A Sit Down – with Dr. Dan Press
This post appears as part of a series called Sit Down – candid conversations with real people detailing their journeys and experiences with Vision Therapy.
A Sit Down – with Dr. Dan Press
For the benefit of our readers, can you explain how you are involved in Developmental Optometry?
I am an Optometrist. I provide developmental vision care to a large pediatric patient base which includes primary vision care and Optometric Vision Therapy. I attended Rutgers University for my undergraduate studies and the Pennsylvania College of Optometry for my Optometric degree. I currently practice in Park Ridge and Deerfield, IL and have been in practice for 6 years.
What led you to Developmental Optometry?
I started my undergraduate studies in economics. I realized quickly that I didn’t have the passion for numbers, and helping people was my calling. I changed my major to biology and researched potential opportunities including veterinary medicine and sports medicine. When I was home on winter break I was able to spend time in my father’s practice. Considering he wrote the textbook on the subject of Vision Therapy, it didn’t take long to see how special this field was. I didn’t have to think about what I wanted to do from that week forward. The following summer I worked in his office as a Vision Therapist and was able to feel how special this field really is. The interaction with the Vision Therapists is really what helped feed my passion for caring for patients.
Being the son of a highly successful and world renowned Developmental Optometrist, you have some pretty big shoes to fill. How do you feel about that?
My father has obviously been a tremendous influence in my life. I don’t worry about comparisons between us since he is not human. He seems to have found a way to make the day longer and I am waiting for him to share his life secrets with me on how to accomplish so much in earthling hours. 🙂
On a serious note, he has shown me that when you combine intelligence, passion, dedication and sincerity there is no limit on what you can accomplish. With all of that being said it is my mother, Miriam, who has truly allowed him to accomplish all that he has and she deserves much of the credit. Frankly, when I stopped worrying about the comparisons and what other people thought, my professional life skyrocketed.
In layman’s terms, how would you explain the difference between a Primary Care Optometrist and a Developmental Optometrist?
A Primary Care Optometrist is concerned chiefly with the structure of the eyes. It is very hard for a primary care eye doctor to assess how a person functions over the course of a day when you are mainly looking at structure. That is a very important piece to the puzzle but there is much more to be evaluated when we discuss overall visual function. A Developmental Optometric Evaluation picks up where the Primary Care Ophthalmic exam leaves off. It includes tracking, eye teaming, focusing, visual processing skills and the integration of vision with other sensory and motor systems.
As we were organizing this interview, you made it clear that you feel strongly about identifying yourself as a Developmental Optometrist rather than a Behavioral Optometrist. Might you elaborate on why this is such an important distinction? After all, what’s in a name?
Some may think of this distinction as a matter of semantics, but it is our labels that can define who we are, and this label is important to me. There are many reasons why I prefer the term Developmental over Behavioral. The most fundamental one is that when we think of vision as a developmental process from birth on, it encompasses all visual dysfunctions and our opportunities to possibly influence them. To me, Behavioral is more limiting in that many people with visual dysfunctions may not have the “behavioral characteristics” that typically are associated with it. The other point I would like to include is that the College of Optometrists in Vision Development, COVD.org, was formed in 1971 to provide board certification in this field for doctors and Vision Therapists. If the great minds behind this influential organization agreed that development is the term that best defines our work, who am I to argue?
Many times, parents will ask why they have never heard of Vision Therapy prior to visiting their Developmental Optometrist. How do you respond to your patients when this topic arises?
It is very unfortunate that this is the best kept secret in eye care and possibly medicine! Our profession has to do a better job of public awareness but I ask each patient to do their part to help spread the word, which has become increasingly easier through social media.
Questions often arise on the ideal age for Vision Therapy candidates. Many parents will ask if their two year old is too young and adults will ask if they, themselves, are too old. What are your thoughts?
There is no age limit, young or old, for Optometric Vision Therapy. You can never start too early and you are never too old to work on changing brain function. We now know plasticity is present throughout life. With that being said, it is much easier to habilitate the visual system than to rehabilitate it, so the younger the better. I believe it is up to the individual comfort level of the doctor and/or Vision Therapist for how young of patients they will work with.
The efficacy of Vision Therapy is often questioned by parents and other professionals. Some have even stated that Vision Therapy is “quackery”. As a doctor, how do you manage this idea?
This just simply isn’t true anymore. I can refer to the National Institute of Health study confirming that Optometric Vision Therapy is the treatment of choice for the most common binocular vision disorder, convergence insufficiency. It is not a hard stretch to realize that the same principles will apply to other non-strabismic and strabismic disorders and there are many studies in Optometry that back that up. There is plenty of research that supports the use of Optometric Vision Therapy and if anyone claims otherwise it is a sign of ignorance.
With that being said, there are always going to be outliers in every profession and Optometry is no exception. There are doctors practicing Vision Therapy that, in my opinion, overstate the benefits of Vision Therapy. They might be ahead of their time, but it does not seem to help form a positive opinion with objective onlookers.
Strabismus surgery tends to be a polarized topic within Developmental Optometry, at times referred to as a travesty conducted by our counterparts in Ophthalmology. Others view surgery as a valuable resource if timed properly. Do you feel there are times this type of surgery is warranted? As a doctor, where do you draw the line?
I absolutely feel that there are times strabismus surgery is warranted. I believe extremism is a dangerous philosophy and that is true of Ophthalmology opinions on Optometric Vision Therapy, and vice versa. I could write a paper on this subject, but to be brief, my feelings are; always try less invasive treatments before more invasive treatments, an intermittent strabismus should not be operated on, any surgical considerations should be complemented with pre and post-operative Optometric Vision Therapy much like the synergy between physical therapy and orthopedic surgeons.
A lot is made of the incredible expense associated with Vision Therapy. Some argue that a few thousand dollars to improve a patient’s life is a drop in the bucket, while others balk at the exorbitant fees. What’s your opinion? How do you manage the cost issues with your patients?
Value is in the eye of the beholder. It is incredibly costly to run a Vision Therapy practice. The cost of materials can vary from practice to practice but the one common denominator in any reputable Vision Therapy practice is time. There is an incredible amount of time involved in administrating a Vision Therapy practice. The amount of behind the scenes work is astronomical compared to a primary care Optometry practice. I can say this with confidence as I currently work in both environments.
Insurance coverage varies, and while I wish insurance companies paid for Optometric Vision Therapy services the truth is that many do not. I don’t think any doctor cares how they get paid for their services, as long as they get paid so that they can continue to provide high level care. It would be much easier to get paid from insurance companies than privately through patients but that is not the world we currently live in. We have to accept that there is some healthcare that isn’t covered by insurance and parents have to make decisions based on what is best for their family.
Your passion for this field has taken you beyond your exam room. Can you tell us more about this?
I believe so strongly in getting the message out about what the field of Developmental Optometry has to offer that it is important to volunteer and participate. This is not only important on a local level to help your practice but more importantly on a national and international level. I was honored to be elected to serve on the board of directors for the College of Optometrists in Vision Development, www.covd.org, in 2012. I also have been lucky enough to participate in the VisionHelp group, www.visionhelp.org. This group has the brightest minds in Developmental Optometry and is constantly striving to improve the care of the “visually misunderstood”.
The VisionHelp Group seems to be a very interesting concept. How was the group formed, and how did you become involved?
Initially there was a group of practitioners that would meet bi-annually to discuss practice management concepts specifically related to Optometric Vision Therapy. The group had evolved over a few decades and about 10 years ago the mission had changed from furthering the individual practices to furthering the concepts of developmental vision for the benefit of mankind. These selfless practitioners are determined to inform the world of the benefits of Optometric Vision Therapy. There is a Website, Blog, and Facebook Page currently set up with continual projects being developed.
On a personal note, COVD’s Annual Meeting is coming up in October. Aside from your duties as a Board Member, what do you enjoy most about the meeting?
Camaraderie. The ability to connect with friends and people who have become like family has become a time of year that I cherish. It allows me to reflect on the prior year on all that has been accomplished and recharges my battery for the upcoming year. As equally important is that the education in and outside of the lecture hall is priceless. I’m looking forward to another great meeting!
Some closing thoughts – A special thanks to Dr. Dan Press for taking the time to share his thoughts. Please join me in wishing him great success in both his professional career and with his young family. He truly is a class act.