OK, so this video is from the last century. Specifically 1999. But although it is not cutting edge, the first segment does a great job of demonstrating some elements of infant visual development and shows how visual scientists construct experiments to understand infants vision.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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PS: It is amazing. You can find almost anything on Youtube nowadays. My two-year old  daughter’s favorites are The ABCs and Los Pollitos.

In the July 2008 issue of Parenting magazine, there is an article titled, “Take Charge of Your Child’s Heath: 5 Common Conditions and How You can help Catch Them.” The article is written by William Sears, M.D., author of many books on childcare and parenting.

The number one issue that Dr. Sears says can be overlooked by a pediatrician is strabismus, which is a wandering or crossing of an eye. While the article is too brief to be complete, I am glad that Dr. Sears makes a point that strabismus can be missed during a routine appointment and that parents should trust themselves. Typically, if a mom sees something really wrong, there is.

I’d like to add a few additional comments to the article. First, it mentions that strabismus can be treated with glasses or surgery. This is true. But it may also be treated with vision therapy. Second, It is better to prevent a visual problem than fix one later. The American Optometric Association recommends eye exams at 6 months, 3 years, and each year during school. To help, the AOA created InfantSee, a program that provides no-cost eye exams for infants less than 12 months old.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care

I was just reading about babies that wear contact lenses. Is that really true? How do you know what lens to give them and how can they put them in?

Yes. It is true. But an infant doesn’t get contact lenses just because they don’t like their glasses. Infants as young as one week old may need contact lenses because that is the only way their eyes can get the best sight to ensure proper visual development. Infants might need contacts if they have had cataract surgery, have extremely high prescription glasses, or have very different prescriptions for the two eyes.

If an infant or very young child needs a contact lens, it can be a challenging  experience for everyone involved. For that reason, contact lenses are only recommended for infants in specific situations wear glasses will not work. After a comprehensive eye and vision exam, I will discuss contacts carefully with the parents and the process should only begin when they have a clear understanding of the risks and benefits of infant contact lens wear.

The benefits include:
· Improved vision with contacts
· Improved conditions for proper visual development
· Increased compliance when undergoing patching (occlusion) therapy

The risks are:
· Can be time consuming and stressful to insert and remove
· Possibility of irritation requiring removal of contact during the day
· Increased level of responsibility and care needed to monitor eyes
· Possibility of infection or ulcer of the eye, especially if proper lens hygiene not followed

Important information to know before we begin:
· Contact lenses must be removed every night for cleaning.
· It will be difficult at first to insert and remove the lens. This can be a two-person job.
· The contact lenses are custom made and may be expensive to replace if lost or damaged.

If you are a parent that has an infant or young children in contact lenses, the yahoo group Aphakic is a truly wonderful resource that I encourage you to check out. If you do need contacts for your child, inform yourself as much as possible and ask lots of questions of your eye doctor to make sure he or she is comfortable with the process.

See Well!

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

My daughter’s name is Nora. She is, of course, adorable. And since I am an eye doctor, I have been watching with interest how her eyes and vision develop since she was just minutes old. First she opened her eyes. Then she got better at moving them (but not necessarily together.) Finally, she developed a wide-eyed inquisitive way of looking at things that has not faded.

Since before she was born, my wife Cristina and I have done our very best to take care of her and made sure that she received all the care and attention that she needed. We have a wonderful pediatrician who has seen her many times. Fortunately, Nora has always been healthy (except for that first ear infection). She is a happy baby girl and she appears to be growing fast without any problems. But there still are some aspects of her eyes and vision that have not been checked fully.

Nora recently turned 7 months old. That means it is time for her first comprehensive eye and vision assessment. For the average baby, all the visual skills should be significantly developed by six months old. The American Optometric Association recommends the first eye exam at six months of age, then at three years of age and every year while in school. So with the help of my father and Cristina, Nora received her first eye exam.

Like I do with all infants, I first checked that she can see well out of each eye. I then made sure her eyes are straight and not drifting inward or outward. I checked to see if her eyes can turn inward the proper amount when she looks at an object or toy up close. I shined some bright lights in her eyes to make sure that her pupils react properly to light. They did.

By using a special flashlight called a retinoscope, I was able to determine if Nora had any refractive error (nearsightedness, farsightedness, or astigmatism). It turns out that she has a small amount of farsightedness, which is perfectly normal. Most commonly, the large amounts of refractive error that a baby may have tend to diminish over time (a process called emmetropization), but it is good to have a baseline measurement to see if the error is increasing, staying the same, or decreasing.

After I was convinced that Nora was seeing well and her eyes moved well for her age, it was time to check out the health of her eyes. I looked closely at all the parts of her eyes on the outside to make sure everything was healthy and working well. Then I sprayed eyedrops onto her eyes to enlarge her pupils to allow me to see inside. This is the same type of drop that we use for adults when we dilate their pupils, but the spray makes sure we get it in their tiny eyes without too much fuss.

The drops take 15 minutes or so to take effect, so we all went out in the waiting area. We passed the time by trying on some baby sunglasses, which were very cute on her. After the spray worked its magic, I had Cristina hold Nora and I examined very carefully all around the inside of Nora’s eye to make sure all the nerves, blood vessels, and other parts were healthy.

So now that Nora’s eyes have a clean bill of health, I don’t need to examine her again until she’s three years old. And, really, she did great. She a had a good time playing with the toys, and I can sleep at night knowing that she’s been thoroughly checked out.

If you have an infant at home between the ages of 6 and 12 months, the InfantSEE program will provide one evaluation like Nora’s at no change. Call the office or visit InfantSEE.org for more information.

Merry Christmas!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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As any parent knows, it is fascinating to watch infants acquire knowledge and skills during the first year. Here is some new research that suggests that as this process occurs in infants, what may superficially appear to be a regression may actually be a refinement that improves efficiency.