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Vision Therapy

Dr. Nate and Betsy Yaros discuss Vivid Vision on Bay News 9

Several weeks ago we mentioned that Dr. Randy Shuck from Bay News 9 interviewed Betsy Yaros and Dr. Nate about Vivid Vision, the Virtual Reality Vision Therapy.

You can watch the whole segment here:

Here are the topics that are covered in the interview

  • Betsy discussed the nature of her vision problems. She explains that she was born premature with cross-eyed and required surgeries. Over time her vision got worse. When the eyes don’t work together, people cannot see 3D.
  • Dr. Nate explained that in some cases, such as Betsy’s, eye surgery can actually over-correct the problem and make it worse.
  • VRVTBetsy described some of the experience she had due her vision problem: being unable to read due to headaches, walking into walls, problems with depth perception, challenges with driving.
  • Dr. Nate explains how Vivid Vision applies Virtual Reality experiences to the principles used in vision therapy. In everyday life, each eye sees the world slightly differently and the brain puts the two images together to provide depth perception. In Vision Therapy, we carefully control the image that each eye sees. This is even more precisely controlled by the Occulus Rift VR system.
  • Betsy describes how easy and fun it was to use Vivid Vision and her experience seeing 3D for the first time.
  • Dr. Nate describes that frequently children do not recognize that they do not see the world the way others do and therefore they don’t complain. For this reason, optometrists recommend eye and vision exams and six months of age, 3 years of age, and every year while in school. This will test the visual skills they need to be successful in school, including the how the eyes move, focus, and work together. These skills can be developed through vision therapy, which includes Vivid Vision.
  • The age of patients that can use Vivid Vision is 6 to adulthood. In some cases, Vivid Vision can shorten the total length of treatment. It certainly makes it more fun.

You can see Betsy’s artwork and read her blog at her website: http://betsyyaros.com/

You can read more about Vivid Vision Virtual Reality Vision Therapy. If you have questions about whether or not Vivid Vision or Vision Therapy in general is an option for you or your child, call us at 813-792-9637, or use the comment section below.

-Dr. Nate

Interview with James Blaha, Co-Founder of Vivid Vision

Vivid Vision Logo - With CircleTo continue our series on Virtual Reality. I was lucky enough to interview James Blaha, co-founder of Vivid Vision. I have known James for couple of years and have been fascinated by both his story and the product of his efforts. I am excited to share his thoughts with you.

 

 

Dr. Nate: Can you tell me about your original visual problem and the treatment options you were given?

James: I was diagnosed with amblyopia and strabismus before I could speak using the fly stereo test. I would rub my hand flat on the paper instead of trying to grab the fly. My parents had me patch, but I would constantly take it off and peek out of the side when they weren’t paying attention. I did vision therapy exercises at home and sometimes in a clinic. When I was 9 years old they told me that I was too old for my weak eye to improve, and we should give up with the patching and exercises.

Unfortunately, many patients hear that. What aspects of your treatment did you want to improve with Vivid Vision treatment treatment?

I want to make it fun for younger kids. I absolutely hated patching and VT exercises growing up, and I think that contributed to the treatment not working for me. We also want to demonstrate that you can improve vision in adults with our system as well and push the state of the art forward for adult binocular vision treatments. There are a huge number of untreated adults with amblyopia and strabismus and we want to get the message out that there is something they can do to improve their vision.

Did you have grand vision of changing the way doctors practice or did it just evolve over time?

It evolved over time. At first I was just planning on making something to explore how my own vision works. When it worked better than I expected, that vision expanded to making a game anyone could play at home. Once I dove deeper into binocular vision and spoke to several optometrists, ophthalmologists, and vision scientists it became apparent that it is a deeply complex issue where everyone has a unique situation. This lead us to want to develop tools for optometrists to use rather than release something that didn’t involve eye doctors at all.

How does it feel to read and hear breakthrough stories of Vivid Vision patients like Betsy who describes her new 3D vision as a “superpower”?

It feels amazing. One of the things I’ve learned from speaking with hundreds of people with amblyopia and strabismus is that even though I had a tough time growing up with it, most people had a much more difficult time than I did. The reason we are building Vivid Vision is to improve people’s lives, to increase the reliability and efficiency of treatment, and to reduce the cost of treatment so that all of the millions of adults and children with lazy eye can get access to it. For many that means being able to pursue careers and hobbies that were previously out of their reach.

I expected Vivid Vision to be a great tool for treating amblyopia. I am surprised at how effective it appears to be for strabismus. What is it about Vivid Vision that you think makes it such an effective treatment option?

I think there are three major factors that contribute to the effectiveness of Vivid Vision over previous treatments. The first is that we have an awesome team of optometrists, ophthalmologists, and vision scientists advising us and providing input on the system. Our Chief Optometrist Tuan Tran worked directly with patients and vision therapists treating binocular vision issues, our Science Adviser Ben Backus runs a vision science lab at SUNY studying binocular vision, and Dr. Paul Harris at SCO has given us advice and feedback since nearly the very beginning of the company.

The second factor is our use of virtual reality hardware. Because the system is enclosed, it means that the viewing conditions are always exactly the same. With other 3D technologies external lightning makes it difficult to be sure you are delivering exactly the right visual stimulus. Another big issue is inter-ocular contrast, and VR headsets provide a higher inter-ocular contrast than other methods of delivering unique images to each eye. Lastly, we think that providing training environments that are more like real life will make it more likely that the visual skills patients are learning will transfer outside of the training environment and into the real world.

The third factor is that the games and activities are more fun and more realistic than previous treatments. Although the locations and games may be more exciting and different than the real world, we believe that the exercises should contain visual activities that closely resemble people’s real life. Instead of choosing between relatively artificial targets on a screen, they could be choosing which basketball to catch at a park, for example. We want people to be practicing how to use their vision in ways they can directly apply to their life.

What has been the general feedback from doctors? Does this new technology make them uncomfortable?

Optometrists have been really positive about the technology. I think that most eye doctors realize that vision therapy could use more tools and that there is no reason these activities can’t be engaging and fun. Some doctors have been hesitant to bring in VR technology, but I think that is normal for any new tech to have a warming up period where people get familiar with it.

Is there anything else you want to add?

We want to empower doctors to treat more patients more efficiently by building them a set of tools to measure, track, and treat binocular vision issues. We want to educate patients so that they know there is a treatment option for them and connect them to doctors. We think this is the only way the millions of untreated adults can get treatment for their binocular vision issues.

Thank you, James, for sharing your story.

Bright Eyes is proud to offer Vivid Vision to our patients who will benefit from it. For readers who are interested in Vivid Vision, read more here or call us at 813-792-0637.

See Well!

-Dr. Nate

Helping Adults See in 3D With Vision Therapy

It is such an exciting time to provide vision therapy! There are so many advancements in treatment and knowledge in this area of Optometry. Although Vision Therapy is often thought of as an essential treatment for children with vision problems, adults can benefit from it too. A case in point is my patient, Betsy. She is a talented artist. You can see her work and blog here.

Betsy had eye surgeries as a child for crossed eyes. Despite these procedures, she still did not have the ability to keep her eyes aligned or see in 3D. For that, she needed vision therapy. She started therapy in a different state and when she moved to sunny Tampa Bay, she continued therapy with us.

Through vision therapy, Betsy has learned to move and focus her eyes at the same time without suppressing (turning one eye off). She has developed the ability converge her eyes to make them straight.

The most amazing detail about Betsy’s cases was that she acquired depth perception. Or, as the headline of the recent online interview she granted says:

“30 Year Old Describes the Experience of Seeing in 3D for the First Time.”

How did she achieve this?

First, Betsy was totally motivated to improve her vision and learn how to use her eyes together. When I first met her, she described how determined she was to improve her vision, which makes this long-term goal of hers all the more easy to achieve.

Secondly, she worked hard. As she said in the interview, she has done Brock String (a particular Vision Therapy activity) for over a hundred hours! That’s like staring at your nose for 100 hours; can you do that? Wow! All of this hard work and determination has prepared her brain and eyes to appreciate 3D vision.

Finally, Betsy is not afraid to try new things. She has had a number of different glasses, a huge variety of vision therapy activities, and most recently, the Vivid Vision Virtual Reality Vision Therapy System.

As Betsy said in an email to me recently, “This is amazing! I’m seeing 3D all over the place.” This is the most rewarding kind of note an optometrist like me can get from a patient.

And Betsy isn’t the only adult patient in our vision therapy program. Other recent adult patients include one who had double vision from a bicycling accident, one who had tremendous fatigue and double vision at work, another who had amblyopia and was told that she would never see well out of her left eye. All of these adults and others have experienced tremendous benefits from vision therapy.

To sum up: Vision Therapy is not just for kids; adults can benefit from it too. If you are an adult and have questions about your vision, see an optometrist who specializes in binocular vision. There may be options for you! You can start by going to COVD.org and OEPF.org to look for doctors.

Be well!

-Dr. Nate

 

Research Shows Adults Can Be Treated for Amblyopia

Adult Amblyopia Treatment

Treatment options for adults with amblyopia isn’t magic. It is real and based on science. For decades there has been a belief among eye doctors that if a patient had amblyopia (AKA “lazy eye”), it was untreatable after childhood. Whether the cut-off age was 6 years old, 8 years old, or 10 years old, it was assumed that after that age, it was pointless to try to improve the vision in the “lazy” eye. It was thought that even if the vision did improve, it would just worsen again after treatment stopped.

Amblyopia is a condition in which vision is reduced in one or both eyes even with glasses on. By definition, it is not caused by disease or injury, but instead develops when the brain does not get enough visual stimulation to use both eyes together. This could be due to blurry vision for a number of reasons or misaligned eyes. Catching amblyopia early is helpful and that is one of the reason that InfantSEE exists.

For many years, the only treatment for amblyopia was occlusion therapy, where a patch is worn over the eye with better vision to force the eye with poorer vision to work. Even if you don’t have a family member who needed to wear an eye patch, you probably are familiar with the concept in popular culture. Patching can be effective if done correctly. But it is hard work and takes motivation. (See the post on #IPatch the social media support of amblyopia patients who are patching right now.)

Ann Adult AmblyopiaAs I have been posting over the years, there has been significant scientific evidence that shows that despite what was once thought, it isn’t just young children that can be treated but also older children and adults. At the bottom of this post is a quick summary of some of the research on improvement of vision in adults with amblyopia:

And it is not just in the vision science laboratory that we notice improvement in adults with amblyopia. One recent patient of ours is a 35 year old woman with refractive amblyopia due to her farsightedness in her left eye. The best she was able to see was about 20/70 in that eye. Following a few months of treatment, she was able to see about 20/30, a significant improvement. She was so happy with her rapid progress, she said. “At my age, I thought all hopes of better vision were gone but after my vision therapy treatment I have seen a significant improvement in my vision!”

One adult patient with amblyopia said, “At my age, I thought all hopes of better vision were gone but after my vision therapy treatment I have seen a significant improvement in my vision!”

Why, despite the research and success in the therapy room, does the belief that “nothing can be done” after a certain age persist? Susan Barry, PhD (AKA Stereo Sue) does a great job of answering that here, but the simple answer is that change takes time and doctors are very slow to change such a prominent belief as this.

Treatment for adult amblyopia is complicated and does take effort on the part of the doctor and patient. Treatment may involve traditional occlusion (patching) with visually stimulating activities, but could also include the use of special glasses or contact lenses and more modern techniques that involve the use of both eyes together (known as MFBF) and also the Virtual Reality based Vivid Vision system.

That being said, treatment for amblyopia is difficult and there may be significant reasons to NOT attempt treatment. It may take longer than in young children and the overall goals might be different. A thorough evaluation by a doctor with experience with adult amblyopia patients is critical. You can search for a doctor in your area with both COVD and OEPF websites.

If you have questions about adult amblyopia treatment, you can call us at (813) 792-0637, or enter a message at the bottom of the page.

-Dr. Nate

Bright Eyes Family Vision Care in Westchase and Bright Eyes Kids in New Tampa

Vision scientists don’t always write in terms that patients can understand. But I thought it was interesting to see what researchers say in their own words when they publish scientific papers on treatment of adult amblyopia. Enjoy. 🙂

  • “Two adult patients are presented whose childhood amblyopia improved markedly.” (Willson, 1992)
  • “perceptual learning can improve basic representations within an adult visual system that did not develop during the critical period” (Polat, 2003)
  • “adult amblyopic visual system retains a substantial degree of plasticity: repetitive practice can substantially improve position discrimination acuity.” (Li, 2004)
  • adults with amblyopia can improve their perceptual performance…” (Levi, 2005) ” clearly show the success of the structured method, targeted at the specific deficiencies in amblyopia, to improve vision in children and adults.” (Polat, 2008)
  • “These results show that the mature amblyopic brain is surprisingly malleable, and point to more intensive treatment methods for amblyopia.” (Li, 2008)
  • “that this approach puts in place the necessary neural precursors required to fully recover stereo acuity in adult amblyopic subjects.” (Astle, 2011) “This provides a basis for the treatment of amblyopia in adults who currently have no treatment options.” (Jinrong, 2013)
  • “The home-based dichoptic iPod approach represents a viable treatment for adults with amblyopia. (Hess, 2014)
  • “perceptual learning of various visual discrimination tasks in adults with amblyopia can transfer completely...” (Zhang, 2014)
  • “new treatments are emerging that directly target suppressive interactions within the visual cortex and, on the basis of initial data, appear to improve both binocular and monocular visual function, even in adults with amblyopia” (Hess, 2014)

The Brooks Celebrate Life Event

As anyone who has experienced severe trauma knows – it can be devastating for the victim, friends, and family. Many activities that were previously taken for granted can be a frustrating challenge.

Recently, however, Dr. Beth and I were lucky enough to participate in a truly fun and magical event. The Brooks Celebrate Life event, organized by Brooks Rehabilitation and Regional Medical Photo by Connie GarcesCenter Bayonet Point and sponsored by Bioness, was in honor of Trauma Awareness Month.

The evening kicked off with hostess and Physical Therapist Connie Garces sharing information about Brooks Rehabilitation, both the main facility in Jacksonville, FL and the outpatient facility in Hudson, FL where she is Center Manager. She introduced the trauma survivors who were in the audience, signified with large red, white, and blue ribbons. Also recognized were their family members and the rehabilitation specialists who care for them.

Connie Garces is a passionate and wonderfully talented therapist, but the highlight of the event was one of her patients, Bronson. Dressed in a suit, he stood in front of the group and delivered an honest, funny, heartfelt account of his recovery from traumatic brain injury. Public speaking is intimidating for the average person. Bronson was courageous to deliver his talk and willing to get a little help from the audience when he needed it. With multiple notes in front of him, Bronson talked about his recovery, his care, and his young daughter. It was one of the most heart-felt and moving things I have witnessed in a long time.

May 2015 is the 27th observance of Trauma Awareness Month. The American Trauma Society has declared this year’s theme “3D Trauma Prevention” and focuses on contributors to motor vehicle crashes – Drugs/Drinking, Distraction and Drowsiness.

Vision is a critical part of life and it can be an important part of rehabilitation for a survivor of traumatic brain injury. Dr. Beth and I work in conjunction with other professionals to provide visual rehabilitation. It is complex work and some of the rewarding care that we provide. You can learn more about visual rehabilitation here.

-Dr. Nate

(Photo provided courtesy of Connie Garces, PT, DPT, CBIS)

 

“Foolproof” Eye Test for ADHD

We have known for years that there is a link between how the eyes work and attention. This is why there are so many children who have both Attention Deficit Hyperactivity Disorder (ADHD) and visual coordination problems. Pediatric optometrists see this in the exam room every day and it is our job to help sort out how much of a child’s difficulty is due to ADHD and how much is due to not being able to visual focus and move their eyes efficiently.

There is some new research about ADHD and eye movements that is very compelling. Researchers in Tel Aviv, Israel, led by Moshe Fried, MD, have found that by simply monitoring involuntary eye movements, ADHD can be diagnosed.

“This test is affordable and accessible, rendering it a practical and foolproof tool for medical professionals,” said Dr. Fried. “With other tests, you can slip up, make ‘mistakes’ — intentionally or not. But our test cannot be fooled. Eye movements tracked in this test are involuntary, so they constitute a sound physiological marker of ADHD.

The study also showed that Ritalin (methylphenidate) does work in improving ADHD as measured by eye movement control. What was not researched in this study is how much other treatments that also improve eye movement control influence ADHD. Optometric vision therapy is commonly used to help patients improve their voluntary and involuntary eye movements.

Clearly more research is needed to better understand the relationship between ADHD and eye control, but this new study is a step in the right direction.

DrNateSigMagnetCapture

 

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

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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