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Bright Eyes Family Vision Care in New Tampa FL
Bright Eyes Kids in Westchase Fl

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New Tampa & Westchase

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How do we check kids’ vision if they don’t know their letters?

One of the most common questions I get as a pediatric optometrist is, “How do you know what kids can see if they don’t know their letters for the traditional eye chart?” We have more options than you would think.

20220309 193121 b — HOTV Chart — This chart looks a lot like the traditional eye chart, but it only uses the four letters H, O, T, and V. Some children will name the letters where others will use a card in their lap with the four letters to match what they see on the screen. This test is great for 4-6 year olds.
— LEA Symbols — Here we have another chart with limited answer options, but instead of letters like HOTV, we have pictures. The choices are circle, square, house or heart. Some children are able to name the picture as they see it and others use a matching card to point to the one they see. Interestingly, some kids are capable of naming the shape, but prefer to use the matching card because they are feeling shy or nervous at their first eye exam. This test works well for many preschoolers. 20220309 193253 b
20220309 193223 b — Broken Wheel Cards — Here we show the child two cards, one in which the wheels of the car are solid circles and one where the wheels are circles with an opening, like a C. As the cars’ wheels get smaller, it tests a finer level of detailed vision, just like when the letters get smaller on the traditional eye chart. Some young kids are overwhelmed with four answer choices on a symbol matching test, so they are more confident with this test which has only two answer choices. We shuffle and repeat the cards several times to ensure they are not getting lucky guesses.
— Patti Stripe Paddles — Infants and young toddlers are shown a gray paddle and a paddle with fine black and white stripes. The child will instinctively look towards the stripes as it is more visually interesting. As the stripes get thinner, eventually the stripes appear to match the gray paddle. It is testing a finer level of detailed vision, known as grating acuity. The measurement we get from this test is helpful to understand one’s functional vision, but the numbers cannot be directly matched to optotype acuity, such as reading the letters or shapes on the chart. 20220309 193030 b


As children develop their attention and communication skills, we test them at the highest level they are capable of performing. These tests are also valuable for patients of any age with communication disorders or intellectual disabilities.

Measuring visual acuity at distance is commonly done during screenings at schools or pediatrician offices, but this is only one of 17 visual skills your child needs to be successful with school or sports. If you are concerned about your child’s vision, please come visit Dr. Beth or Dr. Nate for a comprehensive eye examination.


Back to school in 2021

At Bright Eyes, we3 do “Back To School” season every year. Lots of eye exams for kiddos, education, new glasses, etc. But, of course, this year is different. Way different. Personally, I now have a middle schooler and a high schooler for the first time. But like every other city, this year we are returning to school during a global pandemic.

Here are some important things for parent to know:

Wear Masks!

In public schools in Hillsborough County, masks are mandatory without a medical excuse. Medical reasons are limited. Even it isn’t required, I highly recommend that your kids wear masks. My kids do. Because masks work, according to both the CDC and the American Academy of Pediatrics.

Unfortunately, masks can cause glasses to fog up. My son did his science fair project on this last year . Some hints to help include making sure the masks fit as well as possible and consider No Fog lens cloths (which we have for sale). Also masks can some people to experience dry eyes and styes, so make sure their eye hygiene is up to stuff. Seek profesional eye care if it chronic.

Beware of Myopia

iStock 000019575299LargeMany of my young patients were enrolled in e-learning last year. This was difficult for children who had to spend hours a day at the computer. Increased screen time combined with reduced outdoor time means that kids are more likely to develop nearsightedness AKA myopia. To help, we created a visual guide for students who are e-learning to reduce eyestrain and vision problems.

For kids who have returned to the classroom, many of them are noticing that the board is hard to see clearly. For many, this is a surprise because they didn’t feel like they had problems before; nearsightedness doesn’t affect near vision and children who are e-learning mostly look up close.

Fortunately, for children whose myopia is increasingly rapidly, there are options to help protect vision from worsening.

Be On the Lookout for Problems

A great deal of classroom learning is visual. Proper visual development is important for academic success. If you’d like to learn more about this, I recently recorded a podcast episode with Wendy Taylor, M. Ed, from Learning Essentials.

As kids are adapting to school routines, watch them closely. Signs that may indicate a child has vision problem include:


  • Frequent eye rubbing or blinking
  • Avoiding reading and other close activities
  • Frequent headaches, especially after near work
  • Covering one eye
  • Tilting the head to one side
  • Holding reading materials close to the face
  • An eye turning in or out
  • Seeing double
  • Losing place when reading
  • Difficulty remembering what he or she read

We hope you have a successful and safe school year! If you have questions or concerns about your children’s, a complete eye exam is important to look for significant vision problems. You can request one here, or call us at 813-792-0637.


-Dr. Nate

Bright Eyes Needs Kids Art!!

PXL 20210612 152314795

At Bright Eyes Family Vision Care and Bright Eyes Kids, we love to celebrate the creativity of our young patients!

When you walk in the front door, you are greeted with a display of different kinds of artwork. We currently have drawings of monsters, a painting of the US flag and well as some Pokemon. There is also a gift to Dr. Nate in Simpson-ized fashion and a Lego Mosaic that Dr. Nate did of a close up of an eye. Below we have a display line packed with crayon drawings of our very youngest patients.

We need to freshen up our children’s art display with your kid’s work!

See if your children would like to donate:

  • Original drawings
  • Creative paintings
  • Collages
  • Lego mosaics
  • Anything else you can think of!

All you have to do is drop of the work at Bright Eyes Kids (15303 Amberly Drive). If the work is frameable, we frame it before hanging it up. If not, we’ll do our best. Be sure to let us know who to give credit to! Don’t give us anything too precious, because we cannot promise that we will be able to return it in the future.

You know that your kids are artistic geniuses – let them show off their work!!


-Dr. Nate










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. 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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Children’s Vision Tips for Summer!

Summer is here!!!

When I was a kid, I remember the last day of school: cleaning out my desk and locker, saying goodbye to teachers, and heading home for months of freedom. Even though I enjoyed school, I enjoyed riding my bike, staying up late reading, and sleepovers any day of the week. In fact, a hallmark of summer was not really having to keep track of which day of the week it was, because it didn’t really matter.


(Take a hint from Phineas & Ferb – make the most of summer!)

For my kids and most kids these days, summer is a bit different. There is more structure. Today kids are less likely to roam free like I did as a kid. They are more likely to go to soccer camp one week and then science camp and guitar camp later.

Even if children don’t go to camps, the hobbies and habits of kids today are very different. They are more likely to play video games like Minecraft than marbles or jacks. When I asked one 12-year-old patient last fall what he did over the summer, he replied, “Watched YouTube on my phone.” It may not be obvious, but excessive use of digital devices is much harder on the eyes than playing board games or playing outside.

So with all these changes our children are facing, I thought it would be helpful to write up some helpful tips for children:

Limit Device Use

At home and in car, there is a lot a lot of downtime. Do not let this time get filled in with device use by default. No matter how old your child is, they are at risk of eyestrain and related vision problems if they spend too much time on handheld devices such as phones, tablets, and video games. A good recommendation is to limit device use to no more than 20 minutes at a time, then at least a 5-minute break. And, yes, it is possible to read too much, too, so this also is a good recommendation for books. I provide more information here.

Sunglasses and sunscreen

may 10 beach 13_4658826534_l

Note the sunglasses!

Unlike when I was a kid, parents are much better about protecting their kiddos from the sun. Keep in mind that this includes sunglasses. Just like skin can be sunburned, eyes can be sunburned with too much sunshine in one day. And even without sunburn, the UV and blue light from the sun can cause eye disease like cataracts and macular degeneration later in life. So make sure your kids have sunglasses that fit and they use them. More info about kids and UV can be found here from the CDC. And here is a cool infographic.

Outside time

With all of the precautions needed for sun protection, it is tempting to just stay inside all the time. But that is a mistake, too. Many scientific studies have shown that children who spend more time outside are less likely to develop myopia (nearsightedness) than those that don’t. We do not entirely understand why, but much research shows it’s true. So if the kids are not outside for sports or in the pool, make sure the get some outside time in the form of a walk after dinner or walking the dog. More on this from

Sports glasses for sports

If your child plays any ball sports or full-contact sports, in many cases regular glasses can actually be more dangerous to wear because they are not designed to resist impact. Glasses can break and injure children. Read more about this at

Careful with pools

Speaking of eye protection, consider goggles for swimming. You might keep your pool maintained properly, but not everyone does. And public or water park pools may have much higher levels of chlorine. This can be irritating, causing red, light-sensitive eyes. And one of the (unnecessarily) best kept secrets are prescription swim goggles. They are not expensive and come in a variety of prescriptions, colors, and sizes. Read more on our website.

Stay safe and have fun this summer! School will be here before you know it!

-Dr. Nate

Bright Eyes Family Vision Care & Bright Eyes Kids


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

New Florida Car Seat Rules Go Into Effect Today

My kids are 5 years and 7 years old. They are still in booster seats. I always thought this was

Nora in her car seat

Nora in her car seat

pretty reasonable. I also thought this was the law, but I was wrong. Until today, car seats or booster seats were only required for children up to age 3. Now they are required for age 4 and 5, as well.

Here is the official Florida statute:

316.613 Child restraint requirements.

(1)(a) Every operator of a motor vehicle as defined in this section, while transporting a child in a motor vehicle operated on the roadways, streets, or highways of this state, shall, if the child is 5 years of age or younger, provide for protection of the child by properly using a crash-tested, federally approved child restraint device.

1. For children aged through 3 years, such restraint device must be a separate carrier or a vehicle manufacturer’s integrated child seat.
2. For children aged 4 through 5 years, a separate carrier, an integrated child seat, or a child booster seat may be used.
I think this is totally reasonable. In fact, a quick look at the recommendation flyer of the of the National Highway Traffic Safety Association includes recommendation up to age 12: “Keep your child in a booster seat until he or she is big enough to fit in a seat belt properly. For a seat belt to fit properly the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember: your child should still ride in the back seat because it’s safer there. “

Continue reading

Minecraft & Your Child’s Eyes

minecraftMinecraft doesn’t come up in conversation every day at Bright Eyes Kids, but pretty close to it. I typically ask all my patients, young and old, what they do for fun and Minecraft is the first thing many kids say. And if you spend any time at a mall, school, or other place with kids, you will see lots of kids in Minecraft-themed t-shirts (but you might not get the jokes unless you have played it yourself.) And now Microsoft just bought the company that makes Minecraft for $2.5 Billion (with a B). Clearly they think someone is playing this game.

I don’t have a “love/hate” relationship with Minecraft. It is more of “respect/worry” relationship.

There are many reasons why I respect Minecraft. I have read the story of how Minecraft came to be, and I must say, it is pretty cool: one guy making a game that became a community, mostly by himself. Being a huge Lego fan, I like the simplicity of building with digital blocks. I love all of the amazingly creative projects that dedicated players build.
But I do worry about all the Minecrafters. We have long known that Computer Vision Syndrome can affect office workers who spend their day on the computer. But children who spend a lot of time at the computer can develop the same symptoms. Simple Google searches show that Minecraft fans complain of blurry vision, headache, eye strain and red eyes, and they worry that the game is harming their eyesight.

Check out the infographic at the bottom of the post. It shows that kids are using devices for both fun and schoolwork. Parents tend to underestimate how much time their children use devices. Some kids use devices a lot – 7 hours or more each. I am betting that they do not find their off-screen homework as compelling as games like Minecraft.

Take this scenario: Parents bring in a child for an eye examination because their child is having headaches and blurry vision that only started in the last few months. When I ask if anything changed in this time, they will mention that their child got an iPad and have been playing Minecraft and other games. The evaluation confirms that the child is now having eyestrain and focusing problems from excessive device use.

This is more common than you might expect. In a recent AOA survey 4 out of 5 (or 83%) of kids say they have tired or blurry eyes after device use. That is a huge number!

Here are some suggestions to keep children’s eyes comfortable while using a device:

  • Check in with them, so you know how they are doing. Kids often don’t realize they are having problems.
  • Have them take frequent breaks (follow the 20-20-20 rule)
  • Limit their overall scree time and make them get outside.
  • Make sure they hold the device at a safe distance (Elbow distance)
  • Keep even room lighting
  • Wear reading glasses, if prescribed
If you have concerns about your children’s eyes or have concerns about the effect that device use may be having on their eyes and vision, call us to book an appointment. We would be happy to see your children at either Bright Eyes Family Vision Care in Westchase or the office just for children, Bright Eyes Kids in New Tampa.



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Back to School time is here!

back to school

The Back to School season is one of the busiest for us. In addition to all of the kids who are starting kindergarten who need eye exams, and the kids starting middle school who want contact lenses before they go, we also get high school grads getting their exam before they go off to college and teachers who want to get their exam in before the busy school year starts.

It is an exciting time, full of hope and anticipation, but it so busy for families. Buying school supplies, clothes shopping, getting in pediatrician visits and health screenings for sports, and many other tasks.

But don’t put off the eye exam, if your children haven’t had one in the last year. School is visually challenging and you want to make sure that your kids are ready for the challenge. Or as I like to say, “My job is to make sure that kids’ eyes can keep up with their brains.” (See the video below).

We try to make it has easy as possible for you to check the back to school eye exam off your list. First, we now have a second location, Bright Eyes Kids for you convenience. Second, we know that kids can get anxious about the eye exam (especially eye drops) and we have specially trained staff to make it more fun.

Finally, we have our back to school sale. If your child does need glasses, we know that having a back up pair is crucial. So for August, if you buy a complete pair of glasses for your child, you get a 2nd frame for only $49 (That second frame is basically free!).

If you have any questions about your child’s vision, visual needs, or special care, do not hesitate to call us to help you out.

-Dr. Nate Bonilla-Warford and Dr. Knighton



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