I am excited to share that I am now a full-fledged Fellow of The International Academy of Orthokeratology and Myopia Control (IAOMC), a non-profit organization of practitioners and academics devoted to the science and education of Orthokeratology and Myopia Control. Since I have offered myopia management options for over a decade, becoming a Fellow has long been a goal of mine.
Ortho-K (short for Orthokeratology) is a non-surgical procedure using specially designed contact lenses to gently reshape the curvature of the eye to improve vision.
Myopia is a progressive visual disorder that results in poor distance vision. If the myopia is severe, it will impair near vision as well. Myopia is also known as “near-sighted” or “Short-sighted”.” Options exist to help limit the progression of myopia as a child grows.
According to the Academy, these are qualities of a Fellow:
Fellows have undergone advanced training and rigorous testing to demonstrate their level of expertise in myopia control and orthokeratology
A Fellow is the gold standard and represents the highest level of knowledge, ethics and patient care in the myopia control.
Fellows serve as mentors and role models for other practitioners as well as the general public.
This was a year-long process which included presenting multiple complex case reports, passing both written and oral exams. The exams were supposed to take place at the annual meeting in Seattle in April, but the meeting was canceled due to COVID -19 and the testing process had to be completed remotely.
There are approximately 150 Fellows of the The International Academy of Orthokeratology and Myopia Control around the world. And I am one of only a handful that have earned 3 fellowships in the International Academy of Orthokeratology, the College of Optometrists in Vision Development, and the American Academy of Optometry.
I have learned a great deal in the process of becoming a fellow and I look forward to using this knowledge to better help my patients.
TL;DR: If your child is e-learning, be proactive to help prevent vision problems. If your child appears to be having screen-related eye fatigue, see your optometrist first and discuss it – your child may have underlying problems made worse by excessive screen time.
There is one topic that comes up over and over in the exam room right now and that is school. Let’s face it, school is challenging this year for everyone – students, parents, teachers, administrators, and everyone who knows any of these people. Every child’s case is unique and they need to do what is best for them. I get a lot of questions about vision specifically from parents whose children are e-learning.
I know this well, because not only do I help my patients every day, I have two e-learners of my own: Nora, an 8th grader, and Javier, a 5th grader. As a family, we are experiencing this right now!
E-learning can be the most visually stressful type of education because it is a set schedule of screen use for a large portion of the day, every day. In a classroom setting, there is a lot moving around and looking up at the board and at friends to provide visual novelty. In a Virtual School and homeschool setting, the schedule can be much more flexible to allow for visual breaks. Teachers are working as hard as they can right now, but they are not children’s vision experts.
Based on my knowledge of children’s vision and the research I have done, I list some helpful guidelines below to ensure that your children can get the most out of E-learning this fall, without as much eyestrain.
Why is this important?
For many years, Optometrists have helped office workers who suffered from Computer Vision Syndrome (CVS), a collection of eye and vision problems related to excessive computer use. It was originally thought that CVS was an adult problem, but now research has shown that children can (and do!) experience this problem, too. This can be compounded by the increased screen time and the general stress of e-learning during the COVID-19 pandemic.
Common symptoms from long-term computer use are:
Neck and shoulder pain
It is not hard to imagine how any or all of these can make learning difficult for a child who has to be in front of a computer or laptop most of the week.
What can you do?
1. Have The Right Set up
My personal preference for my children is that their workstations are in public areas of the house, like the living room and dining room. This has several advantages. One is that we can easily check on them and help them if needed. Another is that it is a psychological distinction of their “work area” from their “personal area.” Also, it is just nice to see our kids during the day. 🙂
Selecting a screen – Bigger is better! The larger the screen, the easier it is to focus on details.
Screen settings – Often selecting 110% or 125% magnification helps. Also, white print on black background can be more comfortable.
Position the screen – Position the center of screen straight ahead so head doesn’t need to tilt back or to side. Position screen further back on the desk. Allow for at least Elbow Distance from the eyes to screen.
Chairs – should be firm with back support.
Foot rest – If the child’s feet can’t touch the ground, a foot rest can stabilize them.
Lighting – You don’t want it to be too dark or too bright. Being near a window is great for natural light, as long as the direct sun is not shining in the child’s eyes or directly on the screen.
Water – Designate a place for a water bottle or cup so kids stay hydrated.
Clutter – Keeping the environment clear of visual distraction can help your child focused on class content.
We all know that it can be difficult to get kids to maintain any particular position, specifically if they are little. However, showing them the proper posture and reminding them often can go a long way to helping them stay comfortable during work.
Here are recommendations for efficient posture for kids at the computer.
Their back should be against the chair for support.
The chair seat should not compress behind the knees and cut off circulation.
Their feet should rest firmly on a floor or footrest (no dangling)
The head should be balanced on neck (not tilted back or too far forwards)
The upper arms close to body and relaxed
The elbow should angle >90° (forearm below horizontal)
Here is an illustration from the American Optometric Association:
3. Do Children Need Computer Glasses?
For adults like me who have “joined the club”, we need glasses to see small print up close. Children, however, have more visual focusing ability so they don’t usually complain of not being able to see the screen. However, many children do have functional issues and benefit from wearing glasses at the computer.
Some of these conditions are:
Refractive problems – Conditions such as farsightedness (hyperopia) and astigmatism can make it more difficult to see the screen. Even a low prescription can cause a child to have headaches if they are not wearing eyeglasses.
Focusing problems – If children’s eyes do not focus accurately on the screen, glasses can help make it easier. Having glasses can make the difference between working comfortably and headaches and blurry vision.
Rapid Fatigue – Some children can see the screen clearly for the first 15 or 20 minutes then start to lose interest because they can’t sustain focus on it.
Convergence problems – Some children have issues where their eyes either tend to over-converge (tend to turn in) or under-converge (don’t turn in enough). In both instances having the right glasses helps keep the image of the screen clear and single and makes reading easier.
Specialized prescriptions – Some children have unique vision problems and require alternate prescriptions such as prism or bifocals, these should definitely be taken into account.
4. What About Blue Light?!?
Blue light is a very popular topic in 2020. As I tell patients, it really is the Wild West right now when it comes to blue light protection and companies can say just about anything to sell their lenses. We need more scientific study in this area about which frequencies of light matter, how much filtering is needed, and what are the effects. But after following the research for years, I can say these things:
There is very little reason to think that light from computers and devices is going to cause permanent eye disease. (UV light from the sun is a much, much greater concern and that is why we recommend UV-blocking sunglasses for all ages.)
Blue light can interfere with circadian rhythm and sleep cycles. There absolutely is evidence that blue light exposure especially at night will affect sleep . The best bet is no screen use a couple of hours before bedtime. But if that is not possible, then blue light protection in glasses, as well as night-mode device settings, can help.
There is a lot of anecdotal evidence that patients have less eyestrain and fatigue by limiting the scatter of blue light. The only people who seems to dislike blue light filters are people who need to see colors extremely precisely, such as a digital designer.
In short, I do not believe that every single person requires blue light blocking glasses. I think it can help some people feel more comfortable. If your child appears to be having screen-related fatigue see your optometrist first and discuss it – there may be other visual problems that should be addressed first.
For many patients (including children) a low prescription to reduce fatigue, as well as blue light filter and anti-glare treatment, can be the best combination for reducing eyestrain in front of the computer. Buying a blue light filter is only one part of reducing visual eyestrain. At Bright Eyes and most optometry offices, we can custom make the best glasses for your child!
5. Taking Breaks.
If using digital devices is the problem, then stopping using them is part of the solution. Optometrists refer to proper working distance and taking breaks as “visual hygiene” – like dental hygiene but for your visual comfort. Keep in mind, looking away from the computer only to check messages on a phone doesn’t really count as a visual break! The important thing to remember is that breaking up long sessions into shorter sessions helps a lot to release tension in the eyes. There are some suggestions that are helpful.
Before classes start – Do a few deep blinks and eye stretches (we often call these Eye Yoga)
20/20/20 Rule – Every twenty minutes, look 20 feet away for 20 seconds This lets the focus of the eyes relax.
1/5 Rule – Every hour take at least a 5 minute break and move around. This wakes these eyes, body, and brain up, especially if they go outside (see #6).
I know that you do not have perfect control of your children’s schedule, but by setting reminders you can try to develop these habits. (See Dr. Beth’s video below.)
6. Getting Outdoors!
What is even better than looking out a window? Actually getting outside and moving around. Children’s brains (and mood!) function better with some good old physical activity. When I am at home with my e-learning kids, I make a point of scheduling a time for us all to go for a run together, but this is not always possible (darn rain!). Even if they can’t exercise, just being outdoors is great for them. The change of scenery will help break up the routine.
Even if it just a short walk of the dog, or just standing in the yard or back porch, there are big visual benefits. First, the eyes get to fully relax when they look very far away. Instead of the space of just 5 or 10 feet in the room, outside we can 100 or 1000 feet away. Second, the natural light contains the full spectrum of light frequencies. Also, we tend to blink a lot more when we are outside moving around than we are just looking at a screen “in the zone” of e-learning. This keeps the eyes moist and comfortable. And there is a lot of research that shows that taking young children outside is one of the best ways to reduce the chances of them becoming myopic (nearsighted).
Of course, if you are outside in sun, wear sunglasses to protect the eyes from UV light!
7. When To Check With Your Children’s Eye Doctor.
Extensive computer use more difficult for all patients, but some children are at greater risk. Here are some situations when you should schedule an eye and vision evaluation for your child who is e-learning:
Pre-existing visual problems – If your child has on-going visual dysfunction, definitely have an evaluation and discuss all the options to limit the visual stress of e-learning.
Symptoms – Any symptoms of fatigue or eyestrain should be evaluated.
Overdue – Many patients are overdue for visits due to offices being closed in the spring. Children’s vision can change extremely rapidly, so we recommend annual exams for children in school. This is especially true if they are e-learning.
I want to highlight one specific symptom – blurry vision when looking far away. This can happen for several reasons but there are 2 important reasons to consider:
Eyestrain up-close is causing a focusing spasm (a red flag)
Both of these are on the rise around the world generally due to increased screen time and decreased outdoor time. Both of them have management options that can reduce future problems, including good habits, glasses, and vision therapy. Make sure you discuss this with your child’s eye doctor at their appointment.
And that’s it. I know it was kind of long, but it is important. As different as it is from classroom education, e-learning can be be very effective. And it certainly is beneficial in social distancing and keeping everyone safer from COVID-19. With the information above you can help make sure that e-learning does not cause vision problems as well.
Good luck this year! We are cheering for you. If we can help in any way, please reach out at brighteyestampa.com or (813) 792-0637.
Because the Binocular Vision Evaluation is somewhat different that a standard eye exam, we have created a document to help you understand the different parts of the test, what they look like, and what we hope to learn from them.
You can download the document here to review ahead of time or during the evaluation. We have found that this helps parents understand much more about the testing that their child is experiencing.
First and only FDA approved contact lens to slow the progression of myopia in kids – call 813-792-0637 or click here to request an appointment.
With the high demand of screen time from virtual learning it is crucial to keep an eye on kids’ sight. The increased screen time on computers and electronic devices can cause problems with nearsightedness, but there is a new treatment for Myopia. Dr. Nathan Bonilla-Warford from Bright Eyes Family Vision Care and Bright Eyes Kids is one of the first optometrists in the country to be certified in the first and only U.S. Food and Drug Administration approved MiSight contact lens.
The MiSight contact lens is a single use, disposable, soft contact lens that is discarded at the end of each day and is not intended to be worn overnight. The child can insert the contact lenses in their eyes in the morning and wear them for at least 10 hours during the day, then dispose them in the evening. The design allows the child to see clearly while benefiting from the treatment effect. The average age of children in the FDA trial is between eight to 12 years old, but the office is also seeing patients younger and older for this treatment.
“This is the first time the FDA has approved any method of treatment for Myopia and it is a landmark. Myopia is a problem that exists and MiSight is an option we can offer to our patients for their treatment,” said Dr. Nathan Bonilla-Warford of Bright Eyes Family Vision Care and Bright Eyes Kids in Tampa. Dr. Bonilla-Warford has noticed an increase in children who are visually symptomatic following the spring of online learning.
People with Myopia have good near vision, but poor distance vision. Myopia is very common in children and tends to increase, as they get older. Uncorrected vision problems can impair a child’s development and they may be susceptible to other future eye problems. The Bright Eyes team also offers additional treatment methods for Myopia management including eye drops and orthokeratology, specialized contact lenses that reshape the eye. It’s estimated that more than one-third of Americans are nearsighted, and it is increasing. The certification for MiSight is part of the Brilliant Futures Myopia Management Program.
The office is taking many safety precautions to protect patients and staff including screenings, enhanced cleaning, appropriate use of PPE and all paper work will be filled out online prior to the appointment. Bright Eyes also offers options for remote vision therapy sessions.
If you have ever been to Bright Eyes Family Vision Care or Bright Eyes Kids, you have probably noticed the various Lego sculptures around. My kids and I are big Lego fans! And although we have 65 billion Lego bricks at home (low estimate), after one week of Virtual School, my daughter was already asking for a new Lego set. Your kids probably have been asking for Lego sets as well. While not every set is as expensive as the Imperial Star Destroyer, we know parents are not excited about spending money on toys right now either.
Bright Eyes is here to help with the #LEGOGLASSESCHALLENGE! Think of it as your child being on an episode of Lego Masters where they make Lego Glasses, but not, you know, actually on TV.
Skinny: Make Lego glasses and win one of two (2) $50 Lego gift cards.
Here is how to enter:
Have your child (under 18 years of age) build some glasses with Lego bricks. They do not need to be functional glasses like mine, but they do need to be wearable, at least for a minute or two.
Take a picture of your child wearing their Lego glasses.
Post the picture as a comment on THIS FACEBOOK POST. Have your child write a sentence or more about what the idea is behind their Lego glasses on or before April 30th, 2020.
On May 1st, 2020, the Bright Eyes Staff will vote on the entries. These are the criteria we will be judging:
The creativity of the Lego glasses build. Go crazy and have fun!
The story behind the inspiration of the design. The more imaginative, the better!
The number of Likes their entry gets on Facebook. Get friends and family to vote!
On May 2nd, we will announce the two winners!!! We would LOVE to personally deliver the Lego sets to you, but we think that it is safer to just mail you a $50 gift card.
We cannot wait to see what you come up with!!!! 🙂
Fine print: No purchase necessary to enter. By commenting on the Facebook post, you are entering the contest. Bright Eyes will not save, screenshot, download, or use the entries, nor identify the entrants in any way. Entrants must be younger than 18 years old. Entrants do not need to be established patients of Bright Eyes Family Vision Care or Bright Eyes Kids. Winners do not receive Lego sets or money. Two winners will receive a Gift Card redeemable for $50 at Lego.com or a Lego Store. Bright Eyes is not associated with Lego in any way. Lego is copyright Lego Group, Inc. If you have any questions or concerns about the Lego Glasses Challenge contest, please contact us directly.
Between Virtual School, Facetime with family and friends, and (yes) the occasional video game, screen time is off the charts right now in our house. Maybe yours, too. To help, Dr. Beth made this 1-minute video to remind people about visual hygiene, a fancy word that means “keeping your eyes from getting tired.”
Dr. Beth’s top 4 recommendations for comfortable screen time.
Remember the 20/20/20 Rule. Every 20 minutes look 20 feet away for 20 seconds to relax the eyes.
Smaller screens cause more eyestrain than larger screens, so use the TV instead of phones or tablets when you can.
Remember Elbow Distance, the distance from our first to the elbow.
Use reading or close work glasses if they have been prescribed for you.
If you have any questions, let us know. If you or your children have symptoms such as blurry vision, headaches, or double vision, definitely let us know.
We know that it is “information overload” right now, but we wanted to provide an update that is relevant to many of our patients: Contact lenses. Although the CDC has recommended refraining from routine eyecare visits, there is NO recommendation that you discontinue contact lens wear. You can wear contacts. Yes, there is a recommendation that all people try not to touch our eyes, nose, and mouth. As a contact lens wearer this is difficult.
In general, and specifically right now to reduce possible coronavirus infection, we always recommend that you wash your hands thoroughly (there is no shortage of ways to help you do that) before insert and removing contact lenses. Also follow all manufacturer recommendations and doctor recommendations.
If you will be needing a supply of contact lenses in the next 2-3 months you can order them here. We will soon be closing to non-urgent visits; however we are available by phone, text, and email, to help you. To help you out, we are extending contact lens prescriptions on a case by case basis without an evaluation. We are not sure how long the distributors will have contact lenses available so you may want to order sooner rather than later.
Our patients’ health and safety is our number one concern. The CDC and Governor Ron Desantis has declared that optometrists in Florida can resume care with safeguards in place. Starting May 11th, we are reopening both offices and will resume routine care and urgent care.
If you do come to the office please be advised of these procedures.
To reduce paperwork and time in the office, our intake forms must be filled out online at least one day prior to your appointment. Look out for the email from IntakeQ!
All Bright Eyes staff members and patients over the age of 2 must wear masks or face coverings while in the office. Helpful information from the CDC can be found here. For information on facemasks for children, please read this. If you have concerns about a dependent who may not tolerate a mask, please ask us.
To further limit interaction, patients will enter in the front door and exit through the rear door.
To reduce patient interaction, please come unaccompanied to your visit. Children or adults with special needs may bring one caregiver. You will not interact with other patients during your exam.
When you arrive at the office, stay in your car and text us at 813-792-0637. We will reply when it is time to come to the front door. Your temperature will be taken with a touchless thermometer. Any patient with a fever of over 100.4 degrees F will be asked to reschedule. An assistant will escort you directly to your exam where you will wash your hands. After the assistant cleans the equipment and collects preliminary information, the doctor will conduct the exam.
An important note about retinal imaging:Our doctors want all patients, who are physically able, to have retinal imaging every annual exam. This is the best way to evaluate eye health and reduce prolonged close contact. Retinal problems such as macular degeneration, glaucoma, retinal holes, retinal detachment, and diabetes can be more easy found and documented.
To limit interaction, there are blue floor lines designating patient areas. If directed to a particular area, please stay there until a staff member redirects you. If you need help, please ask!
If you need to select glasses, an optician will assist you and collect any frames that have been tried on for disinfection.
– Dr. Nate Bonilla-Warford, Dr. Beth Knighton, and the Bright Eyes Staff.
What one mom said after her experience at Bright Eyes:
Bright Eyes Family and Bright Eye Kids are now closed to all but eye emergency visits. We plan to reopen for vision therapy sessions as soon as the CDC and Florida Governor Ron DeSantis allow it.
Question: Do patients keep doing vision therapy if my child can’t come into the office?
Answer: This question will be answered on a case-by-case basis – contact your therapist!
To all of our patients and families enrolled in vision therapy, Like you, my family is adapting to life at home. My children are doing virtual school and taking online guitar and cello lessons. We have friends that are doing online taekwondo training. That is just how it is for a little while, but we don’t need to let it take control of our lives.
With schoolwork and leisure being held on digital devices during this time, helping our patients with visual symptoms is now more important than ever. Fortunately, Bright Eyes staff have experience doing online “remote vision therapy” – we have helped patients in different states and even different countries. There is no reason to lose momentum during this time. If your therapist has not already, we will be reaching out to you soon to discuss how we will proceed in your individual case. If there is anything we can do to help you, please let me know.
If a patient or family member actually contracts coronavirus, they may be too sick to do therapy or assist their child with therapy. If your family is in self-quarantine but the patient feels well, we recommend you continue home therapy activities and contact your therapist – we can email you ideas and variations! In the event that Bright Eyes must close for a period of time, we may offer remote therapy sessions on a case-by-case basis. (While remote therapy sessions are not the ideal way for patients to learn in the long term, we do not want patients to lose momentum, or to take an extended time to complete therapy, if possible.)
If you have any questions or concerns, please reach out to us! We will remain vigilant, constantly monitoring the CDC’s standards, as well as city and state government advisories, and will openly communicate with you as the situation progresses. We care about our patients and staff, and will continue to work hard to keep everyone safe and healthy! Thank you for trusting us with your family’s vision!