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