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Dr. Nate Earns Fellowship in the International Academy of Orthokeratology and Myopia Control

Certificate

I am excited to share that I am now a full-fledged Fellow of The International Academy of Orthokeratology and Myopia Control (IAOMC), a non-profit organization of practitioners and academics devoted to the science and education of Orthokeratology and Myopia Control. Since I have offered myopia management options for over a decade, becoming a Fellow has long been a goal of mine.

  • Ortho-K (short for Orthokeratology) is a non-surgical procedure using specially designed contact lenses to gently reshape the curvature of the eye to improve vision.
  • Myopia is a progressive visual disorder that results in poor distance vision. If the myopia is severe, it will impair near vision as well. Myopia is also known as “near-sighted” or “Short-sighted”.” Options exist to help limit the progression of myopia as a child grows.

 

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According to the Academy, these are qualities of a Fellow:

  • Fellows have undergone advanced training and rigorous testing to demonstrate their level of expertise in myopia control and orthokeratology
  • A Fellow is the gold standard and represents the highest level of knowledge, ethics and patient care in the myopia control.
  • Fellows serve as mentors and role models for other practitioners as well as the general public.

This was a year-long process which included presenting multiple complex case reports, passing both written and oral exams. The exams were supposed to take place at the annual meeting in Seattle in April, but the meeting was canceled due to COVID -19 and the testing process had to be completed remotely.

There are approximately 150 Fellows of the The International Academy of Orthokeratology and Myopia Control around the world. And I am one of only a handful that have earned 3 fellowships in the International Academy of Orthokeratology, the College of Optometrists in Vision Development, and the American Academy of Optometry.

I have learned a great deal in the process of becoming a fellow and I look forward to using this knowledge to better help my patients.

-Nathan Bonilla-Warford, OD, FAAO, FCOVD, FIAOMC

Is Your Child at Risk for Myopia? Send Them Outside!

Girl Smiling Grass Flower 1280×480 1024×384Myopia, more commonly known as nearsightedness, is a refractive error that affects millions of adults and children worldwide. This condition occurs when a person’s eyeball is too long, or the cornea or lens has an irregular shape. A myopic eye focuses the image at the front of the retina, as opposed to directly on the retina. it is often hereditary, especially if both parents are nearsighted.

Recent studies show that the more time spent outdoors can slow the onset of myopia for reasons explained below. These findings are significant, as myopia can seriously impact eye health if left untreated. At Bright Eyes Family Vision Care's Myopia Control Center, we’re here to answer any questions you may have and ensure that your child’s myopia is under control.

How Does Spending Time Outdoors Benefit Myopia?

By spending time outdoors, children train their eyes to focus on distant objects and relax their eyes. Just as with any other muscle in the body, the muscles in the eye need to be trained and strengthened in order to produce clear vision. Experts further suggest that moderate exposure to sunlight has a positive impact on myopia and general eye health.

A recent study was conducted by the Centre for Ocular Research & Education (CORE) at the University of Waterloo’s School of Optometry and Vision Science. The study shows that children who spend 1 extra hour outdoors each week reduce their risk of developing myopia by over 14%.

In contrast, according to the National Institute of Health, children who spend a considerable amount of time indoors watching TV or playing video games are at a significantly higher risk of developing nearsightedness.

Outdoor time should be incorporated into every child’s routine, especially those at risk of developing myopia. Parents and caregivers can make being outdoors fun by playing sports, hiking new trails, enjoying picnics or barbeques, or organizing scavenger hunts.

Why Is Delaying Myopia Onset So Important?

Myopia generally worsens over time, mostly during childhood and into the adolescent years. If your child’s prescription regularly increases, this can lead to more serious complications. Myopia progression heightens the risk of developing other eye conditions and disorders, such as cataracts, glaucoma, or retinal detachment. In more severe cases, permanent vision loss — or even blindness— may occur.

This is why it is crucial to monitor your child’s condition with a yearly visit to Dr. Knighton and Dr. Bonilla-Warford. Not sure whether your child has myopia? Refer to the following list.

Signs of Myopia in Children

Children with myopia may exhibit any of the following:

  • Squinting when reading the board or watching TV
  • Lack of interest in playing sports that require distance vision
  • Positioning oneself at close proximity to the TV or screen
  • Sitting at the front of the classroom to clearly see the teacher and board
  • Holding books close to the eyes

If your child is experiencing any of these symptoms or if you’ve noticed some of these behaviors, give outdoor time a try and bring him or her in to Bright Eyes Family Vision Care's Myopia Control Center for a comprehensive eye exam. We offer evidence-based myopia management treatment to slow down the progression of nearsightedness, thus preventing severe vision loss later in life.

Bright Eyes Family Vision Care's Myopia Control Center provides myopia management and other treatments to patients in Tampa, Westchase, Town 'N' Country, University, and throughout Florida.

REFERENCES:

Centre for Ocular Research & Education

National Institutes of Health

Perfect Vision is The Perfect Gift: Ortho-K

girl holiday giftsAs the holidays approach, most of us have one thing at the top of our to-do lists: gift shopping! This holiday season, give the gift of perfect vision that will have your loved one thanking you every morning. If you or anyone in your family has myopia (nearsightedness), there is no better gift than Ortho-K lenses.

What is Ortho-K?

Orthokeratology (commonly referred to as Ortho-K, corneal reshaping contact lenses or corneal refractive treatment) is a process that uses specialized gas-permeable lenses to safely and gently reshape the cornea (the clear front surface of the eye), by having them worn overnight and removed in the morning. Doing so provides clear vision all day long without the need to wear lenses or glasses. This FDA-approved method of vision correction is suitable for children and adults, is a safer alternative to LASIK, and can be used for myopia, astigmatism, hyperopia (farsightedness), and occasionally presbyopia (farsightedness due to aging).

Give the Gift of Ortho-K

Children and adults with mild to moderate myopia or those who cannot undergo LASIK or other refractive surgeries (for a variety of reasons) are excellent candidates for Ortho-K. Believe us — they’ll be grateful for this gift!

Ortho-k is not only effective for correcting refractive errors but is also great for slowing the progression of myopia in children — rendering it a particularly meaningful gift for a child. By slowing the progression of myopia, you can greatly reduce your child’s risk of developing serious eye conditions and diseases later in life, such as cataracts, glaucoma, or retinal detachment.

While you can’t wrap this gift up in a box, with Ortho-K, your loved ones will truly SEE the difference!

The myopia management program at Bright Eyes Family Vision Care's Myopia Control Center is dedicated to improving your child’s eye health. Call us with any questions you may have – we’re here for you.

Dr. Knighton and Dr. Bonilla-Warford provides myopia management and other services for patients in Tampa, Westchase, Town 'N' Country, and University, and throughout Florida.

Dr. Nate is a Fellowship Candidate for Orthokeratology and Myopia Control

I am excited to share that I am now a candidate for Fellowship in The American Academy of Orthokeratology and Myopia Control (AAOMC), a non-profit organization of practitioners and academics devoted to the science and education of Orthokeratology and Myopia Control. Since I have offered myopia management options for over a decade, becoming a Fellow has long been a goal of mine.

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These are qualities of a Fellow according to AAOMC:

  • Fellows have undergone advanced training and rigorous testing to demonstrate their level of expertise in myopia control and orthokeratology
  • A Fellow is the gold standard and represents the highest level of knowledge, ethics and patient care in the myopia control.
  • Fellows serve as mentors and role models for other practitioners as well as the general public.

This has been a long time coming. While attending the annual College of Optometrist in Vision Development (COVD) meeting in 2005 I saw Dr. Earl Smith present a lecture on refractive error regulation in monkeys. I was persuaded. My understanding of visual development and my plans for practice changed forever. I had recently completed my residency in Pediatric and Binocular vision and received my Fellowship at the Illinois College of Optometry in the American Academy of Optometry. My immediate plans were to open a practice where I could provide these specialized services and attain my Fellowship in COVD. I quickly opened Bright Eyes in 2006.

During this time, I became more and more involved in myopia control. Initially, I only offered ortho-k as a method of managing myopia. I learned a great deal. I regularly attended and occasionally lectured at the annual Orthokeratology American Academy of meeting, now Vision By Design. It was hugely inspiring and I started offering multifocal contacts and atropine for myopia management, respectively.

I am certain that the process of completing the Fellowship process will make me a better doctor and allow me to provide better care for my patients!

-Dr. Nate

Podcast Episode #15: Myopia Management With Esther Rodas

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 Optician Esther Rodas about Myopia and the treatment options to control it.

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.

Previous relevant episodes:


Full Transcript:

Introduction [00:00:10] Welcome to the Bright Eyes podcast. Advice for healthy vision for all ages. Your hosts are doctor 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-kertology and sports vision training. Their mission is to empower patients by providing the best in friendly, professional and individualized eyecare.

Dr. Nate [00:00:38] From rainy Tampa Bay. It’s the Bright Eyes podcast.This is episode number 15. I’m Dr. Nate Bonilla-Waford and today’s episode is all about myopia control. I’d like to introduce our special guest today this is Esther Rodas. Esther is an Optician. She works here at Bright Eyes and not only is she an optician, she’s our myopia control coordinator so Hi Esther.

Esther [00:01:05] Hello everyone. So Esther here just like Dr. Nate just mentioned and been here for about a couple of years and usually I will be the one that you talk to if you have any questions on myopia control and scheduling and all of that good stuff.

Dr. Nate [00:01:21] Absolutely. And when Esther joined us she was a student at the Hillsborough Community College in the opticianry program. And now that she’s got her license she works with us full time and we are so lucky to have her and patients just love her and all the staff does too.

Esther [00:01:37] Happy to be here.

Dr. Nate [00:01:38] Excellent. So Esther we introduced myopia in episode six as part of our refractive error episode. And here’s our vision therapist Miriam giving the definition of myopia.

Miriam [00:01:56] Myopia, aka nearsightedness is a condition where objects up close appear clearly while objects far away appear blurry. With myopia, light comes to focus in front of the retina instead of on the retina.

Dr. Nate [00:02:10] So myopia is all about nearsightedness. It’s all about not being able to see very far away without either contacts or glasses or lenses of some sort or for adults they can consider refractive surgery like LASIK. From your perspective Esther when a doctor diagnoses a child with myopia what are some of the most common questions that parents will ask you?

Esther [00:02:36] Definitely first thing they ask is if it’s permanent. If it’ll get better the older that they get?

Dr. Nate [00:02:43] Right. And that’s one of the questions that they ask us doctors are very first thing. They’re like, are they going to outgrow this? Are these glasses that they need? Or is this something that after a while they won’t need anymore? And one of the things about myopia that’s important to understand is while we see it as vision getting blurrier or glasses getting thicker or stronger, what’s really happening in myopia is the eye ball itself is stretching, it’s getting longer and getting bigger and it’s much easier for the eye tissue to stretch and elongate rather than it is to shrink and get smaller. And so for that reason when we’re talking about myopia I like to say it’s a one way street but it doesn’t really get better. And so after they kind of digest that what are the next questions that parents will ask you?

Esther [00:03:40] So once they know what can potentially happen and the inside of the eye they definitely know the options at that point what they can do to limit that progression.

Dr. Nate [00:03:51] Right. And so when I talked to parents, we always talk about myopia as a condition that needs to be managed. It’s not just in one point in time it’s a lifetime of change that we need to think about. We always talk about myopia in the short term and in the long term. So in the short term, kids need to be able to see, they need to be able to see the board at school, they need to be able to see for sports they need to be able to function in everyday life. There’s a variety of different ways that we can help them be able to see clearly and that’s the common things that people are familiar with glasses, contacts, the night time treatment contacts of ortho-K can help people see clearly. So there’s different options and we need to address that first because it’s very important that we make sure that kids have useful vision for living their lives. But, we also need to make sure that we are addressing the long term component. Because myopia tends to worsen and sometimes more dramatically in some patients rather than others- we need to make sure we’re addressing that and offering different kinds of treatments to hopefully reduce the risk of progression. So in our office Esther, what are the three main ways that we use to reduce the progression of myopia?

Esther [00:05:26] We offer here the Atropine medicated eyedrops as one solution. We offer Ortho-keratology which is the night time lenses and we also offer specialty designs soft multi-focal lenses to help with that progression.

Dr. Nate [00:05:46] Right. And we feel very strongly not just with myopia but with all of our patient care that every option needs to be tailored individually to the patient. So it’s not one size fits all. It’s not that every single patient who comes in needs any one particular treatment but it depends on their lifestyle,it depends on their goals,it depends on their genetics,it depends on if they’re more likely to progress. So very briefly we’ll just go over what these options are. The first one which is the most easy to administer are the Atropine eye drops. Now, atropine is a medication that dilate the pupils and it reduces the eyes ability to focus. And for that reason, it hasn’t been widely used in the United States. It’s used for many many conditions but not for myopia control. Until recently when it was discovered that you could use a very low concentration to minimize the side effects. So we have many patients who are on the low concentration atropine treatment to reduce the likelihood of progression. We don’t know exactly how the atropine works, what it’s doing in the eyes but it’s been shown in many many many studies to be effective. So that’s that’s one option. The other option like Esther said was the multifocal contacts.The multi-focal contacts are worn in the daytime just like any other soft contact that you’d be familiar with. But it has a special optical treatment which provides some stimulus to the eye that reduces its need or its inclination to to get worse. We can optically change how the light focus is on the back of the eye to reduce that stimulus to progress and get worse. And so that’s the daytime contacts. The nighttime contacts the Ortho-K does the same thing optically, but it actually reshapes the eyes so that you can see clearly without daytime contacts or glasses. So you get a little bit of a two for one with ortho-K which is great. So once we do the exam and we take lifestyle into account, we look at all of the the treatment options and I will recommend a particular treatment option for a patient. I’ll bring them out and then they will go over the details and the logistics of that treatment option with Esther at that point. What kind of questions do you get?

Esther [00:08:24] So definitely the top question which you kind of touched on right now is their parents are only super interested and intrigued of like the science behind each one and the how is it that the atropine, the multi focal and that the nighttime lends aid in hopefully limiting that progression of the nearsightedness for their child. So anything you can add to what you just said.

Dr. Nate [00:08:48] So the interesting thing about myopia control is even though there are many many scientific papers exploring how well these different options work and how they relate to each other- we don’t thoroughly understand exactly how they work. We have a pretty good idea of how the optical effects of the multi focal contacts on the ortho-K works to reduce that stimulus to progress. We really don’t know as much about how the atropine works. We know that atropine has been used for hundreds and hundreds of years and it’s been used for many many conditions and it’s extremely safe to use. We don’t know what’s exactly going on at the molecular level to help keep the eyes from progressing, but we do know it’s very effective. I know the parents don’t think that that’s a super satisfying answer but it is the honest answer at this point. So what other questions do parents ask you?

Esther [00:09:45] Definitely risks. They want to know what kind of risks are involved and short term risks and long term risk as well. So for example the night time contacts as they are more rigid than the soft lenses. And they always want to know what the risks are for abrasions and things like that. Almost the same for soft contact lenses for short term risks. Long time parents want to know if the ridgid of lenses will affect the kids eligibility to do maybe LASIK in the future. Parents also ask about any effects that that may have on things such as glaucoma and any long term risks in the medicated eye drops. So it’s kind of like a few questions and one.

Dr. Nate [00:10:34] Well I think that that’s really important topic because with any procedure or with any therapy we always need to weigh the benefits and the risks and that’s part of the discussion that always happens between me and the parents when we’re talking about undertaking one of these treatments. Fortunately in the big picture all of these have been proven to be very safe. And that’s why we can feel comfortable doing them. And that’s why I feel comfortable with both of my children using these different methods. My son uses the medicated eyedrops. And my daughter does the night time Ortho-K lenses. Obviously, if I didn’t feel they were very safe I’d be reluctant to use them with my own kids and I know that lots of doctors around the country and around the world have their own children and in myopia control programs similar to these as well. So let’s talk about the different risks with any contacts. There are certainly risks especially if you don’t use proper hygiene, if you don’t care for them properly. If you use them in a way that you shouldn’t be then you increase those risks. Fortunately all of the scientific studies that have shown that with the Ortho-k lenses for night time don’t have any additional risk compared to traditional contact lens wear. And so that that helps us educate patients properly now. The very first question that people ask me is often, well I was told that I shouldn’t sleep in my contacts because it’s not healthy. So why is it healthy to sleep in these contacts. That’s a great question because it’s true that you shouldn’t sleep in your daytime contacts because one- they’re often not intended for that two- if you’re sleeping in them in the nighttime and then wearing them in the daytime then you’re wearing them for a full 24 or multiple cycles. And that can create problems because the lenses never get cleaned with Ortho-k. One, they are super breathable materials. Two, they’re designed specifically to be worn at night and three they’re only worn for about eight hours at night and then they’re being cleaned and stored the rest of the time. Furthermore the Ortho-k lenses rarely or never leave the house. It’s not like the contact lenses that you wear where you get pollen in them you, get dust in them. If you are out and about your eyes can get sweaty you can get sunblock on them if they goes in your eyes etc. Whereas Ortho-k you put them in before you go to bed you take them out in the morning and they’re clean and so the lenses stay very, very clean and we’re very, very clear about the proper method for keeping the lenses clean. Once we have the proper care method established then the risks go way,way down. It is possible in the short term, if the patient doesn’t have good insertion technique for putting the lenses in to lightly scratch or abrade their eye but that’s very, very rare and when it does happen it’s mild and it resolves right away. Now fortunately, we’ve never had any infection for any of our patients and that is incredibly rare with proper care. That’s the same for our for our soft contact lens patients soft contact lenses are healthier than ever before and the risk of infection is is very, very low. I will add here and I always tell patients all the time, that you should never use tap water or you should never clean your lenses with anything other than solutions that have been provided. You shouldn’t shower or swim or go on lakes or hot tubs with your contact lenses on because that can introduce contaminants or bacteria or amoebas that can cause a severe infection. So I was always educating about that.

Dr. Nate [00:14:48] Regarding the atropine, there are known side effects like I mentioned about sensitivity to light and focusing, but by using the lower concentration those are dramatically reduced. Other than that, the only real side effect that can happen with patients sometimes is if the drops come with a certain preservative and the patients are sensitive to that preservative it can cause an allergic like reaction where the eyes get red and irritated. Many of our patients use non preserved drops and that’s not an issue we haven’t found that to be a common problem. But it’s theoretically possible and some patients you it’s hard to know whether they’re they respond to preservatives or not. In the long term, for long term use- atropine has been used for for many years without any problems or side effects.

Esther [00:15:49] We do go through a couple of compounding pharmacies.

Dr. Nate [00:15:53] Yeah, we do have some options and that’s actually an important point. So if you get the high concentration atropine which we don’t use very often except in the very most stubbornly progressive cases, you can get that at almost any pharmacy because that’s the standard formulation that is used to treat eye disease. The lower concentration is only available through compounding pharmacies and we have a variety of options that we can we can help patients acquire that.

Esther [00:16:25] Have you got at all questions about if it’ll affect someone’s eligibility for LASIK in their future or the glaucoma?

Dr. Nate [00:16:33] Yeah and that’s actually a very common question and it’s a great question because sometimes patients are concerned well maybe this reshaping with Ortho-k reshaping of the cornea will adversely affect them for their chances for Lasik and I say you know exactly the opposite. The goal of Ortho-k is to keep the eyes the prescription is stable enough over the long term so that they remain eligible for for LASIK or refractive surgery. What typically happens is people will do Ortho-k starting when they’re when they’re younger maybe you know 10 or 12 years old and they’ll keep doing it until they’re an adult they might stop at 18 or I had a patient just the other day was 12 and she’s now 30 and she’s been doing it continuously. But if she or other patients wanted to stop as an adult they could wait until their eyes go back to their natural shape and once that’s stable and it’s confirmed to be stable with repeated curvature measurements then they are eligible for LASIK just like any other patient will be.

Esther [00:17:44] How about the glaucoma question?

Dr. Nate [00:17:47] So the glaucoma question is interesting because people worry about glaucoma for this reason- they think the Ortho-k lenses press on the eye to reshape the lenses. And if they’re pressing on the eye then that’s going to increase the pressure inside the eye and if you increase the pressure inside the eye that’s going to increase the risk of optic nerve damage called glaucoma. Now the reason why it is not a risk for glaucoma is because Ortho-k lenses don’t actually work by pressing on the eye what they do is they they are kind of a rigid surface that goes over the cornea and then over time the cornea conforms to that lens it- actually kind of expands outwards to meet the shape of the lens so instead of pressing on the eye, the cornea actually reshapes itself or expands to meet the lens. So there’s no reason to think that the pressure inside the eyes increases when we do Ortho-k and therefore there’s no added risk for it for glaucoma. Again kind of like LASIK, nearsightedness itself is a risk factor for glaucoma if you have very high myopia in nearsightedness you have increased risk for for glaucoma. So it may be that doing Ortho-k might actually help reduce the risk long term of glaucoma.

Esther [00:19:25] That’s great information. Thank you. I would say those are the top questions and the last question that I always get at the very end is if these methods are FDA approved?

Dr. Nate [00:19:38] Right. And so here’s the thing about FDA approval all of these methods are FDA approved for a variety of conditions and treatments but not specifically for reducing the progression of myopia. So we’re very clear when we talk to parents and we have it in writing and we explain that while all of these treatments are scientifically valid and there is many studies that talk about the the benefits that the FDA itself has not gotten around to evaluating yet and stating that these methods are specifically approved for the reduction in the progression of nearsightedness. Many other countries have, and there’s lots of scientific evidence to show that it is, but no the FDA hasn’t. Now, all of these things like the atropine eyedrops are approved for treating many, many kinds of conditions including Amblyopia,which is something that we see in the office a lot. A multi-focal contacts are certainly approved for lots of conditions. Specifically, presbyopia for older adults who need to see up close. Ortho-k, the nighttime contacts is approved for treatment of nearsightedness so that people can see clearly throughout the day, but they haven’t gone that extra step yet in approving it specifically for the reduction in the risk of progression. So that’s something that we think it’s important that people understand it doesn’t mean that we shouldn’t do it, but it is in the state of approval right now.

Dr. Nate [00:21:29] Well, hopefully this has been helpful for people who are interested in learning more about myopia control in the future we hope to have some more episodes detailing how each of these methods work. I think it would be kind of fun to have my kids on and they can talk about their experience. That would be that would be interesting to hear it from their own mouth. And we have lots of other topics in mind if you have any suggestions I have topics that you’d like to hear in the future, please let us know. I’d like to thank Esther for joining us and talking to us today. And is there anything else you wanna say before we go now?

Esther [00:22:16] Thanks for having me and to all those listening to this podcast. If there’s any questions if you want to schedule a myopia consultation with Dr. Nate just ask for myself Esther and be more than happy to answer any questions that I can and get you on our schedule right.

Dr. Nate [00:22:34] And if you want to you can call us at 1-813-792-0637. Or you can e-mail the office at office@BrightEyesTampa.com. Until next time,stay dry.

Outro: [00:22:46] 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 noncommercial use. The only purpose of this podcast is to educate and to inform. There’s 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 a medical or other professional advice or services. Please consult your physician for diagnosis treatment.

Intro/outro music: Lucas Warford of Three For Silver.

Dr. Nate Lectures at American Academy of Orthokeratology and Myopia Control Meeting

20160410_102939Dr. Nate Bonilla-Warford just returned from the annual educational conference of the American Academy of Orthokeratology and Myopia Control (AAOMC) in Scottsdale, Az. International speakers presented on a variety of topics, but the myopia epidemic and its impact on public health, and new methods for slowing nearsightedness in kids were the top priority. Over 500 doctors attended, representing the U.S., Puerto Rico, Canada, China, Mexico, Australia, and many others.

Dr. Nate delivered two lectures at the AAOMC meeting. The first was a workshop designed to teach attending doctors different strategies of myopia control. The second was aimed at improving communication between myopia specialists and other professionals, such as pediatricians.

The AAOMC is part of the International Academy of Orthokeratology (IAO), a worldwide organization of orthokeratologists who provide a non-surgical alternative for the correction of nearsightedness, astigmatism, hyperopia, presbyopia and myopia control. Dr. Nate has been a lecturing member of AAOMC for many years.

Myopia (nearsightedness) is an epidemic disease affecting over one billion children and adults worldwide, with expectations that the number will hit 2.5 billion by 2020. Extensive research has proven that there are many methods, including ortho-k, specialized soft contacts, and prescription eye drops, that can slow the progression of nearsightedness. This can reduce the risk of retinal detachments and glaucoma as well as the social issues associated with wearing thick glasses. For more information go here or call us at (813) 792-0627.

You can find more information on myopia, orthokeratology, and to find a provider near you go to: www.orthokacademy.com.

 

 

Top Ten Steps For Myopia Control

Happy New Year!EDA28 300
It is something of a tradition here at Bright Eyes Family Vision Care to celebrate the coming new year with a Top Ten List, starting in 2008 with 10 resolutions you should make for eye health. Since then, I have written Top Ten lists for children’s vision, computer vision syndrome, and saving money on eyecare.

This year, I take on one of the hottest topics in vision care: myopia, also known as nearsightedness or shortsightedness. While this condition may seem like a mild inconvenience, it actually increases the risk of serious eye diseases such as glaucoma, cataracts, and retinal detachments. Most alarmingly, myopia rates are increasing dramatically in the developed world. In just the last generation, the rate of myopia has increased in the US by 65%.

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Here is what you can do:

  1. Educate yourselfMyopiaControl.org, and MyopiaPrevention.org are all good places to start. While doctors cannot predict exact progression of nearsightedness for a particular patient, there are options. It is important to understand that there risks and benefits to every option and many of the options below are considered “off-label” by the FDA. Have these conversations with your doctor.
  2. Get your kids outside – There have been numerous studies that show that the more time younger children spend indoors the more likely they are to become myopic. So for 2016, make sure your kids include going outside for walks, trips to the park, or playing outdoor sports as part of their daily routine.
  3. Find the right eye doctor – Most doctors do not have specialty training in myopia control. While most know how to prescribe glasses and contacts to help people see clearly, some doctors have undertaken post-doctoral education in the methods of myopia control. You can go to the American Academy of Orthokertology and Myopia Control to find a doctor in your area.
  4. Start early – One thing we know for sure: the best way to control myopia is to prevent it. So the earlier action is taken for a patient, the less myopia they ultimately will have. In fact, we can now better predict who will be myopic before they start having blurry vision or before they would fail a school or pediatrician screening. So if you or your spouse are nearsighted, be sure your children have eye exams at the recommended ages and discus myopia with your doctor.
  5. Reduce eyestrain – People become nearsighted for a combination of genetic and environmental. Unfortunately, there are no large studies that guide us yet. However, there are some things that doctors to see clinically. Generally, excessive stress rarely improves any condition. The dramatic increase in eyestrain from digital device does seem to parallel the increase in myopia. In my own clinic, I have seen an increase in teenagers with blurry vision at distance that is not due to myopia from eyestrain. These patients are likely to become myopic eventually and best treated with vision therapy. Until we know more about the eyestrain/myopia connection, I think it makes sense to take it easy with the digital devices. A 5 minute break every 20-30 minutes has been shown to reduce focusing eyestrain.
  6. Do not ask for under-correction – the idea of intentionally wearing “weaker” glasses to keep the eyes from getting worse is a common misconception,
  7. Consider orthokeratology – One method that has been shown to effectively reduce myopia progression is orthokeratology (AKA Ortho-k, or OK). This has the added benefit of providing patients with clear daytime vision without glasses or contacts. Ask your doctor if this is an option for your child.
  8. Consider multifocal contacts – Additionally, certain multifocal soft contacts have been shown to reduce myopia progression. Ask if this is an option for your a child.
  9. Consider atropine eyedrops – One method that has been very effective in slowing myopia progress is the use of atropine. This is very common in Asia, but has been more slowly adopted in the US.
  10. Avoid myopia scams – Finally, beware. There are some websites that promise to reverse or eliminate myopia with special glasses or exercises. Some of these sites charge as much as $9,000(!) for their services. While these sites may sound informative and scientific, they are purely scams and cannot deliver what they promise. Ask your doctor (see #3), instead of spending money on these.
2016 promises to be a very exciting year for us at Bright Eyes Family Vision Care. Hopefully it will be for you as well. If you have any questions about myopia or vision care in general, please let us know by calling (813) 792-0637.

Nathan Bonilla-Warford, OD, FAAO, FCOVD

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Photo credit National Eye Institute, National Institutes of Health.
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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

Myopia Control FAQ & Scientific Research

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Understanding Myopia

Myopia, or nearsightedness is a very common vision problem. It's estimated that more than one-third of Americans are nearsighted, and it is increasing.  Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing. If your glasses or contact lens prescription begins with minus numbers, like -2.50, you are nearsighted.

See the treatment options for myopia control.

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myopia-facts-infographic-580x2400Myopia Control FAQ

Does my child need to have a general eye exam before starting Myopia Control?

Yes, a comprehensive eye exam from an eye doctor is required. We would be happy to provide that exam. However, if your child has had an eye exam with another eye doctor within the last year, you can request that doctor refer your child to our office for Myopia Control.

Is there any additional charge for the Myopia Control procedures?

Yes, standard optometric charges apply. We offer several different year-long programs. Following the comprehensive eye exam, a Myopia Control Consult is necessary to determine which program is best for your child.

Can I request to see either doctor?

Either Dr. Nate or Dr. Beth can discuss Myopia Control at your child’s comprehensive eye exam. After that, Dr. Nate performs the Myopia Control Consult and the Myopia Control treatment visits.

What techniques are used in the Myopia Control Program?

There are three options:

  • Orthokeratology (corneal reshaping) is the wearing of special contact lenses at night to provide clear vision during the day without lenses.
  • Multifocal soft contact lenses are worn during the day.
  • Atropine, in the form of eye drops, is used at night time.

Every patient is different – one treatment does not work for all patients. That is why a specialized Myopia Control Consult is necessary before selecting the best treatment method.

How do I get an appointment at Bright Eyes?

You can request an appointment here or call us at 813-792-0637. Be sure to specify that you are interested in Myopia Control so the Bright Eyes staff can book the appropriate appointment for your child.

Do I need to bring anything to the appointment?

Just the patient. 🙂 Bringing previous eye exam history or old glasses can also be helpful at the initial appointment.

Will Myopia Control require many office visits?

There are multiple office visits as the treatment is begun. After that, there are quarterly (every three months) follow up visits to ensure that all is going well for your child.

Will Myopia Control hurt?

No! If your child is new to contact lenses or eye drops, sometimes there can be discomfort while he gets used them, but we use the latest technology to ensure quick adaptation.

I am nearsighted and my child is nearsighted, too, and it’s getting worse. Is there anything I can do for them?

Probably! More children than ever are becoming nearsighted (myopic). Fortunately, there different options to help children of any age.

My eye doctor told me that myopia is in my genes, and that there is no way to slow or stop it. Is there scientific evidence that this really works?

For years, many doctors thought that myopia is caused only by genetics, but in the last 10 years or so, there has been very dramatic research that has shown this to be not the case. Take a look at the research section below to see some of these studies.

Are there vitamins that my child should be taking to keep his vision from getting worse?

No. At this time, there are no studies that show benefits of taking vitamins. However, it is a good idea in general to maintain a healthy diet including more vegetables and less sugar. Talk to your pediatrician for specific information on nutrition.

What about eye exercises?

There are some specific cases where vision therapy (sometimes called eye exercises) may reverse mild nearsightedness due to eyestrain. This is often called “pseudo-myopia”. However, true nearsightedness cannot be reversed or eliminated with eye exercises. A comprehensive eye exam with a doctor trained in children’s vision is necessary to tell the difference.

My child is only 8 years old. Is really OK for them to do Myopia Control? Even if it involves contact lenses?

Yes! It used to be thought that children should not use contact lenses until they were teenagers. Several studies have shown that contact lenses are safe for younger children as long as they are taught proper care of the contact lenses. Also, contact lens materials and designs are safer than ever for all patients.

Does Myopia Control have FDA approval?

No. As of right now, the treatment options that exist for myopia control are FDA approved procedures, but are not specially approved for myopia progression. For example, orthokeratology was FDA approved for the temporary treatment of blurry vision due to myopia, but treatment for Myopia Control is considered “off-label”. The same is true for atropine and multifocal contact lenses. However, this is changing. Recently a meeting was held between the American Academy of Ophthalmology (AAO), American Academy of Optometry (AAOpt), American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and more to establish an FDA study for myopia control.

Do only optometrists offer Myopia Control?

No, both ophthalmologists (MDs) and optometrists (ODs) offer myopia control. Bruce Koffler, MD, an ophthalmologist wrote this important document called “The Case for Myopia Control Now.” You can find doctors all over the whole who provide this service via the American Academy of Orthokeratology and Myopia Control.

Myopia Control Scientific Research

Below is just a small sampling of scientific research supporting myopia control. If you’d like to see more, go to http://myopiaprevention.org.

Increasing Prevalence of Myopia

Development of Myopia

Risks of Myopia

Myopia Control Options

“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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