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Home » Children's Vision » Podcast Episode #18: Dr. Beth with Dr. Zilniki on Eye Exams of Children with Special Needs

Podcast Episode #18: Dr. Beth with Dr. Zilniki on Eye Exams of Children with Special Needs


Welcome to The Bright Eyes Podcast: Advice for Healthy Vision for All Ages. Your hosts are Dr. Nate Bonilla-Warford & Dr. Beth Knighton, residency-trained optometrist that provide eye exams for glasses and contacts, and specialty services including vision therapy, myopia control, orthokeratology, and sports vision training. Their mission to empower patients by providing the best in friendly, professional, and individualized eye care.

In this episode, Dr. Beth talks about eye exams of children with special needs with Dr. Z from Twin Forks Optometry & Vision Therapy!

Cross posted from the excellent Vision is More Than 20/20 podcast. Vision is More Than 20/20 is a podcast aimed at talking about vision, your eyes and how they play a role in overall visual and systemic function. We often hear if you see “20/20” you have great eye sight, but that is just the first step in the visual process. Dr. Zilnicki & Licausi, with the help of various guests, will work to help you understand more about your visual system and all the pieces to the vision puzzle!

You can listen in the player below or read the transcript. The show is available via StitcheriTunes, and the webplayer below. You can find all previous episodes here. If you have any questions or suggestions for future episodes, please email


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Full Transcript: 

Intro (00:10):

Welcome to The Bright Eyes podcast: advice for healthy vision for all ages. Your host are Dr. Nate Bonilla- Warford and Dr. Beth Knighton, two optometrist who really see "eye to eye". They can help you get perspective of the latest visual scientific evidence for improving your vision and helping you "keep your eye on the ball". We have real facts and (aqueous) humor without making "spectacles of ourselves." And don't worry, the jokes don't get any "cornea".

Dr. Nate (00:39):

Welcome to episode 18 of Bright Eyes podcast. My name is Dr. Nate Bonilla-Warford and we are continuing a theme here with this episode, Dr. Beth Knighton was a guest on the Vision is more than 20/20 podcast. That is a wonderful podcast produced by the doctors at Twin Forks Optometry and Vision Therapy. It's a fantastic show with many episodes on all aspects of vision, vision therapy, vision, and learning. I highly recommend it. I can't recommend it enough. So Dr. Knighton was thrilled when Dr. Miki Lyn Zilnicki, from Twin Forks Optometry asked her to do an episode talking about the examination of children with special needs. This is a topic that is near and dear to Dr. Knighton's heart. We both love doing eye exams for children of all different abilities, and Dr. Knighton is so knowledgeable and expert at it. So it was a great opportunity to share some of the information about how we do things at Bright Eyes, family, Vision Care, and Bright Eyes Kids. So without further ado, let's listen to the conversation.

Vision is More than 20/20 Intro (01:57):

Welcome to vision is more than 20/20 podcasts - talking about your vision, your eyes, and how they play a role in overall visual and systemic function. Dr. Zilnicki, with the help of various guests will work to help you understand more about your visual system and all the pieces to the vision puzzle.

Drs. Z and L (02:15):

Hi guys, welcome to this week's episode of vision is more than 2020. We hope that you were having a wonderful week so far. Let's jump into our weekly insight, which is it was Dr. L's birthday this weekend. So we want to wish her a big happy birthday. She is 35 this year, right on my 35. I was thinking about how old I was. And I was like, oh my God, it's the big three five. So we're just wishing Dr. L a wonderful birthday and the best year to come.   thank you so so much. I had a wonderful weekend celebrating the little date night with Paul will tell you to sleep over and then a very simple pizza party with family the following day, which is perfect. I'm not a huge birthday person, so small celebrations are perfectly okay.

Dr. Z (03:00):

So today we are going to be talking all about the special needs population and we are going to be joined by Dr. Elizabeth Knighton. She received her doctor of optometry degree from the Illinois college of Optometry in Chicago. She completed a pediatric optometry residency at the university of Houston college of optometry, where she was trained in pediatric eye disease. And working with patients who have special needs. She joined the faculty at university of Houston college of optometry, and enjoyed working with students and residents in the pediatric clinics. While in Houston, Dr. Knighton treated patients at the Institute for rehabilitation and research, a rehabilitation hospital for patients with severe brain injuries in 2012, Dr. Knighton earned her fellowship of the American academy of optometry. Dr. Knighton grew up in Clearwater and currently lives in Tampa with her husband, two children and their two Labradors to enjoy cycling, sailing and scuba diving. Welcome to the podcast, Dr. Knighton, we are so excited to have you joined us this morning, and please share with us a little bit about yourself and how you became interested in optometry.

Dr. Beth (04:04):

Thanks. I'm so honored to be here with you. I'm so excited about how you all are bringing so many different topics to the public and educating everyone. This is really fantastic. So I was on the pre-med track in college and every year at my eye exam, my optometrist said, you should think about optometry. And I was like, okay, sure. And then that was it. And I didn't really give it another thought until the next year. Well, so one year I said, okay, fine. I will come shadow you for the day. And I just was so amazed at how many different ways optometry is able to really empower patients like glasses to drive and do your job well contacts for athletes who are trying to get a college scholarship and preventing and detecting eye disease. It was just so fascinating. So that's when I got hooked in,

Dr. Z (04:56):

And once you kind of decided to go to optometry school, tell us a little bit about your journey in optometry school. Like how did you decide to really go into vision therapy and pediatrics?

Dr. Beth (05:09):

So in optometry school at the Illinois college of Optometry in Chicago, I really loved working with kids in clinic. And then I had several opportunities to work with kids and adults with special needs. And that was just my favorite part of the whole week. It was so much fun. I loved interacting with them. I loved learning more about them.   And then most of all, I was really impacted by how much, uh, good eye exam really makes a big difference in their overall quality of life. I mean, having the right glasses, maybe it's with a bifocal, um, like a reading prescription of having prisms special lenses to help the eyes coordinate. It just helps them so much to be successful in their daily activities. And then also being able to educate their whole team of people, to set them up for success based on how their eyes are working. So this includes like their family members, their parents, or caretakers. It includes people from their school like their teachers, their tutors, their aides many of them also have other therapies. So working with their speech therapist, their occupational therapists, their physical therapists, their feeding therapists, their behavioral therapists. I mean, the list goes on about all these people who really benefit from knowing just exactly what they see, how they see and what we can do to help them see better.

Dr. Z (06:37):

I really love that collaborative approach because that's something with the special needs population, you know, you're not the only provider usually involved in their care, right. So I think it's really, you hit on something really crucial there that the visual piece is so big in any little thing that you can do visually to set them up, to be successful within their day and with their other therapies can make such a huge difference. Now, when we're talking about the special needs population, what are the most common visual diagnoses that you're looking for within that population for the parents listening?

Dr. Beth (07:06):

So there are many characteristics that we frequently encounter, and that helps us to know what their strengths and weaknesses are. But I learned very early on in my training that each patient is an individual. So there's no generalizations or stereotypes that can kind of apply across the board. So we're looking at each patient individually, but the things that I see the most common are,    like high prescriptions. So maybe they're very farsighted or very near-sighted, or maybe one eye is very different than the other. And so,    that is, is probably one of the biggest things that makes a big difference for them, because we're able to balance their vision with glasses or contacts. And that's kind of step one. Then secondly, we see a lot of times I coordination issues like strabismus or an eye turn, or maybe,    amblyopia, which is like lazy eye. So those eye coordination problems can be helped in several different ways, depending on, on what's going on. And so it's really something we see very frequently. And then another thing we see often is focusing issues. So being able to turn on that, focusing power in order to see things up close, sometimes it's very difficult or maybe they don't have endurance with that. And so, um, that's another problem area that we see often.

Dr. Z (08:32):

What does your exam look like for this population and tied into that question is when do you recommend if a parent has a baby with special needs, like w how early do they get in for an eye exam? Do you have different exam recommendations for them? Because obviously there is all of this going on with them, right? It's not just vision there's like you had said, there's a lot of specialties involved in their care. So,   what are your recommendations for parents there?

Dr. Beth (09:03):

So there's many different ways that we test vision. And some of that is subjective. Meaning like the patient gives us information, tells us about what they're seeing and some of the measurements are truly objective. So these are just pure measurements that don't really work choir them to tell us, you know, the classic, which is better one or two, right? So,   many parents are surprised when I say that we can do an eye exam if they can't tell us, which is better, one or two. And we do this in many different ways. We have lots of tools, all very simple, tools. It's nothing scary or, uh, you know, painful for the patient. And so it's pretty easy to get this information from them so long as they feel comfortable in the exam room. So part of them feeling comfortable is,   you know, allowing them to sit in a chair that works for their body, allowing them to talk or not talk if they don't feel like talking that day.

Dr. Beth (10:02):

And and being able to impact, being able to empower them to have control in the exam room, helps them to feel comfortable. So then they give us really great information about how their eyes, vision work. And sometimes it's as simple as just observing them while they're making eye contact with their parents while they're looking around at the toys that we have on display in the office.   but then also we have tools that help them to communicate. So like for the eye chart, you know, for most adults, we use the letters and they tell us the letters, but some kids and adults with special needs, aren't able to communicate that way. So we have charts with pictures, some with symbols, some with numbers letters, and then we also have matching cards. So if they can't tell me what letter or shape that is, they can look on their card in their lap and point to the one that matches.

Dr. Beth (10:59):

And sometimes that's an easier task for them. And it's really fantastic having that matching card because it gives them the confidence to communicate. Even if they're feeling nervous about talking to someone new or, you know, just having an off day that they can, they feel confident. I can show you what I see, even if I don't want to talk to you today. There's also tools like a retina scope. This is a special light tool that we use to measure the prescription of the eyes. The light goes into the eye, it reflects off of the back of the eye. And,   we're able to determine exactly the right lens or prescription,   that would give the patient the clearest picture. So,   we use these, these same techniques for kids and adults with special needs. We use them for infants who are not communicating. We use them for adults, with brain injuries who maybe are having trouble communicating. So it's a really great way to use the same tool that in many different ways.

Dr. Z (12:04):

But I think that it's really amazing how much information you can glean from an exam that doesn't require like your, your typical patient interaction and communication piece. Right. And I think it's wonderful that we have all these tools at our arsenal. And like you said, just simply observing your patient can really give you so much information and how they're interacting with the visual world around them. Right.   and I really love that you touched on the adaptability piece, that every patient is really different and unique.   and I know that probably really drives your recommendations and treatment approach. So talk a little bit about that. Like, what is, do you have like a step by session that you follow with patients or are you really truly, you know, treating each patient individually and uniquely?

Dr. Beth (12:49):

So their development is delayed in some way, some more so than others. And so it's not uncommon for their visual skills to also be delayed some only a little bit, some drastically delayed. So we, we work on finding out where they at and how do we help them get to the next step. And then when they get to that next step, how do we help them get to the next step? And meanwhile, while we're helping them build to the next level of their developmental skills with their vision, the things they are doing in their everyday life continue to increase in demand. So maybe they're learning to read, maybe now they're reading chapter books. Maybe now they are,   doing certain things at school with math, where they need to be able to see more detail. Well, we want to make sure that they can track their eyes appropriately, that they can point their eyes together. They're seeing clearly. And so making sure they're meeting all of those needs along the way to not only help them with their everyday life, but even for things they want to do for fun, maybe they're an Olympic, a special Olympics athlete, or maybe they,   really enjoy a certain hobby that requires detailed vision that we can help them with.

Dr. Z (14:07):

That's so wonderful. And I always say to parents, before we even start their exam, like this, isn't a one and done type of thing, right? We are not going to be done in 15 minutes. I mean, if your patient in 15 minutes, we'd done in 15 minutes, but really I set the stage. Like we're going to be developing a relationship until they feel comfortable. So if we only get one piece of the puzzle today, that's cool. We'll see you next week or the week after. And we'll do the second piece. Really understand how that patient is seeing and what their needs are. Now, do you have any special recommendations to help with this population to help them with like the wearing of the glasses? Because some of them may be like a little tactile defensive where they don't like things on their face or when they do need vision therapy. Right. You're talking about like the eye coordination. Do you have any special recommendations for this population that you'd like to share?

Dr. Beth (14:58):

Yeah. So first prescriptions or new prescriptions, it's super important for them to be part of the process of picking out the glasses, because not only do they like want to look good wearing their new glasses, but they also have to be really comfortable. And,   some patients have different physical characteristics that require them to be in certain kinds of glasses. Maybe their, their nose bridge is very flat. And so it's hard for them to wear a certain kind of glasses. So picking out the right glasses that fit them well, but are comfortable, is really key. And then I suggest to parents to just start with a short time period of wearing the glasses. So maybe let's say 10 minutes for the first time. So when you put the glasses on for that 10 minutes, allow them to do an activity they really love. So maybe it's Play-Doh or Legos or drawing or tablet time or snack time, you know, whatever that thing is that they love.

Dr. Beth (15:51):

Now, they're being rewarded for wearing the glasses and they're distracted from the glasses because they're doing the thing that they really enjoy. So start with a short time period, build up to longer, continue adding on time until they're more used to wearing the glasses. But I find that since many of these,   kids and adults have significant prescriptions, they have such a dramatic difference in the quality of their vision. When they have the glasses on that, it really helps them stay motivated to keep the glasses on. Wow, this looks so much better. So maybe yes, there is, you know, some sensory issues at first with wearing the glasses, but they usually get over those pretty quick. Once they can see the whole world.

Dr. Z (16:38):

I love those recommendations. I think that really goes a long way to getting patients comfortable with something that's new to them, if they've never worn glasses before. And then if you are doing vision therapy with your patients with special needs,   what do the therapy sessions look like in general and how do you maybe modify sessions to meet their needs?

Dr. Beth (16:57):

Sure. So it's all about making them feel comfortable and adjusting things to where they're at. So maybe we turn the lights down because having the light's too bright is sensory overload for them. Maybe we don't do certain therapy activities that require them to wear special glasses, because that is hard for them at first. So maybe we start with something else,   that they're not having to wear lenses.   we adjust whether they're standing or sitting or walking around the room to help them feel more comfortable. And every session is unique and then every patient is unique. So it's just,   this whole area is a really fun way for optometrists to think outside the box and come up with creative solutions to help their patients. It's, it's really enjoyable and rewarding part of my job.

Dr. Z (17:54):

I was going to say that, that there are not a lot of optometrists that are comfortable with the special needs population, because it's challenging on our end, right? It's not a mindless exam where we're just, it's a better one or two here, your glasses and straightforward, like you have touched on throughout the episode, special, the special needs population is special in lots of different ways. And it requires a special type of doctor to really want to take the time with that patient. So I think it's really wonderful what you're doing, because I think when parents hear about, you know, especially in the special needs community, there's a doctor that can help them. You're probably flocked with patients. They hear, oh, this doctor actually is taking the time to listen to me and listen to my child and get getting to know my child to make their vision as good as it could possibly be. Even if they can't communicate, you will see the positive effects of good vision, right? Like you were taught, like you had touched upon, they're going to be able to read, they're going to be able to eat better. They're going to be able to ambulate through spaces better. And all of that really has that great trickle down effect.

Dr. Z (18:59):

Yeah. Tell us a little bit about how our listeners can find you. Like where are you located? Do you do any like virtual consultations, like with parents for support, anything like that?

Dr. Beth (19:11):

Sure. So our office is Bright Eyes Tampa and, we have two offices, Bright Eyes Family Vision Care, which is our main office all ages. And then we have Bright Eyes kids, which is strictly pediatric office. It was the first pediatric only optometry office in the state of Florida. So,   we, we see patients of all ages, all abilities, all skill levels. And we have, you know, easy to, easy to reach out to us. So our website is and on Facebook, Instagram, Tik TOK, we're @brigheyestampa. Uh, and so you can kind of reach out to us in any of those ways. And we have patients from all over the world who have come to visit us some of them, oh, we're going to Orlando to visit Disney world. And so we're going to swing by Tampa and get our eyes checked on the way there. So it's really fun.

Dr. Z (20:07):

I love that. And thank you for all of the special work that you are doing and for joining us this morning and we will talk to you next week.

Dr. Beth (20:15):

Great. Thanks for having me!

Dr. Z (20:16):

Thanks for listening. Join our private Facebook group. Vision is more than 2020 and follow us on Instagram for additional content. Check out our practice. Twin forks, optometry on both Facebook and Instagram subscribe, download and leave us a five star review on apple podcasts, Spotify and Google podcasts tune in next week to learn more about your vision.

Dr. Nate (20:36):

So that was fantastic. And I really do want to encourage you to check out the Vision is More than 20/20 podcast. You can find that at and any other place where you get your podcasts. We are always looking for ideas for the bright eyes podcast. So please let us know. You can reach us at office at Thanks for listening

Outro (20:56):

Brought to you by Bright Eyes Family Vision Care and Bright Eyes kids. Find previous episodes and more detailed information at Creative Commons Copyright attribution Noncommercial use. The only purpose of this podcast is to educate and to inform. It is no substitute for professional care by a doctor experienced in the area you require. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Please consult your position for diagnosis and treatment.

Intro/outro music: Lucas Warford of Three For Silver.