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Myopia Management

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

 

 

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.

 

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.

 

 

 

 

 

 

 

 

Perfect Vision is The Perfect Gift: Ortho-K

girl holiday giftsAs the holidays approach, most of us have one thing at the top of our to-do lists: gift shopping! This holiday season, give the gift of perfect vision that will have your loved one thanking you every morning. If you or anyone in your family has myopia (nearsightedness), there is no better gift than Ortho-K lenses.

What is Ortho-K?

Orthokeratology (commonly referred to as Ortho-K, corneal reshaping contact lenses or corneal refractive treatment) is a process that uses specialized gas-permeable lenses to safely and gently reshape the cornea (the clear front surface of the eye), by having them worn overnight and removed in the morning. Doing so provides clear vision all day long without the need to wear lenses or glasses. This FDA-approved method of vision correction is suitable for children and adults, is a safer alternative to LASIK, and can be used for myopia, astigmatism, hyperopia (farsightedness), and occasionally presbyopia (farsightedness due to aging).

Give the Gift of Ortho-K

Children and adults with mild to moderate myopia or those who cannot undergo LASIK or other refractive surgeries (for a variety of reasons) are excellent candidates for Ortho-K. Believe us — they’ll be grateful for this gift!

Ortho-k is not only effective for correcting refractive errors but is also great for slowing the progression of myopia in children — rendering it a particularly meaningful gift for a child. By slowing the progression of myopia, you can greatly reduce your child’s risk of developing serious eye conditions and diseases later in life, such as cataracts, glaucoma, or retinal detachment.

While you can’t wrap this gift up in a box, with Ortho-K, your loved ones will truly SEE the difference!

The myopia management program at Bright Eyes Family Vision Care's Myopia Control Center is dedicated to improving your child’s eye health. Call us with any questions you may have – we’re here for you.

Dr. Knighton and Dr. Bonilla-Warford provides myopia management and other services for patients in Tampa, Westchase, Town 'N' Country, and University, and throughout Florida.

Dr. Nate is a Fellowship Candidate for Orthokeratology and Myopia Control

I am excited to share that I am now a candidate for Fellowship in The American Academy of Orthokeratology and Myopia Control (AAOMC), 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.

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These are qualities of a Fellow according to AAOMC:

  • 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 has been a long time coming. While attending the annual College of Optometrist in Vision Development (COVD) meeting in 2005 I saw Dr. Earl Smith present a lecture on refractive error regulation in monkeys. I was persuaded. My understanding of visual development and my plans for practice changed forever. I had recently completed my residency in Pediatric and Binocular vision and received my Fellowship at the Illinois College of Optometry in the American Academy of Optometry. My immediate plans were to open a practice where I could provide these specialized services and attain my Fellowship in COVD. I quickly opened Bright Eyes in 2006.

During this time, I became more and more involved in myopia control. Initially, I only offered ortho-k as a method of managing myopia. I learned a great deal. I regularly attended and occasionally lectured at the annual Orthokeratology American Academy of meeting, now Vision By Design. It was hugely inspiring and I started offering multifocal contacts and atropine for myopia management, respectively.

I am certain that the process of completing the Fellowship process will make me a better doctor and allow me to provide better care for my patients!

-Dr. Nate

Why a New Pair of Glasses Is NOT the Best Holiday Gift for Your Child

girl hugging her present 3154363If your child is nearsighted (myopic), it may seem like a great idea to get him or her a new pair of glasses. They will surely improve how well your child sees but, unfortunately, will do nothing to slow myopia progression. You can offer your child MUCH more than a pair of specs — something that will ensure long term vision health care and quality of life: Myopia Management.

Myopia Management is made up of several treatments designed to slow down how quickly myopia, or shortsightedness, progresses. In other words, their prescription will remain the same as they grow older. The treatments include uniquely designed multifocal contact lenses, atropine eye drops, and orthokeratology (“ortho-k”). Evidence suggests that myopia management can reduce the progression of myopia by up to 60% after two years of treatment.

What Makes Myopia Management An Excellent Gift?

Currently, myopia is among the leading causes of permanent vision loss and legal blindness.

As a child quickly develops and their nearsighted vision worsens, the child is at a higher risk of developing dangerous eye diseases later in life, such as retinal detachment, macular degeneration, glaucoma, and cataracts.

To thwart any of these sight-robbing conditions, Bright Eyes Family Vision Care's Myopia Control Center offers evidence-based treatment to prevent the onset or reduce the progression of myopia in our pediatric patients.

Myopia management enables your child to experience a more mild form of myopia than he or she would have otherwise had without treatment. Having mild-degree myopia means that your child’s likelihood of developing retinal detachment or macular degeneration is dramatically reduced.

So why don’t you make this holiday gift a particularly special one by protecting your child’s precious gift of sight. And the best part? It will pay off well after the holidays are over.

On behalf of Dr. Knighton and Dr. Bonilla-Warford and the staff at Bright Eyes Family Vision Care's Myopia Control Center in Tampa, we’d like to wish you all the best for the holiday season and the New Year!

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