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Children’s Vision

“Will My Child Be Nearsighted?”

nearsighted childFollowing the American Optometric Association’s recommendations of performing eye exams for children before age 1, at age 3, and before starting kindergarten, that is one of the most common questions that Dr. Knighton and I get. Parents who are nearsighted, or myopic, especially ones who got their first glasses in elementary school, often want to know if their child is going to be nearsighted too.

Over the years, optometrists have had many theories about whether a child will be nearsighted or not. Some of these theories have been helpful, and some have not. Now, thanks to some outstanding research published in this month’s issue of the journal JAMA Ophthalmology, we are closer to an answer.

With 1 simple eye examination, we can now more confidently evaluate if a child will be nearsighted in the next few years.

We have known for a very long time that most newborn infants are not nearsighted, but farsighted (optometrists call this hyperopic). Over time, the amount of farsightedness naturally gets smaller and then levels off at a very small, normal amount. Because of this, eye doctors who see many children have suspected that children who have neither farsightedness nor nearsightedness, rather than being “perfect,” are actually pre-myopes, or kids who will be nearsighted.

This research is big news! It has been covered by Today and NPR. The study of almost 5,000 children over 20 years, shows just that: a 6-year-old child with less farsightedness is at greater risk for developing myopia sooner. The older the child, the more effective the refractive error is as a predictor of nearsightedness onset by age 13.

Fortunately, if a child does have rapidly increasing myopia, there are no options to help slow down the worsening of the prescription. You can read about those options for your child here. One other thing research has shown – kids who spend time outdoors are less likely to become myopic. So make sure those young kids spend time outside each day!

If you are concerned if your young child might be nearsighted, or become nearsighted, call 813-792-0637 to schedule an appointment at either Bright Eyes Family or Bright Eyes kids.

-Dr. Nate

Nathan Bonilla-Warford, OD, FAAO, FCOVD


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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

Bright Eyes Kids Open on Weekends for Children’s Eye Exams & More!

For your convenience, we have added Saturday hours to Bright Eyes Kids for children’s eye exams, vision therapy, and children’s glasses purchase and pick up!

Children's Eye ExamsBright Eyes Kids has come a long way in 2014. From just an idea, to the only optometric office in Florida just for kids! Every month we are making changes to improve Bright Eyes Kids – from adding new equipment to hiring more staff.

And starting in January 2015, we will be making a big change to make it even easier for you to bring your children in – we will be seeing patients on Saturdays! We know that your time is precious. It is not always easy to bring kids in for eye exams, vision therapy, and Orthokeratology follow ups during the week. So starting January 3, 2015, Bright Eyes Kids will be open 9am to 1pm on Saturdays. This is not only for children’s eye exams and specialty services, but also for ordering and picking up infant and children’s glasses.

Note that these weekend hours only apply to Bright Eyes Kids in New Tampa, not Bright Eyes Family Vision Care in Westchase. If you have brought your kids in for an exam at the main office in Westchase, we would be happy to see them at Bright Eyes Kids on Saturdays or Bright Eyes Family Vision Care during the week, whichever is more convenient for you.

Stay tuned for even more announcements of changes and improvements at Bright Eyes Kids. In the meantime, if you have questions or would like to schedule an appointment for your child at either office – just call 813-792-0637 and we would be happy to help you. Or go online. And if you have any suggestions or comments that can make Bright Eyes Kids even better, you can let me know by emailing


Dr. Nate

Specialists in Children's Eye Exams

Specialists in Children’s Eye Exams

Dr. Nate, Cristina, & Kids Lecture on Children’s Glasses and Eye Exams

14 2B 2B2 Dr. Nate and Cristina gave a 2 hour lecture on the topic children’s vision, children’s glasses, and eye exams. As part of the FOCAL Education meeting, the talk was given to approximately 100 opticians from around the state of Florida. The event took place December 6 and 7 at the gorgeous Gaylord Palms resort near Orlando, Florida.

Dr. Nate lecturing on children's glassesDr. Nate spoke primarily on how and why children’s eye exams are performed and visual conditions such as strabismus and amblyopia that affect children. Much of the discussion centered on vision therapy and how it is used to benefit children who have vision problems that interfere with the tasks that are neccessary for school, such as reading, writing, and computer use.

Cristina’s portion of the talk focused mostly about the specialty of infant’s and children’s glasses. This included the different frame styles and materials of children’s glasses, selecting the right size frames for the child, adjusting the frames to stay in place, as well as techniques for working with young children in the professional setting.

For the first time the whole Bonilla-Warford family was involved. Dr. Nate’s and Cristina’s children agreed to be models. Lecture attendees selected glasses from a special “children’s optical” display made just for the lecture. Participants learned about fitting glasses and taking the measurements needed for ordering glasses to ensure the best children’s vision.

The Gaylord Palms resort was in full holiday swing, with a tree lighting ceremony with singers and acrobatics as well as the famous ICE exhibit. A wonderful time was had by all.

Dr. Nate, Cristina, and Dr. Knighton enjoy lecturing about children’s vision and children’s glasses to professional and educational groups of all sizes. Bright Eyes Kids is finalizing our lecture schedule for 2015 now. If you have a group of doctors or other professionals who work with kids (such as occupational therapists or educational specialists), or a parent group (such as homeschooling or PTA), and would like us to come speak, please call 813-792-0637.

14 2B 2B4


Legos, The Lego Movie & Vision Development

I can’t tell you how excited my kids and I are about The Lego Movie! If you haven’t already seen it a bunch of times, here is the trailer.


Here is the backstory – LEGO® products played big role in my childhood- first as toys and then more as versatile structural elements of engineering and science projects. When my mom told me she sold my entire collection (a full Hefty sack worth) for $10 at a yard sale, I was very sad indeed.

Somehow in the process of getting multiple degrees and learning to be a business owner (i.e. growing up), I had lost touch with LEGO® fun. And it wasn’t like I was missing them – my world just didn’t contain them. But now that I have kids AND live close enough to LegoLand Florida to make it a frequent day trip, I am re-connected with the bricks and having a wonderful time.

I am also glad to discover that while I haven’t thought much about LEGO® products, they haven’t stopped. Oh my, how much they have changed since my youth! There are hundreds of mini-figures, different themes, games, and many, many cross-branded sets. Yet the basic brick remains fun and functional.

Lego minifigs

It has been fascinating playing with Legos with my kids. Not only because it is fun, but because I know a lot more now about child development. Truly, the sets are wonderful because while they come in box that requires following directions in an orderly fashion, after that, the fun and explorations are truly unlimited.

As a pediatric optometrist, I also keep some mini-figures in the exam room. Not only are they fun to trade (bring some!), but they also are good to use during the exam as fixation targets for little ones. Recently, I have started to use these bricks in the vision therapy room as well for their developmental value.

Here are some of ways that LEGO® products support visual development:

  • Visual Discrimination – Let’s face it – the studs are small. You really have to pay attention to visual detail to find the one you are looking for. And the mini-figures (and especially their accoutrements) have subtle details that give them personality. While most children naturally are able to distinguish these details (such as ones with amblyopia), some need to be motivated to really TRY to see those details.
  • Form Distinction – When looking for the right brick, it makes a big difference if you are looking for a one that is straight, and if you pick one that is curved or tapered, it simply will not work as well. You will learn by trial and error that it is more efficient to look at the shape first before trying to build with it.
  • Color Distinction – Bricks come in MANY colors. The Duplo® bricks come in primary colors that may be used for teaching the names of colors. The newest LEGO® come in dozens and dozens of colors, and you really have look to distinguish green from dark green, for example.
  • Visual Figure Ground – Figure ground processing means sorting out the important details from the background noise. Is there anything more challenging that looking through hundreds of bricks to find the perfect one?. Doing this efficiently requires visual strategies of scanning for details such as color, size, shape, and texture, and it does take practice. How many times have you heard, “I can’t find his special hat anywhere!” or a similar statement from your child when he can’t find it seconds. This is Visual Figure Ground.
  • Visual Planning – LEGO® building is more sophisticated than it may look. I have been told by parents that some kids are builders and some are players. Both require strong visualization – seeing in the mind’s eye what the final outcome will be and then making it happen. Very few people build haphazardly by randomly attaching bricks – they plan what they want to build, begin, and then modify as needed to accommodate a brick shortage or structural inadequacy. Think of how the Master Builders visually plan their huge projects!
  • Visual Motor Integration – Most people think of this as “eye-hand coordination”. Once you have envisioned what your project will look like, your hands have to make it happen. And if you make a mistake, your eyes have to tell your brain what is wrong and what needs to happen to fix it. And some of those bricks require some serious strength to remove. At least now we have the Brick Separator!

All of the above are reasons why LEGO® products are good for visual development. But let’s not forget the most important one – they are fun! Kids learn through play. And the more fun they are having, the more creative they become. The more they can challenge themselves, then the more they will learn. Our brains absorb more via novel repetition, and the novelty never ends with unlimited play.

So if it has been a while since you have gotten down on the floor to build with your kids – just do it! It will be good for them, and you will be amazed what they can come up with! And then in February go see the movie!

And don’t forget to support the Glasses! board book on Kickstarter!

Dr. Nate

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

Florida Governor Rick Scott’s Children’s Vision and Learning Month Proclamation


I am very pleased to share that Florida Governor Rick Scott has issued the Children’s Vision and Learning Month proclamation. August was first declared Vision & Learning Month in 1995 and now it is an anual tradition. The goal of this national observance is to help educate parents and educators about the critical link between vision and learning. Here is Governor Scott’s proclamation

CVLMFor many parents in Florida, back to school means back to the search for answers to their children’s learning difficulties. While many parents are hopeful the new teacher will have a magic bullet, others are just as frustrated as when the previous school year ended. “There is a light at the end of the tunnel,” says Dr. David Damari, President of the College of Optometrists in Vision Development (COVD), an organization that I am actively involved in. “Statistically more than 60% of children who struggle with reading have underlying vision problems contributing to their challenges.”

But it’s not the type of vision problem most people think of. Most of the children who have vision problems that interfere with reading and learning can actually see the letters on the eye chart just fine. So when parents are told their children have passed a vision screening, what they are really being told is that their child can see clearly far away. But the problem lies in what was not tested – how well the two eyes work together when reading, how they move on the page or track a line of print, to name a few of the 17 visual skills required for academic success.

It doesn’t really matter what the curriculum is or even what country you are in, when children have underlying vision problems contributing to their learning challenges, they continue to struggle until the vision problem is corrected.

“August is historically National Children’s Vision and Learning Month, but this year we decided to share stories from around the globe so people could see this is a global problem with a universal solution,” states Damari. As the new school year rounds the corner, August is the perfect time to make sure your child has all the visual skills required for academic success. For more information, visit

All the best!

Dr. Nate

By Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
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Great Glasses Play Day is Almost Here!

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The Great Glasses Play Day, which is being held August 5th and this upcoming week around the word! It is not only a chance for children of all ages with glasses to get together, but also a chance to educate about the important children’s vision and proper eyewear for kids. This fantastic idea is an effort of both my friend Ann Zawistoski from Little Four Eyes site and Kristin Ellsworth from Peeps Eyewear and Prevent Blindness Wisconsin.

You can read lots of good press coverage of the Great Glasses Play Day here. But I am glad to bring you an interview with Ann and Kristin here. Enjoy! – Dr. Nate

Dr. Nate: How did the idea for the The Great Glasses Play Day come about?

Kristin: For me, it came about shortly after my daughter was diagnosed with strabismus and amblyopia. We were thankful her vision impairment was caught early. We had a positive attitude toward our daughter getting glasses. However, many of my friends’ and family’s reactions were less than enthusiastic. I wanted to change that. Our culture has shifted it’s attitude toward getting braces, why not glasses? I am hoping to do that with my ideas for children’s eyewear and I imagined a day when children will be running around parks and schools proudly wearing corrective eyewear and every parent will know about the importance of early child vision health.

Ann: When Zoe first got glasses, I kept hoping I’d run across some kind of play group or get together for kids with glasses, but never really found anything. Then I started Little Four Eyes, and the idea was always at the back of my mind. Here were all these wonderful people with kids in glasses, and we’re all connecting on line, but wouldn’t it be wonderful to get together in person? Especially for our kids who often don’t know other kids their age in glasses. The idea of a day to celebrate kids in glasses came up about year ago in the Little Four Eyes facebook group, so I started asking around if people were really interested. Kristin called me and said she’d always wanted to do something like this, and let’s make this happen! So we ended up combining the ideas, the day is really focused on celebrating our kids with glasses and their improved vision, and what better way to celebrate than to have ways of meeting in person and online?

There are a lot of great messages you are trying to convey about children’s vision and eyewear. If you could narrow it down to one, what would it be?

Kristin: For me, it would be that “it is great to wear to glasses!” I’m hoping we send the message how lucky we are our children’s vision health can be addressed early and that advancements in eyewear enable our children not only to see clearly but express themselves. Many parents are unaware that 1 in 20 preschool children require vision correction. I didn’t know it, and many of my friends didn’t either. The Great Glasses Play Day will hopefully not only be a day to celebrate but also help increase awareness about this important issue.

Ann: It’s similar for me. I hear from so many parents who have just learned that their child needs glasses, and they’re often very upset by the idea. I was too! I think it’s in part because there just isn’t recognition of how prevalent eye issues are and how important it is to treat them. I really want this day to focus (pun intended) on the positives of glasses and contacts and patching. How wonderful that most of these issues are treatable! How wonderful that our kids can see better!

This is truly an international event. How did the event in China get organized?

Kristin: My eldest daughter took mandarin language lessons through her public school. Our family became friends with her tutors and their families who loved the idea of the Great Glasses Play Day so much that they reached out to friends and schools in China.

Are you planning on doing it again next year?

Kristin: Absolutely, and we hope to get help from others! There are so many great ways families, organizations and eyecare providers can celebrate! We hope Great Glasses Play Days will not only be fun but will help put early childhood vision health on everyone’s radar–all over the world.

Ann: I cannot wait to do this again! The response has been great, and I think there’s a lot we can build on in future years! I really hope that we can have more in-person events so that more of us can meet and connect, but I look forward to expanding the online celebrations, too.

Anything else you want to add?

Kristin: I want to thank you, Nate, and all the organizations, companies, and innovators that take the time to help children and their families with their vision health. Every child has a right to see clearly, enjoy the world around them and learn all that they can from an early start. Healthy vision is truly a precious gift.

Ann: In addition to everyone that Kristin mentioned, I’ll add a big thanks to Kristin who has really put so much in to making this happen. I know that there’s no way the Great Glasses Play Day would have become a reality without everything she’s done. And I also want to thank the hosts of the get-togethers around the world. Everyone has been doing this on a volunteer basis.
Kristin: Well, I know there’s no way it would have happened without Ann! She has brought so many parents together through Little Four Eyes and getting our kids together couldn’t have happened without her!

Bright Eyes at the Tampa Homeschool Conference

FPEAOn Saturday, July 21, Bright Eyes joined the Tampa Bay Homeschool Conference as an exhibitor, promoting children’s eye exams. Dr. Nate and Cristina spoke with many concerned parents and educational professionals, and even a few of our patients. We answered a variety of questions, such as “When should my child have their first eye exam?” and “My child is struggling with reading – Could it be a vision problem?“.

Answer #1: Now! The American Optometric Association recommends regular eye exams starting at age 1, but definitely by age 5.

Answer #2: Yes, but you will only find out when you have your child’s eyes checked by a children or family specialist.

The conference, sponsored by the Florida Parent Educators Association (FPEA) included a variety of instructional and inspirational workshops, and an exhibit hall full of book vendors and local businesses that offer specialty services for homeschool families. I think we were able to encourage a lot of families to seek eye care in their areas! And we had a great time. We look forward to participating in future homeschool conferences and encouraging parents to have their children’s eyes
checked regularly.

Dr. Nate’s TV News Segment About Children’s Vision and VSP’s EyePledge program

It is not everyday that a television news crew comes to Bright Eyes, so when we were given the opportunity we were very excited. We got to the office extra early and made sure everything was ready. The subject was children’s vision and the importance of annual eye exams for kids. Children can have a variety of vision problems that interfere with learning, including difficulty seeing clearly, problems focusing and moving their eyes, and difficulty making sense of what they see. For some children, glasses are sufficient to solve their visual problem. For others, Vision Therapy, a series of therapeutic activities, is necessary to ensure the eyes are working properly.


The video also goes into detail about the excellent program called the Eye Pledge that for every Eye Pledge taken, VSP Vision Care will donate an eye exam and a new pair of glasses to a child served by the Boys and Girls Club – up to 50,ooo children. The Eye Pledge is easy to take and doesn’t cost you a thing! Take the Eye Pledge now and help a child. One of the great things about it is that you can specify if you want the donation to go to a child from a Boys and Girls Club in your area or to an area with the greatest need.

To read more and take the Eye Pledge visit:

Has your child had an eye exam? They should be a standard part of the Back to School Checklist! If you have questions about children’s vision or children’s eye care, do not hesitate to call us at 813-792-0637.

Dr. Nate

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


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