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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.

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.

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

Schedule An Appointment

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.

 

 

Bright Eyes Kids is Coming Soon!!

Bright Eyes Kids

Bright Eyes Kids is coming soon!

Since we opened Bright Eyes Family Vision Care in 2006, the number of pediatric patients has steadily grown. At first we saw very few, but now almost half of our patients are under 18 years old. And that is no accident. After I completed my Residency in Pediatric Optometry and Binocular Vision in Chicago, I knew I wanted to work with kids. I wondered if I was crazy for moving home to Florida, the retirement capital of the world.

Well, lo and behold, there are children in Florida and many of them need eye care. So we have been planning for the last year to expand our services specifically to children. And I am now very, very happy to announce that in March we will be opening a new location specifically for children’s eye care. Called Bright Eyes Kids, it will bring the skill and care you expect from us at Bright Eyes Family Vision Care to New Tampa and be tailored specifically for children!

Why New Tampa? Well there are many reasons. The first is that we frequently have patients that come from areas such as Gainesville, Winter Haven, and other places east of Tampa. Located near I-75, the new office will be much more accessible for patients because they will not have to drive all the way across town. Another reason is that my family and close relatives actually live in the New Tampa area and it will be great to practice closer to home. The new address is 15303 Amberly Drive, Suite C, Tampa, FL 33647.

What will be offering at Bright Eyes Kids? Eye exams for infants, toddlers, and gradeschoolers and teens. We will be fitting contact lenses and specialty glasses for young kids. We will have an expanded area to offer vision therapy, to help children develop the visual skills they need to be successful at school and life. We will offer orthokeratology for kids who want 20/20 vision all day while not wearing glasses or contacts.

But don’t worry – nothing will change at Bright Eyes Family Vision Care in Westchase. I will still be seeing patients there regularly and we will. Moms, grandpas and other adults are welcome to come see us there!

Now, please. Help us making Bright Eyes Kids the best it can be by completing this very, very short survey. While we are finalizing details about the new office, this is your chance to help us get them right. Click here to take the brief survey.

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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Happy Orthokeratology Patients at Bright Eyes

Orthokeratology goes by many names…. Ortho-k, corneal refractive therapy, Gentle Vision Shaping, corneal molding, and others. At Bright Eyes Family Vision Care, we tend to call it corneal reshaping or Orthokeratology. But regardless of whatever terms we choose to call it, our patients call it “awesome!”

Watch for yourself:

(Click here to watch on Youtube).

This last weekend I was fortunate enough to attend and speak at the Orthokeratology Academy of America (OAA) educational conference. The OAA is an international organization of orthokeratologists who provide a nonsurgical alternative to refractive surgery for nearsightedness, astigmatism and hyperopia. Current research also shows that Ortho-K can slow myopic progression in children.

The international faculty of presenters covered topics including myopia control (including soft lens technology), corneal reshaping research, safety of corneal reshaping, progressive/hyperopic Ortho-K lens designs, new corneal reshaping techniques. I heard speakers from Australia, Japan, China, Italy, Spain, and from all over the US.

President Dr. Cary Herzberg had the pleasure of announcing the inception of the new International Academy of Orthokeratology(IAO). The IAO brings together ortho-K organizations from the America (OAA) as well and Europe and Asia. This international organization will support, promote and advance corneal reshaping worldwide thru quality education and research presentations at meetings held around the world. For more information about the OAA click here.

At Bright Eyes, we have successfully treated patients from 7 to 59 years old with orthokeratology. This includes pilots, lawyers, retirees, and lots of kids like Christopher (above). If you would like more information about Orthokeratology, call our office in Westchase at 813-792-0637 or visit http://BrightEyesOrthoK.com

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Interview with Nick Despotidis, O.D. about Corneal Reshaping

[ I haven’t written much for the blog in the last couple of weeks. Mostly I’ve been busy with Javier and Nora. You can see some of Javier’s pictures on Flickr here: http://bit.ly/1MFiuw – Dr. B].

I am very excited to bring you this interview with Nick Despotidis, O.D. (Dr. D). He is one of my mentors in the orthokeratology/corneal reshaping field. He has written, researched, lectured on the subject for many years. I have attended several of his lectures and have always been impressed with his insight and enthusiasm. I was even more impressed when I read his book “My Children are Nearsighted, Too.” Dr. D practices in Hamilton Square, New Jersey.

Dr. B. Writing a book takes a lot of effort. What prompted you to write a book and not just a large pamphlet?

Dr. D. : As health professionals, we often get asked similar questions from patients. However, nothing seems to elicit as much emotion as when parents are discussing their children’s vision. Seeing the concern or sheer disappointment on a parent’s face when I tell them their child needs glasses still moves me, even after twenty years in practice.

Parents often ask: “Why so young? Do they have to wear glasses all the time? Is this inherited? Is it going to get worse? What can be done?” My explanation and subsequent recommendations take time, time we often don’t have while in the examination room, yet parents deserve.

So now I actually give my patients a copy of our book and highlight specific sections I want them to read. Then, after they develop a good background and learn the answers to many of their questions, we discuss how to help their son or daughter. It’s worked amazingly well. I’m very proud after parents tell me how much the book has helped them understand vision and given them an arsenal of recommendations.<

As a parent myself I appreciate the frustration of being told my child requires some type of treatment without fully understanding my options. The book was written to empower parents when it comes to their children’s eyesight.


How long did it take for beginning to end?

Two years!

As an early adopter of corneal reshaping, did you initially suspect that myopia control was going to be as successful as it has recently been shown to be?

No. In 1992 when it was first introduced into our office it was just viewed as a substitute for daytime contact lenses or glasses. That’s it. We reserved recommending corneal reshaping for patients who could not wear contacts during the day or required freedom from contact lenses or eyeglasses during their waking hours. So we had a lot of athletes, teachers and executives wearing the lens, but it was a select few.

However, clinically we observed that teenage athletes wearing the lenses did not need changes to their prescription every year like many of our eyeglass or contact lens wearing patients. In 1998 when my own two sons began wearing eyeglasses, that’s when the light turned out. You see, even though I prescribe eyeglasses daily, when my young children needed eyeglasses, I was upset, even distraught. Seeing the success they’ve had with corneal reshaping inspired me to become an “early adopter” or advocate of this technology.

If corneal reshaping is such a positive and exciting technology, one that may help thousands of young children from having their eyesight worsen, why don’t all doctors provide this service?

That’s a great question, one I get asked daily! Most eye doctors are not familiar with corneal reshaping even though Paragon Vision Sciences, the maker of the CRT design, received FDA approval over 9 years ago! Some doctors may base their opinion on outdated information or personal experience.

As a “seasoned” health provider I understand how long new procedures take to enter mainstream medical offices. But that does not make it fair or right. For example, it took over 30 years for data to arise that a child’s eye coordination skills may affect their ability to read and consequently learn. Even though I understood this in my early training days it took decades to become “accepted.” And even today some practitioners are not on board. Corneal reshaping faces the same challenge. In addition to understanding the technology, doctors need to enjoy seeing patients more often than their contact lens and eyeglass wearing patients. This is often not the case.

Lastly, there is a higher level of technology and training required to perform corneal reshaping properly. Doctors may not be interested enough to upgrade their offices to provide this service.

I personally overcame these apprehensions when I saw how well corneal reshaping helped my own sons. Now, literally 10 years after they started wearing these lenses, their eyesight has not gotten worse. Nothing more needs to be said.


What is your next project?

I’m writing a personal development book extolling the life lessons I’ve acquired as a husband, parent, doctor and philanthropist.


Thanks, Dr. Despotidis, for taking the time. I wish yoy, your family, and your patients the best.


You can read more about Dr. Despotidis and orthokeratology at: http://www.gentlevisionshaping.com/. If you have questions about whether or not corneal reshaping is right for your or child, feel free to contact Bright Eyes at the contact info below or call 813-792-0637.

Be Well!

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

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Ortho-K: Possible Method of Slowing the Progression of Myopia in Children (SMART Trial)

Ahah! I was scooped on this story by one of my favorite bloggers, Ann Z. from LittleFourEyes. I was going to write a post about this exciting news today, but since she already has. Check it out here.

I Will leave you with a quote from yesterday’s press release:

According to Dr. S. Barry Eiden the trial will also investigate why these special lenses may be effective in slowing myopia.

“Current thinking suggests that these CRT lenses flatten the cornea but other evidence suggests that these lenses may influence the growth in eyeball length (termed axial length). A major contributor to progressive nearsightedness is axial length elongation. Corneal reshaping may actually result in decreased axial length growth. The exact mechanism by which this happens is still being investigated” said Dr. Eiden.

“The results of the SMART Study so far are very exciting,” said Dr. Davis. “The outcomes of this study may revolutionize how we manage young nearsighted patients from this point forward”.

You can go to the SMART study facebook page to find more information.You can also watch a news report on the study here.

It should also be noted that the SMART study is building on additional recent studies that have also found that Orthokeratology has been successful in slowly the progression of myopia.

To find orthokeratology doctors in Tampa and elsewhere: go to the Orthokeratology Academy of America. If you are curious, feel free to call or come in for our no-cost consultation to determine if you are candidate.

Be Well.

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

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Nighttime contact lenses show promise in controlling nearsightedness

There is increasing clinical evidence that orthokeratology is an effective method of reduce myopic progression. The latest study, the SMART (Stabilization of Myopia by Accelerated Reshaping Technique) Trial, a national study led by Chicago researchers Drs. S. Barry Eiden and Robert Davis, adds additional evidence:

“At the end of one year, the test group was absolutely rock solid, no progression (of nearsightedness) at all,” Eiden said. “The control group had two power steps of progression on average.” One power step equals a change of .25 diopters in prescription strength.

If the study’s hypothesis holds up, children with mild nearsightedness could have healthier eyes as adults, with a greater chance of successful LASIK, vision-correcting surgery and less risk of retinal complications later in life, Eiden said.

This is exciting because many parents ask me about methods to reduce or eliminate the development of nearsightedness. This study is far from over, but it appears to be supporting the efficacy of orthokeratology as a means to control myopia.

Bright Eyes is one of the few offices in Tampa and the only in Westchase to offer orthokeratology. If you have any questions about orthokeratology, or whether or not you or your children are candidates, contact the office at 813-792-0637.

Be Well!

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Dr Nate Google PlusBright Eyes Tampa on Google PlacesBright Eyes Tampa on FacebookBright Eyes Tampa on TwitterBright Eyes Tampa on YelpBright Eyes Tampa on foursquareWestchase Patch

Video on Children’s Ortho-k

While people are now learning about Corneal Reshaping, or Orthokeratology, here in the United States, it has been very popular in Asia for quite some time. This is due to the fact that there is a very high prevalence of myopia in many Asian countries and corneal reshaping has been shown to not only temporarily eliminate nearsightedness, but can also reduce its progression.

This 7 minute video was not made in Tampa, but in Asia where ortho-k is very popular, so the girls speak little English. Still, the video demonstrates how well two young girls do with the reshaping lenses. One girl is quite young and gets help from her parents. Another girl is perhaps 8 or 9 years old and shows how well she handles the lenses by herself.

Click here

Be well!

Dr. Nate

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.