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.

A recent study came out yesterday that has a lot of people talking. Acupuncture may be as effective in treating amblyopia (lazy eye) as patching.

From the CNN story Needles trump patches in treating kids’ eye problem:

In the randomized trial, researchers compared the effectiveness of two hours of daily patching therapy with acupuncture for treating lazy eye in 88 children aged 7 to 12. All children had already worn glasses for at least 16 weeks. 43 of the children were randomly assigned to the acupuncture treatment group, receiving five treatments per week that targeted five needle insertion sites. 45 children in the patch group had their stronger eye patched for two hours per day and were instructed to do activities such as reading and typing, which helps to strengthen near vision in the weaker eye.

What do I think about this? I don’t know. I’m not highly educated in acupuncture. I do think it has it’s place. I do know that patching alone is not as effective as vision therapy because patching treats one eye and not both. (See this recent post by Dr. Len Press for additional info). So it is not compelling that acupuncture is better than patching.

I also know that amblyopia is much more than a visual acuity problem. It is a problem of many visual skills including focusing and perception. So much more extensive research needs to be done. But this is a good sign that ophthalmologists and visual scientists are looking into complex areas of vision and visual treatment.

Before anyone undertakes acupuncture for amblyopia, I do recommend a comprehensive visual and eye health evaluation by an optometrist who specializes in children’s vision. If you need to find one, COVD is a great place to start.

So that is my opinion. What do you think about acupuncture for amblyopia?

You may have a friend or family member who has had or is currently undergoing treatment for amblyopia. Even if you don’t know anyone with amblyopia, you likely have some idea that sometimes kids have to wear an eyepatch to improve the vision in their other eye. That treatment is indeed the time-honored, effective treatment of “lazy eye.”

But have we learned anything since the first patch was used? How many hours are you supposed to patch? Are there other options? Do they work? How do we know?

Fortunately, visual scientists have been hard at work the last few years, giving us valuable information that can help doctors guide their patients and parents towards the best, most effective, best tolerated treatment. I have selected a few research studies to cover here. If you want more detail, follow the links provided to obtain your own copy of the studies.

Of course, (and this goes without saying, but I must say it)  TALK TO YOUR DOCTOR before acting on anything written here or changing any part of your prescribed treatment. If you have questions about how this research affects your treatment, print out the study and take it with you to the next evaluation.

Now, on to the studies………

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.

Finding: Both eye drops and patching treat amblyopia, but they may not treat it completely.

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.

Finding: Improvement can been seen in kids with amblyopia older than 6.

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.

Finding: For most kids 7 to 12 years old, the benefits of patching become permanent.

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.

Finding: More patching may not really be better. Patients with significant amblyopia  improve faster with more patching at first, but after 6 months of patching the effect is the same as with less patching.

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.

Finding: Patients with amblyopia who are  engaged in near activities while patching improve faster than those who do not do activities.

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.

Finding: Patients benefit from both distance and near activities while patching.

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.

Finding: To decrease the chance to the amblyopia getting worse after patching is stopped, tapering off the amount of patching is helpful.

The antidepressant fluoxetine restores plasticity in the adult visual cortex. Maya Vetencourt JF, Sale A, Viegi A, Baroncelli L, De Pasquale R, O’Leary OF, Castrén E, Maffei L. 2007 Jun;10(6):679-81. Epub 2007 Apr 29.

Finding: Prozac improved vision in adult amblyopic rats. This is yet more evidence that, under the right conditions, adults with amblyopia can have improved vision. As we learn more about this, eye doctors  can provide more effective amblyopia treatments to adults.

So there you have it. It wasn’t so bad, right? Maybe even a little bit interesting.  In addition to reading these studies, I encourage you to check out the online groups Amblyopia Kids, Amblyopia Support, and  Little Four Eyes. If you find any other good ones, let me know!

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

I am a 36 year old male and have struggled with mild to moderate amblyopia most of my life. I am able to fuse close up and have very good hand eye coordination but at distance, such as driving, I am unable to fuse and the resulting strain  worsens the eye turn. Is vision therapy still a viable option at my age?

This is an impossible question to answer without the benefit for a full, thorough vision exam. This would show the cause and severity of the amblyopia, eye turn,  and other visual problems that you may have and identify areas of possible improvement.

But even without the particulars in your case, I can say a few things generally. Because the purpose of vision therapy is to help you develop visual skills that may be lacking, there is not point in life when it is not possible to receive some benefit from vision therapy. The real question is this: Are you bothered enough by your visual problem that you would like to take the steps to improve the situation. (Case in point, this video of a 101 year old vision therapy patient.)

But I don’t want to paint vision therapy as a panacea either, because some conditions are very complicated and can take a significant amount of time, effort, and expense to improve. Some conditions are best treated with a combination of vision therapy and other methods, such as special glasses or surgery. Yet other conditions are better left untreated.

I would recommend against any of the “improve your vision” ads on TV or the internet. Many of these have elements of legitimate therapy, but they tend to over-promise and do not match the person with the appropriate therapy. Instead, only pursue therapy from a doctor with specialized training in visual function and vision therapy.

Have you read Susan Barry’s book, “Fixing My Gaze“? I very highly recommend it. You may also find this blog interesting: http://seeing3d.blogspot.com/.

If you would like more information about the evaluation or vision therapy, please do not hesitate to call and speak to Edna or myself.

Best Wishes.

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

Thanks to Adventures in Amblyopia….

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

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!

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

We’ve known for quite some time that amblyopia can be improved in older children and adults. It may take more work, but it can be done with the proper vision therapy.

Now there is evidence, at least in rats, that Prozac (fluoxetine) may actually assist in the developing the neural connections in the brain to improve visual acuity reduced due to amblyopia.

But remember two things: First, People are not rats and, at best, it will be some time before fluoxetine is studied in people. Second, whether fluoxetine is helpful or not, vision therapy is crucial in developing all the visual skills in people with amblyopia.

Read the whole article here.

Be Well!

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

It is well known, and intuitive, that children and adults with strabismus (crossed or wandering eyes) have greater difficulty with self image and social situations than people with straight eyes. This is partially cosmetic and partially due to self-awareness that something is “wrong” with their vision. To assist people with strabismus, there are many resources including online support groups and a blog.

A related but different condition is amblyopia (lazy eye), that occurs when the vision doesn’t develop normally in one or both eyes and vision is not clear even with the best glasses or contacts. You can’t tell a person has amblyopia by looking at them – an eye doctor has to diagnosis it. There are also online support groups for amblyopia.

Research indicates that people with amblyopia are as likely to have social issues as those with strabismus, even though there is no cosmetic concern. The study found that “a significant number of patients felt that amblyopia interfered with school (52%) and work (48%) to some degree and were generally affected in their lifestyle (50%).” Additionally, sports job choices were affected.

The study concludes with ‘Psychosocial difficulties related to amblyopia affect individuals’ self-image, work, school, and friendships. Amblyopia has a significant effect on psychosocial functioning and warrants aggressive screening, prevention and treatment during the amblyogenic years.”

As I say frequently, it is much easier to prevent amblyopia than to treat it. And fortunately, amblyopia can be prevented. Early eye exams are critical for detecting and treating amblyopia. The first exam is recommended at six months of age. If all is well, the next exams should occur at age three and before school.

Be Well!

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

The evidence continues to support what optometrists have known for years: it is possible to improve amblyopia (lazy eye) beyond childhood years. It is faster and easier to treat at younger ages, but can be treated at any age.

If you’d like to read about this latest study on adult amblyopia treatment, click here.

If you are an adult with amblyopia and have been told that it is too late to be treated, call us for an appointment and, after evaluation,  we can discuss what type of benefit you might receive from treatment.

Be Well!

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