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Dr. Nate Earns Fellowship in the International Academy of Orthokeratology and Myopia Control

Certificate

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.

 

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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.

-Nathan Bonilla-Warford, OD, FAAO, FCOVD, FIAOMC

E-learning Without Eyestrain: Guide for Visual Health For Students During the COVID-19 Pandemic

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.

(Downloadable PDF of this guide can be found here.)

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Credit: Sandra Schoen

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:

  • Eyestrain
  • Headaches
  • Blurred vision
  • Dry eyes
  • 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

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Nora’s Workstation

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.

Here is a cute comic about setting up a work station for kids.

 

2. Posture

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)
  • The wrist should be neutral (not flexed)

(Adapted from Workstation Ergonomics Guidelines for Computer Use by Children.)

Here is an illustration from the American Optometric Association: Body Posture AdobeStock 144114992

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?!?

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Javier’s Workstation

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.break time

  • 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.)

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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:

  1. Recently developed myopia (AKA nearsightedness).
  2. 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.

Conclusion

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.

-Dr. Nate

 

 

Binocular Evaluation Testing Information

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.

Let us know if you have any questions.

-Dr. Nate and Dr. BethCapture

BRIGHT EYES FAMILY VISION CARE AND BRIGHT EYES KIDS OFFER NEW APPROACH TO TREAT CHILDREN WITH NEARSIGHTEDNESS

 

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.

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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.

 

The Bright Eyes Lego Glasses Challenge!

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:

Step one:

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.

Step two:

Take a picture of your child wearing their Lego glasses.

Step three:

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!!!! 🙂

-Dr. Nate

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.

 

Dr. Beth’s Screen Time Tips

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.

-Dr. Nate

 

 

Is Your Child at Risk for Myopia? Send Them Outside!

Girl Smiling Grass Flower 1280×480 1024×384Myopia, more commonly known as nearsightedness, is a refractive error that affects millions of adults and children worldwide. This condition occurs when a person’s eyeball is too long, or the cornea or lens has an irregular shape. A myopic eye focuses the image at the front of the retina, as opposed to directly on the retina. it is often hereditary, especially if both parents are nearsighted.

Recent studies show that the more time spent outdoors can slow the onset of myopia for reasons explained below. These findings are significant, as myopia can seriously impact eye health if left untreated. At Bright Eyes Family Vision Care's Myopia Control Center, we’re here to answer any questions you may have and ensure that your child’s myopia is under control.

How Does Spending Time Outdoors Benefit Myopia?

By spending time outdoors, children train their eyes to focus on distant objects and relax their eyes. Just as with any other muscle in the body, the muscles in the eye need to be trained and strengthened in order to produce clear vision. Experts further suggest that moderate exposure to sunlight has a positive impact on myopia and general eye health.

A recent study was conducted by the Centre for Ocular Research & Education (CORE) at the University of Waterloo’s School of Optometry and Vision Science. The study shows that children who spend 1 extra hour outdoors each week reduce their risk of developing myopia by over 14%.

In contrast, according to the National Institute of Health, children who spend a considerable amount of time indoors watching TV or playing video games are at a significantly higher risk of developing nearsightedness.

Outdoor time should be incorporated into every child’s routine, especially those at risk of developing myopia. Parents and caregivers can make being outdoors fun by playing sports, hiking new trails, enjoying picnics or barbeques, or organizing scavenger hunts.

Why Is Delaying Myopia Onset So Important?

Myopia generally worsens over time, mostly during childhood and into the adolescent years. If your child’s prescription regularly increases, this can lead to more serious complications. Myopia progression heightens the risk of developing other eye conditions and disorders, such as cataracts, glaucoma, or retinal detachment. In more severe cases, permanent vision loss — or even blindness— may occur.

This is why it is crucial to monitor your child’s condition with a yearly visit to Dr. Knighton and Dr. Bonilla-Warford. Not sure whether your child has myopia? Refer to the following list.

Signs of Myopia in Children

Children with myopia may exhibit any of the following:

  • Squinting when reading the board or watching TV
  • Lack of interest in playing sports that require distance vision
  • Positioning oneself at close proximity to the TV or screen
  • Sitting at the front of the classroom to clearly see the teacher and board
  • Holding books close to the eyes

If your child is experiencing any of these symptoms or if you’ve noticed some of these behaviors, give outdoor time a try and bring him or her in to Bright Eyes Family Vision Care's Myopia Control Center for a comprehensive eye exam. We offer evidence-based myopia management treatment to slow down the progression of nearsightedness, thus preventing severe vision loss later in life.

Bright Eyes Family Vision Care's Myopia Control Center provides myopia management and other treatments to patients in Tampa, Westchase, Town 'N' Country, University, and throughout Florida.

REFERENCES:

Centre for Ocular Research & Education

National Institutes of Health

Dr. Nate Talks about Screen Size on Bay News 9

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The end of the year is gift-giving time and for many children, that means digital devices and video games. Roy de Jesus of Bay News 9 reached out to Dr. Nate to talk about how the size of the screen matters.

Many people are have learned that more screen time at younger ages is not best. Man parents are familiar with the recent World Health Organization’s screen time recommendations for chidlren. Here are WHO’s screen time recommendations by age:

  • Infant (less than 1 year of age): Screen time is not recommended.
  • 1-2 years of age: No screen time for a 1-year-old. No more than an hour for 2-year-olds, with less time preferred.
  • 3 to 4 years old: No more than one hour.

But not everyone realizes that the size of the screen matters, too. It is not just whether kids can see the device but how harder their eyes have to work to be able to see it. Basically, the smaller the screen the more the eyes have to work.

Here is what happens:

  • Kids want to see more detail on the small screen.
  • They hold the device closer than they would normally hold a book or a larger screen.
  • The closer the eyes have to focus, the harder the eyes have to work to make the screen clear
  • The eyes have to turn inward to keep the screen from becoming double.
  • This extra effort can cause eyestrain.
  • In the short team, this discomfort may lead to unwanted behavior or frustration.
  • Long term, this can contribute to myopia or other vision problems.

Fortunately, you do not need to throw out the new devices. Here are some things you can do:

  • As parents, role model proper device use yourself
  • Participate in screen time with your children and observer their behavior.
  • Enforce regular screen breaks with outside time.
  • Educate kids on Harmon Distance AKA Elbow Distance and enforce it.

If children complain of persistent symptoms such a burning eyes, blurry vision, double vision, and symptoms such as headaches, it is important that a thorough eye exam is done to look for underlying eye and vision problems. Both Dr. Nate and Dr. Beth are residency-trained in children’s vision. You can request an appointment or call (813)-792-0637.

 

 

 

 

 

 

 

 

Podcast Episode #15: Myopia Management With Esther Rodas

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. Nate talks with Optician Esther Rodas about Myopia and the treatment options to control it.

You can listen in the player below or read the transcript. The show is available via Stitcher, Google Play, iTunes, and the webplayer below. You can find all previous episodes here. If you have any questions or suggestions for future episodes, please email office@BrightEyesTampa.com.

Previous relevant episodes:


Full Transcript:

Introduction [00:00:10] Welcome to the Bright Eyes podcast. Advice for healthy vision for all ages. Your hosts are doctor Nate Bonilla-Warford and Dr. Beth Knighton. Residency trained optometrist providing eye care to all ages with exams for glasses and contacts and specialty services including vision therapy, myopia control, Ortho-kertology and sports vision training. Their mission is to empower patients by providing the best in friendly, professional and individualized eyecare.

Dr. Nate [00:00:38] From rainy Tampa Bay. It’s the Bright Eyes podcast.This is episode number 15. I’m Dr. Nate Bonilla-Waford and today’s episode is all about myopia control. I’d like to introduce our special guest today this is Esther Rodas. Esther is an Optician. She works here at Bright Eyes and not only is she an optician, she’s our myopia control coordinator so Hi Esther.

Esther [00:01:05] Hello everyone. So Esther here just like Dr. Nate just mentioned and been here for about a couple of years and usually I will be the one that you talk to if you have any questions on myopia control and scheduling and all of that good stuff.

Dr. Nate [00:01:21] Absolutely. And when Esther joined us she was a student at the Hillsborough Community College in the opticianry program. And now that she’s got her license she works with us full time and we are so lucky to have her and patients just love her and all the staff does too.

Esther [00:01:37] Happy to be here.

Dr. Nate [00:01:38] Excellent. So Esther we introduced myopia in episode six as part of our refractive error episode. And here’s our vision therapist Miriam giving the definition of myopia.

Miriam [00:01:56] Myopia, aka nearsightedness is a condition where objects up close appear clearly while objects far away appear blurry. With myopia, light comes to focus in front of the retina instead of on the retina.

Dr. Nate [00:02:10] So myopia is all about nearsightedness. It’s all about not being able to see very far away without either contacts or glasses or lenses of some sort or for adults they can consider refractive surgery like LASIK. From your perspective Esther when a doctor diagnoses a child with myopia what are some of the most common questions that parents will ask you?

Esther [00:02:36] Definitely first thing they ask is if it’s permanent. If it’ll get better the older that they get?

Dr. Nate [00:02:43] Right. And that’s one of the questions that they ask us doctors are very first thing. They’re like, are they going to outgrow this? Are these glasses that they need? Or is this something that after a while they won’t need anymore? And one of the things about myopia that’s important to understand is while we see it as vision getting blurrier or glasses getting thicker or stronger, what’s really happening in myopia is the eye ball itself is stretching, it’s getting longer and getting bigger and it’s much easier for the eye tissue to stretch and elongate rather than it is to shrink and get smaller. And so for that reason when we’re talking about myopia I like to say it’s a one way street but it doesn’t really get better. And so after they kind of digest that what are the next questions that parents will ask you?

Esther [00:03:40] So once they know what can potentially happen and the inside of the eye they definitely know the options at that point what they can do to limit that progression.

Dr. Nate [00:03:51] Right. And so when I talked to parents, we always talk about myopia as a condition that needs to be managed. It’s not just in one point in time it’s a lifetime of change that we need to think about. We always talk about myopia in the short term and in the long term. So in the short term, kids need to be able to see, they need to be able to see the board at school, they need to be able to see for sports they need to be able to function in everyday life. There’s a variety of different ways that we can help them be able to see clearly and that’s the common things that people are familiar with glasses, contacts, the night time treatment contacts of ortho-K can help people see clearly. So there’s different options and we need to address that first because it’s very important that we make sure that kids have useful vision for living their lives. But, we also need to make sure that we are addressing the long term component. Because myopia tends to worsen and sometimes more dramatically in some patients rather than others- we need to make sure we’re addressing that and offering different kinds of treatments to hopefully reduce the risk of progression. So in our office Esther, what are the three main ways that we use to reduce the progression of myopia?

Esther [00:05:26] We offer here the Atropine medicated eyedrops as one solution. We offer Ortho-keratology which is the night time lenses and we also offer specialty designs soft multi-focal lenses to help with that progression.

Dr. Nate [00:05:46] Right. And we feel very strongly not just with myopia but with all of our patient care that every option needs to be tailored individually to the patient. So it’s not one size fits all. It’s not that every single patient who comes in needs any one particular treatment but it depends on their lifestyle,it depends on their goals,it depends on their genetics,it depends on if they’re more likely to progress. So very briefly we’ll just go over what these options are. The first one which is the most easy to administer are the Atropine eye drops. Now, atropine is a medication that dilate the pupils and it reduces the eyes ability to focus. And for that reason, it hasn’t been widely used in the United States. It’s used for many many conditions but not for myopia control. Until recently when it was discovered that you could use a very low concentration to minimize the side effects. So we have many patients who are on the low concentration atropine treatment to reduce the likelihood of progression. We don’t know exactly how the atropine works, what it’s doing in the eyes but it’s been shown in many many many studies to be effective. So that’s that’s one option. The other option like Esther said was the multifocal contacts.The multi-focal contacts are worn in the daytime just like any other soft contact that you’d be familiar with. But it has a special optical treatment which provides some stimulus to the eye that reduces its need or its inclination to to get worse. We can optically change how the light focus is on the back of the eye to reduce that stimulus to progress and get worse. And so that’s the daytime contacts. The nighttime contacts the Ortho-K does the same thing optically, but it actually reshapes the eyes so that you can see clearly without daytime contacts or glasses. So you get a little bit of a two for one with ortho-K which is great. So once we do the exam and we take lifestyle into account, we look at all of the the treatment options and I will recommend a particular treatment option for a patient. I’ll bring them out and then they will go over the details and the logistics of that treatment option with Esther at that point. What kind of questions do you get?

Esther [00:08:24] So definitely the top question which you kind of touched on right now is their parents are only super interested and intrigued of like the science behind each one and the how is it that the atropine, the multi focal and that the nighttime lends aid in hopefully limiting that progression of the nearsightedness for their child. So anything you can add to what you just said.

Dr. Nate [00:08:48] So the interesting thing about myopia control is even though there are many many scientific papers exploring how well these different options work and how they relate to each other- we don’t thoroughly understand exactly how they work. We have a pretty good idea of how the optical effects of the multi focal contacts on the ortho-K works to reduce that stimulus to progress. We really don’t know as much about how the atropine works. We know that atropine has been used for hundreds and hundreds of years and it’s been used for many many conditions and it’s extremely safe to use. We don’t know what’s exactly going on at the molecular level to help keep the eyes from progressing, but we do know it’s very effective. I know the parents don’t think that that’s a super satisfying answer but it is the honest answer at this point. So what other questions do parents ask you?

Esther [00:09:45] Definitely risks. They want to know what kind of risks are involved and short term risks and long term risk as well. So for example the night time contacts as they are more rigid than the soft lenses. And they always want to know what the risks are for abrasions and things like that. Almost the same for soft contact lenses for short term risks. Long time parents want to know if the ridgid of lenses will affect the kids eligibility to do maybe LASIK in the future. Parents also ask about any effects that that may have on things such as glaucoma and any long term risks in the medicated eye drops. So it’s kind of like a few questions and one.

Dr. Nate [00:10:34] Well I think that that’s really important topic because with any procedure or with any therapy we always need to weigh the benefits and the risks and that’s part of the discussion that always happens between me and the parents when we’re talking about undertaking one of these treatments. Fortunately in the big picture all of these have been proven to be very safe. And that’s why we can feel comfortable doing them. And that’s why I feel comfortable with both of my children using these different methods. My son uses the medicated eyedrops. And my daughter does the night time Ortho-K lenses. Obviously, if I didn’t feel they were very safe I’d be reluctant to use them with my own kids and I know that lots of doctors around the country and around the world have their own children and in myopia control programs similar to these as well. So let’s talk about the different risks with any contacts. There are certainly risks especially if you don’t use proper hygiene, if you don’t care for them properly. If you use them in a way that you shouldn’t be then you increase those risks. Fortunately all of the scientific studies that have shown that with the Ortho-k lenses for night time don’t have any additional risk compared to traditional contact lens wear. And so that that helps us educate patients properly now. The very first question that people ask me is often, well I was told that I shouldn’t sleep in my contacts because it’s not healthy. So why is it healthy to sleep in these contacts. That’s a great question because it’s true that you shouldn’t sleep in your daytime contacts because one- they’re often not intended for that two- if you’re sleeping in them in the nighttime and then wearing them in the daytime then you’re wearing them for a full 24 or multiple cycles. And that can create problems because the lenses never get cleaned with Ortho-k. One, they are super breathable materials. Two, they’re designed specifically to be worn at night and three they’re only worn for about eight hours at night and then they’re being cleaned and stored the rest of the time. Furthermore the Ortho-k lenses rarely or never leave the house. It’s not like the contact lenses that you wear where you get pollen in them you, get dust in them. If you are out and about your eyes can get sweaty you can get sunblock on them if they goes in your eyes etc. Whereas Ortho-k you put them in before you go to bed you take them out in the morning and they’re clean and so the lenses stay very, very clean and we’re very, very clear about the proper method for keeping the lenses clean. Once we have the proper care method established then the risks go way,way down. It is possible in the short term, if the patient doesn’t have good insertion technique for putting the lenses in to lightly scratch or abrade their eye but that’s very, very rare and when it does happen it’s mild and it resolves right away. Now fortunately, we’ve never had any infection for any of our patients and that is incredibly rare with proper care. That’s the same for our for our soft contact lens patients soft contact lenses are healthier than ever before and the risk of infection is is very, very low. I will add here and I always tell patients all the time, that you should never use tap water or you should never clean your lenses with anything other than solutions that have been provided. You shouldn’t shower or swim or go on lakes or hot tubs with your contact lenses on because that can introduce contaminants or bacteria or amoebas that can cause a severe infection. So I was always educating about that.

Dr. Nate [00:14:48] Regarding the atropine, there are known side effects like I mentioned about sensitivity to light and focusing, but by using the lower concentration those are dramatically reduced. Other than that, the only real side effect that can happen with patients sometimes is if the drops come with a certain preservative and the patients are sensitive to that preservative it can cause an allergic like reaction where the eyes get red and irritated. Many of our patients use non preserved drops and that’s not an issue we haven’t found that to be a common problem. But it’s theoretically possible and some patients you it’s hard to know whether they’re they respond to preservatives or not. In the long term, for long term use- atropine has been used for for many years without any problems or side effects.

Esther [00:15:49] We do go through a couple of compounding pharmacies.

Dr. Nate [00:15:53] Yeah, we do have some options and that’s actually an important point. So if you get the high concentration atropine which we don’t use very often except in the very most stubbornly progressive cases, you can get that at almost any pharmacy because that’s the standard formulation that is used to treat eye disease. The lower concentration is only available through compounding pharmacies and we have a variety of options that we can we can help patients acquire that.

Esther [00:16:25] Have you got at all questions about if it’ll affect someone’s eligibility for LASIK in their future or the glaucoma?

Dr. Nate [00:16:33] Yeah and that’s actually a very common question and it’s a great question because sometimes patients are concerned well maybe this reshaping with Ortho-k reshaping of the cornea will adversely affect them for their chances for Lasik and I say you know exactly the opposite. The goal of Ortho-k is to keep the eyes the prescription is stable enough over the long term so that they remain eligible for for LASIK or refractive surgery. What typically happens is people will do Ortho-k starting when they’re when they’re younger maybe you know 10 or 12 years old and they’ll keep doing it until they’re an adult they might stop at 18 or I had a patient just the other day was 12 and she’s now 30 and she’s been doing it continuously. But if she or other patients wanted to stop as an adult they could wait until their eyes go back to their natural shape and once that’s stable and it’s confirmed to be stable with repeated curvature measurements then they are eligible for LASIK just like any other patient will be.

Esther [00:17:44] How about the glaucoma question?

Dr. Nate [00:17:47] So the glaucoma question is interesting because people worry about glaucoma for this reason- they think the Ortho-k lenses press on the eye to reshape the lenses. And if they’re pressing on the eye then that’s going to increase the pressure inside the eye and if you increase the pressure inside the eye that’s going to increase the risk of optic nerve damage called glaucoma. Now the reason why it is not a risk for glaucoma is because Ortho-k lenses don’t actually work by pressing on the eye what they do is they they are kind of a rigid surface that goes over the cornea and then over time the cornea conforms to that lens it- actually kind of expands outwards to meet the shape of the lens so instead of pressing on the eye, the cornea actually reshapes itself or expands to meet the lens. So there’s no reason to think that the pressure inside the eyes increases when we do Ortho-k and therefore there’s no added risk for it for glaucoma. Again kind of like LASIK, nearsightedness itself is a risk factor for glaucoma if you have very high myopia in nearsightedness you have increased risk for for glaucoma. So it may be that doing Ortho-k might actually help reduce the risk long term of glaucoma.

Esther [00:19:25] That’s great information. Thank you. I would say those are the top questions and the last question that I always get at the very end is if these methods are FDA approved?

Dr. Nate [00:19:38] Right. And so here’s the thing about FDA approval all of these methods are FDA approved for a variety of conditions and treatments but not specifically for reducing the progression of myopia. So we’re very clear when we talk to parents and we have it in writing and we explain that while all of these treatments are scientifically valid and there is many studies that talk about the the benefits that the FDA itself has not gotten around to evaluating yet and stating that these methods are specifically approved for the reduction in the progression of nearsightedness. Many other countries have, and there’s lots of scientific evidence to show that it is, but no the FDA hasn’t. Now, all of these things like the atropine eyedrops are approved for treating many, many kinds of conditions including Amblyopia,which is something that we see in the office a lot. A multi-focal contacts are certainly approved for lots of conditions. Specifically, presbyopia for older adults who need to see up close. Ortho-k, the nighttime contacts is approved for treatment of nearsightedness so that people can see clearly throughout the day, but they haven’t gone that extra step yet in approving it specifically for the reduction in the risk of progression. So that’s something that we think it’s important that people understand it doesn’t mean that we shouldn’t do it, but it is in the state of approval right now.

Dr. Nate [00:21:29] Well, hopefully this has been helpful for people who are interested in learning more about myopia control in the future we hope to have some more episodes detailing how each of these methods work. I think it would be kind of fun to have my kids on and they can talk about their experience. That would be that would be interesting to hear it from their own mouth. And we have lots of other topics in mind if you have any suggestions I have topics that you’d like to hear in the future, please let us know. I’d like to thank Esther for joining us and talking to us today. And is there anything else you wanna say before we go now?

Esther [00:22:16] Thanks for having me and to all those listening to this podcast. If there’s any questions if you want to schedule a myopia consultation with Dr. Nate just ask for myself Esther and be more than happy to answer any questions that I can and get you on our schedule right.

Dr. Nate [00:22:34] And if you want to you can call us at 1-813-792-0637. Or you can e-mail the office at office@BrightEyesTampa.com. Until next time,stay dry.

Outro: [00:22:46] Brought to you by Bright Eyes family vision care and Bright Eyes Kids. Find previous episodes and more detailed information at BrightEyesTampa.com. Creative Commons copyright attribution noncommercial use. The only purpose of this podcast is to educate and to inform. There’s 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 a medical or other professional advice or services. Please consult your physician for diagnosis treatment.

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

MYOPIA AWARENESS WEEK!

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This week, from May 13th to 19th, is the first international Myopia Awareness Week. The goal is to raise awareness that Myopia is a serious condition that can be managed. In fact, rates of nearsighted are increasing all over the world.

 

“We know that almost half the world’s population will be myopic by the year 20501, with nearly one billion people in the high myopia category. Myopia Awareness Week is about getting people talking about myopia in homes and optometry practices around the world,” stated World Council of Optometry President, Dr. Scott Mundle.

 

At Bright Eyes, Dr. Nate Bonilla-Warford has been offering options for the management of myopia for more than a decade. He has worked with hundreds of patients, including his own children, to maintain the best and healthiest eyes throughout life.

 

As scientific research into myopia treatments has progressed, our programs have become more sophisticated. Not only are they more options for managing myopia, but we have better ways to communicate with patients. After all, the mission at Bright Eyes is to empower our patients so that they feel that they themselves are in control of their progress.

Here are some quotes from patients and parents that show how they feel about myopia control.

“We feel blessed to have found Dr. Nate and his wonderful staff. Our daughter started wearing glasses at the age of 4 yrs old and her prescription strength kept increasing. Dr. Nate suggested that we start Atropine Therapy and her prescription strength has been pretty much stable.”

“Myopia control is something that has changed my life, in the best way possible.”

“Myopia should be taken seriously and treated as such. Thanks Dr. Nate and continue to help and educate as many as you can.”

“Myopia control is a great experience. My eyesight has improved so much over time. The process isn’t that complicated either, with a great doctor, like Dr. Nate.”

“In general is a scary feeling seeing how myopia progresses so rapidly. Not having a cure is disturbing. Before atropine, there was no means to control it at all.”

To celebrate Myopia Awareness Week, we are offering $100 off anyone who starts any myopia control program during the month of May. All you have to do is mention the Myopia Awareness Week discount to Dr. Nate when signing up. Remember if you schedule a Myopia Consultation, we will discount the cost of the consultation from the program fee. If you have any questions about myopia or any of the treatment options, please do not hesitate to contact us below or at 813-792-0637.

 

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