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 haven't written much for the blog in the last couple of weeks. Mostly I've been busy with Javier and Nora. You can see some of Javier's pictures  on Flickr here: http://bit.ly/1MFiuw - Dr. B].

I am very excited to bring you this interview with Nick Despotidis, O.D. (Dr. D). He is one of my mentors in the orthokeratology/corneal reshaping field. He has written, researched, lectured on the subject for many years. I have attended several of his lectures and have always been impressed with his insight and enthusiasm. I was even more impressed when I read his book “My Children are Nearsighted, Too.” Dr. D practices in Hamilton Square, New Jersey.

Dr. B. Writing a book takes a lot of effort. What prompted you to write a book and not just a large pamphlet?

Dr. D. : As health professionals, we often get asked similar questions from patients. However, nothing seems to elicit as much emotion as when parents are discussing their children’s vision. Seeing the concern or sheer disappointment on a parent’s face when I tell them their child needs glasses still moves me, even after twenty years in practice.

Parents often ask: “Why so young? Do they have to wear glasses all the time? Is this inherited? Is it going to get worse? What can be done?” My explanation and subsequent recommendations take time, time we often don’t have while in the examination room, yet parents deserve.

So now I actually give my patients a copy of our book and highlight specific sections I want them to read. Then, after they develop a good background and learn the answers to many of their questions, we discuss how to help their son or daughter. It’s worked amazingly well. I’m very proud after parents tell me how much the book has helped them understand vision and given them an arsenal of recommendations.<

As a parent myself I appreciate the frustration of being told my child requires some type of treatment without fully understanding my options. The book was written to empower parents when it comes to their children’s eyesight.

How long did it take for beginning to end?

Two years!

As an early adopter of corneal reshaping, did you initially suspect that myopia control was going to be as successful as it has recently been shown to be?

No. In 1992 when it was first introduced into our office it was just viewed as a substitute for daytime contact lenses or glasses. That’s it. We reserved recommending corneal reshaping for patients who could not wear contacts during the day or required freedom from contact lenses or eyeglasses during their waking hours. So we had a lot of athletes, teachers and executives wearing the lens, but it was a select few.

However, clinically we observed that teenage athletes wearing the lenses did not need changes to their prescription every year like many of our eyeglass or contact lens wearing patients. In 1998 when my own two sons began wearing eyeglasses, that’s when the light turned out. You see, even though I prescribe eyeglasses daily, when my young children needed eyeglasses, I was upset, even distraught. Seeing the success they’ve had with corneal reshaping inspired me to become an “early adopter” or advocate of this technology.

If corneal reshaping is such a positive and exciting technology, one that may help thousands of young children from having their eyesight worsen, why don’t all doctors provide this service?

That’s a great question, one I get asked daily! Most eye doctors are not familiar with corneal reshaping even though Paragon Vision Sciences, the maker of the CRT design, received FDA approval over 9 years ago! Some doctors may base their opinion on outdated information or personal experience.

As a “seasoned” health provider I understand how long new procedures take to enter mainstream medical offices. But that does not make it fair or right. For example, it took over 30 years for data to arise that a child’s eye coordination skills may affect their ability to read and consequently learn. Even though I understood this in my early training days it took decades to become “accepted.” And even today some practitioners are not on board.  Corneal reshaping faces the same challenge. In addition to understanding the technology, doctors need to enjoy seeing patients more often than their contact lens and eyeglass wearing patients. This is often not the case.

Lastly, there is a higher level of technology and training required to perform corneal reshaping properly. Doctors may not be interested enough to upgrade their offices to provide this service.

I personally overcame these apprehensions when I saw how well corneal reshaping helped my own sons. Now, literally 10 years after they started wearing these lenses, their eyesight has not gotten worse. Nothing more needs to be said.

What is your next project?

I’m writing a personal development book extolling the life lessons I’ve acquired as a husband, parent, doctor and philanthropist.

Thanks, Dr. Despotidis, for taking the time. I wish yoy, your family, and your patients the best.

You can read more about Dr. Despotidis and orthokeratology at: http://www.gentlevisionshaping.com/. If you have questions about whether or not corneal reshaping is right for your or child, feel free to contact Bright Eyes at the contact info below or call 813-792-0637.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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Little Four Eyes is one of my favorite blogs. It is well written, now has some snappy illustrations, and is very helpful for parents who have little bundles of joy that need glasses.

This post “when you’ve just found out your young child needs glasses” is a lengthy MUST READ for any parents who are raising young children with glasses. Ann talks about the emotions of dealing with glasses and scads of helpful, pragmatic information.

This info is so good, I will be sharing it with parents who come in the office looking for very small glasses.

Enjoy!

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

This eye doctor makes some extremely valid points about children’s eyeglasses and how and why we prescribe them. I am glad that he took the time to write all of this up, because I agree with a lot of what he says, but probably would not have written all up in one place or in quite the same way.

Check it out here: Common Children’s Eye Care Question

Be Well!

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

It is that time of year again. Time for finishing off those holiday cookies and preparing for a happier, healthier, more prosperous new year. A year ago I posted the Ten New Year’s Resolutions for Your Eye Heath. This year I will turn my attention to children’s vision. So without further ado…

The Top Ten New Year’s Resolutions for Children Vision

1) Read up on children’s vision

There are some wonderfully informative websites about children’s vision and visual development. Check them out at Optometrist Network, College of Optometrists in Vision Development, Childrensvision.com, Parents Active in Vision Education, Optometric Extension Program Foundation, and many others.

2) Spend Some Quality Vision Time With Your Kids

One of the best things you can do is simply spend some time reading books and doing homework with your children. Watch them and talk to them about what they are seeing and what if feels like when they read. Compare what you find with this symptom checklist.

3) Have Their Eyes and Vision Examined

Have your children had an full eye exam?  (A simple screenings done at school or the pediatrician doesn’t count.)  If they haven’t, then make 2009 the year.  The American Optometric Association recommends the first eye exam at age six months, followed by age three years and then before entering school. This exam should be thorough and evaluate all aspects of vision. You can find additional useful information about this at the Vision First Foundation.

4) Bring Their Glasses in for Adjustment and Cleaning

All children who wear glasses -  especially boys – get them bent up a little bit. Sometimes a lot. Often the temples are crooked and the nosepads are flattened down. Don’t hesitate to come by Bright Eyes and have the staff adjust and clean their glasses. You might be amazed how much difference it can make!

5) Consider Contacts

Many parents think that their children are too young for contacts. Sometimes they are correct that the child and family simply are not ready for contacts. However,  contacts frequently provide better vision than glasses and is the best option for a child – if the parents are ready.  You can read my post about this here.

6) Consider the Need for Sports Eye Protection

Many of my young patients participate in organized supports such as baseball, football, or basketball. For these patients, prescription sports goggles are a good idea. First, their use will limit sports-related eye injuries. Second, the improved vision sports eyewear provide may significantly improve their performance on the field.

7) Ensure They are Using Good Visual Ergonomics

Most people are familiar with ergonomics to help them function more comfortable and efficiently. This also applies to vision. Ensure that your kids take frequent breaks from activities such as reading and video games. Watch to see if they hold books or video games very close, which can cause eye strain. When reading and writing a slant-board is helpful. Read more here.

Have them wear their sunglasses.

We live Florida. It is sunny, even in January. Most of my patients have sunglasses and most of their kids do, too. But parents often forget to have their kids wear them. They’ll go outside and put on the SPF 45 sunblock – which is a good idea – but then forget the eye protection. It is not too early to start preventing problems!

9) Myopia Progression

If you are concerned about your child’s rapid development of nearsightedness, there may be some options to consider. First, Precise Corneal Reshaping not only temporarily eliminates nearsightedness, but has been shown in studies to reduce progression of myopia. Additionally, some children may benefit from additional options such as bifocal glasses, bifocal contacts, or vision therapy. Only a comprehensive eye exam can indicate what is most appropriate.

10) Pass this along to anyone who has kids!

If you know a family member or has children, pass this info along. Especially if there are visual problems in the family.

I hope everyone has a fantastic 2009! If you have any questions about this list, or anything else eye-related, feel free to call 813-792-0637 or stop by the office.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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The Vision First Foundation is an organization that was founded by Janet Hughes. I got to know her when I lived in Chicago. She has long been a passionate advocate for children’s vision owing to her experience when her daughter Amy was found to have amblyopia after passing a vision screening.

Janet and the Vision First Foundation have worked hard in Illinois to ensure that children are able to go to school with the clear vision they need to succeed. The latest effort is a petition to upgrade the form used for children’s vision exams to include the following:

• Designed for the parent and teacher.
• Provides education on children’s vision.
• Suitable for recommended and required eye exams.
• Emphasizes a comprehensive eye and vision examination.
• Illustrates eye health, visual acuity, refractive evaluation, and visual efficiency.
• Accompanies prewritten letters for schools.
• Contains a vision screening disclaimer.
• Includes a Reference Page for parents and teachers.
• Represents high standards of eye care.
• Brings meaning and purpose to an eye examination.

I took a moment to view and sign the petition. I encourage you to do the same.

Also, if you’d like to watch a short video on the difference between screenings and eye exams, click here.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

Come to our next office seminar, Reading Problems: The Visual Connection. This evening event will be held at Bright Eyes and will cover how vision problems can interfere with reading development. The seminar will occur on November 17, 2008.

I hope you all had a safe fun Halloween. Some of you know, or know about my daughter Nora. She dressed up as a Bumble Bee. we did a little Trick or Treating, but really she has more fun taking the candy out of her pumpkin and putting it back in again than anything else….

Although the Halloween has past, I thought this was a good post, in the spirit of the season:
Trick or treat? Dispelling myths in eye care.

Bee Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

As parents ready millions of children across the US to start the new school year, COVD’s “August is Children’s Vision and Learning Month” campaign is working to raise awareness about the important connection between vision and learning.

Current research shows that vision problems afflict millions of American children and thereby impact their ability to learn:
• One in four school-age children have vision problems, according to the American Foundation in Vision Awareness;
• 18 million children will not have had eye examinations by a Doctor of Optometry or other certified vision
care professional prior to entering school;
• 60 percent of students identified as “problem learners” have undetected vision problems, according to the American Optometric Association.

“Vision disorders are one of the leading impediments to successful learning in children,” said Dr. Drusilla Grant,Immediate Past President of the College of Optometrists in Vision Development. “Many vision problems goundetected because a child is told he or she has 20/20 vision and healthy eyes. This can be misleading because their visual skills like tracking, eye teaming, and focusing may not have been evaluated and this is really where the problem lies.”

Exams using only the eye chart do not measure how well a child can see at near distances, nor do they evaluate depth perception, eye coordination or numerous other visual skills required in the learning process. They also don’t evaluate the visual abilities that are needed to extract information off of a page.

According to Dr. Dan L. Fortenbacher, COVD President, “We’re dealing with far more than just ‘eyesight.’ Our concern and primary focus is with identifying and treating a delay in the patient’s ability to access and process visual information in ways that are the necessary prerequisites for developmental learning. These issues can be treated through vision therapy, but particularly when diagnosed early.”

While “August is Children’s Vision and Learning Month” is concentrated on the month of August, the goal of the campaign is to broaden awareness year-round that vision is more than 20/20. The 20/20 test does not test how well you see at reading distance. In fact, the 20/20 test fails to evaluate many other important aspects of normal vision such as:
• Eye focusing
• Eye coordination
• Eye teaming (binocular vision)
• Eye movement
• Visual perceptual skills
• Color vision

At the center of its national “August is Children’s Vision and Learning Month” public awareness campaign, COVD urges parents, teachers, and all other decision-makers involved in the health and welfare of children to learn more about how vision impacts children’s ability to learn. Two articles recently published in the COVD journal, Optometry & Vision Development, found that children with vision problems have a hard time learning basic mathematical skills and that if the appropriate vision therapy is given, math skills improve.

Parents and teachers are encouraged to make a comprehensive eye examination part of their preparations for the new school year and to look for the following indications that vision problems may be contributing to learning challenges of their children and students:
• Frequent loss of place when reading
• Poor reading comprehension
• Sloppy handwriting
• Confusing similar looking words
• Failure to recognize the same word in sequential sentences
• Complaints of eyes hurting or headaches after reading
• Avoidance of close work (such as reading)
• Attention problems

Any of the above symptoms may be a sign that your child may be struggling with a learning-related vision problem. Fortunately, through vision therapy, many learning-related vision problems can be corrected. Protocols typically involve a prescribed program aimed at eliminating faulty vision skill patterns and rebuilding them correctly. For an in-depth checklist of symptoms, information on vision therapy and the critical link between vision and learning or to find a doctor near you, visit our website, www.covd.org.

About COVD
The College of Optometrists in Vision Development (COVD) is an international, non-profit optometric membership organization that provides education, evaluation and board certification programs in behavioral and developmental vision care, vision therapy and visual rehabilitation. The organization is comprised of doctors of optometry, vision therapists and other vision specialists. For more information on learning-related vision problems, vision therapy and COVD, please visit www.covd.org or call 888.268.3770.

A recent CNN story, found here, discusses advances in both technology and appeal of glasses, contacts, and patching for infants and kids. It has quotes from my colleague and fellow blogger, Dr. Justin Bazan, as well as Kelly Harmsen, creator of the “Eye Patch Kids” DVD, among others.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care