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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.

Top Ten New Years Resolutions for Screen time and Kids Eyes

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

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

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

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

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

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

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

-Dr. Nate

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

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

Here is the conclusion from the study abstract:

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

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

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

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

-Dr. Nate

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Research Shows Adults Can Be Treated for Amblyopia

Adult Amblyopia Treatment

Treatment options for adults with amblyopia isn’t magic. It is real and based on science. For decades there has been a belief among eye doctors that if a patient had amblyopia (AKA “lazy eye”), it was untreatable after childhood. Whether the cut-off age was 6 years old, 8 years old, or 10 years old, it was assumed that after that age, it was pointless to try to improve the vision in the “lazy” eye. It was thought that even if the vision did improve, it would just worsen again after treatment stopped.

Amblyopia is a condition in which vision is reduced in one or both eyes even with glasses on. By definition, it is not caused by disease or injury, but instead develops when the brain does not get enough visual stimulation to use both eyes together. This could be due to blurry vision for a number of reasons or misaligned eyes. Catching amblyopia early is helpful and that is one of the reason that InfantSEE exists.

For many years, the only treatment for amblyopia was occlusion therapy, where a patch is worn over the eye with better vision to force the eye with poorer vision to work. Even if you don’t have a family member who needed to wear an eye patch, you probably are familiar with the concept in popular culture. Patching can be effective if done correctly. But it is hard work and takes motivation. (See the post on #IPatch the social media support of amblyopia patients who are patching right now.)

Ann Adult AmblyopiaAs I have been posting over the years, there has been significant scientific evidence that shows that despite what was once thought, it isn’t just young children that can be treated but also older children and adults. At the bottom of this post is a quick summary of some of the research on improvement of vision in adults with amblyopia:

And it is not just in the vision science laboratory that we notice improvement in adults with amblyopia. One recent patient of ours is a 35 year old woman with refractive amblyopia due to her farsightedness in her left eye. The best she was able to see was about 20/70 in that eye. Following a few months of treatment, she was able to see about 20/30, a significant improvement. She was so happy with her rapid progress, she said. “At my age, I thought all hopes of better vision were gone but after my vision therapy treatment I have seen a significant improvement in my vision!”

One adult patient with amblyopia said, “At my age, I thought all hopes of better vision were gone but after my vision therapy treatment I have seen a significant improvement in my vision!”

Why, despite the research and success in the therapy room, does the belief that “nothing can be done” after a certain age persist? Susan Barry, PhD (AKA Stereo Sue) does a great job of answering that here, but the simple answer is that change takes time and doctors are very slow to change such a prominent belief as this.

Treatment for adult amblyopia is complicated and does take effort on the part of the doctor and patient. Treatment may involve traditional occlusion (patching) with visually stimulating activities, but could also include the use of special glasses or contact lenses and more modern techniques that involve the use of both eyes together (known as MFBF) and also the Virtual Reality based Vivid Vision system.

That being said, treatment for amblyopia is difficult and there may be significant reasons to NOT attempt treatment. It may take longer than in young children and the overall goals might be different. A thorough evaluation by a doctor with experience with adult amblyopia patients is critical. You can search for a doctor in your area with both COVD and OEPF websites.

If you have questions about adult amblyopia treatment, you can call us at (813) 792-0637, or enter a message at the bottom of the page.

-Dr. Nate

Bright Eyes Family Vision Care in Westchase and Bright Eyes Kids in New Tampa

Vision scientists don’t always write in terms that patients can understand. But I thought it was interesting to see what researchers say in their own words when they publish scientific papers on treatment of adult amblyopia. Enjoy. 🙂

  • “Two adult patients are presented whose childhood amblyopia improved markedly.” (Willson, 1992)
  • “perceptual learning can improve basic representations within an adult visual system that did not develop during the critical period” (Polat, 2003)
  • “adult amblyopic visual system retains a substantial degree of plasticity: repetitive practice can substantially improve position discrimination acuity.” (Li, 2004)
  • adults with amblyopia can improve their perceptual performance…” (Levi, 2005) ” clearly show the success of the structured method, targeted at the specific deficiencies in amblyopia, to improve vision in children and adults.” (Polat, 2008)
  • “These results show that the mature amblyopic brain is surprisingly malleable, and point to more intensive treatment methods for amblyopia.” (Li, 2008)
  • “that this approach puts in place the necessary neural precursors required to fully recover stereo acuity in adult amblyopic subjects.” (Astle, 2011) “This provides a basis for the treatment of amblyopia in adults who currently have no treatment options.” (Jinrong, 2013)
  • “The home-based dichoptic iPod approach represents a viable treatment for adults with amblyopia. (Hess, 2014)
  • “perceptual learning of various visual discrimination tasks in adults with amblyopia can transfer completely...” (Zhang, 2014)
  • “new treatments are emerging that directly target suppressive interactions within the visual cortex and, on the basis of initial data, appear to improve both binocular and monocular visual function, even in adults with amblyopia” (Hess, 2014)

Myopia gene? Well, Partially.

 

For those of us who are concerned about myopia and its development, there is some pretty big news! Just take a look at the screen shot of all the news headlines to the right. It goes on an on.

Under the title, APLP2 Regulates Refractive Error and Myopia Development in Mice and Humans, scientists described a gene identified in children that leads to myopia (nearsightedness). We clearly know that there is a genetic component to developing nearsightedness. It runs in families. We also know that it is not all genetics. The more years of studying a person does, the more likely he or she might become myopic.

Here is an excerpt of the abstract from the study (without all the technical info):

Myopia is the most common vision disorder and the leading cause of visual impairment worldwide. However, gene variants identified to date explain less than 10% of the variance in refractive error, leaving the majority of heritability unexplained (“missing heritability”). Previously, we reported that expression of APLP2 was strongly associated with myopia in a primate model….This work identifies APLP2 as one of the “missing” myopia genes, demonstrating the importance of a low-frequency gene variant in the development of human myopia. It also demonstrates an important role for APLP2 in refractive development in mice and humans, suggesting a high level of evolutionary conservation of the signaling pathways underlying refractive eye development.

This is a big deal because this, as Lead author Dr. Andrei Tkatchenko- Assistant Professor of Ophthalmic Sciences at Columbia University, says, “the first known evidence of gene-environment interaction in myopia.”

So children with the APLP2, “myopia gene,” are more likely to become nearsighted. But here is the kicker from the research: both mice and children who had the “myopia gene” didn’t necessary develop myopia. They only became nearsighted if they also spent time reading or doing close work. Close work would include reading and hand-held video games.

What does this mean for optometrists like me who see people, not mice, in their exam chairs. Business as usual. We will continue to educate patients about options for seeing well despite myopia and options for limiting its progression. And for goodness, sakes, kids need to be outside more!

Stay tuned. There will be more on this front, for sure!

-Dr. Nate

Probable Myopia Gene Owner

Amblyopia Research Supports Treatment Without Patching

New amblyopia research shows that treatment with both eyes is better than patching alone!

eyepatch used in amblyopia researchFor ages, the majority of amblyopia research and treatment has focused on two areas: the use of glasses to provide the clearest vision possible and the use of an eye patch to force the amblyopic (weaker) eye to see. Patching often worked well. But there are some reasons why patching alone often doesn’t work.

The problem is patching is two fold:

1) Patching is hard! (It can be like a form of torture for some patients.) Cover up your good eye and see everything blurry for hours on end. You are forced to use an eye that you are not comfortable using, without having any idea how to intentionally move or change focus in that eye. You are just supposed to figure it out. Patients resist patching, avoid visually demanding activities, get frustrated more easily, and often “cheat” or “peek” from behind their patch.

As the American Optometric Association’s Amblyopia Patient Care Guideline says, “Noncompliance with occlusion represents a significant factor in occlusion failures, especially in patients over 8 years of age in whom up to 50 percent noncompliance is common.”

2) Patching alone does not solve the underlying problem. Amblyopia is not a situation where one eye is normal and the other is lazy. Amblyopia is a situation where one eye is struggling to focus clearly or stay pointed in the right direction, and the other eye is a bully. Yes, literally. The bully eye steals the brain connections from the weaker eye and uses them for itself. So while patching helps the weaker eye reinforce brain connections and see more clearly, it does not teach the bully eye to be nice. It just means the weaker eye can stand up for itself.

For example, it is like taking a right-handed child and putting the right arm in a cast for 8 hours a day for a year or so. Without helping them learn to hold a pencil, button clothes, or eat with their left hand – what will they do? They will avoid activities that need them to use their hands because they are clumsy. And when the cast is off, the right hand still takes over. What about activities that use both hands together, like tying a shoe? They still haven’t really developed equal strength between both hands, fine motor control of the left hand, or any coordination with the right hand.

The same happens with binocular vision (using both eyes). Patients who only use patching, often find the amblyopia returns when the patching stops, because they never learned to use both eyes together. It’s easy for the eyes to slip back into old (bad) habits. More patching? Again? At some point, it would seem easier to just give up and accept less than ideal vision.

But there is good news! I have written about some exciting developments in amblyopia research before, such as the amblyopia Tetris study, which showed that amblyopic treatment not with patching, but by treating both eyes (binocular), improved amblyopia in adults.

I am happy to report that there has been a recent spate of studies concerning the binocular treatment of amblyopia. Optometrists have felt for years that amblyopia was primarily a binocular phenomenon, and therefore required binocular solutions. We have anecdotally observed 1) faster treatment of amblyopia with binocular vision therapy and 2) greater regression with patching alone versus patching plus some form of binocular therapy. We are very excited to see excellent recent research that supports this view, mostly done by ophthalmologists and neuroscientists.

Be warned, gentle reader, the following are quotes directly from the published scientific papers on amblyopia research. I will summarize below each passage. Emphasis mine.

Converging evidence points to the pivotal role of decorrelated binocular experience in the genesis of amblyopia and the associated residual deficits. These findings suggest that a new treatment approach designed to treat the binocular dysfunction as the primary deficit in amblyopia may be needed. Prog Retin Eye Res. 2013 Mar; 33: 67–84.

What this means: It turns out that amblyopia might be due to a problem of both eyes, not just the “lazy” one. We should find a way to treat both eyes together.

…dichoptic perceptual learning, designed to strengthen binocular combination by reducing suppression, improves both stereopsis and acuity in adults and children with amblyopia…. As a whole, these results lead us to question the prevalent view that amblyopia is primarily a disorder of monocular vision and should be treated accordingly with monocular occlusion. If we are open to the possibility that binocular interactions lie at the heart of amblyopia, then we could be at the threshold of a new age of therapeutic interventions that don’t involve patching the fellow fixing eye. Ophthalmic and Physiological Optics Volume 34, Issue 2, pages 146–162, March 2014

What this means: Yep. Amblyopia is a problem of both eyes. And treating both eyes is better. And that means that hours of patching one eye might soon be a thing of the past. And vision therapy is the way of the future for patients of any age.

Update: You can see some examples of modern amblyopia video game treatment in this post.

If you want to read more about the amblyopia treatment that we offer go here. If you would like to make an appointment to have yourself or child evaluated go here or call 813-792-0637.

Onward and Upward!

Dr. Nate on amblyopia research

“Foolproof” Eye Test for ADHD

We have known for years that there is a link between how the eyes work and attention. This is why there are so many children who have both Attention Deficit Hyperactivity Disorder (ADHD) and visual coordination problems. Pediatric optometrists see this in the exam room every day and it is our job to help sort out how much of a child’s difficulty is due to ADHD and how much is due to not being able to visual focus and move their eyes efficiently.

There is some new research about ADHD and eye movements that is very compelling. Researchers in Tel Aviv, Israel, led by Moshe Fried, MD, have found that by simply monitoring involuntary eye movements, ADHD can be diagnosed.

“This test is affordable and accessible, rendering it a practical and foolproof tool for medical professionals,” said Dr. Fried. “With other tests, you can slip up, make ‘mistakes’ — intentionally or not. But our test cannot be fooled. Eye movements tracked in this test are involuntary, so they constitute a sound physiological marker of ADHD.

The study also showed that Ritalin (methylphenidate) does work in improving ADHD as measured by eye movement control. What was not researched in this study is how much other treatments that also improve eye movement control influence ADHD. Optometric vision therapy is commonly used to help patients improve their voluntary and involuntary eye movements.

Clearly more research is needed to better understand the relationship between ADHD and eye control, but this new study is a step in the right direction.

DrNateSigMagnetCapture

 

Adorable Video on Eyes, Vision, and Eye Disease

 

I think we have found our primary training video for all employees! It is great. You simply MUST watch this amazing educational video about eyes, vision, and eye disease. For one thing, it is adorable! Second, it is quite accurate.

If you have a child who is interested in the eyes and vision, watch this video with them. They will enjoy it, I promise. It covers:

Parts of the eye:

  • Cornea
  • Iris
  • Pupil
  • Lens
  • Vitreous Body
  • Macula
  • Retina
  • Optic Nerve

These conditions:

  • Nearsightedness
  • Farsightedness
  • Glaucoma
  • Macular Degeneration
  • Diabetic Eye Problems.

It also has cool eye and vision science experiments. And as my friend Ann Z from Little Four Eyes said after watching the video, “All science experiments should involve safety glasses and oreos.” I couldn’t agree more. 🙂

This video is part of the Learning is Fun series, created by the Amazing John John and his mom. Think of him as Bill Nye, only cuter and shorter. A very curious and photogenic little guy, he has done videos on everything from magnets to layers of the earth. I’ve watched a bunch with my kids and they love them. My staff does, too. You can check him out at http://amazingjohnjohn.wordpress.com. He is on Twitter and Facebook, too.

Can’t wait to see more from him!

 

And don’t forget! Sunday, August 4th is the Great Glasses Play Day! Tons of activities for kids (and grown-ups!). Free sunglasses (like those above) for all kids!

All the best!

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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Tetris therapy for amblyopia? Yes, please.

A new study, about amblyopia, has been published and it is really getting attention. From CBS news to Huffington Post to CNET, everyone is covering it, probably because they get to use the word “Tetris” in the title. Tetris, of course, is the hugely addictive block-stack game that, at least in my memory, was the first hand-held videogame blockbuster.

Amblyopia, known to many people as “lazy eye” is a visual adaptation to conditions that interfere with visual development. On a simple level, it means that even with the best glasses or contact lenses, the eye does not see and function as well as expected. It is not due to disease or injury, but rather a situation where the brain doesn’t communicate well with one eye and can’t use the eyes as a team.
Think of the brain being someone on the internet, and one eye is a friend with 14.4K dial up and the other has a 4G smart phone. Yes, you can communicate with both eyes, but you are going to prefer the 4G because it is faster and can do more things. Trying to use both eyes simultaneously as a team is hard because one is lagging behind and missing information.

I am extremely glad to see this study and I do have some thoughts on it:
First, do not get too excited about the Tetris part. While I really have no doubt that Tetris and similar games stimulate visual planning and cognitive development, I suspect that the main benefit of using Tetris in this study is that it is very engaging, requires attention to visual detail, and requires the player to make decisions based on visual information. Basically this is true for most video games (and real world games, for that matter). So Tetris is not the magic here.

What IS a big deal about this study is the goggles – they required the eyes to work together to play the game. If you play, you can’t just shut off the amblyopic eye, or you’ll lose because you won’t see the falling blocks. And that isn’t motivating or good therapy. It isn’t patching or covering the good eye because you won’t see the blocks on the bottom. You still won’t win. This is like conventional patching. You can stimulate the amblyopic eye (upgrading the modem), but that alone only helps somewhat.

What this study shows is that only when both eyes can see and are given the opportunity to work together to achieve a common visual goal is there significant improvement in the amblyopic eye. In my internet analogy, this is not only giving the amblyopic eye a 4G smartphone but making sure it is net savvy. Both eyes are now friends on Facebook and Twitter so they can work together in real time to solve visual-spatial problems efficiently. (Just to be clear: the eyes do not use Facebook, and they do not communicate directly – all that happens in the brain).

So why is this so exciting? Because this is exactly what we do in vision therapy every day. We “upgrade” the eyes to work well individually (4G) but also “network” them to work together (Facebook, Twitter). We don’t use Tetris, but we do use paper & pens, balls, special glasses, computer programs, 3D art, optical illusions and lots of other fun tools to make it fun and productive.

It is great to see more research on this on adults with amblyopia. For too many years, patients have been told that after early childhood there is no hope of improving the vision in the amblyopic eye. It simply is not true. I did a blog post awhile back on the science behind amblyopia. You can see that here. For a great look at binocular treatment of amblyopia, see this recent post on the VisionHelp blog.

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care