A Sit Down – with Dr. John Abbondanza
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. John Abbondanza
For the benefit of our readers, can you explain how you are involved in Developmental Optometry?
First, Robert, let me say how much I appreciate the fact that you write this blog that is seen by so many. You are doing your share to spread the word about the great work that we do and I am delighted to be a part of it.
I am in private practice at Vision Care Specialists in Southboro, Massachusetts (www.GreatVisionCare.com) and have a subspecialty in behavioral/developmental optometry and vision therapy. It is a full scope primary care practice, so we do routine exams, contact lenses and eye glasses, ocular disease and all that, but my true love is vision therapy. Optometry is the only profession that understands the combination of visual science, neurology, optics, and binocular vision to the level that we do, and therefore can help patients in ways no other profession can. In my practice, I have a special interest in the connection between vision and learning.
What led you to Developmental Optometry?
As an optometry student, I selected the pediatric rotation because I was terrified of kids. When I saw an eight year old child in the chair, I would panic and my palms would sweat. I figured the best way to overcome that would be to force myself to learn how to examine children, so I chose the pediatric rotation as one of my clinic assignments. Once there, I learned how to examine children and to feel comfortable around them. So I achieved my goal, as expected.
I did not expect was what else I learned. I worked with an eight year old boy named Pablo (I remember his last name, even though that was 26 yrs ago). As a student clinician, I had no choice on which patients I got, but I enjoyed working with him and saw him most of the time he came in. On his last day, his father (who was the Mexican consulate in Boston at the time) pulled me aside and told me how much his son enjoyed working with me and he thanked me for everything I did. I told him that it was very kind of him to say that, and I asked “Did it help?” He exclaimed “Did it help? His headaches are gone, he loves reading now, his homework is done in half the time, he always has a book in his hand, and his batting average went up 200 points. Did it help? Absolutely!!”
I was stunned. I knew we could treat visual problems with VT, but I never expected that. What I learned there was invaluable and stuck with me all of these years. Good vision therapy is not about treating this or that eye condition. It is not about the pre- and post-VT measurement changes. Good VT is really about changing lives. Pure and simple. Once I learned that, I was hooked. How could you not be?
You have also recently become an instructor for OEP’s Clinical Curriculum courses and they are very lucky to have you! Can you explain why you have chosen to give back to the community of Developmental Optometry in this way?
Being a clinical instructor for the OEP Clinical Curriculum series of courses is a big commitment. It takes years of study, dedication, reading, and a commitment to the profession. I knew this before I agreed to become a Clinical Instructor but also knew it was something I had to do.
Before I was asked to teach, I began to develop a 20 year plan for how I was going to change the profession and help more optometrists practice in the behavioral/developmental model. Even though every optometrist learns the basics of vision therapy in optometry school, there are many barriers that prevent most optometrists from doing vision therapy (VT). So my goal was to reduce as many barriers as possible and show my colleagues what VT was all about. Besides, I love teaching.
Teaching other optometrists to do really good vision therapy would allow more patients to be helped, which is my ultimate goal. To be able to show them how to succeed with more patients and run a practice at the same time would be extremely important. The OEP clinical curriculum courses allow me to do just that, especially since attendees are encouraged to submit cases and questions to us after the course. This helps to ensure success. It is a big commitment, but I am happy to do it.
In the same way, when I was asked if I was interested in having a residency program in pediatrics/vision therapy in my office, I jumped at the chance. The residents get one year experience of doing VT and examining patients. It may seem odd that the residency is affiliated with the Southern College of Optometry in Memphis, especially since I practice in Massachusetts and graduated from the New England College of Optometry. But when they asked me, I thought it was a great idea, so I did it. We have had two residents complete the program and currently have our third. It is so exciting to see them grow into capable and confident clinicians. I am glad I am part of it.
I am also active in the Developmental Optometric Community ListServe, an on-line group of behavioral/developmental optometrists from all over the world who ask questions, share cases, and discuss all aspects of patient care. It is like a study group without borders and connected through the internet. I enjoy being a frequent contributor to that as well.
As each year passes, my 20 year plan extends another year. So in another 20 years, I will be 72 years old and plan on cutting down to 40 hours per week in the office. 🙂 As long as my body and mind hold up, this will allow for additional time to teach and give back to the profession.
Speaking of giving back, you have been an active participant on the Vision Therapy Parents Unite Facebook page, often contributing what ever advice or guidance you can. In your opinion, how important is it to have these types of resources available to patients and parents alike?
In my opinion, vision therapy is the single most underutilized service in healthcare. As I see it, the biggest obstacle to patients and parents is lack of information about VT. Most of my patients complain to me that they wish someone had told them about VT earlier. So spreading the word is extremely important, which is why I contribute whenever I am able. Time is the limiting factor, however. That means that we all need to do our part so that the load is shared. That is one reason why your blog is so important, and that was my motivation for making several videos on vision therapy and functional vision problems. I put them on YouTube because I want people to see them and to use them. It is time to spread the word! 🙂
A question often floated by skeptical parents is “Does every kid you see need Vision Therapy?” What’s your response?
Another great question. I emphasize the word ‘need’. A related question – could anyone potentially benefit from VT? To that, I think the answer is yes. Does every one ‘need’ VT? – is a different question. Does everyone need speech therapy? My wife delights in pointing out all the words that I just never seem to say correctly, like ‘drawring’ for ‘drawing’, and ‘tangy’, which she informs me is incorrectly pronounced every time I say it. So that means I need speech therapy, right? Obviously not.
That said, I will not deny anyone the opportunity to develop their visual system. If the patient has an unmet visual need that I believe will be met with VT, I will offer VT as one option available to them. I will also discuss the other options available and the likely outcomes of each approach.
The efficacy of Vision Therapy is often questioned by parents and denounced by some other professionals. In fact, recent discussions would indicate other professions are now taking a proactive approach in downplaying Vision Therapy’s value. As a doctor, how do you manage this idea?
There will always be people ready to knock you down, if you let them. So I don’t let them. I concentrate on the positive, what I do and what I know. My experience in vision therapy over the last 25 yrs that I have been in practice has been so overwhelmingly positive that I simply cannot ignore it. I have been doing this for so long that the word has begun to spread. I find that if you stay positive, present things honestly, and genuinely work to help patients, the good that you do will drown out the naysayers and the pessimists.
Over the last 30 years or so, studies have shown a steady rise in myopia in children across the world. In your opinion, why has myopia increased and can we do anything to slow this trend?
Progression of myopia is an increasingly common visual problem in today’s technological society. This is especially true for children, who are frequently attached to a computer, an iPhone, an iPad, a video game, or some other electronic device that adds near stress to the visual system. Add to that a high stakes educational environment where kids are pushed to read at younger and younger ages and you have an epidemic. Genetics explains part of the problem, but not all of it. Environmental influence (such as listed above) do play a role. I could be wrong, but I suspect that epigenetic influences could be found to play a significant role in the development of myopia. Epigenetics is the fascinating study of inherited characteristics that have nothing to do with sequence of nucleotides in the DNA. Rather, it has to do with everything that is around and attached to the DNA, which in turn influences which genes get turned on and when. Epigenetics could be the link between genes and the environmental influences we have been talking about. We shall have to wait and see.
As a Developmental Optometrist, what treatments can you offer to help slow a patient’s progression into myopia?
This is where the developmental/behavioral optometrist can play a huge role. Proper use of the visual system is important. Grandma was correct: you need proper lighting when reading, proper posture, and a proper working distance when reading, writing, and computing. Frequent breaks from prolonged near work are essential. In fact, some studies have shown that increased time outdoors is associated with a slower rate of progression of myopia. Through the judicious application of lenses (eye glasses and contact lenses) as well as vision therapy, the optometrist can play an important role in preventing, or even in some cases reversing, myopia.
Rumor has is that you have a knack, perhaps even an affection, for working with kids on the spectrum. Where does this come from?
Although working with children with special needs can be challenging, it can also be very rewarding. There are few things in life more satisfying than being able to make a difference in the life of a child. I understand that my work with kids on the spectrum allows me to help in a way that few others are able. The primary purpose of the visual system is to guide and direct action. If this is truly so, then what better population to work with than kids with developmental problems, who so frequently show difficulty in using vision to guide their movements.
But on another level, if I can change directions, kids on the spectrum seem to frequently strike a chord in me. I don’t mean to get all spiritual, but I get a certain feeling when I am working with kids on the spectrum. I try to see the person behind the diagnosis, struggling to get out, and frustrated and frightened by what is happening to them. The feeling of joy when I am able to connect with them makes the challenges seem small in comparison. If I have any ‘knack’, this must be where it comes from.
The Developmental Optometry community is quite large, but at the same time, feels like a tight family. How important do you feel maintaining that sense of community is in our collective success?
I think that behavioral/developmental optometrists absolutely are a tight knit community, almost like a large extended family spread out all over the globe. Through my activities within our profession, I have colleagues and developed friendships with optometrists from all over the nation and all over the world. I consider myself lucky to be part of this community and have friends and colleagues seemingly everywhere I go. That is one of the reasons I encourage optometrists to go to as many meetings as they can. You learn from the lectures, but even more so, you learn from the discussions in the hallways and at mealtime. And in the process, they become your friends. So I think that sense of community is critical to our future success, as individuals and for the profession as a whole.
On a personal note, your last name literally translated in Italian means “abundance”. Having grown up in Massachusetts and attended Boston College, is it fair to assume that “abundance” would be the best way to describe your affection for the New York sports teams?
Let’s get one thing straight: I love New York! It is a fantastic and vibrant city. There is so much to do and so much to see that anyone would have a great time there. I love Broadway, Time Square, RockefellerCenter, the EmpireStateBuilding, the Statue of Liberty, and all that.
But as a lifelong Red Sox fan, I can’t stand the Yankees!! 🙂
And yes, ‘abbondanza’ means ‘abundance’. But abundance of what, no one ever told me!! 🙂
Some Closing Thoughts – A great thanks to Dr. Abbondanza for taking the time to do this interview. Although we joked about possible inferences for his last name, it became clear to me this week that “abundance” clearly refers to the amount of passion he has for helping others. He is definitely one of the good guys! Please join me in wishing Dr. Abbondanza, his family and his practice, the absolute best! 🙂