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Educating
and Training the American Optician, Part
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Practice styles have changed over the years. 20 years ago, most Opticians had a goal of becoming independent practitioners. It was unethical for physicians to sell eyeglasses, and the relationship that developed between the Ophthalmologist and the Optician was a natural one. Opticians filled the prescriptions for spectacles and contact lenses written by the Ophthalmologist, who handled medical eye care. Optometrists did their own sight testing/eye examinations and prescribed and dispensed spectacles and contact lenses.
Today, the optical landscape has changed dramatically. Most Ophthalmologists dispense glasses from their offices, and large chain operations have rapidly become the primary market competitor. Optometrists, once the professional adversary of Ophthalmology, co-manage much of the medical care of post surgical patients with Ophthalmologists and have the right to treat many diseases once the realm only of the physician. This article will continue our discussion of education and training for Opticians in the United States, and hopefully provide some insight into what we may become in the future if changes are not made, and quickly.
The Spectacle Peddler
Opticians today have seemingly been relegated to the role of “spectacle peddler” in a retail or chain store environment, far removed from the professional Optician of the past. The changing landscape of the eye care industry presents a quandary for the Optician. Where do they fit into this new environment? Should they expand practice roles through additional education and training, or serve as technicians and assistants working for chains and eye doctor’s offices? What will be the personnel needs for the future and how will those needs be met? In the opinion of this author, one of the major issues is the regulation of the practice of Opticianry in various jurisdictions across the country.
Licensure/Certification Requirements for Opticians in the U.S.
Twenty-two states require a specific state license to practice Opticianry. One other state (Texas) recognizes national board certification as a voluntary state registration, but does not require it to practice (American Board of Opticianry, 2002). The remaining states have little or no restrictions placed on the dispensing of prescription eyeglasses to the public.
Pass rates on state and national boards vary according to training and education of those taking the exams (McDonald, 1987; North Carolina State Board of Opticians, 1995). Additionally, as the core knowledge and skills required for Opticians to pass their licensing board examination increase it may necessitate an increase in the qualifying level of education and/or experience for licensure. Should an increase in educational requirements for Opticians be considered by the profession? Opticians of the future may work under the supervision and direction of an Ophthalmologist or an Optometrist, but will they view us as merely high-priced technicians that can be eliminated? Furthermore, if Opticians only work under the supervision and direction of other professionals, should additional education be required prior to sitting for state board or national certification examinations, or are those examinations even necessary to serve the public as an Optician? Obviously, this question can only be answered by Opticians and other eye care professionals in the states where it is an issue.
The Definition of “Optician”
There are some differences within the Opticianry community as to the definition of “Optician” in the United States. Some within the profession view it as a retail business that demands limited education, while others see the role of the Optician as becoming far more advanced, with an increase in the scope of practice to include refraction and more involvement in contact lenses and other specialties (Opticians Association of America, 2002). Several questions must be answered to gain a clear understanding of what the Optician of tomorrow will be doing professionally. These questions also underlie the problems facing Opticians today. For instance, what level of education and training should be required to utilize safely and effectively new and emerging technology in practice? An acceptable answer to this question has not been adequately resolved by Opticians throughout the United States. This is important because some of the new technology available for Opticians, such as advanced refraction systems, require additional levels of training to safely operate them. These systems allow the technician in the eye care professional’s office to accurately perform refractions to develop a prescription for spectacles or contact lenses, and may be something we can effectively utilize. Some Opticians are currently using advanced refraction systems in their practice; however, it is not known how their education and training differs from that of other Opticians that are not using these systems.
Opticianry’s Role
Another key problem which has not been studied or addressed by the profession is to define the role they will play in the eye care delivery system of the future. Opticians seem to have only two choices – become an assistant or a technician in an Ophthalmologist’s or an Optometrist’s office or expand their current scope of practice. However, Ophthalmologists and Optometrists view the Opticians potential advancement as encroaching on their territory. Optometry regularly fights the ability of Opticians in legislative arenas across the country (Opticians Association of America, 2002). Opticians of today are seemingly at a crossroads. Some feel they will either advance into new areas of activity or be reduced to a paraprofessional under the supervision of an Ophthalmologist or an Optometrist.
As addressed earlier in this article, regulatory problems also impact the Optician. The issue which has a significant effect on the profession is the question of licensure. States have the power to regulate and impose licensure for Opticians under the state’s police power. The state’s power to regulate Opticians is an attribute of a sovereign government. In the United States’ Constitution, sovereignty is found in state governments. However, licensing of Opticians can only be justified to protect the public’s health. This is an important concept to understand because the issue of licensure is resolved by state government and not the optical profession.
The issue of licensure is further complicated by the fact that some members of the profession, particularly those from unlicensed states, as well as other eye care professionals do not see the need for licensure or certification of Opticians.
Redefining the Profession
To adequately understand the role that Opticians may fill in the future, a clear picture of the profession as it currently exists must be presented. The profession is currently ill defined due to the varied role Opticians play in different regions of the country. In many states, Opticians are licensed health care providers with the right to fit contact lenses and other visual appliances. Those states require an examination, state licensure and varied levels of education and training. On the other hand, many states require no training at all. For example, Nebraska has no licensing requirements, but the author’s home state of North Carolina has an extensive 2-day examination (North Carolina State Board of Opticians, 2002). This disparity causes obvious problems in defining a future role, but the emergence of new technology could provide a measurement for what the profession feels will be the level of education and training needed to safely and efficiently practice in the future. This new technology may expand the need for better-trained practitioners or, on the other hand, eliminate the need for them completely. The technology may be good enough that technicians trained at a very basic level could do the tasks that Opticians do today.
Where we go as a profession, and how we get there is something the profession as a whole must determine through focused, strategic planning, and effective leadership that can provide the vision we so desperately need. The purpose of this article is to continue our discussion on education and training. This author feels that only through increasing our education will be reach our full potential. Others have done it, as was addressed last month. Why can’t we? More next month.
References on request
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