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INTO
THE NEXT CENTURY:
Are Opticians Ready for
a Change? Part I |
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Opticianry as a profession is rapidly changing. Unfortunately, some Opticians in the United States may be under-trained and under-educated.
Apprenticeship is the primary training mode for Opticians in some jurisdictions in the country, according to the American Board of Opticianry (2002). This method of training may not provide the needed background for tomorrow’s Optician. Some states, such as New York, Florida, North Carolina and others, require a state license to practice and also prerequisite education prior to sitting for the mandatory licensure examinations (Opticians Association of America, 2002).
In other states, there are no existing regulations for
Opticianry. Coupled with the lack of training in some states is an increase in new technology that may demand a higher level of understanding and knowledge of optics and vision care in general. Several emerging issues will have a significant effect on Opticians. They include: |
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Advances in Technology
Optical research has provided many widely recognized advances in recent years in spectacles, vision testing and contact lenses. Examples of those advances include a new specialty contact lens design, Corneal Refractive Therapy (CRT) from Paragon Vision Sciences. CRT is an advanced contact lens design that can reduce or eliminate the need for corrective lenses by reshaping the cornea. This procedure is effectively, a completely reversible alternative to LASIK surgery. The lenses are worn overnight and gently provide a change in the anterior corneal surface radii as the patient sleeps. This procedure has some potential danger to the wearer if the lenses are fitted incorrectly. To safely utilize this technique in practice an expansion of the knowledge of ocular anatomy and physiology of most Opticians may be necessary.
Several new devices to test refractive error are specifically designed for use by technicians. They allow for accuracy in assessing sight by vision care professionals. Opticians could operate these devices. However, the education and training required of some Opticians may limit their use even under the supervision of a physician.
Spectacle lenses have been developed that are based on complicated computer models. They provide the wearer with superior vision than in the past, as well as a more cosmetically appealing lens generally. These lenses require advanced knowledge by the Optician if they are to be adequately utilized in practice. Under current educational requirements in most states, Opticians lack the education to use these computer-based devices. This leaves one to ponder the question “What level of education and training is needed for Opticians to safely and effectively utilize these new technologies in practice?”
Changing Practice Roles
Practice styles have changed over the years (Drew, 1990). 20 years ago, most Opticians had a goal of becoming independent practitioners. It was unethical for physicians to sell eyeglasses, and the relationship that naturally developed between the Ophthalmologist (a physician specializing in the eye) 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 were a second group of eye doctors who 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 a few diseases that once were the realm only of the physician.
Some 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 are the personnel needs in vision care for the future and how will those needs be met?
Licensure/Certification Requirements
Twenty-two states require a specific state license to practice Opticianry. One other state (Texas) recognizes a national board certification, but does not require it to practice (American Board of Opticianry, 2002). The remaining states have little or no restrictions placed on the sale of prescription eyeglasses.
Pass rates on state and national boards vary according to training and education of the student (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 in order to attain licensure. (South Carolina State Board of Opticians, 2002). Should an increase in educational and experience requirements for Opticians be considered unacceptable by the profession, there may be a reduced need for the profession in the future, as technology may replace some of our existing skills.
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 tomorrow’s Optician will be doing professionally. These questions also underlie the problems facing Opticians today as a profession. 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.
Another key problem which has not been studied or addressed by Opticians 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 a doctor’s office, or expand our scope of practice. 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. They will either advance into new areas of activity or be reduced to a paraprofessional under the supervision of an ophthalmologist or an optometrist.
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 Opticianry 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.
To end our comments for the month, the Optician needs to change. Next month we will discuss whether or not they seem ready. Stay tuned.
References on request
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