eye exam

How Can an Eye Exam Detect High Cholesterol?

“Why is my eye changing color?” is a question we are asked from some patients. While there are conditions that can change the actual color of the eyes, typically the “color change” they are noticing is an accumulation of cholesterol deposits in the cornea. Yes, cholesterol!

The Center for Disease Control (CDC) estimates that 27.9% of Americans have high cholesterol. Most of the time high cholesterol has no symptoms, so many people may not even know they are affected. More importantly, if people are aware of cholesterol, they seldom think about how it affects their eyes. Neither are they aware that a complete, dilated eye exam can detect signs of high cholesterol.

When Dr. Nate and I evaluate the eyes during an exam, we look for signs of high cholesterol in several places:

EYELIDS

Yellow fatty deposits of cholesterol can show up on the eyelids or on the skin around the eyelids, called xanthelasma (zan-the-laz-muh).

CORNEA

With the microscope, we look for cholesterol deposits in the cornea, called arcus. Normally the cornea is a clear tissue on the front of the eye, but when cholesterol deposits develop, it causes a white or gray ring to develop along the outer edge. The cornea is a natural place for cholesterol to accumulate over time, so this is a common finding in patients over 60 years old.

RETINA

A piece of cholesterol, or plaque, may be seen in the arteries of the retina after dilating your eyes. If there is a small plaque in the retinal vessels of the back of the eye, it is likely that there are larger plaques in other places of the body. Large plaques increase your risk for heart attack and stroke. This is one more reason why we encourage patients to have their eyes dilated at their annual eye exams. With both eyes dilated, Dr. Nate and I can look closely at those vessels to rule-out these kinds of concerns.

If Dr. Nate or I find any of these signs, especially if you are under 60 years of age, we may ask you more questions about your lipid levels or even recommend that you get blood tests done with your primary care doctor.

Don’t delay your annual eye exam! Getting your eyes checked should be included in your routine “appointment days.”

-Dr. Beth

InfantSee Vision Screenings for Infants 6 to 12 Months of Age

Most people are surprised to hear that the American Optometric Association recommends eye exams to begin at six months of age. By six months, your child has met several important developmental milestones. At birth, the eyes begin to focus about a foot away from the child, mostly looking at faces. Around two months old, the child is learning to look around. At this point, the eyes don’t always coordinate well together. Your child should be able to track moving objects by four months old and begin reaching for things. As their eye hand coordination improves, they will become more accurate in reaching for things.

IS logo InfantSee is a no-cost public health program that provides vision and eye health evaluations for children from ages six to twelve months. At your child’s InfantSee screening, Dr. Nate and I will be evaluating how well your child can see using specialized tests for infants. We look for excessive or unequal amounts of farsightedness, nearsightedness or astigmatism. If your child does need glasses to help them see better, we have a variety of frame lines at Bright Eyes that are designed specifically for infants and toddlers: Tomato, Miraflex and Bright Eyes Kids frames. Dr. Nate and I will also check your child’s eye alignment and eye teaming skills. During these kinds of tests, the children usually think we are just playing games with them, but in fact we are gathering lots of useful information about their eyes and vision. Additionally, we may dilate your child’s eyes to check for eye health problems. This is a normal procedure that we do for all ages, and we will only dilate your child’s eyes with your (the parent’s) consent.

It is important to look for risk factors that can cause vision problems in the future. If caught early, many vision problems can be corrected or prevented. Even if your child does not appear to have an eye or vision problem, you should bring them in for their first evaluation.

You may remember Dr. Nate’s blog about his daughter’s InfantSee examination. Check it out for cute pictures.

Call our office at 813.792.0637 or click on the button below to schedule an InfantSee appointment at either the Westchase or New Tampa location. Or visit InfantSee.org for more information.

-Dr. Beth

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Minecraft & Your Child’s Eyes

Minecraft 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.

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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.

DrNateSig

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“Foolproof” Eye Test for ADHD

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

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

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

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

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

DrNateSig

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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Bright Eyes Patient Spotlight: Michele Northup

Here at Bright Eyes Family Vision Care, we have some very interesting patients. I am always amazed at the things that patients have going on. Whether it is starting a business, a community project, or personal hobby, our patients always having something fascinating to talk about.

So Bright Eyes has decided to feature our most interesting patient on our blog with a new series called: Bright Eyes Patient Spotlight! And although I have had a few ideas about who to Spotlight, Michele Northrup made it very easy by coming in and tweeting her entire eye exam on Twitter!!

But before we get to the exam tweeting, let me tell you about Michele. She is an incredibly funny, energetic woman. She is always doing a million things and has a million more ideas. One idea that has kept her very busy is her company Intensity Academy, that produces Award-winning hotsauces.

But I’m not the only one who has noticed. For one, Michele is a finalist for Business Woman of the Year by the Tampa Bay Business Journal. This is a big honor and she is very excited about it. But she also is a sought-after social-media consultant, who teaches classes on how to market brands via websites likes Facebook.com and Twitter.com.

So now that you know a bit about Michele. You can see how she works in action, via her eye exam at Bright Eyes. Here is a sampling of Michele’s tweets, including pictures:

@Brighteyestampa on my way to my 1st eye appt with @NateBW & crew at Bright Eyes in Westchase. Twitter Tour of the appt to come. Stay tuned!

@BrighteyesTampa crew welcoming me for my 1st eye appt.

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Seeing 3-D testing depth perception. I passed w/ flying colors! @BrightEyesTampa

@BrighteyesTampa checkin’ to SEE if my eyes are healthy & bright! Doc Nate & crew are GREAT! Dilation next!!

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@BrighteyesTampa ‘s fashion eye consultant! Helping me pick THE perfect pair of glasses!!!

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Here are the lenses I like…a neutral metal frame. Whatcha’ think???

RT @BrightEyesTampa: If anyone wants to make an apt call 813-792-0637 or http://brighteyestampa.com. Say you saw us on twitter for discounts

RT @BrightEyesTampa: When you buy a compete pair of glasses at @BrightEyesTampa, mention Twitter or @MicheleNorthrup and get a FREE bottle of hotsauce!

@BrightEyesTampa bringing the whole fam. in to SEE the fab folks in westchase!I LOVED my appt so much yesterday I decided to rally troops!

So in honor of Michele being the first Bright Eyes Patient Spotlight and for being such a good sport, I am offering a FREE bottle of Intensity Academy hotsauce to anyone who purchases a complete pair of glasses and mentions that saw the ad on Twitter.

Cheers!

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

Guide to a Comprehensive Eye and Vision Exam

If you ever read a summary of a comprehensive exam, you may get a little confused by all the technical vision terms. To try to make it more easy to understand, I have listed a brief explanation of the tests accomplished by comprehensive eye and vision exams.

This does not cover every single test, but the majority of them. Because each patient is different, each exam uses different tests. You may find a Glossary of Vision Terms helpful as well.

MEDICAL HISTORY: Questions about past and current medical problems.
VISUAL HISTORY: Questions about past and current vision problems.
VISUAL ACUITY: Sharpness or clearness of eyesight at a specific distance.
KERATOMETRY: Measures the shape of the front part of the eye (the cornea) where light enters.
EXTRA OCULAR MUSCLES: Measures how accurately the eyes move while following an object and looking back and forth between targets.
COVER TEST (NEAR): Measures the amount that the eyes are misaligned while looking at near.
COVER TEST (DIST): Measures the amount that the eyes are misaligned while looking at distance.
NEAR POINT CONVERGENCE: Measures the ability to converge – the eyes turning towards each other when looking at an object up close.
STEREOPSIS: Measures the ability of the eyes to work together to see fine detail with depth perception “3D”.
NEAR POINT ACCOMMODATION: Measures how close each eye is able to see clearly.
PHORIA (NEAR): Measures the amount that the eyes are misaligned while looking at near.
PHORIA (DISTANCE): Measures the amount that the eyes are misaligned while looking at distance.
NEAR VERGENCE (BI): Measures the ability to converge – the eyes turning towards each other when looking at an object up close.
NEAR VERGENCE (BO): Measures the ability to diverge – the eyes turning outwards at an object.
ACA RATIO: Measures how much the eyes converge while focusing up close.
NEGATIVE RELATIVE ACCOMMODATION: Measures the maximum ability to relax focusing while maintaining clear, single binocular vision.
POSITIVE RELATIVE ACCOMMODATION: Measures the maximum ability to focus while maintaining clear, single binocular vision.
MEM RETINOSCOPY: Measures the accuracy of focusing while looking at an object up close.
REFRACTION: Measures the nearsightedness, farsightedness, or astigmatism of the eyes.
EXTERNAL EXAM: Determines health of the eyes by observation.
SLIT-LAMP EXAM: Determines the health of the eyes with a microscope.
OPHTHALMOSCOPY: Uses special lenses to look inside the eye for diseases.
TONOMETRY: Measures the pressure inside the eyes.
DILATION ORDERS: Specifies the type of eye drops and method used to evaluate inside the eyes.
CUP/DISC RATIO: A way of measuring the health of the optic nerve. Useful in glaucoma and other eye disease cases.
ASSESSMENT: States what the known visual or eye health problems are.
PLAN: Summarizes the recommendations for the treatment of the problems.

Be Well!

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

An Ounce of Prevention is Worth 17 Pounds of Cuteness.

My daughter’s name is Nora. She is, of course, adorable. And since I am an eye doctor, I have been watching with interest how her eyes and vision develop since she was just minutes old. First she opened her eyes. Then she got better at moving them (but not necessarily together.) Finally, she developed a wide-eyed inquisitive way of looking at things that has not faded.

Since before she was born, my wife Cristina and I have done our very best to take care of her and made sure that she received all the care and attention that she needed. We have a wonderful pediatrician who has seen her many times. Fortunately, Nora has always been healthy (except for that first ear infection). She is a happy baby girl and she appears to be growing fast without any problems. But there still are some aspects of her eyes and vision that have not been checked fully.

Nora recently turned 7 months old. That means it is time for her first comprehensive eye and vision assessment. For the average baby, all the visual skills should be significantly developed by six months old. The American Optometric Association recommends the first eye exam at six months of age, then at three years of age and every year while in school. So with the help of my father and Cristina, Nora received her first eye exam.

Like I do with all infants, I first checked that she can see well out of each eye. I then made sure her eyes are straight and not drifting inward or outward. I checked to see if her eyes can turn inward the proper amount when she looks at an object or toy up close. I shined some bright lights in her eyes to make sure that her pupils react properly to light. They did.

By using a special flashlight called a retinoscope, I was able to determine if Nora had any refractive error (nearsightedness, farsightedness, or astigmatism). It turns out that she has a small amount of farsightedness, which is perfectly normal. Most commonly, the large amounts of refractive error that a baby may have tend to diminish over time (a process called emmetropization), but it is good to have a baseline measurement to see if the error is increasing, staying the same, or decreasing.

After I was convinced that Nora was seeing well and her eyes moved well for her age, it was time to check out the health of her eyes. I looked closely at all the parts of her eyes on the outside to make sure everything was healthy and working well. Then I sprayed eyedrops onto her eyes to enlarge her pupils to allow me to see inside. This is the same type of drop that we use for adults when we dilate their pupils, but the spray makes sure we get it in their tiny eyes without too much fuss.

The drops take 15 minutes or so to take effect, so we all went out in the waiting area. We passed the time by trying on some baby sunglasses, which were very cute on her. After the spray worked its magic, I had Cristina hold Nora and I examined very carefully all around the inside of Nora’s eye to make sure all the nerves, blood vessels, and other parts of her eyes were healthy.

So now that Nora’s eyes have a clean bill of health, I don’t need to examine her again until she’s three years old. And, really, she did great. She a had a good time playing with the toys, and I can sleep at night knowing that she’s been thoroughly checked out.

If you have an infant at home between the ages of 6 and 12 months, the InfantSEE program will provide one evaluation like Nora’s at no change. Call the office or visit InfantSEE.org for more information.

Merry Christmas!

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

eye exam

How Can an Eye Exam Detect High Cholesterol?

“Why is my eye changing color?” is a question we are asked from some patients. While there are conditions that can change the actual color of the eyes, typically the “color change” they are noticing is an accumulation of cholesterol deposits in the cornea. Yes, cholesterol!

InfantSee Vision Screenings for Infants 6 to 12 Months of Age

Minecraft & Your Child’s Eyes

“Foolproof” Eye Test for ADHD

Back to School time is here!

Bright Eyes Patient Spotlight: Michele Northup

Guide to a Comprehensive Eye and Vision Exam

An Ounce of Prevention is Worth 17 Pounds of Cuteness.

Myopia Management

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