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3 Reasons Why You Should Kickstart the New Year With Vision Therapy

holidays mug

It’s that time of year again when we sit down with a pumpkin spice latte in hand and think of a resolution we can take upon ourselves for the new year. Here at [tokensname=’SpCenterVT’], we believe that the best resolutions are the ones that positively impact other areas of our lives and enhance our overall quality of life. Vision therapy offers just that! This therapy is made up of a series of customized visual exercises designed to develop or regain visual processing skills.

Vision Therapy is highly effective in treating:

  • Amblyopia, (or “lazy eye”)
  • Strabismus, (or “eye-turn”)
  • Eye movement disorders
  • Focusing disorders
  • Binocular vision problems
  • Vision, balance, and memory problems associated with brain injury

Even those with 20/20 eyesight can benefit from vision therapy because perfect eyesight doesn’t mean perfect vision. Below are the ways in which vision therapy will help you kick-off the new year.

Improve Existing Vision Skills

You’re good at what you do, be it at work, school or sports. But can you do better? By training the eyes and brain to work in unison, you increase your potential for greater performance. Not only will you be more efficient, but performing tasks will become more enjoyable. This especially applies to school-aged children, as their brains are still in rapid development. Vision therapy effectively enables the brain to correctly process information for optimal academic success.

Learn New Skills With Ease

Many people make it their resolution to learn a new skill in the upcoming year but an underlying vision problem can interfere with that. Since learning is 80% visual, vision therapy offers an excellent opportunity to gear up for success! Undiagnosed or untreated vision problems related to convergence and focus can cause memory and reading problems and hinder learning. Dr. Knighton and Dr. Bonilla-Warford will use an array of tools, such as prisms, specialized lenses, filters, balance beams, and computerized visual activities to train the eye-brain connection and help you learn more efficiently in almost any area that requires vision.

Gain The Confidence You Crave

Whether you’re a pro-athlete or a 4th grader struggling to read, improved vision skills will boost your confidence. This confidence will surely trickle into other areas of your life leading to increased self-esteem.

Start 2020 by empowering yourself or your child with vision therapy. Call Bright Eyes Family Vision Care's Vision Therapy Center to book your appointment today.

Bright Eyes Family Vision Care's Vision Therapy Center serves patients in Tampa, Westchase, Town 'N' Country, and University, and throughout Florida.

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 #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

Dr. Beth and Dr. Nate lecture in Miami

This weekend, Dr. Nate, Dr. Beth and vision therapists took a trip to Miami Beach to attend the 6th Annual Florida COVD Study Group. Dr. Nate is one of the founding members of the group and usually goes each summer to listen, lecture, and discuss the very latest treatments for patients.

The talks were very good. Bob Orsillo, OD spoke about about sports vision enhancement. Dr. John Kuluz from Miami Children’s Neurology Dept spoke about sports-related concussion. Dr. Matthew Kay, South Florida’s leading neuro-ophthalmologist, spoke about double vision.

Dr. Beth and Dr. Nate gave a 2 hour Prezi called “Amblyopia and Strabismus Therapy Treatment with Virtual Reality“. It was an interactive discussion of our use of Vivid Vision, the Oculus Rift-based VR vision therapy tool. It was created to bring immersive new technology to long-standing principles of vision therapy. You can read more about Vivid Vision here.

After hours there was swimming, food and drinks, and more discussion about vision therapy. 🙂

The meeting was sponsored by Eyecarrot. They the company behind, Binovi, the new vision therapy tracking technology that we are using at Bright Eyes.

Here are a few pictures from the meeting:

01 Vivid Vision in action02

Fox 13’s Dr. Jo Comes to Bright Eyes to Cover Vision Therapy for Amblyopia

I usually go to bed around 9:30pm, so I was surprised when Edna, Bright Eyes Family Vision Care’s head Vision Therapist, texted me at 10:15 pm to say “You are on the news! Turn on Fox 13!”

She was right. The 4 minute video on our vision therapy program was shown that night and it was repeated the next morning. It was seen by lots of people, judging by the phone calls and email afterward.

You might remember that this summer an adult patient, Betsy, and I were interviewed by Bay News 9 about virtual reality therapy for strabismus (mis-aligned eyes). Well, this was essentially a companion piece to that interview. This time the Dr. Jo from Fox 13 News and her camera man came to Bright Eyes Kids to do a story about amblyopia (sometimes called “lazy eye”). It featured a delightful young patient of mine, Ben, and his parents.

You can watch the video below and if you’d like to read the print story and see some pictures, you can go here.

[youtube]kSud8I5uv4A[/youtube]

I love this video. It makes some important points that modern treatment of amblyopia does not involve wearing an eye patch, but rather new technology to teach the eyes how to work together. Not all patients in vision therapy use contact lenses, but that is common in amblyopia treatment, even for young children.

Not only does it cover the subject of amblyopia well, but you can really see the excitement of Ben and his mom. He really has made incredible progress with vision therapy!

It is very rewarding that the media has been interested in our Vivid Vision Virtual Reality Vision Therapy program. It is a wonderfully fun and high-tech application of the principles we use in vision therapy to help children and adults with problems like amblyopia, strabismus and more.

If you are looking for evaluation or treatment of amblyopia, strabismus, or other visual problem for you or your child, request an appointment or call us at (813)-792-0637.

-Dr. Nate

Bright Eyes Family Vision Care and Bright Eyes Kids

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)

#IPatch On-Line Patching Party to Support Amblyopia

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March, 2016, is “Save Your Vision Month”. Our friends at A Child’s Eyes are hosting an #IPatch on-line patching party to help spread awareness about Amblyopia and we are excited to support them!

Amblyopia is the most common cause of vision impairment in children, affecting 2-3 out of every 100 children. If left untreated, Amblyopia can lead to permanent reduced vision. However, Amblyopia is a very treatable form of blindness. Patching or, more formally, Occlusion Therapy is a widely accepted and common treatment for Amblyopia, but only about seventy-five percent of children and their parents who attempt patching are able to succeed with treatment and vision therapy, if necessary. Failure with patching is often due to a lack of knowledge and support.

Here are ways you can participate in the March #IPatch celebration:

  • During the month of March, post pictures of your super patcher on Facebook, Twitter, and Instagram using the hashtag #IPatch.
  • Go to the #IPatch Photobooth with fun photo effects.
  • Also on the photobooth page is a calendar of themed days to spice up your photos!

Please share this #IPatch event with any friends or family members whom you know are currently patching so that they can join in the fun. And, of course, if you have any questions about Amblyopia and its treatment, feel to ask in a message below or call us at (813)792-0637. We are here to help!

See Well!

-Dr. Nate

Amblyopia Video Game Treatments on the Horizon

In a recent blog post on new treatments for amblyopia (sometimes called “lazy laze”), I mentioned the Tetris study from a few years ago.* When this study was done, it was exciting because it was just a hint of the possibility of treatments that lay ahead.

Well, this morning I see in the Wall Street Journal “Digits” blog a story called “To Play Ubisoft’s ‘Dig Rush,’ You’ll Need a Prescription”. It reports about a new game from a major game company where thepoint of the game is to train the eyes to work together. This approach differs from the traditional treatment for amblyopia in which the stronger eye is patched in an effort to force the weaker eye to do more work. The blog also points out that figures from the National Eye Institute reveal that approximately two or three of every 100 kids may have amblyopia.

Here are some very compelling images from the game. As you can see this is the type of red/blue therapy where one eye sees the red images, one eye sees the blue images, and both eyes see the gray images. Optometists have used this for decades, but not with such fancy graphics.

amblyopia video game

amblyopia video game

I am also very interested in a therapy game for amblyopia and strabismus call “Vivid Vision“. It is based on the head-mounted virtual reality display Oculus Rift. I do not know a great deal about, other than it is being studied for use in clinics and looks AWESOME! You can see it in action in this video here. We will have it at Bright Eyes Kids soon.

amblyopia video game

It will be quite some time before these types of amblyopia video games are available for home treatment of patients, but I think you will agree that they are pretty exciting!

-Dr. Nate

~~~

* Just for fun you can play a Magic Eye version of Tetris here. It is not the Tetris used in the study, but it is interesting.

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

An Infographic About Amblyopia

There is a lot of discussion lately about amblyopia (AKA lazy eye), largely due to the recent news reports of adaptations of Tetris and other video games as treatments for amblyopia. As I described in my previous post, these new binocular techniques are definitely better than old-school patching. However, in there essence, these techniques are not new. In fact, optometrists have known for a long time that treating two eyes is better than one. That is the basis of what we do in the vision therapy room to help patients with amblyopia – play games with both eyes at the same time.

I’m very happy to share with you an infographic on amblyopia treatment from the VisionHelp blog.

Amblyopia Infographic

You can read the full story behind the origin of this excellent infographic here. I think it is fantastic!

If you and your child are struggling with patching – you don’t have to be! Not only is binocular therapy more effective than patching – it is way more fun! If you have questions about amblyopia, vision’s therapy, or children’s vision in general, do not hesitate to give us at call at 813-792-0637 or email me at Doc@BrightEyesTampa.com.

And please – share, pin, tweet or photocopy this infographic!

Dr. Nate

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