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This is a blog for Bright Eyes Family Vision Care, an Optometric practice in Tampa, FL that is owned by Nathan Bonilla-Warford, O.D., F.A.A.O. Most of my patients know that I like to share information. This will be an additional way for me to share news about events and changes at Bright Eyes and discuss new developments about vision care. I like feedback, so feel free to leave comments!

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An Infographic About Amblyopia

There is a lot of discussion lately about amblyopia (AKA lazy eye), largely due to the recent news reports of adaptations of Tetris and other video games as treatments for amblyopia. As I described in my previous post, these new binocular techniques are definitely better than old-school patching. However, in there essence, these techniques are not new. In fact, optometrists have known for a long time that treating two eyes is better than one. That is the basis of what we do in the vision therapy room to help patients with amblyopia – play games with both eyes at the same time.

I’m very happy to share with you an infographic on amblyopia treatment from the VisionHelp blog.

Amblyopia Infographic

You can read the full story behind the origin of this excellent infographic here. I think it is fantastic!

If you and your child are struggling with patching – you don’t have to be! Not only is binocular therapy more effective than patching – it is way more fun! If you have questions about amblyopia, vision’s therapy, or children’s vision in general, do not hesitate to give us at call at 813-792-0637 or email me at Doc@BrightEyesTampa.com.

And please  - share, pin, tweet or photocopy this infographic!

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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Tetris therapy for amblyopia? Yes, please.

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.

Amblyopia, known to many people as “lazy eye” is a visual adaptation to conditions that interfere with visual development. On a simple level, it means that even with the best glasses or contact lenses, the eye does not see and function as well as expected. It is not due to disease or injury, but rather a situation where the brain doesn’t communicate well with one eye and can’t use the eyes as a team.
Think of the brain being someone on the internet, and one eye is a friend with 14.4K dial up and the other has a 4G smart phone. Yes, you can communicate with both eyes, but you are going to prefer the 4G because it is faster and can do more things. Trying to use both eyes simultaneously as a team is hard because one is lagging behind and missing information.

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).

So why is this so exciting? Because this is exactly what we do in vision therapy every day. We “upgrade” the eyes to work well individually (4G) but also “network” them to work together (Facebook, Twitter). We don’t use Tetris, but we do use paper & pens, balls, special glasses, computer programs, 3D art, optical illusions and lots of other fun tools to make it fun and productive.

It is great to see more research on this on adults with amblyopia. For too many years, patients have been told that after early childhood there is no hope of improving the vision in the amblyopic eye. It simply is not true. I did a blog post awhile back on the science behind amblyopia. You can see that here. For a great look at binocular treatment of amblyopia, see this recent post on the VisionHelp blog.

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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Congrats to our newest Vision Therapy grad!

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!

Dr. Nate

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