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

My involvement in developmental optometry has evolved significantly over the past few years. I started my primary care practice from scratch in 2011, and for most of my career I practiced in a fairly traditional primary care model. Over time, though, I began to feel that there was more to vision than what I had been trained to look for during a standard exam.

In the past few years I have incorporated vision therapy into my practice and have started a dedicated vision therapy clinic. That process has transformed the way I think about vision and the way I care for patients in primary care.

I now see vision as a whole brain, whole body process that influences how people move, learn, and interact with their environment. Because of that, I approach my exams very differently than I did earlier in my career. I am much more focused on understanding how the visual system is functioning rather than simply determining whether someone can see clearly.

That shift has allowed me to help patients in ways that I did not realize were possible earlier in my career.

You’re an Albuquerque native who ultimately chose to build your career serving that same community. Did you always imagine coming back home, or did that decision evolve over time?

I actually always imagined coming home. Albuquerque is where I grew up, and even when I left for school and residency I always had the sense that I wanted to return and serve this community.

There is something really meaningful about caring for the place that helped shape you. These are the families, schools, and communities that I understand on a very personal level, and that connection makes the work feel even more purposeful.

There is also a tremendous need here. Access to developmental optometry and vision therapy in New Mexico is still very limited. In Albuquerque there are currently only two optometrists actively providing vision therapy, and I am one of them. Outside of the city there are only a handful of providers serving other parts of the state.

Because of that, coming home felt like more than just a personal decision. It felt like an opportunity to bring something meaningful to a place that truly needs it.

For me, there really is no better place to serve than your own community.

You’ve mentioned that a visit for new lenses helped spark your interest in optometry. Do you remember what specifically stayed with you from that experience?

If I am being completely honest, it was not a very profound moment at the time.

A local optometrist told me that I could make a good living working only three days a week. As someone who already knew I wanted to be a mom one day and also wanted the ability to support myself financially, that combination of flexibility and stability sounded incredibly appealing.

So at the time the decision was actually very practical.

Looking back now, I sometimes think there may have been a guiding force much bigger than that moment that led me toward optometry. But in that moment it was simply the idea that this profession could allow me to have both a meaningful career and the flexibility to be present for my family.

Your training path includes Ketchum followed by a pediatrics and binocular vision residency at Houston, two places with strong cultures around developmental care. How did each shape the way you think clinically today?

To me it will always be SCCO, although it is now called Ketchum. SCCO had a very strong vision therapy program, so I feel like I received a solid foundation there. The approach was very functional, and that early exposure helped me understand that vision involves much more than just clarity.

Later, when I encountered Dr. Bob Sanet’s models of vision, they resonated deeply with me because SCCO had already introduced some functional thinking. At the same time, I realized that my model of vision still had many gaps. His framework helped expand the way I understood the visual system and its relationship to the brain and the body.

My residency at the University of Houston was a very different environment. It was extremely evidence based and rigorous, and I learned an enormous amount clinically, especially about binocular vision and pediatric care. At the same time, the culture there was generally less open to exploring different ways of prescribing or thinking about vision. I would describe it as very functional and structured, but with less room for curiosity and possibility.

Both experiences were incredibly valuable, and I am grateful for the training I received at each institution. If I am being honest, though, the last three years have involved a lot of unlearning and relearning for me. I had internalized certain ideas as absolute truths, and over time I have realized that vision is much more dynamic and adaptable than I once believed.

Even now I sometimes catch myself slipping back into those old frameworks. Interestingly, my vision therapists, who have been trained primarily within my newer model of thinking, often accept these ideas more easily than I do. It reminds me that learning and evolving as a clinician is an ongoing process.

When you meet a new pediatric patient with suspected binocular vision challenges, what are you quietly observing before you even begin testing?

One thing that really changed how I practice in primary care was adding the Neurolens questionnaire into my office. It helped me realize just how many patient struggles I had been missing. Once patients started answering those questions, it became clear that many of them were experiencing symptoms that had never come up during a traditional exam.

That experience made me rethink how I gather information from my patients. In my primary care practice now, I have a short child survey that every child completes before I see them. It is quick, but it tells me a tremendous amount about how that child experiences their visual world and often helps guide my conversations before I even walk into the room.

Even before testing begins, I am observing quite a bit. I watch body posture and movement, and I pay attention to how comfortable the child appears in their environment. I notice the confidence with which they answer questions, their breathing patterns, and even the volume of their voice. I also watch to see whether they answer independently or if they look to their parent before responding.

All of those small observations help me begin to understand how that child is interacting with their environment before formal testing even begins.

For clinicians newer to developmental optometry, what do you think is most commonly misunderstood about binocular vision and its impact on learning and function?

One of the biggest misunderstandings is that binocular vision problems are often thought of as problems with the eyes themselves.

In school I was taught to think about vergence issues, accommodation problems, and eye movement difficulties primarily as mechanical problems of the eyes. Over time I have come to see that these are really whole brain challenges. The eyes are part of the system, but the brain is organizing and directing everything.

When we begin thinking about vision as a brain based process, it changes the questions we ask. Instead of only asking what the eyes are doing, we start asking how the entire system is functioning and how the person is interacting with their environment.

Another shift for me has been how I think about symptoms. Traditionally we are taught to view symptoms as problems we are trying to eliminate. I now see symptoms more as information. They help guide us toward where the system may be struggling.

When we approach symptoms that way, we are not just chasing them and trying to make them disappear. Instead we can use them to better understand the system and support deeper and more meaningful change.

Your work with the New Mexico School for the Blind and Visually Impaired, especially the mobile clinics, stands out. What has that experience taught you about access to care and adaptability as a clinician?

My experience working with the New Mexico School for the Blind and Visually Impaired was incredibly valuable and shaped me as a clinician in important ways. My training at the University of Houston prepared me to gather meaningful clinical information from patients with a wide range of developmental abilities.

Because of that training I felt comfortable examining patients regardless of their developmental status and adapting my testing to meet them where they were. That experience taught me a great deal about flexibility and communication.

At the same time, I eventually stepped away from that work because I felt like I was not truly making a meaningful difference in many of the children’s lives. At that point my understanding of vision was still limited to the framework I had been trained in.

Now that my model of vision has expanded, I often think about that experience differently. I would actually love the opportunity to return to that work someday because I believe I could approach it in a much more impactful way.

Instead of focusing primarily on the parts of the visual system that are not functioning well, I now think much more about how we can strengthen and build upon the parts of the system that are still working.

At one point, you came very close to selling your practice and stepping away, and then something shifted. Can you take us into that moment and share what ultimately changed your mind?

I started my primary care practice from scratch in 2011. By 2023 I was honestly ready to sell it and potentially leave optometry altogether. I had become pretty disenchanted with Western medicine in general, and optometry was not feeling much different to me at the time.

At a Treehouse Eyes meeting, Dr. Thanh Mai and Dr. Charles Shidlofsky told me that if I truly wanted to understand vision therapy I needed to take Dr. Bob Sanet’s course. So I went home and Facebook messaged Bob and told him I needed to take the course.

When I arrived at the first seminar I immediately realized the experience was going to be very different. People were sharing openly and emotionally from the very beginning. That level of vulnerability created a space where I felt comfortable doing something that was very out of character for me at the time.

I raised my hand and admitted to a room full of people I had never met that I was preparing to sell my practice and that this course was essentially my last attempt to see if there might be another path in optometry.

Then Bob started speaking, and honestly it completely blew my mind.

He began describing vision as a whole brain, whole body process. Hearing vision framed that way resonated deeply with me because I had been searching for a more holistic path. It helped me realize that paying attention to the entire visual system might actually be one of the most holistic things we can do.

Up until that point I thought I might need to leave optometry to practice in a more holistic way. Instead I realized I was already perfectly positioned to make a much bigger impact on people’s lives. I simply had not been introduced to the full potential of vision yet.

Since that experience I have started a vision therapy practice and transformed how I approach primary care optometry.

But the change has not only been professional. Vision therapy has actually changed my own vision and, in many ways, changed my life. Experiencing that transformation personally has deepened my belief in what is possible for the people who walk through my door every day.

Outside the office, you’re raising three kids, staying active, traveling, and listening to audiobooks at 2x speed (which I respect deeply). How do those parts of your life shape the way you show up as a clinician?

This is a great question and actually very timely for me.

Raising three kids is already a full time job. On top of that I have my primary care practice, the vision therapy clinic, and the responsibility of managing the overall business. At one point I realized I was essentially trying to do four full time jobs at once.

In the past I would have simply powered through that level of pressure, which is ultimately what led to my burnout before. Recently I noticed myself starting to slip back into that pattern again, but this time I was able to recognize it earlier and make some changes.

Part of that shift has been learning to ask for help and accept it. I am currently working on hiring an associate doctor and an operations manager so I can share some of the responsibility of running the practice. So if anyone reading this happens to be looking for a great opportunity in Albuquerque, please feel free to reach out. That invitation is only slightly tongue in cheek.

Learning the idea of “who, not how” has also been really powerful for me. Instead of trying to do everything myself, I focus on finding the right people who can help support different areas of life and work.

Allowing others to help has helped me remain much more open and present. That presence makes me a better mom, a better leader for my team, and a better doctor for my patients.

Listening to audiobooks at 2x speed has also been a big part of my learning process. It allows me to absorb far more information than I ever thought possible. Interestingly, this journey has also helped me realize how much my own vision challenges shaped the way I learn. For much of my life I relied heavily on auditory processing without realizing it. Even as my vision improves, I still tend to prefer listening to books rather than reading them.

If we checked back in with you ten years from now, what would you hope has changed, either in your own work or in the profession as a whole?

Ten years from now I hope that our understanding of vision has expanded far beyond the idea of eyesight alone.

I would love to see a broader awareness that vision is a brain based, whole body process that influences how we move, learn, and interact with the world. When people begin to understand vision that way, it opens the door to helping many more individuals who are struggling but may not realize that their visual system is part of the challenge.

I also hope that vision therapy becomes more integrated into primary care optometry. My experience has shown me that the two really belong together.

Access is another area I hope continues to grow. In places like New Mexico there are still very few providers offering this kind of care. My hope is that more doctors become curious about developmental optometry and feel empowered to explore it within their own practices.

Personally, I hope to continue growing in my understanding of vision and in the ways I can support my patients. The more I learn, the more I realize how much there still is to discover.

Closing Thoughts From Robert – A big thank you to Dr. Tiffany Martinez for sharing her story so openly and generously. Conversations like this move our profession forward, and serve as a reminder of how many paths there are into developmental optometry and how often the most meaningful ones begin with curiosity. Her willingness to question what she was taught, to unlearn and relearn, and to stay open to growth reflects something deeply familiar to many of us who have been shaped by this work. What stands out most is her clarity about service to her patients, to her community, and to the profession itself. In a place where access remains limited, her commitment to building thoughtful, brain-based care close to home speaks volumes. Please join me in wishing Dr. Tiffany Martinez and her beautiful family all the best health and happiness in the future!