Last month we started this series on Opticianry looking at historical perspectives. We attempted to describe several changes in the eye care industry that are affecting Opticians. Technology, changing practice roles, and the lack of consistent licensure/certification loom large on the horizon for the profession. This month we continue our discussion, and hopefully as the series develops we can look into our crystal balls and envision a clear and successful path into the future for this time-honored profession. Where do we go from here? Several things need to allow Opticians to reach their full potential.

Education and Training

Most Opticians are hired with little or no experience and trained through apprenticeship (or more correctly on-the-job training) programs, with little, if any, formal educational component. Considering all that is required of contemporary Opticians, this may cause some pause for concern. It certainly does for this author. Opticians need to be solidly grounded in the use of precision measuring instruments and other machinery and tools. They deal directly with the public, so they should be tactful, pleasant, and communicate well. Manual dexterity and the ability to do precision work are essential. While little training actually occurs during the "apprenticeship", the professional duties of the Optician require significant knowledge of physics, basic anatomy, algebra, and geometry. Opticians need to be able to take the written prescription of the eye doctor and translate that into a useable appliance for the correction of visual anomalies. It is paramount to what they do, and to be able to do that requires a level of education and training that is lacking. The profession and even the media are beginning to recognize the need to provide higher levels of formal education and training for future Opticians and not depend on the current OJT system. Reading recent news stories clearly point to this need.

Public Perception of Opticians

The public perception of the Optician is important. Gerardi and Woods (2000) completed a study that discusses Opticianry's public perception. Entitled Public Attitude towards Opticianry Education as Human Capital, this study asked several key questions related to this research.

1. Does the public feel apprenticeship is sufficient training for an Optician?
   

2. In the public's opinion, is a college educated Optician a better professional?
   

3. In the public's opinion, what level of education should the Optician obtain? 

This study randomly sampled patients from a large New York optical firm and evaluates the level of education most people perceive Opticians as having. The authors wanted to find out: (a) what level of education and training patients thought Opticians had completed, and (b) what level the public felt was necessary to competently practice. The study found that 100% of those patients polled stated that they would have more confidence in a college trained Optician, and they were surprised to find that Opticians could be trained via apprenticeship. The overwhelming majority felt that at least an associate degree should be required, and 81% felt the bachelors' degree was a necessary prerequisite. The data also suggests that the apprenticeship program is perceived by the public to be a "relic of the past" and should be eliminated. The study selected a 10% random sample of over 1500 patient files in a large New York City firm. It as scientifically designed and clearly points to a public perception that Opticians need more education, and in fact the public felt that the level of education already completed was significantly higher than actually obtained. Interestingly, 81% felt a bachelor's degree should be required as the entry-level educational credential. 

This study indicates that the public has a higher perception of the Optician's level of education and training than actually exists. Interestingly, there is little additional evidence of additional information related to this subject. 

Historical and Political Perspectives

Historical perspectives of Opticianry are interesting and point to many changes within the profession over the years. "Back in the day", as my students say, eye exams were self-administered by trial and error, and the Optician was the only source of vision correction. Typically a male, he also served as a jeweler! Medicine had little interest and there were no Optometrists yet. The Optometric profession has roots that trace back to its origin in Opticianry, as described below. Classé (1989) discussed the early development of Optometry, a profession which evolved from Opticianry in the early part of the twentieth century. Refracting Opticians, as early Optometrists were called, saw a need to form an independent profession separate from organized medicine that would test vision and also provide optical services. This group became increasingly disenchanted with their current professional role, and saw that they could better serve their patients if they could do independent eye examinations. Organized medicine, a formidable foe, did not support such a move towards independence for these "Refracting Opticians" and caused a slow down of the movement from the early 1900s to the first legislative recognition of Optometry back in the late 1940s in Minnesota. This profession saw new developments that would allow them to expand beyond their present scope of practice, and developed educational programs to allow them to do so. Once educated they sought legislation for state licensure, which they have currently in every state and have attained a status to rival physicians in most areas of the country.

Today the Optometrist is a medical professional with comparable scope of practice to the physician, but without the ability to do surgical procedures in most jurisdictions. The Optometrist has the right to prescribe most pharmaceutical agents and has a significant level of income. The growth and development of Optometry is a model for other professions. Can Opticians follow a similar path to a brighter future? 

Opticianry's Conundrum

The Opticians Association of America (OAA) is the recognized national organization representing Opticians politically. Leaders of that organization support a change in the education and training requirements for the profession as noted in multiple resolutions, and established 2001 as the date for requiring formal education as the entry into the profession. But that move to formal education has moved slowly. Movement away from traditional thinking is controversial to say the least. A review of the OAA resolutions passed at recent national professional meetings indicates that similar feelings exist today regarding the expansion of scope of practice. In resolution 2-1 adopted June 1973 and revised as late as June 1984, the OAA General Assembly stated that the dispensing and refraction functions of eye care providers need to be separated, in a similar fashion to medicine and pharmacy. Today, however, the later resolutions beginning in June 1990, call for the independence of Opticians, and the adoption of formal education standards that includes the process of refraction and state licensure for all Opticians (Opticians Association of America, 2002). This is clearly a change in direction from 1984. 

Many professions face a great deal of inner reflection when threatened by change. This is particularly true in the highly competitive and technical areas of practice. While most mainstream health professions rely on traditional education routes such as university, professional school or clinical training to prepare for entry into the profession, Opticians have traditionally utilized "apprenticeship" as the primary training mechanism, although schools do exist. There appears to be some reluctance on the part of many in the profession of Opticianry to change that traditional apprenticeship format, while others want to do away with apprenticeship altogether. Which is "better" for the profession? Let's continue this series next month and try to find the answer to that question, or at least some compromise, to provide greater opportunities for future Opticians. Tune in the same time, same channel as we continue this series. If you have comments, please contact me. I would love to hear from you.

Warren G. McDonald, PhD
Professor of Health Administration
Reeves School of Business / Methodist University