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Podcast Episode #17: Vision and Learning with Wendy Taylor, M. Ed

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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 vision and learning with Wendy Taylor from Learning Essentials.

Cross posted from the IEP Pro Tips Podcast.

You can listen in the player below or read the transcript. The show is available via Stitcher, 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.

 

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Full Transcript:

[00:00:10.040] – Intro

Welcome to The Bright Eyes podcast: advice for healthy vision for all ages. Your host are Dr. Nate Bonilla- Warford and Dr. Beth Knighton, two optometrist who really see “eye to eye”. They can help you get perspective of the latest visual scientific evidence for improving your vision and helping you “keep your eye on the ball”. We have real facts and (aqueous) humor without making “spectacles of ourselves.” And don’t worry, the jokes don’t get any “cornea”.

[00:00:39.150] – Dr. Nate

From Rainy Tampa Bay, Florida. It’s The Bright Eyes podcast. You might be able to hear the thunder in the background. This is episode number 17, I’m Dr. Nate Bonilla-Warford, and today’s episode is a special one. It is all about vision and learning. This episode is actually being cross posted from the podcast IEP Essentials Pro Tips with Windy Taylor. Wendy is the executive director of Learning Essentials an online resource for parents with a mission to understand and meet the educational needs of each child by creating a playbook for learning.

[00:01:16.870] – Dr. Nate

Learning Essentials incorporates one on one tutoring, interactive brain camps, informative workshops, and creative professional development programs to promote learning success for students. I really enjoyed this conversation. Wendy is very knowledgeable. She’s got her Masters in Education and she contacted me via Instagram about being a guest on her wonderful podcast that is packed with information about IEPs special population students, College readiness, and so much more. We talked about how important vision is for learning things parents need to know and about vision therapy. So without further Ado, here is our discussion.

[00:02:05.140] – IEP Essentials Intro

Hello and welcome to IEP Essentials Pro Tips Podcast brought to you by Learning Essentials. Learning Essentials offer special education-based tutoring in your home by state certified educators with advanced degrees in all areas of special education. IEP Essentials Pro Tips Podcast bring professionals together to educate and empower families navigating special education needs in the IEP driver.

[00:02:32.120] – Wendy Taylor

Welcome to IEP Essentials Pro Tips Podcast. I am your host, Wendy Taylor, to follow us on social, you can find us on Instagram at Learning Essentials. Today, we’re talking about empowerment through vision with Dr. Nate. Dr. Nate received his doctorate of optometry from Illinois College of Optometry, located in Chicago, Illinois, In 2004. The following year, he completed a residency program specializing in pediatric and binocular vision at the Illinois College of Optometry. During his Optometric internship, he studied development division in Denver, Colorado, in contact lenses and Ocular disease in Chicago, Illinois.

[00:03:17.400] – Wendy Taylor

Owing to his passion for improving the vision of children, Dr. Nate has published articles on such topics as the use of vision therapy to improve reading skills, and has lectured to optometry students and paraprofessionals, as well as the general public on visual care of children, the importance of vision in personal development and options for controlling nearsightedness. Dr. Nate was always smart as a student in Florida public schools but was a slow reader and standardized test were intimidating. He always had to work very hard in high school and at University of Florida, when it came to courses at the Illinois College of Optometry, he failed a class because he could not perform the eye exam techniques. One of his faculty members suspected that the root cause was that he had a functional vision problem. This was identified and treated and passed the course! Dr. Nate fell in love with functional vision and made it his life goal to help as many people of all ages as possible. He now practices in Tampa, Florida, at his practices Bright Eyes, Family vision Care and Bright Eyes kids. Welcome, Dr. Nate, and thank you so much for joining us.

[00:04:30.760] – Dr. Nate

Thank you, Wendy. I’m really honored to be invited, and I’m excited about our conversation.

[00:04:37.280] – Wendy Taylor

Absolutely. Let’s dive right in. So can you just tell me what is vision therapy? There’s a lot out there on the topic, but I would love to hear from an expert such as yourself of what vision therapy is, right.

[00:04:49.820] – Dr. Nate

So vision therapy is a little bit of a catch all term for anything that we can do as professionals to help empower patients to take control of their own visual system. So it’s basically kind of like being an eye coach where we teach children of all different abilities how to increase their awareness of visual perception, how to increase their fine motor visual skill, how to basically use their eyes better to improve their quality of life and meet their goals. And sometimes that is more centered around at academic success.

[00:05:37.520] – Dr. Nate

Sometimes it’s more centered around their quality of life and comfort if they’re either having headaches or other vision and type related problems, or sometimes it’s more to do with sports, competitiveness and achievement. So it’s a series of activities that are individualized and programmed to help individuals meet their goals.

[00:06:02.290] – Wendy Taylor

Does it involve more the physical or a cognitive approach?

[00:06:06.880] – Dr. Nate

Well, like almost everything that I’m probably going to say when we’re talking about patients, it absolutely depends on the individual patient and their diagnosis. A lot of it is physical or at least rooted in physical because of the visual system. The way our eyes learn to perform is really rooted in movement and development. And so a lot of the type of stimulation that kids get as infants, when we’re talking about tummy time and crawling and lots of bilateral activities and stimulation, all of that kind of gross motor and body awareness sort of sets the tone for visual fine motor skill, which in turn affects the visual perceptual skill. So it sort of depends on where the patient is on that continuum. So if they’re really, really having problems with tracking or what I would call ocular motor dysfunction, then. And we spend a whole lot of time on gross motor body awareness and then work towards eye movement. Fine control, if they’re fine movement control and their visual focusing, et cetera, is really good, but they do have visual information processing or perceptual deficits, then it’s a lot less body movement and a lot more worksheets and cognitive kind of skill development. So it just really depends on the patient.

[00:07:48.440] – Wendy Taylor

If the focus was kind of more school readiness reading that impacts in the classroom, can you walk me through what a session would look like?

[00:07:58.560] – Dr. Nate

Sure. So if I can set the scene just briefly, very many of our patients do not have isolated visual dysfunction or isolated vision problems. Vision is just sort of one piece of a big puzzle of the complex nature of patients. So many any of our patients have gone through sort of a sequence in their life, maybe around two or 3. They might have had some speech therapy, maybe a little bit older. They might have had some OT. And then as they’re sort of getting ready for school readiness, and especially around the ages of seven and eight, if their vision isn’t really quite performing as well as they need to for or the type of academic demands copying from the board, sustained reading, especially nowadays. There’s so much technology both in the classroom and at home, not even counting the e learners, but even the ones who are in classrooms. So technology base these days. So that’s sort of like our bread and butter most common patient. Of course, there’s differences. So for that kind of patient, a typical session would look like this. They would have one therapist that’s pretty much through with them the whole program to develop a very close relationship with that patient. And the therapists really get to know the ins and outs of their lives and kind of what they’re going through. So they would sort of get kind of warmed up and sort of socialize a little bit. They would usually take their shoes off, and then they would kind of go over. Okay. How did you do with the activities that we assigned you at home? Although we do sessions for 45 minutes once a week, the real benefit of the therapy is the fact that they do about 15 minutes, five days a week at home, because that gives them ownership of what they’re doing at whatever skill level they’re at. It could be very, very low.

[00:10:00.000] – Dr. Nate

The fact that this is something that they are doing and they are making connections means it’s not something that we are doing to them. They don’t just show up, and we infuse them with vision therapy. We’re teaching them skills that they then can practice. That review of what they’ve done at home is absolutely critical for each individual session. Then we take those sessions and those skills that they’ve been working on, and we increase the difficulty a tiny bit, just enough to where your audience? I’m sure it’s very familiar with this, but it’s all about finding that sweet spot for individual patients too easy, and it’s boring or it’s insulting, even if it’s way too easy, too hard. And then it’s just, like, frustrating, and they hate it. So you got to challenge them just enough. And that’s really where vision therapists really shine is just really knowing is every patient is different and every day is different. They could be not us left. Well, or they could have a change in medication. I mean, there’s just so many different variables.

[00:10:59.480] – Wendy Taylor

So sounds like the classroom.

[00:11:01.060] – Dr. Nate

Yeah, absolutely. It’s literally it’s like an informal classroom, and we vary it a lot. There’s an acronym we use called Love, and it’s called Lots of Variety in Everything. So we work on individual skills, but in so many different ways that the patient and their brain never gets bored because we’re constantly trying to stimulate them in a variety of ways. And then we prep them to send that home, and then they work on it at home.

[00:11:31.010] – Wendy Taylor

It’s so true in terms of finding that sweet spot. And then we say that as a special agent and educators in general, just trying to find that sweet spot. So the kids aren’t bored, but they’re not frustrated and shut down. And it is that delicate balance and dance, for sure. How our vision issues diagnosed beyond a simple vision test, kids get a vision test just their basic intro. And then how when would a parent know that something deeper has happened?

[00:11:57.780] – Dr. Nate

So that’s a fantastic question. And I want to say one tiny caveat, and that is where it absolutely never shows up. Almost never is in any sort of vision screening at either a pediatrician’s office or a school screening, because those aren’t even designed to pick up those kinds of problems. Those screenings are designed specifically to pick up kids who are near sided or myopic the kids who are having trouble seeing the board. Well, the reason why that is silly, in my professional opinion, is the kids who are near sighted, the ones who are bookworms, the ones who are myopic, they tend to, on average, be advanced performers like those are the ones who are doing really well.

[00:12:41.750] – Dr. Nate

It’s the ones who are farsighted or have functional vision problems, who pass all the screenings but are Super struggling when it comes to reading development and other issues. And so right off the bat, screenings don’t count. Just get that out there. Now, the second thing is for most people can see. Our listeners can see, but I can see you are wearing glasses. So the chances are really good that you’ve had an eye exam at some point in your life. And the purposes of that are primarily number one, to make sure your eyes are healthy and if not to treat it, figure it out what’s going on. And to make sure that you can see 20/20 at distance in year. And that’s pretty much all it is, and it’s pretty fast, and it’s pretty efficient because most people that is a certain model. That makes a lot of sense. Doctors know it. Patients know it everything just sort of works. What I’m talking about for these sorts of evaluations, I like to call it a visual stress test. It’s like a treadmill test for cardio patients, except for it’s for the visual system. So it’s not necessarily can you see 20/20 that’s necessary, but not sufficient for school readiness. But it’s all about… When we ask your eyes to work, how well do they work, and how well are they able to sustain extended hard work? Because it’s one thing, if kids eyes can do it for 15 seconds in the exam chair, boom, your eyes can move. Your eyes can focus. Great. You’re all good. It’s another thing if they can do it for two hours or eight hours. And Here’s the key thing, as I’m going to say over and over and over again, every child is different.

 

[00:14:25.700] – Dr. Nate

Every person is different. So when some people are challenged visually, some people’s eyes just shut down. They just shut off. They’re just like, no, I’m not doing this. I’m done. I’m checking out. Some people go into, like, way over drive. They have, like a hair trigger, everything just like, absolutely maxes out in red lines. And they also can’t function, but they present with different symptoms. There’s other people who go into sort of like, for lack of a better word for the audience, sort of like denial, meaning they just sort of like they have all of these problems, but their brain filters all of them out, and they perform terribly on exams, but they don’t present with the same kind of symptoms because they just are sort of checked out from their vision entirely. So these exams are longer and they’re all a lot more about observation. How are they doing these different things? When I ask them to look at something up close, are they holding it Super close? Are they getting really, really tense? Is their breathing getting, like, Super shallow, or do they just look at it and be like, Yeah, I can see it. Now. We also have very specific tools. We have flashlights called retinoscopes and all of these other fancy things, which allows me, as a developmental optometrist to look and see where they are focusing.

[00:15:51.430] – Dr. Nate

And this is absolutely key so I really kind of want to talk about this for a few seconds. There are lots and lots of times where children of all ages, but especially patients who have different types of developmental disabilities look at something, say it’s a paper in their hand, and they think they are looking at it. But their eyes, because of their poor, fine motor control, their eyes are actually focused either far away or about a foot or two behind it. And I can see that with my flashlight. I know literally where they’re focusing. Or Conversely, they could be looking at the board, and they think they’re looking at the board, but their eyes are still focused on the page. So it’s all blurry and frustrating for them, even though they can see 20/20 and their eyes are healthy. So there’s lots of different ways that we evaluate that sort of autofocus system. And I talked about eye tracking a little bit. That’s the most intuitive for parents, because if they can see that their kids eyes are just not pointing where they need to, if they’re just kind of like all over the place, people kind of intuitively understand that.

[00:16:56.810] – Dr. Nate

And then the last part that I’ll mention is the way the eyes work together, depth perception. If both of you eyes are pointing at the same place, they’re sending the same information to the brain. The brain can process that spatial awareness, and we have ways to evaluate that. So the whole process is like, depending on the patient, like, an hour. I mean, it’s a lot of work. And I always ask parents when I talk to them afterwards, how was your kid after when you got in the car and you went home? Because a lot of kids, well, they’re eager to please. They’re great, great, great kids. So they hold it together in here and they work and they do everything I ask, and they smile and they’re Super sweet and they’re great. And they get in the car and they absolutely fall apart because it is so difficult. They have headaches, they’re exhausted. And if you just watch them, it doesn’t seem like any of this is difficult because they’re just sitting in the chair looking around like it’s not like I’m asking them to do push ups, but it’s so hard for them to coordinate this much effort. And I wouldn’t know it because they’re so good at asking it and being delightful that it’s only when they leave. And the parents say, like, Yeah, he was like toast.

[00:18:06.730] – Wendy Taylor

it’s fascinating to me, this whole conversation, we could speak many hours on this topic. Absolutely. And that’s why I’m so excited to have you here and just thinking about my special education lens. Right. So you have parents as being in a classroom and then now doing the support that I do through educational therapy, an IEP coaching. You have parents say something’s happening, and you’re absolutely right. You mentioned the kids have had maybe speech or T or P parents are just trying to figure out something is happening, something’s going on, and that fatigue is so real and agreeing with what you’re saying in terms of you have these kids, they’re in class.

[00:18:50.770] – Wendy Taylor

I’m just thinking of what you’re explaining as you’re doing your process. But I see these kids in class and they’re lovely and working so hard, but then they’re so fatigued and they fall apart and and it’s trying to figure out what is happening. How would a parent know? How would a teacher now to refer to a visual exam? What would that be called? What are they looking for? What are they asking for? Because I’m sure this is not something like a neuropsych is not going to pick up on this or what.

[00:19:22.220] – Dr. Nate

Well, yes and no. Where the neuropsych evaluation may pick up on. It is the non verbal section, because there’s definitely only some visual processing and spatial awareness things that happen during that evaluation. And the challenge that I see parents having with that specifically is the neuropsych evaluation is great, and I encourage it frequently, so I don’t want anything I’m saying to sound anything other than positive, but the frustration the parents sometimes have is okay. They do poorly and the non verbal section and there are some accommodations, but there often isn’t, like a next step, like, okay, so how do we improve this situation?

[00:20:15.220] – Dr. Nate

And I don’t know. I know some, but I don’t know all of them. I don’t even know a lot of school psychologists or pediatric psychologists to have that conversation a lot. But anyway, that’s one way. It’s not the most common way, but it’s the most common way. There are some very classic tail tail signs, for example, headaches if the child never wakes up with a headache, but often gets a headache in the afternoon, especially if it’s pretty highly correlated with visual work, especially like up close work, either tablet or screen work, and then it kind of goes away when they’re done, especially if it starts in the forehead and maybe sort of goes around to the temples.

[00:21:06.940] – Speaker 1

Not always. There’s a zillion reasons for headaches, but vision is a big one. You know, if they’re doing a lot of rubbing their eyes, not when they’re tired, because everybody does that when they’re tired. But I mean, just like, in general, that’s a red flag. But honestly, I want to say two things about this, if kids just look like they are just not able to kind of do the work, if they sort of start off strong, and then 10 minutes later, they sort of drift out. This is where it absolutely looks like to parents, not to give dad the bad rap because I’m a dad, but to dad, it it can look like they’re just being lazy and even to teachers, and honestly, even to excellent special Ed teachers. If you don’t realize how hard. These kids have to work. It can just sort of appear like they’re just kind of not interested. Like they’re just not applying themselves, even though they’re doing their very, very, very best. Quick caveat, I’ll just say is that little window before they kind of lose confidence. Like at first they’re working really hard and they’re into it, and then eventually they sort of like, Oh, maybe I am just dumb. Like, maybe I just shouldn’t expect myself to do this. Like catching them before then is like, absolutely critical. But that’s a whole other thing. So I would say any of those are key. Now I will say this and you can put a link in the show notes. I think you will. But there’s an organization called College of Optometrists in Vision Development. Cod org is their website, and they have a symptoms checklist that has been very well studied and vetted. They have normative data and what you can do, you can use it in two different ways. One, you can just sort of look through the checklist and see. I wonder how much this sort of its my child. Now, the younger they are, the more they’re going to Act like immature people because they are. So you have to take that into account. But you can also click on the buttons and get a number. And then there are doctors there that the website can kind of connect you with on one of them, but there’s tons of them. Then you can see if you really need a a thorough pediatric evaluation.

[00:23:28.450] – Wendy Taylor

What an excellent resource. Thank you for sharing that. I absolutely put that in our show notes. Does vision therapy have the ability to permanently fix issues, or does it provide strategies to help children overcome the obstacles? So in other words, does vision therapy provide more of a cure or treatment?

[00:23:43.480] – Dr. Nate

So like everything, it depends. So I like to break it this way. This is not true in the very most literal sense, but I like to break it down this way to parents, because I think most parents understand this. It depends if they have more of a hardware problem or software problem. So if it’s a software problem, meaning their brain just never quite calibrated their eyes, they think they’re moving to from one word to another, but they’re actually moving three words down. And so they’re skipping, and then there’s gaps. But they do it so often that their brain sort of filters it out and think that that’s just how you read, then that’s the type of problem that by improving their awareness, by calibrating their eyes. When I move this much, it looks like this, and it feels like this. And with enough practice, I can not only do it, but I can do it over a period of time, and I can develop my stamina. And then eventually I can do it while I multi tasking and I can do it long problem solving, and I can even do it while the teacher is talking. And I’m really thinking about a thought, but I’m still copying from the board at the same time, all of that is happening. So that is an absolute permanent fix. Similarly, with the auto focus issue, if they can’t copy from the board because it’s just too blurry, they can see the board perfectly fine. But then they look down at their page and then they look up at the board, and then it’s blurry because they focused on their page. Those problems are totally fixable. We fix them. Then we give them some maintenance therapy afterwards, and then they come back. Three months later, we quantify all of the exam tests. We confirm, Yes, you’re exactly as good as you. You’re need to be your exactly average or above average because you’ve sustained it for three months. It’s assumed that unless if you have some sort of event which we can also talk about, then you’re done, you’re fixed. If it’s a hardware problem. Meaning they either have a physical issue with the muscles of their eyes the way they were developed, or they have, like an actual either congenital or developmental genetic condition with the way their brain processes information, then it’s not going to be a fix. It’s going to be adaptive. It’s going to be. How can we help you live with this? So it minimizes adverse effects to your quality of life? And I’ll say one more thing about that, which applies to all of our patients, is just as important as developing skills. Is developing good habits because they’re not going to be our patients for the rest of their life. They’re going to move way. They’re going to eventually go high school are going to go somewhere else. Different things are going to happen.

[00:26:26.830] – Dr. Nate

So the more we can teach them good visual habits to reduce eye strain and reduce the types of problems that they are likely to develop, then the better it is for them in the long term. And I spend a lot of time talking about “the race.” . To me, the race is… Okay. Like, life is stressful, and school is stressful. And even video games are stressful visually. And all of that stress is not great for us, visually speaking. Meaning we develop bad habits. We adopt for posture, we develop all of these issues. And so all of that is going to create problems also through just natural development from living because we’re smart and our kids are amazing, they’re going to slowly improve. The question is, which is going to grow more. Is there a natural development going to outstrip the rate of problems that they’re going to have? A school gets more demanding, and they have to go from reading individual pages to chapter books or not. And so the whole point about vision therapy is to make sure that they win that race. It all boils down to just that, or at least not make sure, but give them every possible advantage they can to win that race.

[00:27:42.180] – Wendy Taylor

Are there certain vision conditions linked to academic difficulties?

[00:27:46.120] – Dr. Nate

Yes. So there’s a couple of different ways to talk about this. There was a paper done by one of my all time favorite optometrist vision scientists from Ohio, and what he did is he had gone through, I don’t know, hundreds of students who had IEPs and then did very thorough, like visual evaluations and kind of correlated that with just sort of like a pool of, like, normal or neurotypical kids. And there were some interesting findings there, because definitely the kids who were in the IEP needed glasses more often, especially for far sightedness or hyperopia, the word would be used.

[00:28:33.450] – Dr. Nate

They also had more challenges with amblyopia and Prisms, what most people would call lazy eye. We don’t say lazy eye, but that just basically means the eyes aren’t working together. They may not be aligned in one, I may dominate the other. So absolutely. Those types of conditions appear significantly more frequently in the IEP population than in sort of the mainstream population. So that’s just sort of kind of one way to look at it. But on an individual basis. Yes. When children have a lot of these, quote, software problems because it just makes it a lot more work for them, it doesn’t mean that they can’t read.

[00:29:21.290] – Dr. Nate

It doesn’t mean that they never learned to read properly. But if their eyes aren’t really calibrated for tracking and they make so many mistakes when they’re reading, that they have to kind of go back and reread it so dramatically increases how much time they need and how much fatigue they experience when they read. And there’s basically correlates to that to the auto focusing system. The word optometrist use is accommodation, but never use that word because it means totally different things to you and everybody listening to this. So I use auto focus instead of that word, even though that’s the word. So when we write reports, we’re really careful to try to distinguish the two. So those are exactly the type of problems that we look for. But one more thing, and that is there’s a whole other group of people who have problems, and they’re not really necessarily the people who would be listening to this podcast because those are the academic overachievers. Those are the ones who are, like, gifted, straight as Super motivated. And then what they do is they wind up through overuse and stress at an older age, more like high school instead of Elementary school, creating a whole set of other developmental problems.

[00:30:44.850] – Dr. Nate

We don’t need to get into the details of that. But my point is that also affects school work, because if you get headaches so quickly and you just can’t even get your homework done when you’re used to getting straight A’s, that’s devastating for high achieving kids because they work so hard to get it done. It’s missed forever. They fall through the cracks because nobody knows how hard they’re working, because to everybody, they’re smiling and they’re polite and they’re getting straight A’s and they’re also playing sports, and they’re also learning violin. You know what I mean? So why would they possibly be having any problems, but they just can’t hold it together forever. So anyway, that’s a different group of people, but they’re a group that sometimes has a lot of problems.

[00:31:31.160] – Wendy Taylor

What are the more common learning related vision disorders?

[00:31:34.980] – Dr. Nate

Mostly what I’ve been talking about are the physiological or functional kind of mechanical things, like the brain sends signals to the muscles. Do the eye muscles have sufficient fine motor skills to kind of do what they need to do? But there’s a whole separate category, visual information processing or perceptual visual perceptual skill. And this does sometimes come up in neuropsych reports. And it very often comes up in occupational therapist evaluations. And this is less about, like I said, how the eye muscles work. But it’s more about, for lack of a better word, like how visually overwhelmed kids get, because there’s probably lots of parents and professionals who would be listening to this who are familiar with the kid who on a flash card will get the word every time 10 out of 10 times. Totally, totally get it. But then you put that exact same word in a small paragraph, and then all of a sudden they’re just like, Oh, my gosh, I have no idea. Now I have to either try to sound it out or I have to I have to, like, recall, or I just skip it all together because or the most common of all is I just guess I see the first letter is B. And so I’m just going to throw in any word that begins with B, you know what I mean? And so kind of what they may be having a problem with is visual figure ground, meaning they can see the whole thing, but they have a block or a delay in being able to pull out the most relevant thing at that moment. And when you’re reading, the most relevant thing changes every second because you’re going from word to word to word to word, and it just becomes so completely overwhelming. That is really, really difficult. Visual memory is another one, and that’s pretty intuitive to people. Some people just have a very hard time looking at something and sort of like making a picture of it in their mind and then being able to recall it later.

[00:33:37.920] – Dr. Nate

Most people sort of think intuitively get that. Another part of it is visual closure. So that’s taking a bunch of individual things and making one mental object out of it. So if you see three dots, just three dots, you can look at it and sort of like, Oh, that’s a triangle. And it could be a triangle and different. And then your mind doesn’t have to work as hard because you just sort of remember triangle instead of three separate things, there’s a kind of a famous that’s famous to me, optical illusion, which when you first look at it, looks like random rectangles, just sort of screw in about. But then when you put it together, it says Love, because you can sort of see the individual blocks, and then you can see, like in the contrast, actually, the space in between all those spells out. Love, this visuals closure skill is absolutely important for learning to read because the whole well, I mean, I’m not a reading specialist, and I don’t claim to be. But if you look at a word, especially one that’s long, it’s like seven letters long. And what you physically see in your mind are a lot of lines with sticks and crosses and little loops. And then you have to look at each one individually, but you don’t visually group it into one object, which is a word. It makes it much harder. So those are all types of things that we would test for. And then we would help patients with. And then we would re test with the idea that as they develop these visual skills, they would become more proficient at reading. So just to be Super clear, I don’t ever promise anything, because these patients very often have other challenges. But if we can solve part of these problems, then all of the other resources and everything that you are so fantastic about and all the people in the system, all of that just makes their job easier. And it makes it less frustrating for the patient. And they do feel empowered because they’re like, Oh, look, this is a tiny piece of it that I absolutely learned how to control myself. And I have all these skills, and I have this little tool belt or I have more tools to put in my tool belt. And so that’s kind of how that fits together.

[00:36:01.640] – Wendy Taylor

It certainly sounds that vision therapy can definitely help kiddos with their academic success. How often? And I’m sure it depends on the individual patient client. How often will they participate in vision therapy? So they come to you and they do the process. And then what does that? So a segment look like.

[00:36:23.020] – Dr. Nate

So it highly, highly depends. The patients who are referred to us from a psychologist or an occupational therapist or another another optometrist. They are very, very often kind of in a growth mindset where they, like, understand like, Oh, this is like another piece of the puzzle. And so this is something that we can do that makes sense. And the good news is unlike a lot of other sort of developmental type, therapies I mean, because occupational therapy, which is the closest analog to what I do, is so broad that can go on for years because there’s always sort of a next stage where they could do more. But this is a lot more defined. So this is usually like it’s not a trivial amount of time, but it’s more like six months. It’s like, okay, we’re going to do this for a short amount of time. It’s going to pay off long term. So the patients who kind of come in that way very, very, very often they will do it. And if they can’t do it because they travel from long distances nowadays, we can do it online. It’s not quite the same, but we’ve adapted really well. And so we can do a lot of it online, and that helps. One of the downsides is most of the medical insurance plans cover our kind of service correlate, if at all. And so that is an absolute kind of barrier for lots of patients. And so we kind of have systems to where we sort of make it as accessible as possible because everything is individualized. There’s ways that we can see patients once a month instead of once a week, and we can give them a lot more, like, information that they can do on their own. We can prescribe other kind of short term things. Or one of my favorite things to do is if they’re already in occupational therapy and they’re young and they don’t have extra business amblyopia, but they might have, like, an Ocular motor problem is then just kind of work with their OT, like, OTs are fantastic. Like, I can sort of tell them, Hey, if you include these sorts of things into what you’re already doing, and I’ll say come back in six months, and we’ll sort of see one of the things that I don’t know the history necessarily.

[00:38:53.910] – Dr. Nate

But unlike speech, that this doesn’t exist in schools at all. There are teachers for the visually impaired, you know, there’s, like, visual assistants, but not not this exact thing. And so that’s a big kind of barrier for a lot of patients. And then one more thing is if patients just kind of come in and parents don’t know any of this, and they think the absolute worst case scenario is that their child is going to be prescribed glasses, and that’s all they know. And if I’m their first stop because they haven’t explored all of those other things we talked about, then it is so overwhelming that they just they need time to process it. They just need they just need time and resources. And so I say, Hey, Let’s go to COVD. Look at the information here. So another information come back in six months. We’ll sort of regroup talk to your pediatrician or whatever resource you have currently, because it’s just too much for them. The conversation we’re having right now is they’re just not ready for it.

[00:40:03.180] – Wendy Taylor

Yeah, that’s a lot of information to absorb, especially if you’re coming in thinking you’re getting glasses, and then you get a whole other spectrum of information. I love that you collaborate with OTs. You mentioned that do you ever collaborate with schools in terms of kiddos with their IP school support accommodations? Is there any kind of overlap or any way that people could overlap as a school to kind of better serve students? That maybe cost could be a barrier or just in general, to better serve a population in need?

[00:40:39.120] – Dr. Nate

Yes and no, as much as absolutely possible. Every single report that we write based on functional visual evaluation has a whole page of educational accommodations. And that’s honestly true. Whether they’re in a public school system or whether they home school because they still have the same the same needs, they’re just sort of implemented differently. And so we encourage all of our patients to give that part of the report to parents, especially when it’s time to get ready for their IEP. We very, very often will write letters to kind of update on their present level of visual performance and sort of how they’ve improved or how they haven’t. And in my in my experience, this is just my experience, but individual teachers are amazing at implementing things. The system isn’t always so amazing, but that’s just my experience. Now, beyond that, not really. I practice in Florida, and in general, the school system is so under stress that they are not really actively looking for more things to think about. We try to coordinate with the school nurses as much as we can so that they’re aware we haven’t made a ton of progress in that specific Department. But individual teachers are amazing.

[00:42:18.650] – Wendy Taylor

So my question is how functional vision problems and short attention spans, how are they related? We kind of touched on that in the beginning of our conversation when we started. But how are they related?

[00:42:33.900] – Dr. Nate

Again, This is, like, Super fascinating. So there’s been some scientific research into the degree to which visual attention being able to look at something for a sustained period of time and mental attention, being able to pay attention to something for a sustained period of time. And they’re absolutely not the same thing, but there is a very high degree of overlap in general. And when you help a child improve either one of those things, kind of both of them tend to improve, like they’re so interrelated that you can’t affect one without the other. So that’s sort of the Foundation for the whole thing. But when it comes down to individual actions, is this sort of my favorite way to think about this? Because most people have never, ever they would have no reason to ever think about this, but two different parts. One, there’s some other research that says that when kids, not just kids, adults when they have poor eye movement control, tracking, ocular, motor function, like we’ve been talking about, they have a very hard time decoupling separating when they are moving their eyes and looking at the world versus their staying still. And the world is moving. Their brain has a really hard time knowing the difference. So if our patients, in addition to all of the other problems, they have also never totally certain whether the world’s moving around them or whether they’re moving or something else is happening. That’s really kind of unsettling. And so they’re often distracted by that. And then way that that specifically will happen is this happens all the time? Say, I’m like looking at you were doing this over some, and I want to kind of go over and shift my attention to look at my picture on the Zoom. But because my eyes aren’t calibrated, I go a little bit too far. I kind of overshoot. And now I’m looking at my microphone. Well, that can feel to a patient, especially one who’s got attention issues or ADHD. Like, the microphone just appeared out of nowhere and inserted itself into my awareness. And so now you are like ancient history. And I am, like, all into this microphone because it’s, like, shiny. I’m no longer listening to what’s going on, because all of a sudden this is like, right there. And that would have never happened if the eye movements were calibrated accurately. Now there’s all kinds of other things going on, but that interference. I mean, it happens all day, every day for these kids. It just happens. It’s just, like, kind of watching TV. And then somebody is just, like, beaming in every 30 seconds, like a whole different program. It’s exhausting for them. That’s exhausting.

[00:45:44.580] – Wendy Taylor

Yes, 100% exhausting. As a parent, can my child receive special education services for a functional vision issue?

[00:45:54.520] – Dr. Nate

Well, kind of like I said, I mean, like, school based occupational therapists can be amazing at this. It really depends on the issue. If it is ocular motor, they’re fantastic at that. If it’s like, perceptual, they’re fantastic at that. If it’s some of the other things. Like I said, where you really need tools and lenses and training, that’s kind of more difficult for them. Usually usually not always. But usually when we write these reports and we write these letters and we write these recommendations, they kind of are already identified.

[00:46:33.190] – Dr. Nate

And we are providing more ammo and more recommendations for accommodations. By the time they get to us, it’s rare. It’s not impossible that we’re like the very first ones who say, look, this child needs some additional assistance, attention, and this is what we recommend. So we definitely will advocate as best we can for the children. But just sort of due to the nature of human development, you know, where their skills are at, it’s usually not until a little bit later to where vision really becomes critical now, of course. I mean, I think vision is critical from, like, you know, six months. But in terms of being identified, that’s kind of how it tends to go.

[00:47:20.280] – Wendy Taylor

Do you typically see an age range where kiddos are being identified?

[00:47:24.160] – Dr. Nate

Well, it depends. There are certain conditions, like crossed eyes, which I would call estropi, which, like, moms and grandparents, like, see, and they freak out about appropriately. And so we see them really, really early. And so if they have additional problems and those are all caught real early. But a lot of times it’s really not until nine or 10, you know, unless of somebody like you who’s, like, really in tune with these children. And they’re like, no, you really got to have their their eyes checked. I mean, it honestly takes it takes somebody to have had this sort of knowledge to be like, Yeah, you just got to just make sure that that’s fine. And sometimes it’s totally fine. And they say, like, you’re all good. Just keep plugging away. You’re gonna be fine. But, you know, sometimes it’s not that way.

[00:48:21.320] – Wendy Taylor

I hope from this podcast, somebody is getting some additional information and insight and and we’ll be able to help. Absolutely.

[00:48:32.800] – Dr. Nate

This is one of the biggest paradoxes of my life, and I’m just going to say it and you can react to it. What I find is that the best, most dynamic, most wonderful, patient, student loving teachers have the worst classrooms for visual attention because they cram every single surface with something that’s fascinating. The walls I go into classroom sometimes, and the whiteboard is like three quarters covered with amazing things. And they have this tiny little piece that they write on there’s, like aquariums, and then there’s, like, tactile sensory stuff in the back. And it’s impossible for kids to not all kids, but for a lot of kids, it’s just impossible to pay attention in that environment. And it’s just a paradox because those are the best teachers, so you don’t want to discourage them. It’s just very hard. I don’t know. What do you think about that?

[00:49:33.220] – Wendy Taylor

I think it’s very true. Very true, I think. Dr. Nate, if you teleported to the past my classrooms, that’s exactly what you would have seen. And I’ve taught kindergarten all the way up to post secondary, and it didn’t matter what the age was. I had it all happening.

[00:49:51.440] – Dr. Nate

Yes.

[00:49:54.720] – Wendy Taylor

What are some accommodations that you list in your report that perhaps somebody that may not have access to your knowledge could say, Oh, that’s something I could implement.

[0050:04.740] – Dr. Nate

Right. So right off the bat, there is like, the very kind of no brainer things, like preferential seating. If it’s hard for them to switch from the board to the desk, then if they’re closer, then there’s going to be fewer visual distractions and everything’s going to look bigger and it’s just going to be easier. So that’s obvious. Also, I will very, very often prescribe glasses and then they should just be used. But then again, that’s, like, obvious to everybody. Ergonomics, makes a giant difference. So we will very often recommend or issue slant boards. Now, when I was a kid, our desks were all at a slight angle and that would promote good posture. And it would sort of help kids stay at the right distance. Desks aren’t like that. I mean, my kids are 11 and 13, and they’ve never had basically, like, an ergonomic desk. And now someone has a computer built right in to his desk, and it’s very challenging. So we will issue, like I said, plant boards very often. They will take those to school, and they will become part of their work surface. And that sort of helps. One thing that sometimes creative teachers will do is they will take a sheet of paper and to be environmentally friendly, they will put it on two pieces of paper or sometimes even four. They’ll shrink it down so it fits. But then the font gets impossibly small, even for average mainstream kids. But for somebody who’s got an auto focusing problem, it becomes impossible. So we make sure that they don’t use anything that’s less than, like, roughly 14 point on something like that, but not too small.

[00:51:42.650] – Dr. Nate

It becomes difficult for earlier ages. We encourage using their finger to keep their place until they feel like they no longer need to. They probably won’t need to do that forever. But a lot of teachers will and discourage that because they want them to learn how to use their eyes independently, which is a reasonable thing. But if they’re just not ready for it, then you’re mostly just kind of frustrating with them. You can also use either, like, a bookmark or what we call a letter box to isolate individual words or sentences. And that sort of cuts down on that visual information overload there’s a certain thing. It’s called the Harmon distance, but we often call it the elbow distance. And basically what that means is if you make a fist and put it under your chin, you shouldn’t hold anything visual closer than elbow distance. And as you get taller, that ratio stays roughly the same. And that’s been validated a whole bunch of times, so that that reduces long term like eyestrain and improve performance. But if you watch kids, I mean, they will get within, like, inches or sometimes even centimeters to the page, and that just causes lots of problems.

[00:53:00.220] – Speaker 1

So we just want teachers to know that they should kind of encourage that sort of posture. Not that that’s possible to really fix that sort of, because that’s like a really long, deep seated habit. So sort of be aware of that. And then, of course, depending on the diagnosis, extra time for assignments and testing and time for additional breaks, you know, that’s in my experience, that’s gotten harder and harder to to get even when it’s appropriate. But we absolutely requested because it’s program functional vision problems.

[00:53:37.630] – Wendy Taylor

Are they related more to the eye or the brain?

[00:53:39.940] – Dr. Nate

So this is great because functional vision problems are the brain and coordination and sensory integration and those sorts of things. Now, the other thing that I mentioned earlier, when we’re talking about what I would call low vision. But what a lot of people would call a teacher for the visually Imperator, like a vision teacher, like, those are people who are partially blind or have some sort of visual limitation, and that’s from a disease or from a developmental anomaly. So if they don’t physically have the structure to be able to see either clearly or to see fully, they might have a restricted field of vision, or they might have other reduced contrast. Or there’s a zillion different things. That’s a hardware problem, and that’s their eye.

[00:54:31.500] – Wendy Taylor

Everything else that we talked about is their brain as we’re kind of winding down our conversation today. And again, this has been so incredible. And just what a pleasure and honor to have you with me today. What should I have asked that I didn’t know enough to ask.

[00:54:48.080] – Dr. Nate

So this is something that is very, very challenging for parents, because I will go through the whole exam findings and I’ll say, your child has 2,020 Visio. They’re not nearside, they’re not farsighted, they don’t have a SIGNIS. Everything is great about how their eyes are healthy and they can see really well. And then in the very next sentence, I’ll say, and I’m going to prescribe these glasses for your child, and it is such a disconnect that now I’m a little bit more savvy than that, and I try to explain it ahead of time. But the glasses that we will often prescribe has nothing at all to do with seeing more clearly. Their eyes see plenty high res. That’s totally fine. The glasses are designed for many of our patients that we’re talking about these sorts of students to do some of the work for their eyes. So they have more stamina and they can work longer without having the sort of symptoms or their performance is better. And like my glasses, because I’m like I’ve got a life sentence, like, I wear glasses all the time, and I will for the rest of my life.

[00:55:57.470] – Dr. Nate

These glasses are very often somewhat temporary. They may only use them for a year or two. And then, as their visual skills improve, they may not really need them or certainly not need them as much. They might need them for standardized testing, but they don’t necessarily need them for 15 minutes of homework. But it’s just so important for parents to be aware that we do prescribe glasses for lots of other reasons other than just improving clarity. And nobody knows.

[00:56:30.530] – Wendy Taylor

Thanks for sharing that. It’s fascinating, and it’s great to know. My final question for us is always, if you had a Billboard with one tip for parents, what would it be and why?

[00:56:41.720] – Dr. Nate

Right. And I thought about this a lot, because a lot of times I have very limited time to sort of talk to parents. And this relates Similarly to kind of what I was just saying. But vision is more than 20/20. I ask parents like, what do you think 20/20 is and they’ll be like, it’s perfect vision. It’s like everything there is. But in reality, it only takes us, like, five seconds to measure. Do they have 20/20 vision? Yes, they can read those letters. Great. But it’s so much more than that. It’s not just that your eyes can see, it’s that they can see easily and comfortably. And it starts at infancy where vision is movement. Vision is coordination. Vision is gross motor skills and fine motor skills. And all of the systems have to have to work together. And that’s why every single patient I see, even if they’re normal and every single way, middle of the Bell curve and every single possible way, I say. And it’s really important to go outside and play.

[00:57:43.740] – Speaker 1

I joke sometimes about, like, I’m going to start prescribing dogs because if they have dogs and they have to play with them and they’ve got to take them outside and they’ve got to go for walks and their eyes have to do all of these different things. And it’s very difficult to be on an iPad or a phone while you’re paying attention to your to your dog. And that’s because our visual systems grow and develop through movement and interaction. It’s way, way more than just 20/20. So that’s my billboard.

[00:58:15.380] – Wendy Taylor

Excellent final advice. I love it. And thank you again for this tremendous conversation. And I’m excited to have our listeners digest it. And I’m sure some are furiously taking notes as they’re listening to this and to kind of go on and help support kiddos in the future. So I really appreciate your time today.

[00:58:35.060] – Dr. Nate

Well, it’s an honor to be here. I enjoyed it so much. You do so much fantastic work for both parents and professional. I mean, it’s just really important, and I’m happy to do it.

[00:58:49.440] – Wendy Taylor

Thank you.

[00:58:50.950] – IEP Essentials Outro

Thank you for joining us today for our IEP Essentials Protip podcast. To hear more protests and find additional IEP Essential, including our IEP webinar, please visit www.LearningEssentialsEdu.com.

[00:59:09.060] – Dr. Nate

So I hope you enjoyed that as much as I did. Of course, I will put the links to Wendy Learning Essentials and the IEP Pro Tips podcast in the show. Notes, Thank you for listening. If you have questions, comments or suggestions about how we can improve our podcast, you can email us at office at Bright Eyes Tampa, com until next time. Stay safe out there.

[00:59:35.410] – Outro

Brought to you by Bright Eyes Family Vision Care and Bright Eyes kids. Find previous episodes and more detailed information at Bright Eyes, Tampa com. Creative Commons Copyright attribution Noncommercial 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 position for diagnosis and treatment.

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

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.

Podcast Episode #14: Adam Cegielski From Eyecarrot on Binovi

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.

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In this episode, Dr. Nate talks with Adam Cegielski From Eyecarrot about Binovi and Binovi Touch.

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.


Full Transcript:

Intro: 00:10 Welcome to the Bright Eyes Podcast, advice for healthy vision for all ages. Your hosts are Dr. Nathan Bonilla-Warford and Dr Beth Knighton, residency trained optometrist providing eye care to all ages with exams or 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: 00:39 From St. Petersburg beach in Florida. This is the bright eyes podcast. My name is Dr. Nate Bonilla-Warford and I am here with Adam Cegielski. Adam is the CEO of a company called Eye Carrot and I’m so excited about this because I’ve wanted to do this for almost a year. I’ve been talking and emailing with Adam for a very long time. I’m a big believer in what he does and what his company does and I’ve wanted to get him on this podcast for a long time and it just finally happened that we are in the same room and we can, we can get it done. So how are you doing today, Adam?

Adam: 01:13 Oh, I’m doing great. Dr Nate. Thanks for having me.

Dr.nate: 01:16 Yeah, so this is, so this is really good. So we are here at the college of optometrists and Vision Development, Florida study group. This is an annual meeting that, happens in the summer and the doctors that provide vision therapy and are specialized in children’s vision a get together and we all take turns lecturing and sharing thoughts and cases and , you know, it, it’s, it’s a great meeting. Now you were able to come last year or when the meeting was in Miami you, had an opportunity to interact with some of the doctors and so it’s nice that you’re here and I think that you’re enjoying it because you are from Canada. Yeah. You know, coming down to Florida is not all bad.

Adam: 02:01 No, it’s absolutely great. It’s my second time here. I’ve actually been to Florida three times now because of the COVD annual meeting we had in Jacksonville and it’s not exactly cold right now in Toronto. We are escaping a bit of a heatwave.

Dr. Nate: 02:15 So our office, bright eyes kids was one of the first offices in the United States to have Binovi, which is the product that you guys make and I found out about it before you even really launched and I was very interested in the benefits that this could have for our patients, who do vision therapy. So why don’t you just very briefly introduce our listeners to what the Binovi system is and the different parts of it. And then we’ll go on from there.

Adam: 02:43 Oh, okay. Thanks. Dr. Nate. so really this whole started with my personal experience with vision therapy and my son’s rehabilitation back in Toronto and we had a great doctor help us achieve the goals of vision therapy and got through 40 weeks of therapy. But we had that experience of binders and papers and notes and as a, as a technology futurist or whatever we call ourselves. I and my partner Sam said, listen there’s, a better way to deliver therapy. We think and doing that, we, we sort of unveiled the idea that this should be delivered smoothly through a mobile app with videos with content and we built the Binovi platform, not really a product we built software and hardware that delivers a modern comprehensive experience that, that really maximizes what you get out of in-office therapy and gives you the tools you need at home to be able to do really good homebased therapy.

logo binovi finalAdam: 03:42 So, so the Binovi platform is really a mobile platform that allows the doctor and the therapy teams to deliver home based activities through one to two minute videos that really explain, you know, the way to do these activities which are complex, which are difficult. And that platform was launched and you were one of the first people to even talk to us before we even went live, and so we’ve now launched that software. We’ve launched some hardware and we’re at a spot where I can come back to this meeting and have the confidence of, of, you know, customers that are actually enjoying the product and using it.

Dr. Nate: 04:20 So, you know, I was very interested in what you guys are doing because like you said, vision therapy is very, very powerful, but it’s difficult if you’ve got these binders, these sheets of paper with instructions and you know, in, in our experience. And I think that this is pretty true for, for a lot of offices. The person who’s providing the home therapy is not always the person who brings the patient. There might be a grandma who’s bringing them because mom and dad are work

Dr. Nate: 04:51 Or we’ll live in split households. There’s different things going on. And so communication with the people who are assisting the patient at home, has always been been a challenge and it’s something that we’ve always tried to improve upon by, giving them a manual at home with instructions and those have links to YouTube videos and we’ve tried to make sure that everybody understands the process. But when I saw what you guys were doing, I said, Aha, this is this is a modern way to do this. And that’s why I was, I was on board,

Dr. Nate: 05:28 So what have other doctors told you about their experience with taking it live.

Adam: 05:36 Well, you made a really good point about sending materials home youtube links and you’re not the first person to have this idea. You know, we’ve had many, many doctors across the United States say they had the exact same idea, but obviously the development work to put this all together is, is extensive and took a lot of time and effort and money. Um, but doctors have, you know, have been waiting for some sort of a platform like this to come live. Obviously there’s a lot of different doctors in the United States, a lot of different ways to do therapy. and we’ve, we’ve obviously embraced as much and as many of the ideas as we can from, from all the different people using our software. But for the most part we’ve had really good experiences.

Binovi Touch in action.

Adam: 06:15 You’ve had some doctors that have said, listen, I haven’t done home therapy and years just because of the difficulties you’re explaining right now. And, uh, we live in a different world than we did five, 10 years ago. We have Netflix, we have these video delivery platforms, um, that are such a big part of our lives. And, uh, and really we’re, we’re now at a spot where, the cost of hosting video and the cost of doing these things is at a spot where it is suddenly scaleable. It is realistic. And you know, there are 2.7 billion people with smartphones, I think in the world at this point, maybe closer to 3 billion people. So naturally, video and compression of, of content and compression of data put us into a spot where we can do this. And doctors are absolutely loving the platform. Therapists are loving the platform. And most importantly, when we have a short term window where the, where the APP is not functioning, we realized its value when we have all these patients contacting us saying, I can’t live without this. I need this. Where is the APP? So we’ve had all sorts of really good feedback. And, you know, we’re, we’re in a really good spot right now

Dr. Nate: 07:24 So at our office we see vision therapy, you know, essentially as, as teaching learning and just like my son takes a cello lessons, he has to have both the instruction from an expert, but he also just needs time to practice. That’s that skill and he needs to know what to practice and, and so Binovi does a fantastic job of keeping the patients and the parents up to date on what they’re supposed to be doing. And there’s a checklist that patients and parents know what, what to do. There is a chat feature. So if parents or providers at home, there’s a chat feature, so whoever’s helping the patient at home can interact with the therapist right away and give them some information, that is really helpful. And um, what we like is we can actually see when patients are doing the therapy because patients who practice things get better at them in, you know, in my experience. And so that’s been really helpful.

Adam: 08:29 Yeah. And I’ll give you an example in Canada and a cold winter, we’re doing therapy. Uh, my wife goes to therapy with the doctor and, and my son, they come home, we eat dinner. Therapy’s, usually the last thing on our list to do and of course the binders in the car and it’s snowing outside and you get the binder, no I’ll get the binder and it becomes a a bit of a chore. And ultimately, you know, compliance is a big factor in how healthcare technology is really changing our, our medical landscape and knowing that we’re actually doing this homework, knowing that we’re actually logging into the APP as a clinician. I think it’s very powerful.

Dr. Nate: 09:07 So why don’t you tell us a little bit about what you’re doing right now and where, Eye Care and Binovi are headed in the future.

Adam: 09:14 Okay. So as of right now, the binovi platform has been out for about a year. We have doctors in basically four continents around the world that are using the software. And we’ve completed our first video library. We’re extending the content now to add more educational content through some of our doctors. We have developed a tool that’s been around since I think 1974 called the Wayne Saccadic fixator and we’ve released, I think the seventh version of that now as the Binovi touch. So that is a device that is used in the vision therapy clinics with doctors that actually gives you that, uh, in office Rehab, in that office training. That device is now launched to about 100 clinics across the United States, Canada. And, um, and, and we’ve, really we spent two years working in developing this tool. We’ve probably done about 25 different prototypes. We’ve got an early feedback.

Adam: 10:11 We’ve tried to keep it as true to its original version that was loved and used across thousands of locations around the world. Most importantly now it gives the doctors in the therapy teams simplicity of using the IPAD. It gives the children and the patients using this fantastic experience where they can actually engage with modern tools, too complete therapy and obviously most importantly capture patient data profile data. That ties back to these, to these patients so you can measure progress, not just what you’re doing at home, but in the clinic. Now we’re starting to capture that in clinic data, tie it to the patient experience and obviously share with the parents. You know, that progress has happened week after week.

Dr. Nate: 10:55 And that data that you’re collecting from the Binovi touch, which is modeled after one of the most beloved vision therapy instruments of all time. tell us a little bit about some of the other population, some of the other people you’re working with. This is some pretty exciting stuff.

Adam: 11:11 Yeah. You know, this device has been used with professional athletes across the world. Recently we’ve worked with, an individual named Bryce Salvatore who was captain of the New Jersey Devils. He’s using it in, in his New Jersey training facilities with, with kids and trying to promote the importance of what could be done for vision performance. We have championship mma fighters and boxers and soccer players and football players that absolutely love the device and, Rehab hospitals that are using it on stroke patients and a wide range of utilities essentially.

Dr. Nate: 11:49 So, we’re gonna wrap up here because our meeting’s about to start. But anyhow any last few words you want to mention to our listeners,

Adam: 11:56 Just listen. Just go and do that homework. Log into your APP. Hopefully Binovi is giving you a really good experience that multiplies the benefits of what you’re getting from the doctors and therapy teams you’re working with.

Dr. Nate: 12:08 All right, well thank you Adam. we’ve been wanting to do this for for a very long time. We’ve been together at meetings but just didn’t have our schedules line up so I’m thrilled that we were able to do this to everybody who’s listening. Thanks so much. If you ever have questions, you can reach us at office at BrightEyesTampa.com. And, I hope you have a good time and stay dry. Avoid the rain!

Outro: 12:32 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 country.

 

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

Podcast Episode #13: Peter Shaw OD and Shaw Lenses

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 Peter Shaw OD and Shaw Lenses

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.

Full Transcript:

Intro: 00:10 Welcome to the Bright Eyes Podcast, advice for healthy vision for all ages. Your hosts are Dr. Nathan Bonilla-Warford and Dr Beth Knighton, residency trained optometrist providing eye care to all ages with exams or 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: 00:39 On location in Bellevue, Washington. This is Dr Nate Bonilla-Warford at the 2018 College of Optometrists and Vision Development meeting and it is the Bright Eyes podcast. I have a special guest Dr. Peter Shaw with me today. Hi Peter.

Dr. Peter Shaw: 00:58 Hi Nate. Thanks for inviting me to talk to you on this podcast. It’s a great opportunity to talk about lenses.

Dr. Nate: 01:05 Excellent. Yes. I am excited about this because, uh, there’s a, a useful tool that we have in our office called the Shaw Lens and I think that has some relation to you. Why don’t you tell us a little bit about your background first and then we can talk about the Shaw Lenses.

Dr. Peter Shaw: 01:21 So I started life as an optometrist with, with a, with a degree also in physics and computer science and practice for 35 years. But during that time I came across a lot of problems created by glasses that are unique to the fact that the glasses sit away from the eyes and not on the eye. And Shaw lenses is a comprehensive way of designing eyeglass lenses that eliminates the image difference. In other words, the size and image position that’s common with many pairs of glasses made. So what we do is we actually designed lenses based upon exactly where the lenses fit on the face, taking into account both the prescription and the underlying magnification that glasses create. So this fixes is something called Aniseikonia, and Aniseikonia is the optometric word that describes the image difference and the end results in the inability to put images together in the brain.

Dr. Nate: 02:25 So one thing that I really like about the Shaw lenses is, is I’m what I consider myself to be a binocular vision specialist, which means I take measurements and I measure how both eyes work together as a team. And one of the things that is unique about the Shaw lenses is they are not just individual lenses, one for each eye, but they also take into account the way the eyes work together as a team. Do you want to talk about that a little bit?

Dr. Peter Shaw: 02:55 Absolutely. So the way that lenses on ordinary glasses are designed is they make a lens for the left eye. and make lens for the right eye and within the system that the bar too is that manufacturers use. There’s no way that those two features are never correlated. In other words, they don’t take into account the effects that individual lenses have upon the eyes. What we do is we look at the prescription and the way the glasses fit and design a system. That eliminates the obstacles that normal glasses create. These two obstacles come about because of a natural aberration of glasses. They make things look bigger and sometimes smaller. And when the prescription is slightly different, frequently the image size difference and the effect the glasses have upon we call. Gaze direction interfere with the ability of the brain to keep the images together. We call that fusion, so regular glasses often cause a breakdown of images being together and staying together as the eyes look around and Shaw lens design. It’s called iseikonic or sometimes isophoric lenses can be designed to eliminate that image difference and provide comfort and function that regular glasses can’t attend to.

Dr. Nate: 04:22 So what type of patient can benefit from these types of lenses?

Dr. Peter Shaw: 04:30 Well, every patient benefits from having isochronic lenses. Not all patients require the added technology, but it never hurts. Where we do really well are patients that have come across a different eye prescription, due to surgery, like cataract surgery, patients who were born with their eyes a different and just happen to start wearing glasses. Patients that are new to progressive lenses or bifocals, when we hit 40, we have to start wearing glasses full time. We are especially helpful for kids with lazy eye, I would call an Amblyopia. Amblyopia comes about, we think as an active inhibition of one eye because the image is created in an amblyopic child, a different in each eye and they fight for attention. So the kid ignores the one image. What Shaw lens does, it equalizes the images and so the eyes can blend the two images together and they don’t have to fight for attention

Dr. Nate: 05:32 and we’ve seen incredible benefits for a certain patients, especially the younger children who, who might have Amblyopia and as part of our vision therapy program, or even if they’re not enrolled in the vision therapy program. The benefits that we’ve seen, uh, from use of the Shaw lenses has been a really remarkable. It'[s really, really exciting. Tell us what kind of research has been done using the Shaw lenses?

Dr. Peter Shaw: 06:06 well, research has been done both in published papers on isochronic therapy and also on a few cases that we have with our, with our partner universities were currently doing a research project of a double blind study, but our research is a little simpler than that. We’ve been selling and providing optometrists with Shaw Lens now for six years and our market share in treating Amblyopia has dramatically increased from when we started. And I put that down to the fact that doctors see the difference and that’s the best research we can have. It’s unbiased. No one gets paid to use our lenses, there’s no subsidy. It’s, it’s organic, and if the product wasn’t working, it wouldn’t be happening. What we do know is that an Aniseikonia has been known about since the 1850’s, and it’s been talked about routinely, but making what we call iseikonic lenses for some reason hasn’t been done until recently because it’s been an arduous mathematical chore for Optometrists to Design Lenses so it doesn’t get done.

Dr. Peter Shaw: 07:21 What I’ve managed to do is to simplify the process of ordering iseikonic lenses and what a isochronic lens is simply a lens that equalizes the images. Now we can make assumptions about patients, but the bar choice that make glasses are just fulfillment houses. They don’t really design lenses no matter what the marketing says. What they do is they put a prescription lens in a frame that gives clear vision, but no one talks about the interaction between the two eyes. What I’d like to say, what I will say is that the difference in the eye measurement units we call diopters doesn’t have to be very big to disrupt how eyes work together and especially with kids with Amblyopia bear the issues. These kids are really good at shutting off one eye, so any excuse they have to shut one eye down and only use that one become monocular, so to speak is triggered by small differences.

Dr. Peter Shaw: 08:24 So we don’t have to have a very big difference between the two lenses to make a huge impact on how that patient sees.One example is, you know for some reason, traditional eyecare tends to minimize approaches to therapies that they don’t understand. So there is some rule sometimes where what should be three diopters or more to consider iseikonic lenses personally i disagree with that. I think there is no difference small enough, if the optometrist can measure a loss of depth perception or loss of acuity. If the patient’s not functioning well, there’s something wrong. And I think we should use any treatment available to us to try to remedy that situation. And fulfill our role as as doctors to treat the deficit, not pass it off as something that kids should get used to.

Dr. Nate: 09:27 So if you’re a parent or a patient looking, considering Shaw lens is, are there any downsides or other things that that they should know?

Dr. Peter Shaw: 09:41 The only downside is yes, they cost a little bit more and the reason for that is that our lenses are all custom designed like a custom made suit for the for the child. They don’t come out of an envelope already made and that comes apart because cost of production, the lenses are always made in the country where that dispense. So for example, for the US market Shaw lenses as a manufacturing in a US facility, another downside is sometimes one might be a bit thicker, which is similar with any prescription that’s therapeutic. We use prism sometimes that makes the lens thicker, so thicker lenses maybe not as cosmetically attractive, but that hasn’t been an issue because what we’re looking for with our design is a medical therapy for Amblyopia ends to business. I’m making kids more comfortable with their glasses on and I think those are the only two downsides that, I come across. The upside is that it provides a great foundation for better vision and increased efficacy from vision therapy. So what we provide is a good foundation for your vision therapy I doctor to help your child gain better, more efficient vision using both eyes and increase their reading ability.

Dr. Nate: 11:02 Well, I definitely use the Shaw lenses when I think that they, the patients would benefit and I’ve seen a lot of success. Before we wrap up here, is there anything else that you’d like to tell our patients?

Dr. Peter Shaw: 11:16 The most important thing I think to remember is that we’re not a radical treatment. We are, we are irrational treatment. And the vision that you get with the Shaw lens is never worse than you’d get from an ordinary pair of glasses. It can only improve things. We don’t use patching. We don’t use anything that’s not scientifically valid. Our advisory board is made up of ophthalmologists, optometrists and researchers. We don’t have any smoke and mirrors.

Dr. Nate: 11:54 Well, this has been a great meeting here in Washington state. I thank you Peter for giving us your, your time and I hope you have a wonderful meeting as well for all patients who are listening. If you have any questions or comments, you can always reach us at office at BrightEyesTampa.com and we look forward to bringing you the next episode. Thanks Dr Shaw.

Dr. Peter Shaw: 12:15 Thanks, Nate.

Outro : 12:17 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 country.

 

 

 

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

Podcast Episode #12: Betsy Yaros on Vision Therapy and Developing 3D Vision

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 Betsy Yaros about vision therapy and discovering 3D vision.

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.


Related:

Podcast episode about how vision therapy with therapist Edna Moore

Betsy and Dr. Nate in the news:
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The Full transcript:

Intro: [00:00:02] Hello. Welcome to the bright eyes podcast advice for healthy vision for all ages your house. Our Dr. Nate bonilla Warford and Dr. Beth Knighton two optometrists who really see eye to eye. They can help you get perspective of the latest visual scientific evidence for improving your vision and helping you keep your eye on the ball. We have real facts and acqui is humor without making spectacles of ourselves. And don’t worry the jokes don’t get any cornea than this we promise.

Dr. Nate: [00:00:41] Hi. it’s Dr. Nate and this is the bright eyes podcast. This episode is a little bit different. Instead of sitting down at my desk and having a conversation either with Dr. Knighton or a different doctor or one of our vision therapists I had a conversation with Betsy one of our vision therapy patients and the conversation starts in the vision therapy room and then went out into the parking lot and then we went to the waiting room to finish up the conversation. And the reason why we walked around will be apparent when you listen to the episode. I really like the way Betsy explains her experiences developing her vision as a vision therapy patient specifically her appreciation of depth perception and what it brings. So I really hope you enjoy this episode. Thanks.

Dr. Nate: [00:01:37] So Betsy we’re here in the vision therapy room at Brighteyes kids and this is where we were when you first observed 3D vision. Do you remember that.

Betsy: [00:01:51] I did. It was a great day. Yeah we were just playing the Vivid Vision. Yeah it was after we played the spaceship going through the rings and I just remembered taking off the glasses or taking off the goggles and seeing everything pop out and then I also remember you going to grab the goggles in your hands just you know they it was scary. Your hands are just coming out of the goggles and I can also just see all the details on your hands and everything coming at me.

Dr. Nate: [00:02:32] What I remember from that moment was you looking at your own hands and you were trying to describe what you were noticing but you really didn’t have words to describe it. So the word that you used while you’re looking at your hands was that they were big.

Betsy: [00:02:57] Everyone looked like they had monster hands at that point. Me included. So that’s what happened.

Dr. Nate: [00:03:05] Now that was a very big big moment. But it didn’t happen all at once tell tell the listeners maybe a little bit about your back story visually like when you were a kid and then some of the things that you had done up until that point to get there.

Betsy: [00:03:25] Yes. As a kid I was my eyes used to flip back and forth a lot so I never had the depths. So I was used to walking around with you know my vision shifting a lot and I was just like when I was walking down the street I would walk into a pole because you know my other eye is looking out not seeing the pole where I’d walk into a wall or I open the fridge door in my face. Stuff like that.

Betsy: [00:03:55] So that’s kind of how it was as a kid and then as I started doing therapy I just started having more control over my eyes and I started having more like maybe really quick instances of seeing 3D but it wasn’t till that day where it really happened and it stayed. So it was just really me.

Dr. Nate: [00:04:19] And so one of the things that we used to do when when we were first trying to develop your sense of depth perception and 3-D vision was not only to do activities here with the virtual reality and the Brock String and some of the other vision therapy activities but we would go outside. So you want to take a field trip you want to go outside.

Betsy: [00:04:40] Yeah. Sounds good.

Dr. Nate: [00:04:41] So yeah this is exactly what we would do. The reason why we would do this is because outside is full of detail and things are very very far away. So we would come out here and so now we’re literally in the parking lot. And so one of the things that we used to do would be to walk through the parked cars and there’s a lot of space in between the cars. But for you it was sort of like a different a different experience when you were seeing 3-D.

Betsy: [00:05:16] Yeah yeah at first it didn’t all come together so like why are we outside. Are we doing this. You know you’ve had me like you’re saying that I didn’t do a great job of explaining it was just like nothing was clicking. And then you’d asked me to go look at a building near and far and I wasn’t seeing it but then I wasn’t sure if it the same day but I remember we just told me to go walk down the sidewalk here.

Betsy: [00:05:45] Yeah I just remember walking down the sidewalk and all of a sudden I freaked out and flinched because this tree here just popped out at me and it looked like it was attacking me. So it was just like an amazing experience. And then I just started looking around and when you see 3-D it’s like you have you know if you’re doing HDR photography you have double exposures so you can see like, Then I just noticed I could see all the details and leaves and grass everything with popping now and when I looked up at the sky the trees actually looked like Dr. Seuss trees they had the little fluff ball softballs and then.

Dr. Nate: [00:06:28] So how did trees look before that?

Betsy: [00:06:31] Flat green like construction paper sheets of construction paper that or maybe have different tones in them. It’s all flat. But then when you see in 3D you can actually see like for example on this leaf here you can see the wax coat on the leaf and just all the detail within the leaf and then each one each leaf is on a different plane. So it just becomes a very complex object to look at really incredible. So I remember even after the appointment I was like oh I’m going walk around walkaround I was just staring at everything like piles of dirt you know on the ground. Anything was just like incredible. From that point forward.

Dr. Nate: [00:07:14] And you were so kind of excited by that that you actually told the tree story in your blog which you did you have and you had some other some other stories you talked about.

Dr. Nate: [00:07:27] You said one of the things that you discovered that there was like a part of your car that you hadn’t noticed before.

Betsy: [00:07:34] Oh yeah I can remember now like . Yeah they were like so i used to drive a Jeep, recently got a different car but there were other compartments in my car that I didn’t actually see because the other thing that happens you don’t see 3-D is everything. You know it’s a flat surface so you just assume that thing over there it’s flat. But then when I got in what is this . And then I also notice my dashboard was really dusty 3-D right. Really. Wow. It’s really like oh my gosh!

Dr. Nate: [00:08:09] That’s interesting. That’s the type of thing that when you’re in the exam room as a doctor and you’re doing the tests and you’re quantifying things and you’re trying to extrapolate and make predictions you don’t think about that sort of real world experience of being able to see to see the dust or see the compartments in your car. One of the things that happened that I that really struck home to me which I which I really liked and I and I tell the story sometimes is I think I had been to a concert the night before and I got home like super late. And you know we had we had done activities and you said something like You know you said that you were tired but now that I’m seeing in 3-D I can really see that you’re tired. Yeah which I thought was actually great because I don’t think many people think a lot about or talk about the interpersonal aspects of having depth perception and 3-D vision.

Dr. Nate: [00:09:15] The social cues that that people get when they interact non-verbal communication do you have any thoughts or anything you want to say about about that.

Betsy: [00:09:27] Oh yeah it’s definitely totally different. So like I experienced my first break up in 3D and you know I really just broke up and it’s been like a very like process where it’s like they say something and I get the message you know I can get the message and I process it later. But when you’re actually 3D in this space I can actually Ill just use an example of the last breakup I can really see the emotion in their face and what they were saying and I could just process it was much more intense. Actually it was a very intense experience because you can when you’re seeing 3-D the wrinkles in someone’s forehead relates to their actual emotion and their expression. And it’s people are more animated. Like think about watching like maybe 2D cartoon an old Roadrunner cartoon versus like current Pixar film. You really see the expressions and the characters so that was how it was when it was being broken up with I could really see it and it was just very intense and I processed everything much more quickly. So it’s it’s really interesting. seeing 3D.

Dr. Nate: [00:10:46] That’s a wonderful observation that you’re not going to read in textbooks maybe at most a single sentence but certainly not not somebody who’s who’s experienced the difference you know with and without being able to talk to somebody and experience that that kind of emotional situation. With the benefit of depth perception. So I think that that’s that’s really great.

Dr. Nate: [00:11:16] Let’s head back into the office because I hear a little thunder which its Florida – its the lightning capital of the world so that’s not that’s not unusual. So for somebody who you know maybe has visual problems they might have strabismus or exotropia or Esotropia. I understand that you know you get e-mails from from people in that sort of situation. So what types of things do they ask you and what kind of things do you tell them.

Betsy: [00:11:47] Well I get a lot of e-mails from concerned parents who they’ve come across my blog. And since you know they had you know the child was born prematurely like I was and they might be having other developmental issues such as speech delay other things which are similar to what I had. And they’re not sure what to do. So all they want to do is help their child. So I think they’re a little bit in panic mode. Cause thier child isnt meeting their milestones. So I just try to provide comfort for them and explain. You know I went through. I’ve been through speech therapy auditory processing. And then lastly this vision therapy. And each time I’ve been able to be more connected with the world. So with this last you know with vision therapy now I’m really I’m actually like feel like I’m in the world you know in space and really interacting with people and able to interact with people. So I just you know when I get these e-mails from parents I tell them you know maybe just wait a little bit. I know the doctors wanting to perform eye surgery. I had two eye surgeries the first one was successful and I’m crossing my eyes. But the second one wasn’t. But you know vision therapy works.

Betsy: [00:13:09] And it worked on me as an adult so I can only imagine what it can do for your child. And the other thing too is by taking the initiative and getting the child into therapy at an early age it helps them so much tremendously across thier life because it’s like me as a child growing up. I was picked on. I didn’t really have very many friends. And I had a lot of difficulty going through life basically until I was finally able to have these different kinds of therapies. So as a parent you know if you take this initiative get them into therapy and get them started on this path it’s only going to positively impact your child long term. So that’s why I try to encourage them you know to do that.

Dr. Nate: [00:13:59] And what other ways do you think that doing vision therapy as an adult rather than as an elementary school kid. What are the ways has it changed your life.

Betsy: [00:14:11] Well for me it’s just it’s made me appreciate so many things like I’m just very appreciative of the opportunity to do that. And it’s really opened a lot of doors for me. It’s like as a child I wanted to be a dentist and I couldn’t do that and the doctor basically said there’s no real career path you can take there. So I stayed photography’s so now that I have these abilities to see and I can read textbooks and I can interact with people.

Betsy: [00:14:41] Now I can I mean I want to go be an optometrist too so I’m just really excited that I’m able to pursue any career path not ant career path this career path want to be an astronaut you can be an astronaut princess. That’s right.

Dr. Nate: [00:15:01] But you know, reaching reaching potential and doing what people want to do and feeling like they have those opportunities is is really important. You know our mission statement at Bright Eyes is all about empowering patients through vision care to help them do whatever they they want to do. And we do that in all kinds of different ways. We do it with contact lenses we do it with glasses we do it with myopia control. One of the greatest ways that’s the most exciting and most rewarding for for all of us is with vision therapy because people really do set different and larger goals for themselves after they sort of see what’s what’s possible. And the fact that you’ve been able to go through that is you know is great. It’s it’s really really wonderful.

Betsy: [00:15:57] I’m really excited about my future. So it’s it’s just really. And I’m just I’m so happy say all this really hard work. It’s not like I saw 3D instantly or my issues went away instantly it took you know several years of work. It’s not like my vision is perfect but I’m now able to manage my vision.

Dr. Nate: [00:16:20] And actually that’s an important important thing to talk about because you did work really hard. You worked many many hours but you’re no stranger to hard work. You worked as a student when you were younger. You worked in the you know the different types of therapies you talked about and so you understood that this is something that I want to work on that I think is achievable.

Dr. Nate: [00:16:45] And so you get lots of lots of credit for it for wanting to do it and actually going through with it. And you know that’s one of our goals with all of our patients is encouraging them and motivating them and educating them this is what’s possible this is how much work. I think it’s going to take. So if I remember correctly there was a time when you were going to see lots of 3D movies. Oh yeah. Very cool stuff. I mean if they have more time it’s going to happen. Well yeah because they’re busy with work. And we you know we understand that but wasn’t there one there was like a children’s movie that you went to see a bunch of times.

Betsy: [00:17:29] Yes so Trolls in 3-D. It was. It was amazing. So I went and saw it five times because each time I saw it in 3-D there’s a lot of bright colors in that. As soon as I took off the 3-D glasses I saw 3-D and then I could go walk around the parking lot and go over to a target and see everything was 3D for. And it lasted for three hours. So it was just really cool. so i just repeated the experience several times. So now I have a 3-D projector at my house where I just a little bit cheaper. So I watch films that way.

Dr. Nate: [00:18:12] Yeah yeah no I remember you. You’re talking about it. And I was like really you went to see trolls again. You’re like, yeah!

Betsy: [00:18:23] Not for the storyline.

Dr. Nate: [00:18:25] But I think you’re right about the colors because a lot of movies like if you were to see like Batman in 3-D it’s like really dark you know even for people who have totally normal vision it’s kind of hard to see because it’s just it’s so dark and the contrast is so low. That was probably a great one to see.

Betsy: [00:18:23] Yeah except I went and saw other darker ones like he just had the same effect. Yeah yeah but the cool thing to see that just reminds me of every year my family went to go see the Rockettes had sound at the beginning they have this 3-D experience. And I was never able to see Santa throw the wreaths over the audience but it was just incredible. So I actually saw him throw the wreathes over the audio. Finally a couple of years ago. So you really need to have that are great.

Dr. Nate: [00:19:23] Well thank you for your time. And it was great catching up with you and good luck with everything else.

Betsy: [00:19:29] Thanks. Good to see you.

Outro: [00:19:34] 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 country.

 

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

Podcast #11 – Colorblindness and EnChroma Glasses with Dr. Jeff Goodhew

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. Jeff Goodhew of Abbey Eye Care about color vision deficiency (AKA colorblindness) and EnChroma glasses.

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.


The Full transcript:

Intro: 00:11 Welcome to The Bright Eyes Podcast: Advice for Healthy Vision for All Ages. Your hosts are Dr. Nate Bonilla-Warford & Dr. Beth Knighton, two doctors who really see eye to eye. They can help you get perspective of the latest visual scientific evidence for improving your vision and helping you keep your eye on the ball. We have real facts and aqueous humor, without making spectacles of ourselves. And don’t worry, the jokes don’t get any cornea than this, we promise!

Dr. Nate: 00:39 Hello, this is Dr Nate and this is the first international episode of the Bright Eyes Podcast. Today’s episode is all about color deficiency and EnChroma Lenses. And I have special guest. His name is Dr Jeff Goodhew and he practices at Abby Eye Care in Toronto, well outside of Toronto. Where exactly are you, Jeff?

Dr. Jeff: 00:59 I’m in a suburb I guess a small town called Oakville were about half an hour outside of outside of Toronto.

Dr. Nate: 01:04 And in my understanding, you were the first practice in Ontario to provide Enchroma lenses. We were also the first in Florida.

xenchroma balloons.png.pagespeed.ic.Oz2sDXBdHd

Simulation

Dr. Jeff: 01:15 Ontario is a province, Florida is a state, so they’re just similar, similar entities. Ontario is probably 15 million people and we were the first retailers and the demand for this product is, has been huge. I think a lot of color vision or color blind people out there have known about this product and of course it’s sold from the US. So here in Canada, people were a little bit leery about ordering something online. What if it didn’t work? So there was this huge pent-up demand, uh, in our area and once we flip the switch and went live, we had always people phoning and emailing and stopping by. It’s been, it’s been crazy. It’s been good. It’s been awesome.

Dr. Nate: 01:52 Yeah, EnChrome is one of those things that I had been following for quite awhile and I had talked to other doctors and I had heard great things and I really am thankful that you took the time to talk to us about color vision and what EnChroma is. And I think this will be a great conversation. So Jeff, let’s just start off with the basics. When we say somebody is colorblind or we say they have a color vision deficiency, we don’t necessarily mean that they see the world in black and white, but they may see color differently than other people. When you see somebody in the exam room who has problems with color vision, how do you explain that to them?

Dr. Jeff: 02:28 Right. So, so patients, patients think of it as, as colorblindness. That’s the term that they’ve heard. And like you, I’m not a huge fan of the word colorblind because people think, oh, they’re going to see in black and white. I kind of changed the conversation and say it’s more color confusion. So certain reds and Greens are going to look kind of a muddy brown. So they’re, they’re, they’re gonna think right in green are the same. So I try to frame it as confusion here, your Color Palette is not as big as other people. Um, cause, cause colorblindness, I carries kind of a scary connotation for people at least that’s, that’s what I find. I try to turn it into something that’s not as scary as that.

Dr. Nate: 03:08 Yeah, I agree. And I think that that’s a great approach. I also think it’s actually more accurate even though the term colorblind is what people usually use a shorthand. I think your color confusion term is a great way to approach it. I have two practices. One that’s for all ages and the other one is exclusively for kids and so often I’m the first person to do an eye exam for these younger patients and I’m definitely the first person to detect color vision problems. And so it comes down to educating them about school and occupational options and other factors. I’m not exactly sure when you graduated from school, but you went to Waterloo, one of the two optometry schools in Canada, if I’m correct?

Dr. Jeff: 03:08 Yes.

Dr. Nate: 03:47 And when I was in school, there weren’t a lot of options for people who had color vision problems. We took a lot of classes and we learned a whole lot about how your eyes work and how we see color, but in terms of what we could actually offer or patients, there weren’t really a lot of options. There issomething called an X-Chrome lens where you wear a colored lens in one eye and it helps people detect colors that they might not normally have seen, but it wasn’t really a very natural or helpful option.

Dr. Jeff: 04:13 No, exactly. The, you know, the X-Chrome lens was a was a contact lens that you could wear in one eye, it was deep, deep red, so cosmetically looked a little strange, but all it did was allow certain people to pass some of the standardized color vision test so maybe they could get into the police force or become an electrician or a commercial pilot. So they would wear this lens just for that color vision test and then never wear it again. This is the first product that’s out there that can actually enhance a person’s, you know, quality of life. What I’ve observed about EnChroma is unlike the X-Chrome Lens, you can’t get patients to take them off. Yes, even though they’re tinted, they become their full-time glasses. Agree completely.

Dr. Nate: 04:53 Yeah. There was a patient who just happened to be the husband of one of our staff members and the first day that we got EnChroma, he had come in for his eye exam, so he put on the EnChroma, fit over testing glasses and he went outside and it’s Florida, so we always go outside and look at the plants and the flowers and look at the buildings stuff.

Dr. Jeff: 05:15 Stop rubbing it in. The flowers are just starting to come out as we as we record this.

Dr. Nate: 05:20 Well good. Yeah, but it’s something that really helps them see the subtle differences between the bright leaves and the more orangy ones and the green. And he was really excited about being able to see the different colors and he actually took those fit over years with them and we had an event where we’re going to, as a staff, go to the Tampa Bay lightening game and I saw him later that day and he wore them the whole game and now he’s got his own prescription pair and he wears them all the time. I never seen him without them. You know, he really likes him, but I think we’re getting a little bit ahead of ourselves. We’ve mentioned EnChroma several times, and these are glasses that people can where they can get them in their lenses, their prescription glasses in different frames, but why don’t you talk just briefly about what they are and what they do.

how eyes see color enchroma logo purpleDr. Jeff: 06:09 We need to back up a little bit and go back to your first question about what is colorblindness? I think for the lay person, we’ve got three color receptors I guess at the back of the eye in your retina, sort of a blue sensor, that green sensor in a red sensor, and normally with folks who have have colorblindness, the lights, the colors of the red and green receptors can pick up they overlap so they don’t get that differentiation between the reds and the greens because those two sensors aren’t doing their jobs the way they should. And with EnChroma Lens, it’s got a special filters that that knock out very specific wavelengths are very specific colors of light and what that does is it separates what the green and red receptors can now detect, so it makes them more kind of a normal, what a normal color vision person would would would see. So yeah these lenses, they’re tinted so they look like normal sunglasses, but they’re much higher tech than that. They’re blocking very, very specific colors that allow those color sensors at the back of the eye to do the job that they’re normally supposed to do.

Dr. Nate: 07:21 Yeah It’s really elegant because I think that if you just look at the lenses themselves, they look like sunglasses, but it’s so precise and so specific when they’re filtering out that muddy, confusing overlap that you’re talking about, you know, you need some pretty sophisticated equipment to see the specific frequencies that they’re filtering out. You wouldn’t necessarily know what they’re doing if you just look at them. You know, it’s interesting because our brains are fascinating things and you know, in my experience when I go outside with patients and we’re talking with them and they’re looking around and everything, it almost never works instantaneously. It does take them a few moments to sort of compare and contrast and sort of realize what’s going on. And then they get kind of quiet, they get that sort of smile and their mouth kind of drops a little bit and then they’ll say like, oh, I thought this was that color, or now I realized it’s a totally different color. I see this whole pattern of things going on.

Dr. Jeff: 08:19 I would agree. We’ve had a couple of those kind of, you know, over the top Internet YouTube moments. But most people, it’s almost like sensory overload. They put the glasses on and they get to see these things for the very first time and their brain, their eyes or they’re just overwhelmed. They really don’t know what to do. So. they kind of go quiet, like, like you said, it’s almost like their demeanor changes and some of them get, you know, start to get excited. Some of them get quite emotional. So, um, we, we try not to hover over them and say, you know, what color is, what color is that? We just let them absorb, you know, to experience it because it’s, you know, we take this for granted for them it’s, it’s completely new and we just like, you, I just like to stand back and just watch the reaction, each patient’s different. But it’s, you’re right, it doesn’t get old and super fun to be part of that.

Dr. Nate: 09:10 You know, the closest think I think I’ve ever experienced to that is we provide vision therapy for a range of visual problems and I’ve worked with patients who’ve developed 3D vision for the first time in their life and when they’re trying to take it all in and they’re looking around and they’re trying to make sense of the things that, that they see. It’s just, it’s just really cool. You know, they don’t, uh, they don’t always have words to describe what they’re experiencing. And it really is an interesting thing.

Dr. Jeff: 09:41 We had a patient probably two months ago who drove about 90 minutes to come to our practice, came in with his wife, and I don’t know if you’ve found this, but they never come in by themselves ever.

Dr. Nate: 09:51 Right. It’s often the whole family, but it’s usually at least a spouse or a brother.

Dr. Jeff: 09:56 Yes, exactly. So it’s kind of a big outing for, for these folks when they come, when they come to our practice and this gentlemen put the glasses on and for 25, 30 years, the number of years he’d been married to his wife, he thought her eyes were blue and they actually weren’t blue, they were Hazel, so they had, you know, Brown with a better green and he just couldn’t see the green. So the first time ever he could see the true color of his, of his wife eyes and that was emotional for, you know, everybody in the whole office. So he, he ordered a pair of prescription EnChroma because he needs prescription, so that takes a couple of weeks to come in. So this was on a Saturday. Um, try the glass on, Love them Monday morning he drives all the way back to our practice, another 90 minutes, so three hours both ways just to try the Fittovers, just to try the samples again. He knew his glasses wouldn’t come in for another couple of weeks. He just wanted that experience again. And then two weeks later his glasses came in and we called him and it’s like he was sitting by the phone, 90 minutes later he was there like, this guy is so excited and like the other, you know, the spouse of your staff member. This patient hasn’t taken them off, they’ve become as regular eyeglasses.

Dr. Nate: 11:10 Yeah, that’s a, that’s a cool story for sure.

Dr. Jeff: 11:16 So here’s one thing I’ve noticed, and maybe it’s just me, but you’re a fellow optometrists or fellow eye doctor. But um, we’ve got some flower arrangements, unlike you, we need fake flowers for six months, six months of the year. So I’ve got some blue flowers next to some purple flowers and purple of course really is just blue with some red in it. And for some folks who can’t really see, red those blue and purple flowers look the same. They put the glasses on, all of a sudden they can see purple and they’ll actually call it purple. And for me I’m like, OK, you’ve never seen before. How the heck do you know that purple? So I think there’s a lot we still don’t know, but for me that’s always been interesting. How can you name colors that you’ve never seen it.

Dr. Nate: 12:00 Yeah, it’s, it’s fascinating. I think it’s really been an exciting and interesting experience. The other thing I’ve noticed just working with these patients is that everybody comes in with slightly different things that irritate them or you know, they have, they have different goals, you know, I mean, no, no two people are the same. So I think it’s very important for them to come in and try them personally and everybody has a different story and his different lifestyles and different goals.

Dr. Jeff: 12:28 I like, you know, patients will often tell their story on social media, you know, a couple days later maybe it will post on facebook about these Enchroma glasses that they’ve got and they’ll, they’ll, they’ll tag our office most times because their best where they got the glasses from.

Dr. Nate: 12:43 Right, right. Yes.

Dr. Jeff: 12:45 So it’s really fun to read what they talk about. It could be, you know, how overwhelmed they were. They saw how vivid red cars on the road look like on the drive home. They stop at the grocery store and they could, they did not have to ask somebody OK, can you tell me when she was the red pepper and the green pepper? Because to them they always look the same. Bananas don’t look all, you know, rotten anymore that you can, you can see the yellow. No peanut butter looks brown not green. So it’s really neat to see them document their first couple of days, uh, after having the EnChroma eyewear and then just to see the, how happy their friends and family are for them. Like they’ll get, you know, 40, 50 likes, I’ll have all these comments like I’m so happy for you. And everyone’s really emotional, like they’re so happy that this person, um, get some of the, the color world back I guess. Um, so that’s been, that’s been super, super cool is just to, just to kind of sit back and just read the stories that people are posting and how it’s affected their lives because every, you know, it’s one in 12 males of color vision problems. So we all, everyone knows somebody who has a color vision problem. So there’s lots of folks out there who can benefit from this, so I think, you know, helping spread the word about this exciting technology is, uh, is great.

Dr. Nate: 13:58 Well, Jeff, I appreciate you taking your time to help us out. Do you have any other thoughts and anything else you want to share before we go?

Dr. Jeff: 14:05 No, well, I guess I maybe just managing people’s expectations like this does not cure colorblindness. You can’t all of a sudden you don’t pass the test to become a policrainbow fencee officer.

Dr. Nate: 14:05 Yeah. Right.

Dr. Jeff: 14:17 That being said, there’s still huge benefits in this, um, in this product in the sense that it improves your color fidelity, your color Palette expand. So, um, yeah but that, and we do tell patients that and they’re fine with that. They know that. But the funny thing is it, and you’ll probably find this, they all want to say the color vision test again.

Dr. Nate: 14:35 Yeah, you’re exactly right.

Dr. Jeff: 14:37 The glasses on every single one, even though we tell them you’re not going to pass the test, they all want to take it.

Dr. Nate: 14:42 So Jeff, I really want to thank you for your time and sharing your experience and your expertise and that’s been really wonderful and thanks to all of our patients and listeners we’ll post some information about EnChroma on the website in the show notes so you can follow that online. There’s information, there’s an online color vision test that you can take. There’s different things you can do. As always, if you have any questions, comments, or suggestions about our podcast, you can email us at office@brighteyestampa.com. Until next time, this is Dr Nate. Thanks for listening.

Outro: 15:13 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 country.

 

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

Podcast #10: NaturalVue Contact Lenses with Dr. Douglas Benoit

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. Douglas Benoit about contact lenses and NaturalVue spherical and multifocal lenses from Visioneering Technologies, Inc.

 

The Full transcript:

Intro: 00:11 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 eye care.

Dr. Nate: 00:42 Not far from Clearwater beach, the number one beach in the nation, It is the Bright Eyes Podcast. This is episode number 10. I am Dr Nate Bonilla- Warford, and I have a special guest with me. Dr. Douglas Benoit.

speaker benoit 300×300

Douglas Benoit, OD

Dr. Benoit: 00:42 Hi Nate.

Dr. Nate: 00:42 Hi, how are you?

Dr. Benoit: 00:55 Doing well, how about yourself?

Dr. Nate: 00:56 I’m great. I’m doing really, really well and I’m excited that you are here with us. We’re going to talk about contact lenses, which you have many years of experience with. Before we get into that, why don’t you tell us a little bit about yourself. I’ll give the basics. You’re an optometrist. You’re a fellow of the American Academy of optometry. You’re the director of professional affairs at Visioneering Technologies, Inc, otherwise known as “VTI”.

Dr. Benoit: 01:21 That is correct. I practiced for 34 years in OD, MD group, we were all sub specialty folks. I had the pleasure of working primarily with contact lens patients, generally the type that had special needs such as GP wearers, people that needed scleral lenses, et Cetera, and I had the opportunity to work with a lot of bifocal patients, which was really a passion of mine. I also, over that period of time did a number of clinical studies, which is actually how I became involved with VTI.

Dr. Nate: 01:53 And you’re originally from New Hampshire, but I gather you get around the country quite a bit these days.

Dr. Benoit: 01:58 Yes. As part of the job I do have to travel quite a bit and with some changes that have occurred recently I’m traveling more much to the chagrin of my wife.

Dr. Nate: 02:08 My Dad actually, he does consulting and speaking in the education field and and he’s on the road a lot, but he’s narrowed down his primary gigs to Hawaii and California.

Dr. Benoit: 02:21 Well that would be a nice goal. My wife would like to travel back to California, I’m sure as it is, sometimes she gets to go with me depending on where it is and how much time I’ll actually get to spend with her.

Dr. Nate: 02:32 Right. Absolutely. So. OK, so for our listeners who are patients, we know that there are many contact lens options, uh, for patients, but a lot of times patients don’t really know what their options are or why they should be interested in them. If you’re like me, you’re probably somewhere, a family gathering or a barbecue or almost anywhere and they find out that you’re an optometrist and they always want to say, oh, you, I was told I cannot wear contacts or uh, you know, I tried contacts 15 years ago, you know, and they didn’t work. Do you feel like things have changed a lot since your, you know, your early days with context?

Dr. Benoit: 03:11 Well, yes, they have changed a large, large amount. When I was first in training a 30 some odd years ago, they had pma lenses and they were just coming out with soft materials. Those were two radically different types of contact lenses and it really took a different approach. Over the years, the old hard lenses have changed slightly, the materials now breathe so that they’re much gentler on the tissue of the eye, but the soft lens is really where the large changes have occurred. In the beginning, these lenses were produced in a vial, they were autoclave for sterility and the lenses were very expensive and you tried to keep them for a year or more using very heroic cleaning methods. Over the intervening years we have gotten smarter about the care, so that has become easier. But in the last 15 or so years, the move has been towards daily disposable lenses so that we can eliminate the problem of solution reactions or just poor cleaning. Anybody that has a question about poor cleaning with a contact lens, just think about your teenage son and his room

Dr. Nate: 04:19 Exactly. That’s something I actually mentioned in the, uh, in the exam chair here at Bright Eyes Kids pretty regularly. What are some reasons that patients might want to consider contacts over glasses

Dr. Benoit: 04:32 Well contact lenses do give you the opportunity to do active things such as working out, riding a bike, golf, things of that nature where glasses sometimes could get in the way either by slipping off or steaming up. So contact lenses are really, really nice in that regard. There are some folks that are into theatrical and in certain situations they might not want to be wearing glasses if they’re doing a period piece. So a contact lens there would give them the opportunity to blend in with their surroundings, so to speak.

Dr. Nate: 05:03 And who is a good candidate for contact lenses?

Dr. Benoit: 05:06 Well, I think anyone that’s motivated and has a healthy eye is a good candidate for contact lenses. At, you know, one point they used to tell folks that they had astigmatism, that they really couldn’t wear a contact lens. Uh, thank goodness that actually is not the case. The original contact lenses which were commercially available in the United States back in 1887 were for severely deformed corneas, primarily a very severe form of astigmatism. So that has evolved over the years. We now have many, many ways to correct both astigmatism and the need for a bifocal in a contact lens and there are some instances where we might actually use a contact lens in youngsters to try and prevent changes in their vision.

Dr. Nate: 05:46 Yes. That’s something that we talk about here a lot at Bright Eyes Kids. Now, you know, you mentioned kids, a lot of parents are very surprised to find that we can do contact lenses at all. A lot of people feel like until children are teenagers contact lenses are just not an option. Do you think that that was true previously that we initially started it at teenagers or do you think that was just a myth that sort of came out of nowhere?

Dr. Benoit: 06:17 I think it’s probably a combination. I think it was the comfort level of the doctor and or the parent as far as getting a contact lens on that particular youngster. What I have found over the years is that it really isn’t an age thing so much so maturity level thing. Some youngsters are ready to wear a contact lens at six years old and some won’t ever be ready again think about that teenage boy.

Dr. Nate: 06:41 I agree completely. I think that a motivation is absolutely everything. The worst case scenario in my opinion is when the parent really wants their kids to wear contacts and the kid really does not because if he doesn’t want the lens in his eye, he’s not going to get it in his eyes. There’s just no way, no way around it, but if there’s, if there’s sports, if it’s cosmetic, if there’s some other motivation than kids who can be very successful at wearing contact lenses. Pretty much independent of the age. That’s my experience for sure.

Dr. Benoit: 07:15 I would agree with that.

Dr. Nate: 07:16 What about people who were either bifocals or reading glasses are contact lenses a good option for them?

Dr. Benoit: 07:23 Yes, they are and there are a number of ways that that can be approached. I mean, one of the simplest ways would be to have contact lenses for distance and then put on a pair of reading glasses when you need it to do something on the computer or to read your cell phone, let’s say. But a lot of folks that are interested in contact lenses really don’t want to be bothered wearing glasses at all. And luckily for them, since about 1949, we have had bifocal contact lens is available and the designs that we have currently are really very, very good at correcting most patients needs as I used to, like to tell my patients if they’re motivated and willing to put up with the adaptation to these different optics in these contact lenses, about eighty percent of the time they’ll be able to function very, very normally and not have to rely on glasses at all.

Dr. Nate: 08:12 Yeah. Some of the happiest patients are ones that are so irritated with their reading glasses, misplacing them, having one in every room in the house except for the room that they’re in. And uh, you know, getting those patients into contacts is extremely rewarding.

Dr. Nate: 08:27 Now, when I first got my first pair of contacts, I was in high school, I got one pair, one for each eye. The pair had to last the entire year and I told all my friends, I’m like, Hey, I’m coming to school tomorrow and I’m going to be in my contacts. I’m not going to be wearing my glasses. And the very first morning I let one go down the drain and that was, I don’t know, $80 worth, you know, or something. Nowadays, you know, it, the idea of a fitting a child in an annual lens is just completely unheard of. I definitely have seen in my practice going to the, uh, the daily disposable or single use lenses has dramatically increased the comfort. Um, but most importantly, the health and safety of lenses. You travel around and talk to docs from, from all over. Do you think that that’s something that every doctor’s reporting?

Dr. Benoit: 09:25 I agree with that, yes, the advent of daily disposables of single use lenses has really improved the health of all patients. It makes it a lot easier for travel. If you do have one go down the drain, which you shouldn’t because the water shouldn’t ever be running when you’re doing your contact lenses, but if you should happen to lose a lens in that fashion, you can just open up another lens and put it in your eye. I don’t have to refer it to wearing glasses until you can order a new lens.

vti differenceDr. Nate: 09:50 One of the things that we see as doctors is companies are, you know, they come out with contact lenses on a very regular basis. Sometimes it’s a little bit overwhelming for doctors because there’s just, there’s so many products. However, um, I was very excited when Brian, our rep from, from VTI, from Visioneering Technologies came in, uh, because I had been trying to get my hands on the natural view of Lens set for patients because I’d heard so many good things about it. So why don’t you tell us just a little bit about what sets Natural View apart from some of the other lenses that are out there.

Dr. Benoit: 10:30 Well, the natural view multi-focal contact lens is a one day Lens. It has a center distance design where the majority of multi-focal soft daily disposable lenses are currently center near designs, a the center distance design also uses what we call an extended depth of focus mechanism to actually create the power for reading, so folks that have the need for a bifocal that are say 42 or someone like myself that is 63 can wear the same lens and not have to worry about having a different add power as we call it. So it’s very, very nice for the doctor because you have one shape, one size and this universal add and you don’t have to worry about trying to pick too many parameters at once. So it really makes it very convenient for the doctor.

Dr. Nate: 11:21 So I’m, I’m very happy and very impressed with the lens and the patients have been too, before we wrap up here today, I appreciate your, your time. I appreciate you coming to the office. It’s always fun to be able to record in person as opposed to to over skype, which we do sometimes. Uh, is there anything else that you’d like to tell a patient? Maybe they’re interested in contact lenses. Anything else that you’d like them to think about that, that maybe they hadn’t thought about before?

Dr. Benoit: 11:51 Well, I think that anyone that’s listening to this podcast, if you haven’t thought about contact lenses, maybe you should. Contact Lenses can work for pretty much anyone as long as you’ve got motivation to where the contact lens and certainly here at a bright eyes, you will get to some of the best care that you will get anywhere.

Dr. Nate: 12:11 Well, thank you for that Dr. Benoit. So to all of our listeners, thank you for listening. If you have any questions, comments, or suggestions, you can email us at office@brighteyestampa.com. Until next time, we’ll all be at the beach,

Exit: 12:30 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 treatment.

 

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

Podcast #9: Vivid Vision with James Blaha

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 James Blaha From Vivid Vision about virtual reality vision therapy.

** See the related blog post of previous text interview with James Blaha.

** See the related episode about how vision and performance – #3 VISION LEADS.

** See the related episode with Edna Moore – #8 VISION THERAPY.

The Full transcript:

Intro: 00:01 Welcome to the bright eyes podcast advise 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, Ortho-keratology, and sports vision training. Their mission is to empower patients by providing the best in friendly, professional and individualized care.

James: 00:39 It’s march and so that means it’s fall in Florida when all the leaves and pollen make everyone miserable. This is the bright eyes podcast. This is episode number nine. I’m Dr Nate Bonilla- Warford, Dr. Beth is away, and I have a special guest with me, James Blaha. Vivid vision. How are you doing, James?

James: 00:59 I’m good. Thanks for having me on.

Dr. Nate: 01:01 Yeah, well I’ve, uh, I’m excited about doing this. We’ve talked many times over the last few years and I had wanted to have you as a guest on our podcast for a while and so, I’m glad that it worked out. So for listeners who don’t know, vision therapy is a program of treatment to help people who have certain types of functional visual problems that can be an eye movement problem, an eye focusing problem, an eye alignment problem, or other kinds of problems. There are many different strategies in many different ways that vision therapy can be performed, but vivid vision is a way to apply those same principles in a virtual reality environment. And that is the product of years of work that James had done. Now, the interesting thing about this is that James is not an optometrist. What is your background?

Vivid Vision Logo With CircleJames: 02:01 I’m I’m a programmer and an entrepreneur, um, but I also grew up with Amblyopia and Strabismus. So I got Interested in all of this from my own personal perspective going through treatment as a kid and later as an adult reading about it.

Dr. Nate: 02:16 Yeah. Which I think is fascinating. So when you were first developing this, it was nowhere near the level that it is now in terms of features and sophistication. What was the first kind of prototype like?

James: 02:32 Yeah. So when I, when I first started building it, I guess I was kind of a naïve as to what the complexities of all this would actually be like. I thought it would be a lot simpler than it actually is. The first version I had a cube in VR (Virtual Reality) and basically I can use the arrows on my keyboard to make it brighter and my weak eye in dimmer in my strong, and I would make an adjustment until I could see parts of the cube with my weak eye. So that was sort of our first, the first test we made. And that was basically a rough estimate of suppression of the weaker eye first game I had, it was actually a version of what’s now Breaker, which is like a breakout style game, but in 3D in VR where you use paddles to hit a ball to destroy bricks on the other side of a marina. So the very first version we would take a measurement of the suppression using the first tool and then we would set up the game so the bricks were brighter and the weak eye and dimmer in the strong eye according to that measurement, and that was about four years ago, I guess

Dr. Nate: 03:35 Four years ago and a lot in four years. So for patients who might be listening with the features and the current state of the virtual reality treatment, a vivid vision in particular who would be a candidate?

James: 03:50 You would probably be able to answer that even better than that I could, you know. But in general Amblyopia, Strabismus, although with Strabismus it can be complicated and it really depends on the case I think. And also convergence problems and divergence problems. We’ve seen the most success with refractive Amblyopia. That seems to be easiest to treat.

Dr. Nate: 04:15 Yeah. Well, I agree with that. In our office, uh, we use it for people who have Amblyopia, which commonly is called a lazy eye by people. People also use the term lazy eye to mean Strabismus, where the eyes aren’t necessarily aligned all the time, or maybe not, some of the time. Those conditions result in a condition called suppression where one, it sort of takes over, dominates the other one, is dominant and less dominant eye. And so the whole point of this virtual reality treatment is to stimulate the eye that suppressed, to get the eyes to work together in a very, very engaging in immersive way. Uh, what we see in the clinic is that it works extremely well, it’s very very effective. But also it’s, very fun.

James: 05:01 Yeah. The motivation part of it is sort of one of the missing parts of other treatments. It’s a lot easier to do the actual therapy time and I think the therapy times more effective when people want to do it and are engaged in it as well.

Dr. Nate: 05:17 Yeah, I think that that’s true kind of across the board. If it’s more engaging, if it’s more interesting the brain’s gonna learn faster and make better use of that information and so we try to do that as much as possible, but few things are has engaging has a virtual reality video games, I think we’re gonna see a lot more of in different contexts. And I’m excited to be able to be able to offer it. Now we’ve had some tremendous success stories, people who’ve improved dramatically in terms of how clear they can see with their Amblyopia eye. We’ve had patients who formerly didn’t see in 3D, but then we’re able to develop their depth perception. I would imagine that you’ve heard just a huge number of wide variety of success stories all over the country and all over the world. Do you have maybe like a couple of, like a favorite case that really you really kinda sticks with you, I guess, aside from your own because your own is pretty compelling?

James: 06:21 Yeah, I’d have to I’d have to think about that a little bit. I think, um, we have heard of cases all over, you know, one of the cases that sort of sticks out in my mind was a guy in his fifties who had a strabismus surgery and following the surgery, he used a vivid vision with an ophthalmologist and actually saw a really big results getting stereo for the first time in his fifties after the surgery. And it sort of surprised the ophthalmologists and um, usually we don’t expect recovery and Strabismus and let that, you know, later in life, but it seems like right after her surgery is the right time to be doing this practice. And so that, that case really interested because um, you know, it could be, uh, something we’re going to study a little more closely in the future whether or not there’s this period after surgery that’s really optimal for, for doing the perceptual training.

Dr. Nate: 07:16 And that’s actually one thing that’s exciting, you know, your team has grown a whole lot since four years ago and now you have a optometrists visual scientists research and so that’ll be, you know, that’s going to be great to see, you know, as we learn more about what the opportunities are and what the results are right now. It’s all so new. It’s exciting but it’ll be even more exciting when we have more data behind it.

James: 07:48 Yeah. I’m working with a number of universities right now. Each group has sort of a specific area they’re looking at in detail. One of the sort of hard things about this is that every patient has has a unique situation going on and so it’s really difficult to study, you know, lazy eye when it’s really a bunch of different things each with their own causes and effects.

Dr. Nate: 08:10 Right. Yeah, absolutely. And I know that the newest update also includes one of the activities that’s beneficial for sports vision, so peripheral vision, reaction time and so, I assume that you are working on more opportunities for treatment as time goes on. I’m sure you have a lot of stuff that kind of in the pipeline that you’re not ready to talk about, but it’s probably super exciting. So, you know, that’s, that’s gotta be really fun to be, you know, this far ahead of something that has so much potential.

James: 08:48 Yeah, I think, um, you know, over the next couple of years, like you said, we’ve been growing and are hoping to grow a little more. Part of that is expanding, researching development and sort of expanding the kinds of things we measure in treat with VR headsets. So sports vision is part of that. We’re doing a little work in low vision as well, and we actually just announced publicly that we’re working on a visual field test. I’m using that headset

Dr. Nate: 09:16 Now, one of the things that’s most exciting, I think, is that the virtual reality VR devices are becoming so common and widespread,at home, everything from kind of higher end oculus rift to like the Samsung gear VR. So the opportunity to be able to do what is extremely sophisticated visual treatment at home is something that I think has been a goal of yours for a long time. And I know that people are interested because we get emails from all over the world. We actually had a family that, lives in Brazil, but they came to Florida to go to Disney world for vacation. But then they took a day off of their Disney world vacation to come to my office to see if they were a candidate for vivid vision. And she is, this young girl had had two different surgeries to align her eyes. And I thought she was an excellent candidate, so they just recently started doing a vivid vision at home in Brazil, which is way more exciting, I think with potential for benefit, than they were able to do a locally before, you know, that’s just one story. And I’m sure that there are many stories like that, that people have access to, you know, to this kind of therapy where they didn’t before. So I think that that’s going to be a wonderful for patients all over.

James: 10:44 Yeah. You know, that’s, um, our original mission was to have some kind of home treatment and then we found out how complicated it is, found out doctors really, really do need to be involved in and make that initial diagnosis and follow-up on the treatment and sort of manage it on and make sure things are going correctly. And so it took us a little longer than we expected to get out the home version and sort of make sure we were doing it correctly. Um, but now that it’s out, you know, we’ve been hearing a lot of stories like that of doctors. I’m managing the treatment of patients who normally wouldn’t have access to a good care.

Dr. Nate: 11:19 Yeah. I think it’s anything, it’s extremely exciting. And I, you know, we talked to you kind of early on and as soon as it was kind of out of the Beta testing stage, we, you know, we implemented in the office and we’ve been very happy with it. Uh, and so, uh, I know that I will see you at some of the, uh, upcoming vision therapy meetings, COVD is a big meeting and that’s, you know, that’s coming up soon. So that’s, you know, that’s exciting. Um, anything else that you’d like to share with patients before wrap this? Wrap this up?

James: 11:55 Yeah, I guess, uh, you know, one of the things that, that really helps companies like us to hear from patients and just sort of here, you know, what people want, what people need, um, those stories really help us figure out what we should prioritize, what we should be working on. So it’s always great to, um, you know, getting, getting an email from somebody or something like that through our website. Just hearing you know, what their problems are and what we can try to figure out what we can do to help fix it.

Dr. Nate: 12:26 Yeah, that’s a great point. I’ll definitely make sure that we include your contact info and the website is seevividly.com

James: 12:26 Yeah, That’s right.

Dr. Nate: 12:38 Yeah, absolutely. All right. Well, I really do appreciate you taking the time to talk to me today and uh, I’m looking forward to editing this, this episode so we can get it up for people to listen to.

James: 12:52 Yeah, very nice talking to you. Thanks for having me on.

Dr. Nate: 12:54 Yes. And to our listeners, thanks for listening. If you have any questions, comments, or suggestions, you can email us at office@brighteyestampa.com. And until next time we’ll see you later.

Outro: 13:05 Brought to you by bright eyes, family, vision, care, and bright eyes kids. Find previous episodes and more detailed information at brighteyetampa.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.

 

VRVT

Podcast Episode #8: Vision Therapy with Edna Moore

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 Bright Eyes Family Vision Care vision therapist, Edna Moore about what vision therapy is and what it is like to be a vision therapist.

** See the related episode about how vision and performance – #3 VISION LEADS.

The Full transcript:

Intro 00:00 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: 00:41 From the endless summer of Tampa, Florida this is the bright eyes podcast. My name is Dr Nate and I have our first special guest on the podcast. This is episode number eight and I am joined by Ed More. How are you doing, Edna?

Edna: 01:00 I’m doing great. How are you?

Dr. Nate: 01:02 I am super fantastic as always. So, Edna is our lead vision therapist at bright eyes. How, how many years have you been with us?

Edna: 01:02 Over eight years Dr. Nate.

Dr. Nate: 01:19 That is what I thought it seems like forever.

Edna: 01:25 No, it just seems like yesterday, actually it’s gone by a lot faster than what you would think eight years is.

Dr. Nate: 01:30 It’s been wonderful. It has been, and so for those who are not familiar with what vision therapy is, vision therapy really is a program of therapeutic activities that’s designed to improve some aspect of visual skill and that could be somebody who’s a child who either gets headaches or is having difficulty because their eyes don’t move or focus or it could be somebody who’s had some trauma or a brain injury or concussion and they are having double vision and that’s difficult for them. So it could be any of those types of things. Edna sees all different types of patients. And can you describe a little bit about what a day in the life of a vision therapist is?

Edna: 02:27 Sure. Actually, it’s a fun day. Each patient is different and when they come in, they are ready to get started. My job is to not only make it fun but also make it productive. So, we have a list of activities that the doctor has prescribed for the patient specifically during that forty to forty five minute session. And it’s my job to make it fun so that their eyes and their brain can learn quickly. Without thinking that these activities are going to be boring or that it’s hard to do, it’s fun to be able to create ways to show the patient that it can be done. A lot of these patients come in and they’ve already been frustrated with some of the things that they’ve had to do, whether it’s reading or not being able to see clearly, things like that to, being able to go through these different activities and then be able to do at the end. So a day in the life of the therapist is always changing. It’s challenging, but it’s also rewarding and it’s fun.

Dr. Nate: 03:42 Now you had some experience with vision therapy, before you came to work her as a vision therapist, can you tell us a little bit about that?

Edna: 03:47 Yes, my second child, he was ten and at school was hit with a soccer ball, by accident and he fell on the ground and hit his head and for, a number of months, his visual system, I didn’t know what was going on, but his, um, he started experiencing double vision, headaches, vomiting, and I had to, get him from school almost every day we didn’t realize what was going on. He didn’t have a concussion, he didn’t have whiplash, but, he kept telling me that, mom, I’m having double vision on and off, I’m having trouble balancing, I’m having trouble walking, I’m dizzy all the time, so through a battery of tests and getting MRIs, things like that, really all the different conventional ways of testing for these particular symptoms came up negative.

Edna: 04:42 It was only through a remark from a dean at USF had just mentioned in passing that maybe we should try seeing a vision therapist, a doctor who specialized in vision therapy. And that particular doctor had found out that just by doing a number of simple tests with his eyes that he had his center, was shifted to the right. So if you asked him to walk in the center of the hallway, he was actually a walking on the right side of the hallway. So through vision therapy, he went three times a week, about one hour a day and, , he also wore prisms in his glasses. Um, and for about three months we did that. And, after three months I was happy to see that I had my child back. He no longer experience double vision. His headaches were gone. He was no longer dizzy when he walked.

Edna: 05:45 It was as if this was a miracle cure or, but, I had no idea what this was. I did not know what they did with him in that room, but I know that experience as a mother when your child is going through headaches every day and it changes his life it changes the parents life too and and to see a child needlessly suffer like that and not be able to help him, I was relieved and elated that these symptoms had all disappeared and was resolved through vision therapy. So that was my, experience with vision therapy.

Dr. Nate: 06:23 I always love to hear that story because I had my own experience with vision therapy, which I’ll share on a different podcast, but I know that it helps you to be a better therapist when you understand what the patient and the parents are are going through. What do you think patients and parents think of the vision therapy program

Edna: 06:49 After they’re done with vision therapy, I’ve had both patients and parents make comments like “if it wasn’t for vision therapy, he wouldn’t be as confident as he is now”. “He’s doing activities that, before vision therapy, he would not have chosen to even try. Now my child is trying. I’ve had,, patients who hated reading, did not enjoy reading and didn’t understand why her other friends loved reading books where she found it very hard and not enjoyable. And after vision therapy, she’s now reading 400 page books and her mother says she’s just devouring the books left and right because she’s found that reading is now effortlessly.

Dr. Nate: 07:39 Some people, when they think about therapy, they think about physical therapy which might have happened after a surgery or some sort of injury and they don’t always have positive associations with that kind of therapy. What do you say to a parent or a patient who might feel like this is gonna be like that?

Edna: 08:00 I think that, if parents are unsure about vision therapy, it may mean that they don’t quite understand what’s going to take place and so, um, to explain it to a patient or a parent it’s like a sports or taking lessons for music. You come into the office or you go see your coach or you’re going to go to practice and you learn new skills and then you’re gonna go home and you practice, those skills so that you can improve upon them and then you come back the next week and, show your instructor or to learn new skills to build upon that. And that’s what vision therapy is. So as not some type of program where you wouldn’t understand the concepts. So I try to compare it to things that they already know about , if a child is in sports, you know, the child understands that, yeah, they go every week to practice, to learn new skills and then they, it’s to them to go home and practice. And the parents understand that to whether they’ve a learn to play an instrument or play sports. They understand and recognize the importance of that. And so that’s what vision therapy is. It’s as simple as that.

Dr. Nate: 08:00 Think most patients think it’s fun at least some of the time?

Edna: 09:13 Yes. I have heard often whether it’s my coworkers outside the office, outside the vision therapy room rather with the door closed, they can still hear us laughing. They don’t know what’s going on. They hear is clapping. They hear us saying that’s a great job. I hear children, laughing, you know, they mainly comment. They wonder why what’s going on in that room. Sounds like there’s a party going on. So, , a lot of times it is, we do have a lot of fun and sometimes we think some of these things are silly, but uh, there’s a lot of learning and um, a lot of improvement going on. , in these four walls.

Dr. Nate: 09:51 Does that mean they don’t have to put in any effort or work?

Edna: 09:55 No, I’m on the contrary. It just means that their focus is not so much on how hard it is, but the more fun they have, it just makes everything easier for them.

Dr. Nate: 10:07 Want me to put you on the spot?

Edna: 10:07 Sure. Why not?

Dr. Nate: 10:11 Of all the different types of patients that we see, what do you think is your favorite kind?

Edna: 10:17 That’s hard to say. I think the most memorable ones are the adults who have gone through a lot in their life and then all of a sudden something happens and then they are unable to function. They cannot drive, they cannot walk, they cannot ride a bicycle. Something happens and a life stops, for them until they come see us. And then through vision therapy and through practicing on their own, which these are highly motivated adults, their progress is so much quicker and I get to see from where they were, their tragedy or their traumatic experience changed your life, to now seeing them successfully be able to do the things that they enjoy that they couldn’t before they came to see us. So I think that’s, to me is the most rewarding.

Dr. Nate: 11:14 Anything else you want to tell people about vision, therapy, things you’ve learned over the last eight years?

Edna: 11:20 No. Two patients are alike and it’s , again, very rewarding to see that, especially me being here for this long now that I, enjoy seeing past patients who have completed vision therapy and has seen now, where they are in life. When I have seen patients who are six, seven, and eight, and now six years later they’re getting ready to drive or they’re getting ready to, you know, embark on different experiences. It’s just really cool to see sort of these little, what I call a “little, you know, chickens coming back to the hen house”, and showing off what they can do now. And their parents are beaming with pride in saying if it wasn’t for vision therapy, they are, they wouldn’t be. You know who they are today.

Dr. Nate: 12:12 All right, well thank you Edna for being our very first guests. You did a wonderful job. Several episodes of the brightest podcast are all going to be about vision therapy and I’m really looking forward to those episodes so everyone, stay tuned. You can always contact us at office@brighteyestampa.com. See you next time.

Outro: 12:35 Brought to you by bright eyes, family vision care, and bright eyes kids. Find previous episodes and more detailed information at http://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 #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:
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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.

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