VT Works

For the benefit of our readers who may be meeting you for the first time, can you share how you found your way into Developmental Optometry and detail your current role in the profession? 

As many of you know, I happen to share a surname with a prominent figure in our field. Just as my father has been a mentor and leader for many, he was, of course, a primary influence in my own life. I was immersed in Developmental Optometry long before I even knew what it was. As a child with convergence excess, I spent my elementary years sporting some very “fashionable” bifocals. Over time, my entry into this profession became a natural evolution.

In high school, my father offered me a summer job as a vision therapist. Seeing the impact this work had on patients was truly “eye-opening.” During that time, I administered therapy on myself between patients so I could better train others. Over the course of that summer, I inadvertently cured my lifelong, debilitating motion sickness. I had never realized it was visual until it was gone. That experience taught me the gravity of the impact we can have on others.

Later, as an undergraduate at Lafayette College, my father invited me to collaborate on a research paper that was ultimately chosen to be presented at the 2010 COVD meeting in Puerto Rico. Standing in front of hundreds of doctors as a college student was very intimidating, but the warmth and openness of that community solidified my decision to follow in my father’s footsteps and pursue a career in Developmental Optometry.

I went on to graduate from SUNY College of Optometry in 2016, completing my residency in pediatrics and vision therapy at Salus University. Today, I work alongside my father in private practice, mentoring residents and students, and splitting my time between vision therapy, neuro-optometric rehabilitation, and myopia management.

Growing up as the son of a well-known developmental optometrist, what did you absorb about the profession long before you ever entered optometry school, and was there a defining moment when you realized you didn’t just admire your father’s work, but wanted to follow in his footsteps and ultimately make it your own?

For a long time, I actually tried to separate myself from optometry, and my father was careful never to apply pressure or steer me in a particular direction. He wanted any interest I developed to be genuinely my own, not something I felt obligated to inherit.

In fact, his humility meant I did not fully appreciate how influential he was until my first COVD meeting in Puerto Rico. It was there that I realized he was about as close to a rock star as an optometrist can get. Seeing the respect he earned gave me a deep sense of pride, but also a new motivation. Not to replicate what he had done, but to carry it forward responsibly.

My father’s work laid the foundation, but my own path has been shaped by a synthesis of my experiences and the many mentors and visionaries I have learned from along the way. That perspective has allowed me to integrate developmental optometry, neuro-optometric rehabilitation, and myopia management, while balancing clinical care with teaching, scholarship, and the realities of running a practice.

I am also intentional about modernization. We do not need elaborate tools to do meaningful work, but judicious use of technology can enhance care. Whether through emerging technologies, evolving systems, or the thoughtful integration of AI, my goal is always the same: to spend more time focused on patients and mentoring others.

Following in the footsteps of a father in this profession places you in the company of names like Dr. Dan Press and Dr. Bryce Appelbaum, who also built upon their fathers’ legacies. Having met all three of you, it’s clear that each of you carries ‘that something’ that makes you far more than a protege. How would you define the inner force that drives you, and perhaps your contemporaries, to not only honor that legacy, but to expand it through the level of care you provide to those who need it most?

I appreciate the notion of my “somethingness” and I’m honored to be mentioned alongside colleagues I greatly admire. We are fortunate to have inherited many positive traits from our parents and been given opportunities to flourish in this field. But expectation and circumstance only go so far.

What drives me is not obligation, but impact. There is no greater feeling than a patient telling you that you changed their life. I am lucky enough to hear that often. At the same time, I am aware of how many people still need this care.

That is why teaching and giving back matters so much to me. Training residents and students is how we all can extend our reach. I think of our profession as a living tree, rooted in the work of those who came before us, growing outward through each new generation. If someone I have trained helps someone I will never meet, and then passes that knowledge forward, the work continues. I find that deeply comforting.

Your training spanned pediatrics, vision therapy, and neuro-optometric rehabilitation. How did that breadth of residency experience shape the way you now look at the developing and injured visual system?

It reinforced a simple but essential truth for me: we treat people, not eyes. The visual system is complex, and its components are deeply connected. I have come to appreciate how vision interacts with the individual in ways that only a breadth of experience can reveal.

That perspective allows me to blend approaches rather than rely on a single framework. For example, a unilateral myope may continue to progress despite orthokeratology if intermittent suppression is present. In those cases, a binocular therapeutic approach may be more effective in stabilizing the prescription. Similarly, for many patients with visual snow, the psychological burden of the condition can be more disabling than the visual phenomenon itself, making lifestyle and supportive interventions just as important as addressing the visual system directly.

Ultimately, I have learned that listening and validation are as critical as diagnosis and treatment. Effective care means understanding each patient’s concerns within the broader context of their life and tailoring treatment to the whole person, not just their visual findings.

With fellowships in both the American Academy of Optometry (FAAO) and the Optometric Vision Development & Rehabilitation Association (FOVDR), what do those designations represent to you in terms of commitment to excellence and lifelong learning?

Those designations represent more than just prestige. While they certainly lend credibility, I believe they should be pursued primarily for personal growth and professional fulfillment.

I want to be the best clinician I can be, and that requires an ongoing commitment to betterment. I hold myself to the idea that there is always something new to learn or refine, and I see that mindset as essential not only to my career, but to life in general.

These fellowships also offer a sense of community and shared purpose, which I find deeply meaningful. At the same time, they carry a responsibility to contribute back through teaching, service, and mentorship. That reciprocal relationship, learning while helping to advance the profession, is one of the most rewarding aspects of these affiliations for me.

You’ve lectured and published on topics ranging from myopia control and nystagmus to traumatic brain injury. Have you found a common thread which connects all of these seemingly different patient populations?

What a great question. Yes—very much so. The common thread is that vision is not a static optical system, but a dynamic, adaptive process that is deeply shaped by how the brain interacts with the environment.

Whether I’m working with a child in myopia control, a patient with nystagmus, or someone recovering from a traumatic brain injury, I’m really treating how the visual system organizes, stabilizes, and uses information under stress or change.

In myopia, the stress may be prolonged near demand and reduced visual variability; in nystagmus, it’s an instability in fixation and sensory-motor feedback; in brain injury, it’s disrupted integration between visual, vestibular, and proprioceptive systems. But in each case, the core issue is the same: the visual system is struggling to maintain efficient, stable performance in a complex environment.

What’s exciting is that across all of these populations, we see that the visual system retains plasticity. When we design interventions that respect how vision develops, adapts, and recalibrates, we can meaningfully change outcomes.

As a recipient of the Optelec Low Vision Award for Excellence, what did working with low-vision patients teach you about resilience, adaptation, and the role of hope in clinical care?

It taught me how resilient people can be. There is a moment when a patient stops focusing on what the eye cannot see and starts focusing on how to use the vision they do have. Hope, in that context, isn’t false reassurance or promises of recovery. It’s showing patients that there are still paths forward, even if those paths look different than what they expected. When patients experience a tangible success, that hope becomes self-reinforcing.

You are also a co-author of A Parent’s Guide to Raising Children with Healthy Vision. What do you most wish every parent understood about visual development that often gets overlooked?

While my book is primarily about myopia, there are a few things I wish every parent understood. First, that 20/20 is a measure of eyesight, not vision. Vision is a complex suite of skills that allows a child to understand what they see. We need to stop asking “Can they see the board?” and start asking “How much effort does it take for them to acquire and process visual information?”

Second, children don’t know what they don’t know. They don’t have a normal to compare to. If the words on a page are moving or blurry, they just think reading is hard and that they aren’t smart. I want parents to know that behavior is often a symptom of vision. Avoidance of reading, short attention spans, or even behavioral challenges are frequently visual issues in disguise.

Lastly, we need to look at a child’s “visual diet.” Just as we monitor what they eat, we must monitor their visual environment. The increase in myopia isn’t just genetic; it’s environmental. I wish parents understood that sunlight and distance viewing are biological necessities for healthy eye development. Simply being outdoors daily can be a powerful prescription for preventing visual issues later in life.

In neuro-optometric rehabilitation, progress is not always linear. Can you discuss the importance of good communication in this setting, and maybe share how you help patients and families stay grounded and motivated when recovery feels slow or uncertain?

In neuro-rehab, my first job is to act as a communicator and validate the patient’s experience. When I explain that their dizziness in a grocery store isn’t just anxiety but a visual-vestibular mismatch that can be treated, there is a sense of palpable relief. Good communication provides the diagnostic framework that allows the patient to understand their experience.

Equally important is how we define progress. I help patients and families look beyond symptom checklists and recognize functional gains like shorter recovery time after visual effort, improved tolerance to busy environments, better stamina at work or school, or increased confidence navigating daily tasks. These changes are meaningful, even if they don’t always show up clearly on a chart. I find patients often don’t recognize improvement since they are still experiencing symptoms, failing to notice just how much more productive they are in a day. 

To keep people grounded and motivated, I emphasize short-term, achievable goals and make improvement visible. We track small victories, revisit baseline comparisons, and regularly recalibrate expectations. I also encourage families to view recovery as a collaboration rather than a timeline that needs to be completed.

Looking ahead, where do you see the greatest opportunity for growth and impact in developmental and neuro-optometric care, and what role do you hope to play in shaping the next generation of clinicians?

I think one of the most important opportunities for growth is simply to continue doing the work well and let the outcomes speak for themselves. Developmental and neuro-optometric care can be controversial and has at times been labeled as alternative or fringe. But when you’re sitting across from a child who can now read without fatigue, or a brain-injured patient who can now return to work, the reality of the work becomes undeniable.

I’ve found that we don’t win trust by arguing our legitimacy. We earn it by being rigorous, transparent, and patient-centered. When other doctors, educators, or parents see meaningful outcomes, skepticism starts to fade. In that sense, doing what’s right for patients has a compounding effect, building credibility without needing to defend the field at every turn. In many ways, the profession’s future is built quietly, one patient at a time.

Ultimately, I want to play a role in making neuro-optometry the standard of care, not the exception. Whether it’s through publishing, lecturing, or mentorship, I want the next generation to be equipped with the best tools, knowledge, and the highest level of clinical compassion.

Closing Thoughts from Robert: A sincere thank you to Noah for his thoughtfulness, depth, and generosity in this conversation. What stands out most is not simply the impressive breadth of his training or the legacy he carries, but the humility and clarity with which he approaches patient care. Noah represents a generation of clinicians who are not content to inherit a profession; they are committed to refining it, strengthening it, and expanding its reach with both scientific rigor and human compassion. I am very grateful for the time he spent with this interview and for the steady, purposeful work he continues to do on behalf of patients and families who depend on developmental and neuro-optometric care. Please join me in wishing Noah and his family continued success, fulfillment, and happiness as he carries this work forward and shapes the future of our profession.