A Sit Down – with Dr. David Damari
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. David Damari
For the benefit of our readers, can you explain how you are involved in Developmental Optometry?
I am the Dean of the Michigan College of Optometry at Ferris State University, one of 21 colleges of optometry in the US. I taught VT and neurological disorders at Southern College of Optometry in Memphis, Tennessee for 16 years and cut my teeth in academic administration there. I graduated and did a residency in VT at State University of New York College of Optometry in New York City. My undergraduate degree at Colgate University was in physics, mathematics, and chemistry, and I probably had enough credits in English to have had a minor.
What led you to Developmental Optometry?
After an awful time in first grade during which I spent more time in the hallway (an ancient form of “time out”) than in the classroom, my second grade teacher decided to test my reading vocabulary. After I read all the words in the sixth grade text, she decided my problem was not misbehavior but boredom. That started several trends in my life: an undying questioning of authority, a love of reading, and a natural tendency to gravitate toward teachers (and bosses) who reward rather than those who punish.
I breezed through junior high and high school because my reading experience was far ahead of my classmates and what I hadn’t read I learned through my visual memory. I always knew I was a slow reader — in fact, I was what I call a “page counter” — but I was a voracious one nonetheless, and so I always tested well. Then I went to an undergraduate institution, Colgate University, where two things were paramount: you wrote essays for every exam, even in physics and chemistry, and you were forced to learn more from the mountain of reading assignments given than from the lectures. I foundered and my grades plummeted, because testing during that time showed that my reading comprehension was in the 95th percentile but my speed was in the 5th. I never sought out help during that time but still, somehow, I graduated with a degree in physics, math, and chemistry and got a job at IBM as a systems analyst, although I knew I eventually wanted to go to law school.
During my short time at IBM, where I absolutely hated the regimentation, I had an exam with my optometrist, Dr. Steve Solomon in Owego NY, where Dr. Gary Williams was and still is a partner. Dr. Solomon let me know in no uncertain terms that he thought my future as a lawyer was, shall we say, problematic because I have a bit of a problem hiding my opinions. He strongly recommended that I consider a career in optometry and that I spend a day at his office. I did and saw that he and Dr. Williams did far more than refractions and sell glasses, including this wonderful thing called vision therapy. The die was cast.
Who were some of your biggest influences while you were a student at SUNY?
I chose SUNY because of its strong reputation for VT and, let’s be honest, because in-state tuition was unbelievably affordable at the time. I loved everything I was learning and found the curriculum quite manageable. Then, in my third year, I began doing VT on myself under the guidance of Dr. Marty Birnbaum. It was an unbelievable experience and reading went from a task I happened to enjoy to an easy, enjoyable pastime that was no longer a task. It became clear to me that I needed to offer this service to as many patients as I possibly could. I soaked up everything I could learn from the most amazing VT faculty ever assembled at one institution, including Nat Flax, Al Cohen, Len Press, Richard Soden, Arnie Sherman, Jeff Cooper, Iz Greenwald, Hal Freidman, Harold Solan, Irwin Suchoff, Ira Bernstein, and Mickey Weinstein (Elliot Forrest had died during my second year, so sadly I never got to work with him). I couldn’t get enough, so I applied for and was accepted into the VT residency there, and was able to learn from people outside SUNY during that time, including Lou Hoffman, Al Sutton, Bob Kraskin, Dick Appel, and Gerry Getman. It was an amazing time and learned about far more than VT from all these giants.
After spending the early years of your career in Garden City, Long Island working with Dr. Nat Flax and teaching part-time at SUNY, you started your private practice in Rochester, NY. Can you tell us about that?
After my residency, I began to work four days each week at the practice of Nat Flax and Al Rappaport in Garden City, on Long Island, and two days a week as an Assistant Clinical Professor at SUNY. I consider this my “fellowship” in VT, much like surgical specialists do a fellowship after their residency. During this period, I personally did or supervised over 300 therapy visits each week. In addition, I did primary care optometry at the Long Island office and VT evaluations at SUNY. Al Rappaport was a genius for programing and implementing a therapy plan, and for managing the therapy room. During many sessions, there were 8 patients going with two therapists and me setting the patients up, watching to make sure they were doing their techniques correctly, and then debriefing them to make sure they were getting the most from every technique. This established my philosophy on VT for the rest of my career.
After three years in these two positions, my wife and I determined that the best move for my future career was to start my own practice. SUNY had so many amazing doctors in VT, I could not see myself teaching a course there for a decade, and my wife’s and my family was still several hours away in upstate NY. So we packed up our one month-old daughter, quit our three jobs, and I started my practice in Rochester. It was a VT-only solo practice. I had mailed an announcement to all 87 optometrists and 89 eye surgeons in the area and, I found out later, someone on the staff at the University of Rochester Department of Ophthalmology had written “quack” across my announcement and posted in on the bulletin board. Needless to say, it was an uphill battle but eventually, with the help of an outstanding network of occupational and physical therapists, audiologists, and reading specialists, my practice took off.
During my time in Rochester, I received an unusual referral. In 1995, the National Board of Medical Examiners, who administer the national board for all the medical doctors and most of the osteopathic physicians in the United States, asked me to evaluate a University of Rochester medical student who claimed she had Scotopic Sensitivity (Irlen) Syndrome. I did so, and found that she had a severe accommodative disorder. This was no surprise, because Dr. Mitch Scheiman and his co-workers had found that 95% of subjects in their study who had been diagnosed with Irlen Syndrome had accommodative problems. I wrote my usual report, which is short on narrative and general claims about VT and long on data, reported as standard scores, and specific recommendations for the classroom or workplace geared to that individual. Three months later, I received a consultant agreement in the mail from the medical board. I called them, assuming they had made a mistake but they told me, “Why would we want to have an ophthalmologist consult about visual disabilities when we know what they cannot do?” I have been the lead visual disability consultant for them ever since.
Five years later, you became a professor at Southern College of Optometry in Tennessee and began to integrate your private practice skills with those required in academia. Can you tell us about those experiences and your time at SCO?
My work with the medical board, and then other testing organizations, began to give me a small reputation in academic optometry, and I found that I really missed teaching. In addition, my practice had gotten so busy that I couldn’t keep up the pace with it and my young family at the same time. I had to either get a partner or sell the practice and go back into teaching. Luckily, Southern College of Optometry was very interested and I found that they had become one of the most selective, outstanding schools of optometry during the five years I had been out of education. I gladly took a faculty position there and our family found ourselves warmly embraced by the wonderful hospitality of Dr. Glen Steele and his wife, Brenda.
Part of the difficulty in going from your own private practice into a large clinic is that, of course, you have distinct ideas about how things should be run. After two years, the chair position for the Department of Optometry came open and I saw this as an opportunity to express my opinions about how the clinical education at SCO could be improved. I did not really want the position, only the chance to interview and be heard. To my great surprise, though, I was offered the job. I still remember sitting down with Rita (my wife) at a local Chili’s and discussing whether or not I should go into academic administration. I was well aware, even at the time, that this decision would significantly change the path of my career. It wasn’t an easy decision then and I have consciously re-evaluated that path every few years since.
In early 2013, you accepted an appointment as Dean of the Michigan College of Optometry at Ferris State University. What did this move mean to you?
My background in VT has given me a real appreciation for demonstrating outcomes, because outside forces have always questioned the effectiveness of vision therapy. My experience has shown that this also applies to education, and I have been fortunate that the rise in assessment of outcomes in higher education has coincided with my career. I have been grateful for the opportunities I have had to help several optometry programs across the US develop methods to assess their educational outcomes.
After I led the effort to get SCO reaccredited by their regional accreditation organization, the position of dean at Michigan College of Optometry became available. I didn’t aspire to be a dean; in fact, I thought it would be an awful job. I thought of myself much more as an academic leader (which usually has the title of vice president for academic affairs or associate dean). However, the search firm for Ferris State University called me and after six months of discussions, the principal for the dean search at the firm convinced me that I could indeed help MCO as their dean. It may sound strange, but the two days of interviews were some of the most fun I have had in my professional career. The faculty at MCO are outstanding and incredibly dedicated and the new building (2011) is an amazing, LEED-Gold certified clinical and educational facility. It is my honor to be able to help the individuals on the faculty and staff of MCO meet their professional goals, while moving the academic program forward into the increasingly patient-centered and evidence-based world of healthcare.
Among numerous other roles, you have served as an advisor to national and state testing organizations involved with students seeking accommodations under the Americans with Disabilities Act. For those readers who may not be aware, can you explain in general terms how the process works, and how parents can better understand if their child qualifies for these accommodations?
In 1999, one of my heroes in the field of law, Sandra Day O’Connor, wrote a landmark decision on the ADA: Sutton v. UAL. The case itself is fascinating because it involved myopic twins who wanted to fly big jets for United Airlines, but the key concept for my career in disability consulting is that of the “gatekeeper,” a role O’Connor describes in the Sutton decision. My role as a gatekeeper is to match the abilities of a person who has a visual impairment with the format and presentation of a test or an opportunity higher education.
I have written entire book chapters on this topic but to summarize for parents of children with disabilities or for adults with disabilities, here is a brief summary of what goes on when you submit a request for test accommodations under the ADAAA (Americans with Disabilities Act as amended, 2008): the organization looks to make sure the documentation meets all the guidelines published on its website; the organization then sends that documentation, along with the request, to the gatekeeper; the gatekeeper reviews the clinical data in the context of the visual task required for that particular examination and determines three things: 1) Is there adequate documentation to support the claimed diagnosis? 2) Was visual functioning (NOT ocular health, which is irrelevant to the question) adequately tested to determine the level of impairment and the presence of a disability? and 3) If a disability does exist, is the accommodation requested justified and will it indeed “level the playing field” for the individual? The thing most people do not understand is that there is increasing literature indicating that extended time invalidates test results because people without disability do better with more time. Testing organizations really do want to be completely fair to disabled individuals and comply with the ADAAA, which is why they retain consultants like me. However, they also have a responsibility to every individual that takes the test that it will fairly represent that individual’s abilities relative to everyone else who takes that test.
Incredibly, you have been involved in all aspects of optometry from examinations, to lecturing, to Vision Therapy, to serving on numerous advisory boards, to most recently serving as President of COVD. With all this experience, is there one lesson you’ve learned along the way that really stands out?
That’s a great question, Robert, thank you. The one thing that stands out to me is that optometry in general and developmental optometry specifically does more to improve the everyday quality of life for individuals than any other health profession, bar none! We need far more young people interested in our fantastic profession. We do more than medicine to help people in more profound ways every single day. Yes, they save lives, but we change lives!
Your passion for helping others through optometry has taken you many places, most recently the Global Optometry Conference, DIOPS, in South Korea. What can you tell us about that experience?
My recent trip to South Korea was extraordinary. I was there representing both COVD and the Michigan College of Optometry because a few universities in Korea who are offering programs in optometry would like to see the level of professionalism and practice elevated to nearly the same level as in the United States. They see that US optometrists offer two services that will help them take a big step in that direction: specialty contact lenses and vision therapy. This is because both those areas are based on solid science and both greatly improve patients’ quality of life. Of course, any time I go abroad, I am standing on the shoulders of giants such as Paul Harris, Bob and Linda Sanet, and WC Maples.
Switching gears now, the diagnosis of ADD and ADHD in children seems to have grown exponentially in the last decade, and continues to skyrocket. What are your thoughts on this phenomenon?
ADHD is controversial because, as with many mental health disorders, the behaviors seen are behaviors that every individual experiences from time to time. What makes a disorder is not the presence of a behavior, but the fact that the individual exhibits that behavior so often and so compellingly that it disables his or her interactions with everyone around.
Optometry has a critical role to play in the diagnosis and management of ADHD because many children and adults are being diagnosed despite the fact that their behaviors are not impacting interactions with everyone, but only in certain situations such as academics or the workplace. Most often, this is because these individuals have visual disorders that are causing behaviors often seen in ADHD. I can tell you from both personal experience and from my disability analysis work with psychologists who are world specialists in adult ADHD that many, if not most, adults diagnosed with ADHD do not have the disorder. It is my firm belief, which I would like to see a good study to confirm, that perhaps over 80% of these individuals have a binocular vision or accommodative disorder which could easily be treated with VT. The prevalence of misdiagnosis in children is probably significantly less, but still a substantial problem.
A common misconception among parents is that the medications prescribed for ADD and ADHD are “curing” their child’s challenges, when in reality the medication only dampens the symptoms. Do you feel there is value in reversing this perception?
What many parents and teachers still do not understand is that many studies show two interesting things about medication for ADHD: even normal individuals have less distractibility when taking those drugs and the drugs lose effect for those who truly have ADHD in the long term unless accompanied by cognitive behavioral therapy. Indeed, long-term academic performance on ADHD drugs is not improved over those who never took the drugs, according to some studies. That said, there are many individuals with ADHD who are so disabled that the drugs are literally a life-saver.
What role might Developmental Optometry play in treating these kids before parents decide to medicate their children?
In my dream world, every adult and child who is suspected of having ADHD would have evaluations by three caring professionals: a neuropsychologist who truly understands all the literature, an audiologist who can test central auditory processing in addition to hearing acuity, and a developmental optometrist. This would avoid almost all misdiagnosis currently occurring and prevent a great deal of frustration.
Closer to home, among your many other passions you have shared your desire to improve the profile and education of Vision Therapists – a topic which, for me personally, is incredibly important. Might you elaborate on your ideas?
Robert, my assumption is that you are an intelligent human being, as is everyone involved in vision therapy. Intelligent human beings who work hard to earn a credential should own that credential. The credential should not be owned by the doctor she works for right now, or the doctor he will work for next year, but by the individual who earned it. This is a very contentious issue for two reasons. The first, and most serious, is that unfortunately there are vision therapists who have earned the COVT credential but are no longer working for a certified FCOVD doctor. This is not only unethical, but according to the COVD bylaws, can result in the loss of the COVT certification. The other issue is that many times a FCOVD doctor has paid for the training and the COVT process for a therapist.
As you know, vision therapists are not licensed professionals, so the credential of COVT is somewhat problematic. My thinking is that this issue could be addressed by making certain that every COVT pays her or his own way or, alternatively, enters some type of contract with the FCOVD doctor who pays for the training and other expenses. Also, and this is going to make some of my colleagues who are FCOVDs very angry with me, I think a COVT should be able to do — not program, but perform — vision therapy in any licensed optometrist’s office. The core of the programming and the monitoring of progress has to be done by an optometrist, that is state law, and it would be best if that programming is done by an FCOVD-credentialed optometrist. I know that right now, many COVTs are doing the programming because the doctor doesn’t really know as much about VT as the therapist, but that is a serious problem for that office because of some of the dangerous conditions that can mimic binocular disorders. Therefore, a licensed optometrist should always be supervising the therapy.
Lastly, COVD’s next Annual Meeting is coming up in October, held this year in San Diego, CA. Aside from your administrative duties as Past President, what do you enjoy most about the meeting?
I enjoy the people. The people who attend COVD are helpers and humanitarians by their very nature and they are just so much fun to be around. It energizes me every time. I love the Academy meeting for the amazing research that is going on in our profession, but the COVD Annual Meeting is where I go to get my yearly dose of energy and passion for what we do for patients throughout the US and around the world.
Some Closing Thoughts – A great thanks to Dr. David Damari for taking time out for this interview. Along with a few others, Dr. Damari will always hold a special post in my perspective of the VT world, as he was the person to inform me of my COVT of the Year award over the phone last year. As we completed this interview, it quickly became quite evident to me that Dr. Damari is definitely one of the good guys. His intelligence, compassion, dedication and determination to lift up those around him are nothing short of a true inspiration. He is definitely a class act! Please join me in wishing Dr. Damari and his family, the absolute best! 🙂