visual skills they need to read and write. I routinely hear how after appropriate glasses and/or vision therapy, patients are reading better than ever, not fighting over homework, checking out books for fun, doing better in sports, and so many other achievements.

Here is one:

And you can find many more videos like this one at on YouTube.

If I’m not convincing enough, read these quotes from more well-known people and organizations.

• “25% of students in grades K-6 have visual problems that are serious enough to impede learning.” - American Public Health Association
• “When vision problems go undetected, children almost invariably have trouble reading and doing their schoolwork. They often display fatigue, fidgeting, and frustrations in the classroom—traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” - American Optometric Association
• “It is estimated that 80% of children with a learning disability have an undiagnosed vision problem.” - Vision Council of America
• “Early diagnosis and treatment of children’s vision problems is a necessary component to school readiness and academic learning; and that vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor. Comprehensive eye and vision examinations … are important for all children first entering school and regularly throughout their school-aged years to ensure healthy eyes and adequate visual skills essential for successful academic achievement.” - National PTA Policy Statement 2005,
• “Early testing for vision problems is key to preventing learning disabilities or, in some cases, significant visual impairment in children.” - Ned Calonge, MD, MPH, Task Force Chairman, Chief Medical Officer and State Epidemiologist at the Colorado Department of Public Health and Environment.
• “A three year study of 540 children found that those children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” - Dr. Lynn Hellerstein, FAAO, FCOVD,

You can find tons of information on vision and learning on COVD.org. I wholeheartedly encourage you to take part in Vision and Learning Month by  reading and sharing your success stories on COVD’s Facebook page! And, of course, if your kids haven’t had their back to school exam yet, schedule one here or call us at 813-792-0637.

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

At Bright Eyes Family Vision Care we love it when patients share their successes with us. Many times and they simply tell us when they come in. Sometimes they’ll write an amazing e-mail. One thing we really love is a good video!

Take for example this video of Kellan and his mom describing how vision therapy has helped him:

I’m excited to say that many other people are sharing their vision therapy success stories by video as well these days! Check out this very creative and timely one from Jillian, of Jillian’s Story. See also this very moving story of vision therapy and how much difference it made for Ann.

The College of Optometrists in Vision Development (COVD) is an organization dedicated to educating doctors and the general public about vision therapy.  This summer, in conjunction with Children’s Vision and Learning Month, COVD  is hosting an amazing vision therapy success story video competition called Visions of Hope video contest.

The goal of the competition is to see how many great vision therapy stories they can get on line to help share the positive impact vision therapy can have. It is exciting because the contest has already gotten lots of attention online. I can’t wait to see all the great videos that result from it!

Do you have a vision therapy success story that you want to share? Join the Vision of Hope contest! Read exactly how to submit your entry on the COVD Facebook Page. Submissions are due by August 10, so don’t dilly-dally! If you want to submit a video but have any questions or need help, do not hesitate to let me know!

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

This new video from VSP is great! Not only is it pretty fun and entertaining, but it also makes a great point about the importance of vision and activities like sports. I’ll be honest I don’t know who  Tyreke Evans is, because I don’t follow basketball, but I do know that vision is very important for sports! Not only do you need to see clearly, you and have to have  good peripheral vision and good visual reaction time; all of these things are necessary to win. The great thing is that if there are problems with any of these things, they can be fixed with corrective lenses or vision therapy!

This video shows that protecting your eyes on the court or on the field is very important. Regular glasses are not designed for sports and are actually less safe than sports glasses. And don ‘t worry,  the modern sports glasses are way cooler than the ones I had when I was a kid! Stop by Bright Eyes to check out some of the new models.

The VSP video also does a great job of highlighting the American Optometric Association’s recommendation that the  first eye exam should occur at six months, then three years, then before kindergarten, assuming nothing is wrong.

If you have any questions about your little one’s vision,  have concerns that vision may be interfering with sports, or whether or not they are protecting their eyes sufficiently during sports, ask us!

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

We have had an amazing few weeks at Bright Eyes Family Vision Care in the Vision Therapy department and I just want to share! There have been several patients who have graduated with flying colors and it is so wonderful to see them so proud of their accomplishments  – and so happy with the results!

One young patient is very bright but has a variety of different problems including difficulty with eye movement control and visual attention. During the course of vision therapy not only has his visual skill improved but his parents have noted a dramatic difference in his awareness of the world around him. They say that he is better able to work with groups of people and get his behavior at school on has improved dramatically!

Another young patient had amblyopia (which means a lazy eye) as well as a few other related visual processing problems. Her therapy was primarily for the amblyopia to improve the vision in her eye and to improve the way the eyes work together. Then at one point a few weeks ago her mother reported that her reading had really taken off. She had her nose in a book almost all the time! Needless to say her mother is thrilled.

I am also excited because we have several new patients starting therapy program. One young man has had ongoing problems with double vision that have interfered with reading and school work. He is excited to get started and I am too because I know he is going to do very well. Another one is a typical case where the family came in with concerns about having to see blurry in the distance and only after we did the evaluation did we find out that there were focusing problems that may also be contributing to avoidance of homework and their close activities. Once I explained how and an underlying focusing problem can actually cause vision in the distance to be blurry, it made a lot of sense to them and they were excited to sign up.

Although vision therapy is the most time consuming and most complicated part of my career, it is also the most rewarding to being out the potential of these patients and their joy when they themselves realize it! If you have any questions about vision therapy and and whether or not you or someone else is a candidate, please feel free to give our office a call, e-mail us, or stop by.

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

The American Optometric Association recently held a School Readiness Summit: Focus on Vision in which doctors, nurses, educators and advocates for children’s health gathered to examine learning-related vision issues that are keeping children from achieving in the classroom. This summit was created to address the concerns that our current system is flawed and a policy shift is needed. The problem is that currently, the U.S. educational system and some health care providers rely heavily on vision screenings to discover the kids that need comprehensive exams. These screenings do catch some types of vision problems but they can miss about 75% of those children that have learning-related vision problems. Detecting these vision problems is very important as “studies show that much of what children learn comes though vision, and undetected and untreated eye and vision disorders in children, such as amblyopia and strabismus, can result in vision loss, additional costly treatments, delayed reading and poorer outcomes in school.”

The take-home statement that the summit produced is that comprehensive eye exams must serve as the foundation to determine school readiness in school-aged children. Another important point established at this meeting is the establishment of the link between healthy vision and classroom learning.

This historic summit is an important step in ensuring that children receive the proper detection and treatment of vision problems before they become detrimental to their learning. Here at Bright Eyes Family Vision Care, we are excited to see these changes being made, since it has been our goal from the beginning to not only catch vision problems at an early stage, evidenced by the InfantSEE program that we offer that provides free eye exams to infants between the age of 6 months and 1 year of age, but to also treat certain types of problems through our extensive one-on-one vision therapy program.

If you have any questions regarding the InfantSEE program, vision therapy program, or would like to schedule a comprehensive eye exam for your child before they start school, give our office a call or come in to schedule.

All the best,

Justin Schoonover, CPO

Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

It’s true! According to several recent entertainment stories such as this one from Engadget,  Johnny Depp is unable to see the 3-D effects in the very movies that he stars in. Specifically the upcoming  Pirates of the Caribbean: On Stranger Tides, which is to be released May 20th.

They way Depp described it, “I’m unable to see in 3D. My eyes don’t see in 3D. I have a weird eye… It just doesn’t work.”

While  all this may seem like a small bit of movie trivia to many people, this may remind a lot of folks of themselves… or their children.  We don’t know exactly what is weird about his “eye”, whether it is amblyopia (often called “lazy eye”) or some other condition. But we do know that many of the types of problems can be detected at a very early age. It is recommended that babies have their first eye exam at six months old. Treatment such as glasses or contacts or medical procedures to prevent further problems may allow the patient to have as normal vision as possible…. even normal 3-D vision. Also, vision therapy may be an option to give 3-D vision to patients,  young or old. The book “Fixing My Gaze”  by Dr. Susan Barry is an excellent example of this.

The recent news about Johnny Depp is just one more reminder that if you or anyone you know has trouble with 3-D movies you should see an optometrist.

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

Recently the Star Tribune of Minneapolis-St.Paul ran a story on Tampa Bay Lightning goalie, Dwayne Roloson. Part of the story explains how he uses sports-vision, to keep him at the top of game at age 41.

Says Dr. Mark Gordon, Roloson’s optometrist:

“We take a look at eye-hand coordination, reaction time, processing speeds, peripheral awareness,” Gordon said. “Do we know where our teammates are? Do we know where the opponents are? Do we know where the puck is? Do we know how fast the puck is moving? Can we make sense of not only where the puck is at this moment but where it’s going to be a half-second from now?”

Sports vision is a type of vision therapy. Sometimes vision therapy is used to help someone develop skills they did not develop on their own. For example, vision therapy could be used to help a patient with autism develop control of their eye movements. Sometimes vision therapy is used to help people cope with visual stress, like the high-school student who gets double vision while studying. In sports vision, the goal is to help people who already have average or better than average visual skills have even better skills so that they perform at their maximum potential.

This exemplifies a great point. Vision therapy isn’t “a procedure.” It is the application of any of a number of procedures and concepts to increase a patient’s visual skill. And this in turn can help them reach their goals, whether they are passing the FCAT or blocking the next hockey goal.

If you have questions about vision therapy, please do not hesitate to come in or contact us!

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

For months, I’ve been reading, writing, and speaking about the Nintendo 3DS, all without actually seeing or using it. I was finally able to change that yesterday. After helping put the kids to bed, I slipped off to Best Buy and purchased a shiny black 3DS. I brought it home and Cristina and I spent a few hours setting it up and using it. We’ve had a Nintendo DS at Bright Eyes for years that we use as a reward activity during vision therapy, so it was immediately very familiar.

3D Effects

One of the biggest selling points of the 3DS is that the user does not need to wear special glasses to see the 3D effects. This is called autostereoscopic 3D and is definitely where 3D technology is going. It works surprisingly well, considering the small screen. You do have hold the screen flat relative to your head. If you angle the screen, you will either see double or lose the 3D effect.  The 3D does work from positions other than dead-center. This means that, while not ideal, it is possible for more than one person to see the 3D effect at one time.

I was particularly interested to see how well the “3D volume” slider worked. This allows users to adjust the amount of 3D shown to suit their tastes and the particular game. It works amazingly, seamlessly well. I was able to adjust the 3D anywhere from none, to just-noticeable, to full with just a flick of my thumb.

Augmented reality

One of the most intriguing aspects of the 3DS is its use of AR (augmented reality) as part of the game. This allows the viewer to play the game within the room or area that they are really in. (See picture to the right).  Not only is this extremely fun, there are some potential visual benefits to this. If the game is getting further away, it is more likely that the user will hold the game further away and look further away, potentially reducing some strain on the eyes. (I should note that I don’t have any research on this, but it occurred to me while playing.)

3DS vs. DS

One of the biggest visual concerns with 2D game systems such as the original Nintendo DS is that children tend to hold the screens incredibly close – as close as 3 or 4 inches. A person of any age should not hold a book or game closer than their Harmon Distance (or the distance from the knuckle to the elbow). With the 3DS, the 3D effect is better when the game is held a foot or so away from the eyes, so this will naturally encourage users to stay within their Harmon distance.

Safety

Much has been made, appropriately, of the potential adverse effects of using 3D technology, due to the differences of 3DS and real-life 3D.  Nintendo’s official warning of “vision damage” occurring for those six and under has gotten a lot of attention. While I haven’t seen any proof of this, I think it is reasonable because a person has to pretty visual sophisticated to use the 3DS. So I do recommend keeping it away from the young kids. They should be building with blocks and playing outside anyway,

For the older kids and adults (like Justin, on the left) who use the 3DS, eyestrain is possible. Already, I’ve talked to patients who have experienced headaches, nausea, and blurred vision from the 3DS. I’m happy to report that after an hour neither Cristina nor I experienced any of these symptoms. However, we routinely do activities during vision therapy that require visual skill and flexibility. For that reason we are much more accustomed to the visual demands required by the 3DS.

The #1 thing to remember: moderation. Take frequent breaks, even if you feel OK. Use the 20/20/20 Rule – Every 20 minutes, look away from the screen at something 20 feet away for at least 20 seconds. Even Nintendo recommends that players take a 10 minute break every hour.

If you or your children do experience symptoms, or don’t see the 3D even with the 3D on “full” be sure to get a through eye exam to look for vision or eye coordination problems. And remember that eye exams are recommended at age six months, three years, and before kindergarten.

For more on potential health effects of the Nintendo 3DS, see my interview with PCWorld. See also the American Optometric Association’s press release on the subject

Overall

In summary, the Nintendo 3DS easy to use and fun. The 3D effects are effective and being glasses-free is very nice. The augmented reality really works well. When used in moderation for the appropriate ages, I do not see any harm. If you do have concerns, schedule an appointment at Bright Eyes either on our webpage or calling 813-792-0637.

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