Last month we evaluated the study upon which these articles are based, and described the change theories involved and the methodology used to conduct the study. This month, we attempt to tie it all together and make some recommendations for the future.

The Cross-Sectional Study
A broad cross-sectional study of those in the field was utilized to determine the profession's feelings about the direction we should take. We received responses from 38 states and found generally that level of education and training had no real effect on income levels. We measured selected criteria such as contact lens fitting and low vision and found that only those who utilize low vision in practice make significantly more money that other Opticians. Generally speaking, almost anyone could practice Opticianry today with very limited requirements. If education and training are not rewarded in the profession, why then should Opticians seek to gain such credentials? This research indicates that it will provide the practitioner with a greater ability to serve the public with greater understanding; something seen as important to the Delphi panel. To provide an adequate summary of the questionnaire will be nearly impossible in this brief article. It consisted of approximately 50 pages of data describing the feelings of a large population of average Opticians across America. 

Summary of the Questionnaire Responses
These practitioners responded to the survey questions with the following responses:

Survey respondents indicate that new lens technology, refraction systems and frame materials are important issues, with new edging systems, advanced contact lenses, and surfacing and molding equipment coming up in the bottom half. 7.5% selected other and generally selected low vision devices in this category. To reinforce the selection of important technology, the respondents were asked to describe what technology they use in practice and to estimate the time they spent in their day doing the selected tasks. Only 12% actually did refractions, and spend less than a half hour daily in this activity. When asked for important technology for the future, refraction systems were second. New education will be required to train Opticians to use this technology, which will be an increase in the Opticians scope of practice. Contact lenses have been within the Opticians professional jurisdiction for many years, but only 40% of the respondents fit them and spend 1.32 hours daily in this activity. Most of the survey respondents do some type of lab work, but interestingly it was primarily tinting and repairs. In times past, Opticians spent significant numbers of hours in the lab edging or surfacing lenses. This indicates a shift, and most probably is based on the emergence of major corporations. Large corporate organizations that employ Opticians may not have lab equipment and are focused more of the dispensing and sales of eyewear than in the past. The average time in the lab was 2.6 hours daily for this population. 

Forty percent (40%) did some low vision, and spent 0.45 hours daily in this activity. Lastly, 61.5% of those responding spent more than 2 hours a day in administrative duties. The data indicated a mix of things new and old for the Optician of the future. New training will be required to learn refraction and to provide more in-depth knowledge of new lens designs and frame materials. Should surfacing and/or molding of lenses continue as a part of the training and education of Opticians? Few respondents indicated they did a great deal of this any longer. Refraction and other training may supplant surfacing in future curricula. Contact lenses are an interesting subject. Only 40% fit contact lenses, and with these devices changing rapidly this part of the curricula should be strengthened, particularly in licensed states. However, according to the survey data, an increase in training should be required in contact lenses. If the Optician is to branch out into providing more services in low vision and in administration of eye care facilities, a higher level of training and education is required for them to provide those duties at an acceptable level. 

The final section of the survey polled the respondents on their feelings regarding the importance of selected issues. They strongly favor maintaining Apprenticeship as the primary mechanism for training Opticians, but support adding a formal education component to assure theoretical competence. They favor expanding the scope of practice to include refraction and advanced contact lenses, but also indicate an increase in the level of education and training should be required prior to the expansion. They feel Opticians should assume a stronger role in administration, and feel that coursework in business and management, as well as in critical thinking would be beneficial. 

From the data, we can safely assume that more Opticians want to include contacts as a part of their practice. Low Vision and Refraction ranked next, with similar numbers of respondents feeling that they are important issues for future Opticians. All of these tasks relate directly to new technology described earlier in the study. For example, refraction systems are widely used in doctor's offices and are run by inexperienced technicians with minimal training. Opticians could safely provide refraction services with some supervision by medical professionals and additional education and training. This would provide increased access to vision services and reduce the cost of those services to the public through the use of new technology in the hands of properly trained Opticians. 

The Delphi Panel Summary of Responses
The panel went through two iterations, with well-developed responses to all questions from each panel member. The panel did reach a consensus on most of the issues presented. The panel's responses also yielded important information which supported many of the results from the study questionnaire presented in the previous section. In fact, the Delphi Panel validated several of the findings from the questionnaire research. For most of the questions, significant agreement was evident. A summary of representative responses for the Delphi Panel is presented as follows. 

Question I – What level of education and training do you feel Opticians need to safely and effectively operate new technology, specifically refraction systems, advanced contact lenses, and low vision services and devices?

The panel had some interesting responses to this question. The quantification of the grouped responses and the comments found that all panel members believed that a higher level of education is required to provide more complex services.

Question II – The panel was asked to quantitatively rank the importance of the above tasks to the future of the profession. Answers are on a 1-5 scale, 1 being not important and 5 being very important.

Refraction yielded a mean score of 4.079, indicating the panel believed that Opticians probably would provide refraction services in some manner in the future. Most of the panel believed that there needed to be some medical oversight where refraction was concerned, but that Opticians would be excellent refractionists in a doctor's office, particularly if trained appropriately. Not all panelists thought independent refraction should be considered, but refraction in some form would be important for future Opticians.

Question III – The panel was asked, “What level of education Opticians needed to maintain their current levels of service?”

The panel recorded a mean score of 2.62, indicating that apprenticeship with a formal education component is necessary for current scope of practice. The range of answers for this question was narrow; from 2 to 3. 

Question IV – Where do you see the Optician's role in the next 10 years? Will Opticians be considered professionals, or serve in more of a technical role under the direction of other professionals?

Overall, the panel believed that Opticians will increase their scope of practice as Optometrists move closer to the medical model. However, all agree that Opticians have to strengthen their educational background if they are to grow as a profession. It was also considered that advances in ophthalmic technologies will require Opticians to have a higher technical knowledge base. Furthermore, the panel agreed that the future of the Optician is dependent on education and some panel members considered that Opticians may have already been relegated to trade status. The also strongly believe that Opticians must become engaged as a group with other medical professionals.

Question V – Should the Optician be licensed or certified in every jurisdiction in the United States, and should it be mandatory? 

The panel of experts indicated that licensure was favored with a mean score of 1.00, or 100% of the panel. This was the lone question where complete consensus was achieved.

Question VI – Should Opticians seek to expand their current scope of practice? 

All but one panel member felt that Opticians should seek to expand their scope of practice, with almost a 100% positive response on this issue as well. The panel's mean score was 1.079. The only negative was a panel member who reported that scope of practice could be expanded if Opticians were working under the auspices of an MD or OD. 

Next month, we will wrap this series up with some recommendations for the future for the American Optician. I am enjoying these articles, and appreciate the overwhelming responses I have been getting.