Dr. Bonilla-Warford is an optometrist with a passion for children’s vision. He writes the Bright Eyes News blog, and has commented here a few times. If you haven’t read his blog, you should absolutely take a look, it’s readable, and he writes often about news and advances in children’s vision research. He graciously agreed to an email interview with me to talk about his career and interest in pediatric optometry, what to expect from eye exams, differences between optometrists and ophthalmologists, and much more.
Ann: I saw on your website that you studied natural resources and environmental sciences in college. What led you to pursue a career in optometry and to focus on children’s vision?
Dr. B: Well, I have always known that I wanted to combine my interest in science with some meaningful contribution to the world, but I really had no idea what form that would take. Originally, I was a physics major, then environmental science, but I realized that although I enjoyed learning about the basic sciences, I wanted to focus on an area where I could engage with people. (Also, I had many classes outdoors, which I liked!)
After I graduated with my degree in Environmental Science, I felt that I knew a great deal about how the Earth functioned, but I still did not have a clear idea what to do. I taught schoolchildren briefly and though I enjoyed it, I realized that I preferred one-on-one interaction to working with large groups.
After I got married to my wonderful wife, Cristina, I knew that I needed to get serious and turn my skills and interests into something that would both satisfy me and provide for my family. During this time, I considered many different areas, including naturopathic medicine. I remembered my family Optometrist that we had gone to since I was child. He had always been an interesting guy and I thought it would be an interesting career. So I worked as an optician for a few years, shadowed several optometrists, and applied to Optometry school. Then we moved to Chicago for Optometry school.
Regarding my interest in children’s vision, it is kind of funny how random experiences can shape your life. Before going to Optometry school, I had limited experience with children and didn’t know that children’s vision existed as a specialty. In fact, I really disliked the first few classes that I had in the subject area during my second year of Optometry school. But then two things happened. First, I had the opportunity to spend time with my cousin’s children and found out, to my surprise, that I really enjoyed children. Second, I fell in love with the next set of classes at school that focused more on vision therapy and how it can change children’s lives. At that point I knew what I wanted to do and that I would do it for the rest of my life.
Ann: What are some signs that parents should watch for in their children that might indicate a vision problem?
Dr. B: This is such an important and complex question! Before I answer, there are a few things I’d like to point out. First, children will almost never complain about their vision, even when directly asked by a parent or a doctor. This is because children are amazingly good at adapting to things, including vision problems. They simply do not know any other way to see. An example: the other day a young boy was brought in by his mother, who felt that there were no problems. I tested his right eye and his vision was perfect. I tested his left eye and he said, “Oh. That is the eye I can’t see out of.” The mom nearly fell out of her chair.
Here are some critical things to look for:
- An unusually large pupil or white reflection in one of the pupils
- Eyes that are red, watery or irritated
- Squinting, blinking, or rubbing of the eyes
- An eye that appears to wander in or out (even occasionally)
- Closing one eye during tasks such as reading or watching TV
- Avoidance of detailed near-work such as reading, writing or drawing
- Needing to use a finger to keep place while reading (after learning to read)
- Frequent headaches, especially if during school or while reading
- Complaints of seeing double
- An unexpected difficulty with reading
Ann: What can parents expect from an initial eye exam? Is there anything they can do in preparation to help out their doctor?
Dr. B: Obviously, what they can expect varies depending on what type of doctor you go to and how prepared they are to see children. You can expect a certain number of things that almost every eye doctor will do: check the clarity of vision, check to see if they need a prescription, check the alignment of the eyes, and dilate the eyes to carefully evaluate the health and structure of all parts of the eyes.
Here are some things you can do to make the visit more enjoyable:
- Reassure your child that it will be fun. Mostly it is like playing games (really).
- Try to schedule the exam when your child is alert and active (i.e. not nap time)
- Try to fill out any paperwork and information online or in advance
- Bring toys and snacks
- Almost every child is afraid of eyedrops, but don’t lie to them and say that they aren’t going to get them. Some doctors use a special spray that is less scary for kids.
Ann: We’ve had some questions and discussions on our blog about the differences between ophthalmologists and optometrists. What are the differences in the professions, and when would you counsel a parent to take their child to one over the other?
Dr. B: Unfortunately, this is a difficult area. One thing that parents need to know is that while all doctors want the best for their patients, they all have different areas of specialty, training, and interest.
Pediatric Ophthalmologists are primarily concerned with diseases of the eyes. They go to four years of medical school and then several years of residency and fellowship. They expertly manage complicated conditions where the eye did not develop correctly, there is trauma, or disease using surgery, medicine or glasses. Accordingly, most of their testing is more medical in nature.
Pediatric Optometrists are primarily concerned with vision. They go to four years of optometry school and many complete an additional residency if they want to specialize. They expertly manage complicated vision problems using glasses, contact lenses, and vision therapy. They can manage some eye diseases such as glaucoma and pink eye (conjunctivitis). Optometrist evaluations typically involve more areas of visual skill.
Generally, speaking Optometrists believe that vision can be improved with therapeutic activities while Ophthalmologists do not. This is partly because of the training that each type of doctor receives, and partly because, historically the quality of the research on vision therapy was not adequate. However, the scientific research on vision therapy is developing rapidly now and the efficacy is now better documented.
Which type of doctor you should see depends on what types of problems you are worried about. If it is an eye disease, then see an Ophthalmologist. If you think the eyes are healthy, but you are concerned that the vision isn’t as it should be or that some aspect of the vision is affecting part of their life, an Optometrist will likely be a better choice.
If your child has an eye turn (strabismus) and you want them to have surgery, then an Ophthalmologist is the person to see. If you are reluctant to have surgery or want to learn about other options, then an Optometrist is the person to see.
If you are truly not sure who to see, then you may want to see both. Be sure and ask as many questions as you need to to ensure you know what they are testing and what information they are using to make their decisions.
Ann: Is there anything else you want parents to know about their children’s vision and vision development?
Dr. B: Well, this is my favorite topic so I could go on and on. One thing I routinely tell parents: If you are certain there is something wrong, I mean absolutely certain, then you are probably right. Moms that see a problem are almost never wrong. If they go to a doctor, they shouldn’t accept “everything is fine” until they’ve asked enough questions that they are satisfied. And if they aren’t satisfied, they should get a second opinion.
Another thing I tell parents: Vision is a learned skill. The eyes develop due to genetic programming, but every aspect of vision is learned starting at birth. We learn to focus on objects near and far, we learn to move our eyes smoothly from one point to another (both near and far), and we learn to interpret information from both eyes to understand what we see. This usually happens naturally, but sometimes children need a little help learning to see correctly: getting their eyes to do whatever they are supposed to and getting their brain to know what do with the information that eyes send it.
Because vision is learned, we need to ensure that it is being learned properly That is why the American Optometric Association recommends eye exams starting at 6 months of age, 3 years of age, and before starting school. Not every organization agrees with this schedule, but I encourage parents to follow it. The InfantSee program exists to provide no-cost exam exams to babies who are between 6 and 12 months of age. You can find out more at infantsee.org.
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I’d like to again thank Dr. Bonilla-Warford, not only for participating in this interview, but also for keeping his own blog, and joining the discussions on this blog from time to time. It is wonderful to have the insight of someone who is clearly so committed to caring for our children’s vision. You can read more of his thoughts on his Bright Eyes News blog.