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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.

 

Podcast Episode #7: Myopia and Outdoor Time

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 Dr. Beth about recent research that supports the idea that spending more time outside will reduce the likelihood of children becoming nearsighted.

Note: See these related episodes: #4 UV Protection and #6 Refractive Error (Myopia and others).

Full Trascript:
Ad: 00:00 Do you want to improve your view? Biotrue One day daily disposable contact lens feature a bio inspired design providing clear comfortable vision throughout the day. Call us at 813-792-0637 to see if Baush and Lomb Biotrue Oneday contact lenses are right for you.

Dr. Nate: 00:18 Hi, this is Dr Nate. This episode was actually recorded in the summer of 2017 before Dr. Knighton went on maternity leave and then we got so busy it took me this long to put the episode up. That’s why even though it’s cold and rainy in Florida right now, we are outside at a park where it’s sunny and kids are playing. Enjoy.

Intro: 00:49 Welcome to the bright eyes podcast, advice for healthy vision for all ages. Your hosts are Dr. 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 orthokeratology and sports vision training. Their mission is to empower patients by providing the best in friendly, professional, and individualized care

Dr. Nate: 01:19 From sunny Tampa Bay. It’s the bright eyes podcast. This is episode number seven and I’m Dr. Nate Bonilla- Warford.

Dr. Beth: 01:19 And I’m Dr Beth Knighton

Dr. Nate: 01:30 And today’s episode is all about going outside and why that’s important. So why do you think were outside?

Dr. Beth: 01:39 Well, today is about as lovely as the day as you get in the summertime in Florida. So we thought it’d be nice to just get out of the office. Occasionally we go for walks at lunch and what not just to get out.

Dr. Nate: 01:54 And that’s totally true, and that is completely important, and it is very nice even though it’s a little warm, but it’s still very nice out here. Um, but there’s also another reason why we’re outside. Now, we already talked about getting outside once in episode number four. Can you remind what our listeners, what that was all about?

Dr. Beth: 02:15 Well, we reminding you all about why it’s so important to have UV protection for your eyes when you’re outdoors.

Dr. Nate: 02:22 Absolutely. And I’m still blown away when I ask people about their sunglasses and they say like “No, I just don’t wear sunglasses, I just don’t really need them”. And in Florida, having sunglasses, prescription sunglasses, is a must, but that’s not what we’re talking about. That episode is all about some of the dangers of going outside if you don’t do it cautiously or carefully. This episode is about the benefits of going outside. And so what we’re talking about is specifically how going for children reduces the likelihood that those kids are going to be near-sighted. Now, for a long time it was thought by many people that nearsightedness, or myopia, or not being able to see far away clearly without glasses, was purely genetic. Are your parents nearsighted?

Dr. Beth: 02:22 Only one of them.

Dr. Nate: 02:22 Only one of them.

Dr. Beth: 02:22 And I am.

Dr. Nate: 03:31 Well, both of my parents are and almost everybody in my family is. And I thought that I was going to be and I am nearsighted and that’s why I have my prescription sunglasses on right now. But there has been a lot of research in the last ten years and even a lot of research just in the first half of this year, which shows that nearsightedness is not purely genetic. And as a matter of fact, what we know is the more time children spend out doors when they’re younger, the less likely they are to become nearsighted and need glasses to see far away. And that is one of the most interesting and exciting developments that somebody like me who is a pediatric optometrist is a reading about right now because this means that we can educate our patients and help them understand why going outside is so important and actually reduce people’s dependence on glasses in the future. But before we get to the details and the studies just kind of in general, do you think going outside is a good idea?

Dr. Beth: 04:52 Well absolutely. I mean we have to stay active, we need to enjoy nature as it is and both Nate and I, our families are outside all the time doing things. So we are very aware of both the dangers and the benefits of being outdoors with everything in moderation is key.

Dr. Nate: 05:13 Absolutely. And what’s so great about this particular subject, the beneficial thing which is going outside is free. It’s easy. It’s convenient because it’s everywhere and it is fun. I tell families probably every day or almost every day, one of the best things you can do is just go for a walk after dinner. If you have a dog, go walk the dog. If you don’t have a dog, just go outside with your family. Some of my best memories from when I was a kid was going for a walk with my family and seeing other people and finding out what’s going on in the community and seeing other people walking their dogs and so now we have lots of evidence that just something as simple as that is really important for children’s eyes and it’s also important for a reducing obesity and just general strength and exercise. There’s so many different reasons.

Dr. Nate: 06:10 So what I brought today were three different studies which have different results, which talk about this relationship between the more children go outside and how likely they are to become nearsighted. So, the first one that I have is from the British Journal of Ophthalmology earlier in 2017. What it says is that of the hundred and thirty seven children that they studied, all of the different factors that they looked at whether or not they became nearsighted was more dependent on environmental factors. Most of those children before the age of six is when you could start to see differences and so environmental factors include all kinds of lifestyle choices like going outside and like the types of different activities that people do, but it also has to do with education and socio economic status, so there’s lots of different factors that are that go into that, but one of them is just exercising going outside and so that’s just the type of study that we see on a very regular basis. When I read the new studies that have come out in, I care, I see studies like that all the time. Twenty or thirty years ago, that would’ve been really surprising. Do you think that that’s surprising now?

Dr. Beth: 07:31 I think that in general, people are paying more attention to what can we do to prevent problems in the future as opposed to reacting once we’ve already got problems and that’s across the board in healthcare. These are very simple, easy ways to help prevent our children from becoming more near sighted because not only does it cause them to have thicker glasses and harder time seeing, but it also can cause a higher risk for eye disease later on. They’re at higher risk for having glaucoma. They’re at higher risk for having retinal issues like a detachment or a hole in the retina. And so if we can prevent those things early on, much better outcome for them.

Dr. Nate: 08:17 And that’s actually a great lead into the next study which was from this year and Acta Ophthalmologica. And the gist of that study was a few different things. This was a review, a Meta analysis of twenty five other studies. What they found was that if children spent seventy six minutes outside each day, there were fifty percent less likely to become nearsighted. So that’s if they are not near-sighted, they’re not myopic at first. And then they spend roughly an hour and fifteen minutes outside each day, they’re fifty percent less likely to become nearsighted, and that corresponds with a lot of the individual studies that we’ve seen. But this is nice because this is twenty five studies all kind of pulled together that held up. What was very interesting though is there really wasn’t much benefit for children who are already near-sighted. So, this doesn’t mean that if you’re already near-sighted, all you got to do is go outside more and then you’re nearsightedness won’t progress.

Dr. Nate: 09:26 We have other ways of controlling the progression, limiting the progression, reducing how quickly vision gets worse, but going outside isn’t one of them. So the key, like Dr Beth just said, is prevention. So the idea is to go outside, do everything you can before kids become nearsighted instead of after. Now, the third study, which was from Investigative Ophthalmologic Vision Sciences, was taken from the Avon Longitudinal study of parents and children, which was a study, they followed children from age two to fifteen. And this was really, really specific. This was a news for me that I thought was very useful. And the conclusion of that was additional time spent outside between the ages of three and nine was associated with the less likelihood of becoming nearsighted at the ages of between ten and fifteen years old. So now we’re starting to zoom in on the really key age of younger than ten, between three and nine, and that really is when kids should be outside recess playing and paying dividends in the form of not becoming nearsighted once they become teenagers. And it’s just amazing how much research is coming out right now. That’s something that as there is more research we will continue to talk about and will continue to educate our patients about.

Dr. Nate: 10:57 The study that you just referenced also was looking at the amount of time spent reading versus the amount of time spent outdoors and just like outdoors had a positive effect. The amount of time indoors reading had a slightly negative affect and not that we want to tell everyone, go live outside and never read a book. Obviously we need to do both, but it was very interesting that both of those things had a correlation on the nearsightedness of the eye. Another interesting thing that came out of that study was parents who were near sided were more likely to have children who spent more time reading and it also said that parents who were not near sighted, were more likely to have children who spend more time outdoors and less time reading, so those things kind of match up as well. It clearly stated that the impact of outdoor time reduce the likelihood of nearsightedness regardless of those other factors.

Dr. Nate: 12:01 So, the main point here is if you have children, make sure that they spend time outdoors, but also remember if they’re going to be outdoors in bright sunlight when UV light is a risk, make sure that they were sunglasses. So thank you for listening. This is one of my favorite topics. We’re going to talk more in the future about what to do after children become nearsighted. Until then, if you have questions, comments, or suggestions, you can email us at office at office@brighteyestampa.com. Until next time, go outside.

Intro: 12:35 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, non-commercial use. The only purpose of this podcast is to educate and to inform. It is no substitute for professional care by a doctor experienced in the area you require. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Please consult your physician for diagnosis and treatment.

 

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

Podcast Episode #6 – Refractive Error (Myopia, Hyperopia, Astigmatism, and Presbyopia)

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 about Refractive Error and explains how they affect how people see. Specifically Myopia, Hyperopia, Astigmatism, and Presbyopia.

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Intro: Welcome to the Bright Eyes Podcast: Advice for healthy vision for all ages. Your hosts are Dr. Nate Bonilla-Warford and Dr Beth Knighton, Residency trained optometrists providing eye care to all ages. With exams for glasses and contacts and specialty services including vision therapy, myopia control, orthokeratology and sports vision training. Their mission is to empower patients by providing the best in friendly professional and individualized eye care.

Dr. Nate: From Tampa Bay Florida it’s the Bright Eyes podcast. This is episode number 6. I am Dr. Nate Bonilla-Warford and I’m going to be talking about “refractive error”. I know that this is an area that confuses a lot of people. People will get a prescription for glasses or contacts and they’ll say “What does this mean? What does this number mean?” Or they’ll say “I think I have an astigmatism.” like it’s some sort of dreaded condition, which it really isn’t.

Dr. Nate: So when we talk about refractive error – refraction means the refraction of light. It’s how light is focused. And error just means that it’s not focused accurately. What I want to explain first of all is that these conditions that we’re going to talk about are not a disease the same way glaucoma and cataracts are. However different diseases can cause different refractive errors. What the refractive error is is all about the shape of the eye. People may have heard different things about the shape of their eyes such as their eyes shaped like a football or their eyes are too long or too short. And that’s what we’re going to talk about now. More or less, your eyes around. They are more like a sphere. Light enters your eye through the cornea, the clear front part. It travels through the pupil and is focused through the lens to focus clearly on the back of the eye, which is called the retina, as the light goes through the cornea lens to the back of your eye.

Dr. Nate: If the light isn’t focused correctly, your brain will see this as a blurry or distorted image. And this is what we mean when we say refractive error. Eye doctors can measure this in a variety of different ways. The most common way that we think about measuring this is the “which is better 1 or 2” test. However we can do this without patients saying anything this is what we do with infants and young children where in this case we shine a light in their eyes and we measure the refractive air as it bounces back out of their eyes. We also have diagnostic equipment which measures the same things. All of these procedures are done during the standard eye exam which we recommend every year not only to evaluate refractive error but to see if there’s any underlying diseases or conditions.

Dr. Nate: So what we’re going to do here is have one of my vision therapists Myriam read the definition from the National Eye Institute of different types of refractive error and then I’m going to talk about them.

Myriam: MyopiaMyopia aka nearsightedness is a condition where objects up close appear clearly, while objects far away blurry. With myopia, light comes to focus in front of the retina instead of on the retina.

Dr. Nate: Now, I know this gets a little confusing because we’re talking about near-sightedness and that means you can’t see far away. We’re defining the condition based on what you can see even though the problem is something else. And that sounds sort of weird… myopia, near-sightedness, is probably the most commonly recognized type of refractive error. This is the one that a child may have trouble seeing the board at school and so they come in and they get an eye exam. People may have trouble driving or seeing the menu on the TV for one reason or another. Their eyes have gotten too long and the light focuses in front of it giving them blurry vision far away. So we deal with this in a short term and long term fashion. In the short term, we need to provide clear vision so people can function and this can happen in the form of glasses or contacts or orthokeratology or LASIK or other different kinds of procedures. And that’s important so that they can do the things that they need to do in life. Now for the long term perspective, myopia tends to get worse over time. And so we sometimes need to do some things to keep that rate slow so it doesn’t get worse very dramatically and we’re going to have several different episodes in the future talking about that.

Myriam: 20258792625 944954b6bc bHyperopia AK farsightedness is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience differently. Some people may not notice any problems with their vision especially when they’re young. For people with significant hyeropria, vision can be blurry for objects at any distance, near or far.

Dr. Nate: Now this one is even more confusing because we talk about far-sighted meaning they can see far away. But in this case most people can also see up close. And the reason is, unlike myopia or near-sightedness, where you can’t really do anything other than just sort of squint with hyperopia, or farsightedness, your eyes can adjust and focus to make it more clear so when you’re looking at something far away or up close your eyes can work a little bit harder and make that clearer. The problem is if your eyes have to work very hard in order to see clearly then your eyes either get tired vision gets blurry or or it creates other problems where maybe there’s double vision or other issues. as with myopia, the most common ways to treat this are either glasses or contacts. Although there are other issues as well.

Myriam: AAEAAQAAAAAAAAinAAAAJDFjMGU5MjJiLTZhYjgtNDJhMC04ZTI0LTI0YjRiMDVkMzgwNQAstigmatism is a condition in which the eye does not focus light evenly onto the retina, the light sensitive tissue at the back of the eye. This can cause images to blurry and stretched out.

Dr. Nate: Astigmatism really does sound like an affliction that people have but really all it means is when the light is focused on the back of the eye because the curvature is not uniform. It’s different in different places of the eye the eyes literally see multiple images and it is distorted or it looks confusing. And so people will say that they sometimes see double or their vision is smeary or their vision is blurry and that isn’t a disease. It just has to do with the shape usually of the front part of the eye and so they can wear glasses or they can wear special contacts which are called toric lenses for astigmatism or other procedures to give them clear vision unlike near-sightedness and farsightedness astigmatism affects everything near and far, sometimes more one worse than the other. This is the one where people will say “My eyes are shaped like a football” and the reason why that analogy exists is because football is longer on one side than it is on the other. So it gives this non-uniform curvature but people’s eyes aren’t really shaped like footballs. It’s just an example. I prefer to use the example the side of an egg because I think it’s a little less pointy than a football.

Myriam: eye12 72 PresbyopiaREVPresbyopia is an age related condition in which the ability to focus up close becomes more difficult as the ages. The lens can no longer change shape enough to allow the eye to focus close objects clearly.

Dr. Nate: And so we get to the last one which is presbyopia which people confuse especially with farsightedness because it’s a problem of having to see up close. The main difference is where and hyperopia the eyes too short for the light to focus on the back of the eye, with presbyopia, it is that over time the lens of the eye isn’t as flexible due to age and so people need either reading glasses or bifocals. Most people know somebody who’s in their 40s or 50s who have to carry around glasses to be able to see a little bit more clearly a close reading a menu reading a book etc.

Dr. Nate: So that’s a quick summary of refractive error and we’re going to talk more about all of these different things in future episodes. Thank you for listening. if you have any questions comments or suggestions or you can email us at office@Brighteyes Tampa.com.

Outro: Brought to you by Bright Eyes Family Care and Bright Eyes Kids. Find previous episodes and more detailed information and BrightEyesTampa.com. Creative Commons copyright attribution non-commercial use. The only purpose of this podcast is to educate and to inform, It is no substitute for professional care by a doctor experienced in the area you require. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Please consult physician for diagnosis.

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

2017 Spring Newsletter:New Hours, Sales, Giveaway, Ortho-K, VR & more!

 

Hello, Bright Eyes Patients! Welcome to our first email update of 2017. We have so much to tell you that we’ll get right to it:

Not One But Two Spring Events

Spring EventsSpring has sprung and we have 2 big events coming up! The first is our Spring Eyewear Show on Wednesday, April 26 from 4 to 8pm. This is a trunk show of all the Banana Republic and Smith Optics eyeglasses, including sunglasses. Win a FREE pair of prescription sunglasses from Smith! The second is the Spring Cleaning Sale Monday April 24 through Friday, April 28. The doctors are away at a conference most of the week, but both offices will be open – all eyeglasses and sunglasses on sale! Read more here.

Hours Reminder

Our Westchase office has new hours: Monday, Tuesday and Thursday 9am-5pm. Wednesday is still 12-8pm, Friday 8:30am-4:30pm and Saturday 9am-2pm. See all the details here.

Big News about Ortho-K!

We have been getting more requests than ever about Ortho-K, the overnight contact lenses that allows for clear, glasses-free vision. You might have seen Dr. Nate on the news! You can read about Dr. Nate’s daughter’s own experience with Orthok-K and also read more about the process here. Treehouse Eyes is an office in Washington DC that specializes in myopia control, and they did a story on Dr. Nate’s daughter.

VR Home Therapy is Live

We are one of the first eye doctors to offer Vivid Vision Virtual Reality Vision Therapytreatment for amblyopia and strabismus, but we are now able to offer this treatment as part of a home Vision Therapy program. This is a game-changer for patients both children and adults. If you are interested, call us at 813-792-0637.

Updated Website

You may have noticed that we’ve been hard at work on our website BrightEyesTampa.com, especially pages on Myopia Control, Ortho-k, Vivid Vision and others. Check it out!

Other topics of interest from our blog

We’ve covered some important topics such as Top 10 For Screentime, Women’s Eye Health & Safety Month, Cleaning Your Glasses, The Importance Blue Light, & Eye Color.

Reviews

Finally, we want to say that we are very thankful for all the Yelp and Google reviews. Most people find us through online reviews or word-of-mouth, and as a small business, we appreciate it! If you haven’t left a review, it would mean a lot if you did.

Thanks and have a great spring! 🙂

-Dr. Nate

Bright Eyes Family and Bright Eyes Kids

A custom uploaded image.

My Daughter’s Ortho-K Journey

I wear glasses. Most people in my family wear glasses or contacts because they cannot see well at a distance. They have myopia, also known as nearsightedness. This story is similar for my wife, Cristina who is also the office manager at Bright Eyes. She and many members of her family are myopic. So it was not surprising that our older child, Nora, has also become nearsighted. She has now started orthokeratology to help keep her from become even more nearsighted. Read on to find out more about her Ortho-K journey.

Nora's First Eye Exam

Nora’s First Exam

Nora is not alone. All over the world, people are becoming more myopic and kids are needing glasses at earlier ages. At Nora’s regular eye exams (see recommendations here), I have been checking her vision carefully. Two years ago it was obvious that she was going to be become nearsighted. We had been implementing several steps to delay her impending myopia.

Finally, the summer before 4th grade during a game of “eye spy” it was evident that she was having trouble seeing clearly far away. An eye exam was scheduled and a prescription for -1.00 D glasses was written. She picked out some lovely and fun glasses before school started. She also had soft daily disposable contacts for occasional use.

Nora before Ortho-K

Nora Before Orthok

By Spring Break, Nora was squinting again even with her glasses. Indeed, her exam showed that her prescription had increased. We were ready to employ some methods to reduce the rate at which her vision was getting worse. This is called myopia control and the basic options are Ortho-k, soft multifocal contacts, and atropine eyedrops. So Cristina and I decided that it was time for Nora to do Ortho-K. We knew this time would come, it was just a matter of when it was convenient to start. We decided Spring Break was the perfect time.

The first step was to get Nora on board. After all, she liked her glasses and was not excited at first about giving them up. Cristina and I talked with her about freedom from glasses for sports and swimming. We also showed her some of these videos from YouTube. She was ready!

Nora came to Bright Eyes Kids for her Ortho-K exam. This includes more vision testing and special testing of the front part of her eyes called corneal topography. This special test allowed me to design custom NightLens Ortho-K lenses for her. They were produced in a specialized contact lens lab and sent to the office.

Nora was very excited when her Ortho-K lenses came in. At this point she was taught how to put them in and take them out safely as well as everything she needed to know about caring for her lenses. That night, she put the contacts in and went to sleep. It was surprisingly easy. The next day she came to Bright Eyes Kids for her 1-day evaluation and she was seeing 20/20! Her vision has been great ever since. She was able to do everything on her Spring Break trip including kayaking, Everglades Airboat rides, and the Trampoline park all without her glasses.

Nora After Orthok

Nora After Orthok

If you think that your child is a candidate for Ortho-K and want to find out more call us at (813)792-0637 or request an appointment.

By the way, Nora’s brother is two years younger than her and he is not nearsighted yet, but we are trying to prevent it with atropine eye drops. You can learn more about that here.

-Dr. Nate

PS – If you are an eye doctor who has employed any myopia control strategies with your kids, I’d love to talk to you about it. Email me at Doc@BrightEyesTampa.com.

 

TV News Segment on Orthokeratology and Myopia Control

The mission of Bright Eyes Family Vision Care and Bright Eyes Kids is to empower our patients by providing the best vision care possible. One of the most exciting ways that we are able to do this now is called orthokeratology. It is one of the methods used to keep children from getting more and more nearsighted. Like vision therapy, it is complicated, but very, very rewarding.

I am very happy that word of orthok and myopia control is spreading! You can see for yourself from this excellent recent news segment from 10News CBS WTSP did featuring me and a patient of Bright Eyes.

Here it is:

A HUGE THANKS to reporter Courtney Robinson She was great to work with and genuinely interested in children’s vision and the effect of screen time. She took the time to come to the office and ask many fantastic questions. You can read her whole story here.

 

I am also thrilled that my daughter, Nora, has started orthok. I will write a blog post about that next. 🙂

If you have any questions, please let us know. Use the button below or call us at (813) 792-0637. And as a reminder, orthok is not just for kids. We do have adult patients that use orthok to be free from glasses for sports or while reading their phones or other activities.

See Well!

-Dr. Nate

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Top Ten New Years Resolutions for Screen time and Kids Eyes

(Note – You can read my previous Top Ten New Year’s Resolutions for Healthy Vision for Eye Health, Children’s Vision, Saving Money on Eyecare, Myopia Control, and Computer Vision Syndrome, -Dr. Nate)

Did your child receive any gifts with screens this holiday season? Or gifts such as a movie or new video game that are viewed on screens? My kids did. And they are VERY excited about them. They are not alone. The kids that I see in my office beg, whine, wheedle, and cajole their parents into as much screen time as possible. Many of them have their own tablets. And this is incredibly common. In fact, one 2015 study found that three quarters of 4 year-olds had their own devices.

There are obvious benefits for children to use technology. They can watch educational programming, Skype with distant friends and relatives, and download STEM and creative apps. But all of this screen time can come with downsides. One is childhood obesity. Another is social awareness and skill.

Others problem associated with screen time have to do with vision. This is something I talk about all day, every day at Bright Eyes Kids. Increased screen time can put children at risk for myopia (nearsightedness). Games such as Minecraft can be great, but can cause headaches and blurry vision due to eyestrain. In fact, eyestrain from device use can actually contribute to digital eyestrain or other visual problems that can make school work more difficult and require vision therapy to treat.

10 ways to keep your child’s electronic device use healthy:

  1. Set a clear Family Media Use Plan. For example, in my house, my children are not allowed screen time before noon. It is worth reading the American Academy of Pediatrics statement on media use from October 2016 to get some ideas.
  2. Optometrists recommend that people of all ages limit screen time to 20 minute intervals. Teach your child about the 202020 rule, every 20 minutes, take a 20 second break, and focus on something 20 feet away. Every hour, take a longer break.
  3. Buy a blue light reducing screen protector for your child’s phone, computer or tablet. http://health-e.com/offers one that reduces by 30%, but they offer through select optometrists 60% reduction.
  4. Mitigate the potential damage of focusing on close images, by having your child spend 2 hours a day outside. A recent study showed a 2% reduction of Myopia progression for every hour a week spent outside, or 28% for 2 hours a day.
  5. Minimize electronic device usage at night, a recent Harvard study showed that blue light at night effects melatonin levels, which effect sleep, blood sugar levels, and may be linked to certain other diseases.
  6. Ask your doctor about computer glasses or contacts which are specially designed to reduce eye strain by reducing the visual focus needed for computer use.
  7. Create fun alternatives to electronic devices, write a list of “cool” activities to do throughout the week. Great alternatives are outdoor time, board games, and creative projects. Even things as simple as walking to grocery store can be more rewarding than most things are your child’s screen.
  8. Role model proper screen use. As always our children learn from us, if we are glued to the screen, they will be less likely to take screen limitations seriously. Make a New Year’s resolution to limit your screen time and be more present for your kids. This is hard, but important!
  9. Make sure your child’s posture is not being affected by the chair or couch they are using while watching TV or on the computer. Adolescents with high computer usage were nearly twice as likely to report neck and back pain than those with moderate use.
  10. Talk to your eye doctor if your child avoids using the computer or complains about blurred vision or eye fatigue when using a screen, as this may signify a larger issue that needs to be addressed.

Happy New Year. May 2017 be better than 2016. 🙂

-Dr. Nate

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Tell Your Kids to Go Outside: Exposure to Sunlight May Reduce Risk of Myopia.

diagram explaining myopiaBig news today for pediatric eye doctors, parents, and children! The New York Times reports exposure to sunlight may reduce the risk of developing myopia, according to a new study published in JAMA Ophthalmology. Researchers found that people “with the highest UVB exposure, especially in the teenage and young adult years, had about a 30 percent lower risk for myopia than those with the lowest exposure.”

Here is the conclusion from the study abstract:

The conclusion of the Increased UVB exposure was associated with reduced myopia, particularly in adolescence and young adulthood. The association was not altered by adjusting for education. We found no convincing evidence for a direct role of vitamin D in myopia risk. The relationship between high plasma lutein concentrations and a lower risk of myopia requires replication.

USA Today reports the researchers found that exposure to UVB “between the ages of 14 and 29 years was associated with a significant decrease in the chance of developing nearsightedness as an adult.” The article points out that a previous study found that the number of Americans with myopia between the ages of 12 and 54 increased from 25% to 41.6% from the early 1970s to the early 2000s.

child squinting and running with water balloonOne thing that was interesting, is that this was the first study that I have read that showed a correlation between lutein and myopia. From NYT, “The researchers were surprised to find that people with the highest blood levels of lutein, a nutrient found in leafy vegetables, had a 43 percent reduced risk of nearsightedness compared with those with the lowest levels.” Before we make specific recommendations, doctors will need more information about myopia and lutein. But it is always a good idea to eat more leafy green vegetables.

It is encouraging to see more research on myopia and its development. For those children who develop nearsightedness, there are treatment options that can slow or prevent worsening vision. To see if your child is at risk and find out what you can do, visit our myopia page.

-Dr. Nate

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Dr. Nate Lectures at American Academy of Orthokeratology and Myopia Control Meeting

20160410_102939Dr. Nate Bonilla-Warford just returned from the annual educational conference of the American Academy of Orthokeratology and Myopia Control (AAOMC) in Scottsdale, Az. International speakers presented on a variety of topics, but the myopia epidemic and its impact on public health, and new methods for slowing nearsightedness in kids were the top priority. Over 500 doctors attended, representing the U.S., Puerto Rico, Canada, China, Mexico, Australia, and many others.

Dr. Nate delivered two lectures at the AAOMC meeting. The first was a workshop designed to teach attending doctors different strategies of myopia control. The second was aimed at improving communication between myopia specialists and other professionals, such as pediatricians.

The AAOMC is part of the International Academy of Orthokeratology (IAO), a worldwide organization of orthokeratologists who provide a non-surgical alternative for the correction of nearsightedness, astigmatism, hyperopia, presbyopia and myopia control. Dr. Nate has been a lecturing member of AAOMC for many years.

Myopia (nearsightedness) is an epidemic disease affecting over one billion children and adults worldwide, with expectations that the number will hit 2.5 billion by 2020. Extensive research has proven that there are many methods, including ortho-k, specialized soft contacts, and prescription eye drops, that can slow the progression of nearsightedness. This can reduce the risk of retinal detachments and glaucoma as well as the social issues associated with wearing thick glasses. For more information go here or call us at (813) 792-0627.

You can find more information on myopia, orthokeratology, and to find a provider near you go to: www.orthokacademy.com.