VT Works

For the benefit of our readers, can you describe your current role and how you are involved in the field today?

Thank you, Robert, for providing a platform and an opportunity for clinicians to share their trajectory through this wonderful profession that we all share.

My current role is as a Developmental/Rehabilitative Optometrist within the San Diego Center For Vision Care. This clinic is now owned by an excellent doctor, Justin Matsuura, O.D., FOVDR. This practice started with Amorita Treganza OD, our first president of COVD. Bob Sanet followed her lead, and I from him, and now from me to Justin.

I examine and treat the full spectrum of individuals who experience visual challenges, secondary to acquired brain injury, neurodivergency, genetic disorders, developmental delay, athletes, as well as those struggling with learning in the academic setting. I work with any individual, regardless of their current situation,  who wants to improve their ability engage effectively with their environment and enhance their thinking skills.

Another role is teaching. We have students from The Illinois College of Optometry, Marshall B. Ketchum University, Southern California College of Optometry, Western University of Health Sciences College of Optometry, as well as graduates from the Centro de Optometría Internacional in Madrid, Spain. I continue to lecture in the clinical domains  surrounding Visual Perception, Visual Cognition and Developmental Vision.

I am also the Program Chairman for the Wold Behavioral Vision Therapy Seminar.  Bob had been the Program Chairman for many years. Talking with him before he passed, he agreed that in addition to Behavioral Optometrists, inviting other professionals in the field of vision development would be  good idea.  Our  November 2026  seminar will also include speakers who will present new information for those of us who are engaged in Vision Therapy.  They are directors of research in the following laboratories at the University of California, San Diego: Visual Learning Laboratory, The Vision And Memory Laboratory and the Human Performance Optimization Laboratory.

You’ve had a remarkably diverse career spanning clinical care, military service, academia, sports vision, and rehabilitation. When you look back, what through line connects all of these chapters of your professional life?

The through line for all of this is establishing and constantly challenging my own model of vision. My model is comprised of three domains: 1) What is vision. 2) What is the purpose of having a visual system. 3) How does the environment, brain, and body arrange conditions for this purpose to be manifest. Knowing my own model (derived and often modeled after others’ models!), enable me to clinically engage all people regardless of their clinical background (other professionals) or their clinical needs (patients).

Early in your career, you helped establish mobile clinics in rural Honduras and later served as a lieutenant directing a vision therapy clinic at Balboa Naval Hospital. How did those formative experiences shape your philosophy of patient care?

Being in Honduras and at the Naval Hospital shaped my philosophy of patient care by realizing that fundamentally, we all benefit from a disease-free visual system. Visual health is fundamental and primary. Since the eyes are the forward-most extension of the brain (the only part of our brain that we can voluntarily move), and since the interaction between the eyes, brain, body and environment make up the visual system, all these collaborative domains benefit from being disease-free.

Therefore, our professional responsibility to maintain visual health in our patients involves not only the health of the eyes, but also the brain, body and being in a healthy environment.

Once a healthy visual system is developed, then developing abilities with learning and creativity become much more available. This enriches the possible contributions that can be made for everyone in the world.

You were a longtime co-owner and clinical partner with Dr. Bob Sanet. How would you describe the professional dynamic you shared, and what made that partnership work so effectively over time?

Trust. That was the professional dynamic – trust. We never had a signed professional agreement. Respect, humility, and a strong work ethic were our guides. We both worked very hard ensuring that the community understood the value of our work and that our patients were engaged in the best clinical care possible. We always looked out for each other because we truly cared for each other.

As our profession reflects on Dr. Sanet’s legacy, what do you believe your shared work best represents about collaboration, clinical rigor, and leadership in developmental optometry?

Our shared compassion for misunderstood children, and our strong work ethic is why our collaboration worked so well. In regard to leadership, it was all him. I had nothing of significance to offer. He was a loving and caring mentor, learning what I could though his actions. He courageously and boldly expressed his thinking and had the humility by constantly learning from others.

One of his favorite quotes was: “Ships are safe in harbor, but that is not what ships are built for.”  His commitment to others through Optometric Vision Therapy meant not keeping his ship in safe harbor. He was the captain, a voyager of one of the most courageous ships that ever set sail for Behavioral Optometry.

Your work in sports vision, from Olympic-level volleyball to Major League Baseball, has brought vision therapy into high-performance arenas. What lessons from elite athletics do you believe translate most powerfully to everyday clinical practice?

Vision Therapy was brought into high-performance arenas by Don Getz and Gary Etting. It was Don and Gary who were approached by the USA Olympic Committee to work with either weightlifters or volleyball players… of course they picked volleyball, and USA Volleyball happened to be training here in San Diego. So, Don and Gary offered the opportunity to Bob and me. All variety of sports followed from the professional and athletic community who saw the success that we had.

The lesson learned is that “everyday clinical practice” in Vision Therapy is really “Daily Miracles in clinical practice!” Part of my model enables me to conclude that high level Olympic and professional athletes’ visual needs are not much different than the six-year-old who we all have in our practice; all people are athletes in their own way – gravity is a major driving force behind the body’s contribution to visual development. This along with developing Just-Noticeable-Differences (JND),  pattern recognition, peripheral vision, visual attention and working visual memory are a part of everyone’s success.

You developed the Multi-Matrix activity as a way to nurture physiological, perceptual, and cognitive development. What gap did you see in therapy approaches that led you to create it?

I enjoy elaborating on existing therapies. This provides clinical opportunities, helping patients who don’t connect with existing methods. I love to integrate visual thinking, visual attention and visual memory with ocular motility, accommodation, binocularity and visual-motor integration. Vision Therapy should be fun and interesting. It’s important for patients to engage in  three-dimensional space and not with more screen time from “another app.” Developing visual sequential processing and spatial pattern recognition in a dynamic 3-D environment is much more of a “full brain” experience. So, for the Multi-Matrix, I melded together ideas from others who used manipulatives and movement: Frank Belgau, Harry Wachs, George Cuisenaire, Jean Piaget.

You’ve lectured internationally and served as an adjunct professor across multiple optometry schools. What do you believe educators must prioritize if we want to prepare clinicians for the realities of modern vision therapy?

On “Day One” of Optometry School, I wish I were asked, “What is vision?” “What is the purpose of having a visual system?” When asking  our 4^th year optometry students these questions, most of them have never been asked these questions. Wrestling with these questions makes better clinicians.

Three other priorities are important:  a deeper understanding of binocularity, visual perception and visual cognition.  The role that the body, gravity, reflexes, peripheral vision, motion detection, spatial attention play in binocular development is often beyond their training.

The basics of visual perception and visual cognition, as well as the role that fundamental visual skills (Ocular motility, accommodation, binocularity) play in these critical domains of human development needs to be more deeply understood.

Having received both the AOA Sports Optometrist of the Year award and COVD’s Getman Award, what does clinical excellence mean to you now, after decades in the field?

To me, clinical excellence means compassionately and sincerely listening to your patients. It means answering your patients’ questions and following through. It means truly educating  your patients. Clinical excellence means to accurately share the reality of their situation.

For example, I don’t tell my patients that if they have astigmatism, that their eye is shaped like a football – that’s ridiculous. If they scope +.50 spheres in the distance, that isn’t a refractive “error” it is their refractive status that tells us something about how they engage the world around them.  Glasses don’t “correct” myopia, they compensate for it! Myopia means far more than blurred distance clarity. If I tell my patients that they are farsighted, they’re confused, because they know that they can see clearly up close. I let them know that they have hyperopia; they can learn new words and they appreciate it. Patients love to learn accurate information.

Clinical excellence is referring patients to colleagues for care that I can’t provide. Knowing and appreciating a community of caring clinicians helps everyone acquire the services they need.

After a career defined by service, innovation, mentorship, and partnership, what do you hope future clinicians understand about the responsibility, and privilege, of practicing developmental optometry?

I want future clinicians to know that if your model of vision is “big” then your responsibility is “big.” For example, if your model includes “Vision is a major driving force in nurturing a fulfilling life”, then every patient that comes into your office will experience your commitment to this goal. They will see it in your office décor, your website, the words that you and your staff use, and your sincere interest in them and the community. I hope your models are so big that they are just barely manageable 80% to 100% of the time.

The privilege is that optometry is the only profession that combines an understanding of three essential domains of human development: 1) how to enhance the functional connection with one’s environment with lenses, prisms, filters, selective occlusion and environmental modifications. 2) how to enhance the functional connection with one’s environment by ensuring skillful binocularity, accommodation and ocular motility. 3) how to derive meaning, determine utility and create new possibilities by developing visual perceptual, visual motor and visual cognitive skills.

Closing Thoughts from Robert: Dr. Hillier’s steady influence is a reminder of how clarity, depth, and generosity of thought can shape an entire profession, and his ability to articulate complex ideas with both precision and humanity continues to inspire not only how we think, but how we communicate what truly matters in our work. My sincere thanks to Dr. Hillier for taking the time to complete this interview. He has long been someone I have looked up to for his grace in advocating for patients and for his unwavering willingness to go the extra mile in strengthening the profession. Please join me in wishing Dr. Carl Hillier and his family continued health, happiness, and success!