A Sit Down – with Jessica Zwilling COVT

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 Jessica Zwilling COVT

 Mom & Abigail on Spirangle

For the benefit of our readers, can you explain how you are involved in Developmental Optometry? 

Currently, (since 2004) I work as a Vision Therapist at the office of Drs. Michele Bessler, Jennifer Ceonzo and Shoshana Bell-Craig in Garden City, NY which is on Long Island not far from Manhattan.  Our practice was founded by Dr. Martin Birnbaum, and although I never got to meet him personally, I know that we continue his legacy and “style” of VT everyday in our office.  Our doctors do some primary care, but the main focus is on Vision Therapy.  As of now, we have 8 therapists and see an average of 130 patients per week.  We work with all ages, all walks of life, with and without developmental/physical delays – you name it, we see them.

I have been working in this field for 19 years (yikes!) and along the way have worked with some really wonderful people on Long Island and in Southern California.  Although I now primarily work in the therapy room, over the years I have done everything from admin work, answering phones, handling insurance, and scheduling appointments to frame styling and repairs, contact lens training, visual fields and exam pre-testing.

How did you first discover Developmental Optometry?          

I can’t say that I knew what Developmental Optometry was when we first encountered each other.  I was very young, 9 or 10 years old, and becoming increasingly myopic.  We were lucky enough that Dr. Edward Goldstein happened to be on our vision insurance plan and, my parents happened to pick him from the plan’s list to be our regular eye doctor.  I had already had glasses for a year or two, and when the myopia just kept increasing, and my parents clearly could not afford VT sessions, Dr. Goldstein put me in a pediatric bifocal.  I’m still a -6.00 today, but it probably would have been higher if not for Dr. Goldstein’s intervention.

I come from a family of 6 siblings, and you know that large families like us become like permanent fixtures in any medical office.  One of us was always in for something.  Dr. Goldstein and his wife Sherri, who ran the front office, knew that we were nice kids with responsible parents, and as soon as I turned 15, they were looking to give me a job even though I wasn’t looking to take one.  I remember Sherri asking me if I wanted a job, and when I asked her if I would be doing filing and answering phones, she said, “No, we want you in the back.”  I was a little afraid by that response, as I didn’t know what was “in the back.”  I didn’t even know there was a “back” to the office.

It was pretty terrifying and overwhelming at first, especially since in those days we were doing “group VT.”  We would have anywhere from 3-10 patients in the room at a time with 3 therapy assistants moving from station to station, setting up, checking on, and moving along the patients.  I had a fantastic COVT(T) teacher and partner-in-crime, though, (Thank you Michele!) so I caught on pretty quickly.  I worked mostly with the elementary aged school children.  It was weird working with teenagers since I was a teenager myself, and I didn’t dare go anywhere near an adult patient until I was at least 18!

Looking back, I am so fortunate to have worked under Dr. Goldstein as my introduction to Developmental Optometry.  I learned, from the start, the REAL way to do VT – the hardcore, behavioral, “get on the floor” kind of VT.  I continued this job through my high school years and into my first few college years, and in 1999, I went for my COVD certification.

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Aside from Vision Therapy, you work with children in other capacities as well. What can you tell us about that?  

Besides chasing after my own three children (ages 3, 7, 9), I also teach music.  Although I continued working as a Vision Therapist throughout my college years as my “job,” my undergrad degree is in Music History and Theory.  Vision Therapy was what I knew how to do, and a career in music was supposed to be what I was working toward.  It actually wasn’t until my senior year at Cal State Fullerton that I seriously considered switching to the college across the street which happened to be Southern California College of Optometry.  Clearly, I did not take that leap, and I found myself back in New York in 2004 with a degree in music and a drive to stay in VT.

I taught private music lessons throughout college and after as well for extra income, but now I volunteer as the music teacher for grades 1-4 at my parish school.  I direct a choir of 50, teach recorders to the 3rd and 4th graders, and put on two concerts per year.  I also prepare any vocalists (through grade 12) for performance at our NY State music festival each year.  It is hard to squeeze in the time to do it all, but I hate to see my music education to go to waste, and I really enjoy singing and playing with the little rugrats each week.

You completed your a Vision Therapist Certification (COVT) in Miami, FL in 1999.  What the process of certifying like? 

First, a small correction – back then, we earned the title COVTT (certified optometric vision therapy technician).  Somewhere over the years, I lost a “T.”

Originally, I had planned to go for certification in 1998.  I was graduating high school, survived the SAT’s a few times, finished all my state exams, written tons of essays for college.  I was in testing mode and ready to start the process.  However, since my birthday isn’t until October, I wasn’t old enough to apply for certification.  You had to be 18 to apply and sit for the exam.  (This is hilarious for me to think back on it now.  I was just a kid!)  So, Dr. Goldstein agreed that I should wait the year and hone my knowledge, especially in the areas of strabismus and amblyopia.

The process of certification was the same – 10 open book questions to answer, submit, and revise if necessary.  Once those were completed and approved, you were able to sit for the multiple choice test and oral interview at the annual COVD meeting.  Dr. Goldstein gave me some material to read on each topic as I wrote the open book essays.  I would write, he would correct and critique, and then I would re-write.  I remember it being easy since I was in student mode already from school, and I remember being amazed with myself that I had all that information stored in my brain.  I knew a lot of the material, but never knew it was there until I was asked to put it all on paper.  When I got up to the questions on eccentric fixation and anomalous retinal correspondence, Dr. Goldstein had a few private teaching sessions with me (complete with chalkboard diagrams) before I began to write.  Somehow, I still have a copy of those essays saved on my hard drive, and they are comical for me to read.  They were only the very beginning of what I know and understand now as a therapist.  I was not officially assigned a mentor, like we do now, but there was a list of mentors made available to the candidates, so that we could call another therapist with questions if we wanted.

When I arrived in Miami, dragging my older sister Lorraine with me for moral support, I didn’t know anyone and I didn’t really even understand the concept of a professional meeting.  I knew where and when I had to show up for my written and oral exams, but otherwise I didn’t realize that I should also have attended the lectures.  Most of the lectures were geared toward doctors anyhow, so on the morning  of my written exam, I remember cruising the sidewalks of Miami on my skateboard instead of being in a lecture and possibly picking up some helpful information.

At the written exam (50 multiple choice questions), I remember that I was definitely the youngest one in the room by many years, and I remember finishing pretty quickly.  I’ll have to check with COVD archives, but I wonder if I may have been the youngest to have gone through the COVT process.  (Hey, I’m no Doogie Howser.  I just started really early!)

The oral interview was pretty scary.  I had no idea that there would be THREE doctors in there shooting questions at me!  I felt like I was in there forever, and I don’t remember half of what they asked me, but I was doing well until they asked me to explain the different uses of a Visi Flex.  “What is that?!” I screamed inside my head.  I explained that we did not have anything by that name at our office, but when one of the doctors started describing the instrument, I blurted out, “OH! We call that the Auto String!”  (Readers: I would LOVE to see via comments how many of you know what  this instrument is).  The only other thing that really stands out in my memory is how all three doctors were confused and intrigued at the same time as to how we managed group VT sessions especially when metronome work was involved (which was ALL the time).  It was an eye-opening experience for me to find out that not every office did VT exactly the same.  All in all, it was a smooth and positive experience for me.

In the years since completing your certification, have you chosen to mentor others through the process? 

Over the years, I have always made myself available to be on the mentor list, although I can only remember one candidate calling once to pick my brain.  Back then, candidates were not assigned a mentor or required to have one, but strongly encouraged to choose a mentor from an available contact list or at least call someone on the list when you needed help.  Each year, I volunteer to make myself available as a mentor, as teaching is something I really love doing.  This year, I have the pleasure of mentoring my co-worker who is deep into her open book questions with her sights set on San Diego. 

Working in Vision Therapy while having young children of your own at home certainly places you in a unique position of possibly identifying with the parents you meet professionally. Do you find yourself becoming overly quickly empathetic for this reason? 

Yes and no.  It’s funny that you ask this question, because we discuss and debate this topic a lot in our office.  Half of the staff are mothers of young children.  When it comes to patients who have a hard time getting to their appointments or fitting in their assigned home therapy, we can empathize.  Now that my two oldest are in school, I understand how hard it is to try to fit in one more thing.  There aren’t enough hours in the day!  However, as a parent, you have to prioritize.  You can’t do it all, all of the time.  Sometimes, you have to decide if it’s more important to resolve your child’s double vision and headaches, or play baseball this season.  You don’t want the child to view VT as a punishment for poor academic performance, since it is often necessary to scale back on one (or more) after school activity.  In the end, no matter what, you have to do what is going to give the child his best chance for success and the best quality of life.  No excuses.

Interestingly, being a parent has opened my eyes to the true severity of perceptual delays.  I didn’t fully grasp how debilitating it is for an 8 year old to score <4.0 on all areas of the TVPS.  Obviously, I knew it was a real issue and an area we would need to address during therapy.  Over the years, however, it became normal for a typically developing 8 year old to have trouble duplicating a basic parquetry block pattern.  So, when my oldest could easily do a Wachs Blocks direct match at age 3, I realized on a much deeper level how much my patients (and their parents) were struggling.  Additionally, when I work with special cases such as toddlers with TBI, babies with severe developmental delays, and children on the Autistic Spectrum, it reminds me how truly blessed I am to have three healthy, intelligent children. 

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You shared an interesting perspective recently as someone who works hard to improve the lives of struggling children, it can become difficult to “turn it off” when in other environments – a perspective most of us can appreciate. Do you still approach people outside of your office to educate them on Vision Therapy? 

No. I have learned to keep my mouth shut.  There is a time and place for giving people parental advice, and at the playground with a complete stranger is not the time nor the place.  If my kid had a hearing aid and some random parent (who happened to be an audiologist) came up to me and started asking questions about my child and what doctor we go to, etc., I would be polite (because that’s my nature), but I would not be too happy.  I think it’s human nature to feel challenged, and take it personally when it comes to other people trying to tell you how to raise your child.  On the other hand, if my job comes up in conversation and the person wants to know more about VT, I’ll talk their ear off.  If someone outside of work comes to me asking for advice for their struggling child, I will give them more information that they could have hoped for.  I will even check in with them at a later date to see if they followed through.  It is hard to do, but sometimes I do have to remember to “turn off” my therapist mode before going out in public. 

Among other fine doctors, you have worked with two of the greatest in Dr. Edward Goldstein and Dr. Donald Getz.  What can you share about those experiences? 

I won’t divulge too much here in this interview as I was planning to use many of those experiences for future blog posts!  I will say, though, that each doctor I have worked with has taken me to a brand new level as a therapist.  Just when I thought I was pretty well rounded and had “seen it all,” there would be another patient, another technique, or another school of thought that would open another door for me.

At the office of Dr. Edward Goldstein, my first job, I received the best intro to VT from a behavioral and developmental viewpoint.  I learned VT from the ground up, quite literally, as we were always on the floor.  I learned so much about the connection between vision and motor, the importance of posture, 101 things to do on a chalkboard, how to coach the patient to think and figure out a problem on their own, and so much more.  I am so lucky to have had such a strong foundation on which to build.  However, I did not work much with adults and certainly never a patient with a TBI.  I did not see autistic children, nor patients with severe developmental or physical delays.  I did not treat any patients younger than the age of six, nor children with behavioral problems.  Although I worked with a handful during these beginning years, I had very little experience with amblyopic and strabismic patients.

Six years into the field of vision therapy, I moved to Southern California for school, and I entered the world of Drs. Don Getz and Gary Etting.  I decided that’s where I wanted to work and I made sure that it happened.  It was a short, yet invaluable year of my life.  Dr. Getz, along with his wonderfully talented therapists, gave me a crash course in effective strabismus and amblyopia training.  They even threw a few pre-schoolers at me! He made everything so black and white, true or false.  There was no room for guesswork or gray areas in strabismus training.  Parents would come from faraway places like Europe and China and stay the whole summer so that their child with strabismus could do vision training with the best.  I tagged along to a few of Dr. Getz’s lectures that he would present at local schools, and I could just listen to him for hours.  What a great speaker!

So, at that point, I had old school motor VT training, basic visual skills and perceptual training, and top notch strabismus and amblyopia training under my belt.  Before I left the west coast, I was able to work with another brilliant doctor / therapist duo that once again moved me to the next level as a therapist.  But, really, I should save a little something for my own blog post, don’t you think? 

Dr Ceonzo and JessicaFor parents who may be researching possible avenues to help their child, what are some good questions to ask the teacher at conference time, or anytime there might be a concern? 

Once again, your timing is laughable, as I have a parent / teacher conference to attend tonight for my own children.

Often times, teachers are not aware of the possibility of a vision problem, so it is important for parents to find out specifics regarding their child’s performance in the classroom.  Bringing a symptoms checklist for the teacher to fill out would be a good start.  Parents can find one here on the COVD website – http://www.covd.org/?page=Symptoms

Additionally, parents need to ask:

  • Is reading slow and labored only when at near or with certain sized print?  Can the child read signs or posters more fluently in the distance?
  • Does the child have more difficulty when asked to copy from the board than when the material is all on their desk?
  • Is academic performance a struggle all the time or only when in time sensitive situations?
  • Are things easier for the child in the morning as opposed to the afternoon?
  • If student conduct is a problem, could the behaviors be related to the academics?  Does the child seem to be avoiding certain tasks with disruptive behaviors?

During the school year, a child’s teachers spend more waking hours with the child than the parents.  That is why a teacher has the ability to have an enormous impact on a child’s life.  A teacher can give great insight into a child’s academic and behavioral difficulties if they only know what to look for. 

In your experience, what can parents do to make sure Vision Therapy is a positive and successful experience for their child, and for themselves?  

As I touched on earlier, priority is key!  Resign yourself to the fact that there is no overnight cure for a binocular vision disorder.  Achieving your child’s visual goals will take some time.  When a mother goes through nine months of pregnancy, she can’t expect her body to go back to the way it was pre-pregnancy overnight, and certainly not without effort.  It is the same with learning or re-learning a visual skill.  It takes time and effort.

Make the commitment and follow through!  Children learn by example, so it is important for the parents to lead by example for a positive outcome.  Arrange your schedule to make room for consistent weekly or bi-weekly in-office sessions.  Set aside time for home therapy (if prescribed by your doctor).  Consistency and repetition is essential to a vision therapy program that will work.  If your child sees that it is important to you, oftentimes, that proactive attitude will rub off on your child.

Make VT fun.  Everything can be made into a game, and if your child has a sibling, sometimes they can be recruited as a helper or “playmate” for the home activities.  If that’s not an option, your child will simply appreciate, especially if there are siblings, to have that special alone time with Mom or Dad set aside just for them.

Know your child’s limits so you can stop practicing BEFORE you reach your child’s tipping point, whether it manifests as crying, silliness, restlessness, or anger.  You don’t want your child to associate VT with negative feelings.  And yet, don’t forget to be the parent.  Be firm when you hear, “I don’t want to!”  Remember that it is your job as a parent to help them get the job done and not try to be their friend.  Set the rules and follow through even if you temporarily become the tyrant in your child’s eyes.

Lastly, listen to your doctor and therapist!  We are here to help.  Always bring us your questions and concerns even if you think it might not be related directly to the therapy program.

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As a Vision Therapist, is there a patient age range of patient that you enjoy working with most? 

I do enjoy working with all ages.  Most recently, I have been having a lot of fun working with babies and toddlers.  They are so easy to work with since everything is a game, and they show improvements so quickly, which makes my job even more rewarding.  However, if I really had to pick a favorite age group, I’ve always said that my favorites are the pre-teen / teenager boys (ages ~12-15, give or take a few years).  I’ve always been a tomboy, and I love that generally there is no drama with these kids.  They are usually awkward and insecure around this age, and I like that we can create a comfort zone for them in VT where they can make mistakes and not have to impress anyone.  We can talk about Star Wars, bands, skateboarding, or snowboarding and that often makes them more willing to come for their sessions and work hard.  Motivation in this age group is so important because most of them say that there is nothing wrong with their eyes and they are only coming because their mom is making them.  Unfortunately, I realize that I don’t have too many more years before I become so un-cool and they look at me like I’m their mom.  That will be a sad day for me. 

Part of my goal in writing this blog is to offer perspectives from the therapist point of view. You have recently agreed to help me with this by becoming a contributing writer and offering your ideas to our readers – which, incidentally, I am thrilled you have joined me.  Why did you choose to contribute and what can we look forward to in future posts? 

Thank you so much, Robert, for this incredible opportunity.  I am thrilled as well to be part of your team!  I am actually quite honored (and a little surprised) that you reached out to me for this.

As to why?  I like your style and I feel that our views and opinions in VT are very similar.  I really enjoy reading your posts.  Aside from that, in a few short years, all of my children will be in school and I have been thinking a lot about when that day comes.  I have so many ideas brewing in my head; big things I want to accomplish in Developmental Optometry.  Your invitation to contribute to your blog could not have come at a better time.  This is the next door that I am supposed to open, a small fire lit beneath me to get me going.  I figure that in the next 5 years I will be either working toward a Lora McGraw type of career, or I will find myself in optometry school.  Either way, I am getting ready to take the next big step.  I just needed a big push from a smart guy like you.

As for future blog posts, our readers can look forward to more on my latest adventures as the VT baby whisperer, gems from my beginning years in VT and my years in California.  I have so much to share.  It’s just a matter of retrieving the information out of this mommy brain of mine.

029Some Closing Thoughts – A great thanks to my friend Jessica Zwilling COVT for taking time out for this interview. Jessica and I first met at a Wold Behavioral Vision Seminar in San Diego circa 2002-2003 and she has long been someone whose opinion and input I’ve looked to and respected. A few months back, I asked Jessica if she would be willing to share her knowledge by becoming a contributor to my blog, and it was such a thrill when she agreed. I am very much looking forward to her future writings. Please join me in wishing Jessica, her doctors, and her beautiful family, the absolute best! 🙂

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Posted on April 11, 2014, in Sit Downs. Bookmark the permalink. 2 Comments.

  1. OK Jessica, I give up. What is a Visi Flex?

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    • Jessica Zwilling COVT

      You’ve probably seen one, perhaps even used one. It is the ancestor of the “Eyeport.” Instead of sitting on a tabletop, it is perched on top of a height adjustable tripod. You can use it like a Brock String or turn it sideways for horizontal eye movements. It also has a nifty “Jeopardy” clicker for manual mode instead of an auto setting. I don’t know how to get a picture in this reply box, but I have one I can email if you’d like.

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