Through the Looking Glass: A Career in Optometry

Kaytlin Kilian

English III Honors

Mrs. Kopp
February 26, 2014

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Through the Looking Glass: A Career in Optometry

Sight is one of lifes most precious gifts. Without the ability to see, the world is DARK.
How do you dream or imagine if you have not seen images or colors? For years, optometrists
have diagnosed and cured ocular diseases and deformities through ophthalmic innovations
created by those who share a passion of helping others see better. The field of optometry
continues to develop and become more widespread as time progresses. Current innovations in
the field have allowed for many procedures to become easily accessible, as well as more cost
efficient. By researching this field and the prerequisites require to obtain a degree, it will enable
me to prove how this is a plausible career choice.
Through the years, the technology has evolved and the field of optometry has seen
profound advancements, which has exponentially increased the need for optometrists. The
earliest mention of the study of eyes occurred in the mid-1200s when Roger Bacon discussed
how lenses strengthen sight of those who have vision impairments. At this time, many people
looked down upon optometry and dictated it as not a true field of medicine, because medical
scholars viewed optometry as a form of taboo, due to the unorthodox ideas. This insufficient
amount of respect caused the practice of optometry to lack high regarded for another 200 years
(History of Optometry).
Although the field of optometry lacked high regarded at the time, many people still
aspired to change the field and turn it into a highly respectable career as well as an official form
of medicine. Johannes Kepler, who demonstrated that concave lenses fix myopia while convex
lenses correct hyperopia as well as described how the retina, a light-sensitive, multilayered
membrane that lines the membrane of the inner posterior chamber of the eyeball, contains the
rods and cones that connect to the brain through the optic nerve, became one of those visionaries.

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This remarkable breakthrough led to The Use of Eyeglasses, which became the first book
published on optometric principles (Glaucoma The Gale Encyclopedia of Medicine). For the
next 200 years, new findings remained few and far between, causing it to predominately
consisted of spectacle making and basic eye exams (History of Optometry). Finally, by the
early 1800s, the Ophthalmic Market Revolution began, causing a boom in eye related
innovations (Brownlee, 599).
In 1847 Charles F. Prentice scholars named him as the father of optometry due to his
remarkable findings and efforts put forth to make optometry what it is today. Four years later,
Herman von Helmholtz invented the ophthalmoscope (Brownlee 599; Jeffries 1). This device
originally used inverted illumination created by the light from a lamp placed on a table nearby, to
allow the optician to see within the eye without having to open it up (The Ophthalmoscope).
Once created, the ophthalmoscope received much ridicule due to the belief that the illumination
harmed the diseased eyes, by creating extra strain on the eye. It also received ridicule because
the device did not compensate for oculists who themselves had poor vision and many also feared
of the possibility that it could lead to amaurosis. Although the invention if this device originally
received much ridicule, it became a more highly regarded instrument used by optometrists
worldwide. Due to the fact that they professionals now able to see inside the eye without
physically opening it, which allowed for new observations and theories to emerge, the device
gained popularity and respect among the field (The Ophthalmoscope).
Glaucoma, a group of eye diseases characterized by damage to the optic nerve usually
due to excessively high intraocular pressure, emerged as one of the observations found by the
ophthalmoscope. When left untreated, the increase in pressure within the eye can lead to optic
nerve damage resulting in progressive, permanent vision loss. This disease has become more

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prevalent over the years, effecting between 2-3 million people in the US and has resulted in more
than 120000 people to become legally blind (Trattler, Kaiser, and Friedman 14; Shaarawy 16).
Glaucoma, now the top leading cause of preventable blindness in the United States, has also
become the most frequent cause of blindness in African-Americans due to genetic make-up.
Contributing factors from the aging population increased the frequency of cases, thus
accompanying higher health care costs (Trattler, Kaiser, and Friedman 14, Glaucoma).
Glaucoma has many categories, but open-angled glaucoma and narrow-angle glaucoma
fill the position of top two types in current day optometry (Trattler, Kaiser, and Friedman 14;
Root 33). Open-angled glaucoma has remained the leading type of glaucoma for over fifty
years, and accounts for at least 90% of all cases. This type of glaucoma causes slow clogging of
the drainage canals, and results in increased eye pressure. As the pressure increases, the optical
nerve shifts out of place, and then causes and increase in loss of vision that will continue to
progress and eventually lead to full vision loss. The other category of glaucoma, narrow-angle
glaucoma (also known as angle-closure glaucoma), effects slightly less than ten percent of
people diagnosed with glaucoma, making it the second most common type among effected
patients. This form causes blocked drainage canals, results in a sudden rise of intraocular
pressure. Unlike open-angle glaucoma, the angle closes or narrows out between the iris and the
cornea, which develops very quickly and produces noticeable symptoms and damage (Types of
Glaucoma; Trattler, Kaiser, and Friedman 14; Shaarawy 16).
Until recently, Glaucoma caused loss of vision in many individuals, since permanent
treatment still remained impossible. Patients would take pills or apply eye drops religiously to
prevent any further damage, but ended up ineffective most of the time since patients would
forget about taking/applying the pills or eye drops. Finally, in 1993, Boston surgeon Mark

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Latina, MD, introduced advanced laser technology called Selective Laser Trabeculoplasty. This
procedure, when set at the appropriate wavelength, injures pigmented cells while sparing the
rest, resulting in a decrease in released cytokines. These cytokines are substances secreted by the
body and promote cell growth. By demoting cell growth in the eyes, the iris, cornea, and
drainage canal remain intact and open so that clogging does not occur and create pressure (Katz
68-70). On top of the cell growth prevention, the pressure decreases so that the vision will
repaired to a certain extent, and the patient will no longer experience gradual vision loss due to
glaucoma (Root 33-35).
By 1900s, optometry gained more respect as it continued to expand academically and
technologically, causing the field to finally become recognized as an actual field of medicine.
Because of the increase in information and respect for the field, the first School of Optometry
opened in 1910 at Columbia University (Goss). The opening of the school allowed for the
professing to grow exponentially, making this a big milestone and leap towards gaining the
recognition it deserved.
Over the years, optometry gained more recognition and has now become a well-respected
field of medicine that continues to advance as time progresses. Nowadays, the Association of
Schools and Colleges of Optometry (ASCO) require college students applying to optometry
school to take an exams known as the Optometrist Admission Test. The Optometrist Admission
Test (OAT), a standardized examination for acceptance to optometry school, measures academic
ability and the students comprehension of scientific information.

This test requires the

completion of seventeen specific classes, as well as five completed applications to optometry

schools before registering for the test.

These applications, just like undergraduate college

applications, entail the students official transcript, application fee, and a specific amount of

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recommendations from numerous employers, mentors, and/or professors. Within in previous
years, the ASCO has utilized the use of the optometrys centralized application service, or the
OptomCAS, to allow an efficient and convenient way to apply to multiple optometry programs
simultaneously while allowing people to see that the student has in fact applied to the required
amount of schools (Association of Schools and Colleges of Optometry, 5).
Once accepted to optometry school, students receive hands-one instruction as well as
lecture on both clinical, preclinical, and optometric sciences. The program consists of one fouryear degree (including the entire summer of the last two years) which allows for students to
receive hands-on training within both the classroom and actual functioning clinics/hospitals by
divide the four years in half and dividing the summers up into intensive seven-week rotations, in
which the students rotate working at various clinics and hospitals throughout the state (Monson;
Association of Schools and Colleges of Optometry 83-88). This rotation allows rising third and
fourth year students to receive in depth hands on training without needing a license (Association
of Schools and Colleges of Optometry 83-88).
After completion of optometry schooling, future graduates must successfully complete
and pass all three parts of the Board Certification exam. This three-part exam assesses applied
basic science, ability to diagnose and treat different cases, and the clinical skills required to
perform sufficiently within the professional world. The first part assesses the applied basic
science skills needed to perform the required tasks of an optometrist. This part of the exam splits
up

into

four

three-and-a-half

hour

subsections,

which

assess

epidemiology/history/symptoms/signs, clinical testing, and diagnosis/pathophysiology within

125 questions per section, totaling up to 500 questions overall. This part of the exam requires
students to have begun their spring semester of their third year before attempting and allows

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three attempts prior to graduation.

The next part of the exam that the NBEO administers

electronically includes two 175-question sections, which compiles multiple types of mock
ophthalmic cases. This part of the exam allows the national board to examine how the student
will approach real life cases and whether their reasoning leads them to the correct treatment.
This particular part of the exam remains available for students to take up to two times and
becomes available to students once they have begun their final year of graduate school. The last
part of the exam evaluates the future graduates ability to diagnose and treat the issue as well as
communicate with the patient. This part of the test mimics a real world situation in which the
student acts as the doctor and evaluates and diagnoses the patient in the simulated doctors
office. For this part of the exam, registration opens February 15 of each year. Although, each
part of the exam becomes available in numerical order, students do not have to pass the previous
parts of the exam before beginning the next one (National Board of Examiners on Optometry).
Unlike most medical fields, optometry does not require residency. Residency, (also
known as medical residency training) a form of medical training after medical school, allows
recent graduate to practice under fully licensed professionals while still receiving a paycheck. In
most other medical professions, the government requires students to complete four to seven years
of medical residency training so that they can receive proper hands-on training in a professional
environment. Since optometry school includes two summers of intensive training with licensed
professionals, it stands in place of residency training and allows the student to go into the
professional world immediately after graduating (Association of Schools and Colleges of
Optometry).

Although the National Board of Examiners in Optometry does not require

residency, completing one year of optional residency allows the optometrist to receive the next
level of credentials. The NBEO purposefully set this up so that the student may receive specialty

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training within the area of their choice if they choose to (The American Board of Certification in
Medical Optometry).
Pediatric optometry, one of the leading specialties within optometry, refers to the
examination of children's eyes by optometrists who train to evaluate and treat visual disorders in
children. Due to the lack of verbal communication in younger patients, the profession remains
quite difficult because the inability of communication between the optometrist and patient
creates and issue in which the doctor had to diagnose the child without the use of reading eye
charts. Because of this, optometrists must dilate the patients eyes so that they can observe the
inside structures of the eye to look for abnormalities of the retina or optic nerve (The Children's
Mercy Hospital).
After optometry school, optometrists become accredited with a state license as well as
level one credentials, which validity withstands only within specific state boarders. In 1985, the
American Board of Certification in Medical Optometry created the Accreditation Council on
Optometric Education and a three-tier credential system that set regulations for those looking to
specify in a certain subsection of optometry. After receiving level one and state practice license,
optometrists may choose to go for residency, which allows eligibility for level two credentials.
To obtain the next level of credentials, optometrists must attending residency training in their
chosen specialty as well as a specialty passage exam. Those who hold this level of credentials
also must renew their specialty certification every ten years. After level two, there remains an
even higher level of certification, which requires the same as both level on end two credentials
on top of training in subspecialty. This uppermost level also requires that competency remains
maintained through association to a specific subspecialty society or college (The American
Board of Certification in Medical Optometry).

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According to the ASCO, as of 2013, professionals younger than forty years old make up
the majority of licensed AOA (American Optometric Association) and out of all AOA members,
females represent approximately sixty-five percent. A significant need for underrepresented
minorities in this field remains, since Latino, African American or Asian American encompass
only a little more than one third of optometric graduates, which results in high application
encouragement for minority students interested in the field. Statistical data indicates that in 2011
the average net income for non-owner optometrists who had practiced for 10 years or less made
$120,000 while non-owner optometrists who had practiced 21-30 years averaged $171,316
(Monson; Association of Schools and Colleges of Optometry 4-5).
Although the American Optometrists Association categorizes optometrists, opticians and
ophthalmologists within the same field, their jobs remain quite different. Out of the three
professions, opticians remain the lowest of the three.

Many community colleges and few

colleges and universities nationwide offer formal optician training, which comprises of a twoyear associates degree in either ophthalmic dispensing or optometric technology, and only allows
for accreditation from the Commission on Opticianry Accreditation. Other times, employers will
hire individuals with no optic background and training remains an informal, on-the-job or formal
apprenticeship. Since opticians do not receive proper extensive training, the AOA dictates that
opticians cannot supply prescriptions or perform vision tests, making their sole job designing and
fitting eyeglasses lenses, frames, contacts, and other corrective lenses. Due to the low education
requirements, opticians receive an average net income of $33,330 annually (USAEyes; Bureau of
Labor Statistics; American Association for Pediatric Ophthalmology and Strabismus).
While opticians can only design and fit optic devices, optometrists can examine,
diagnose, treat, and manage diseases and disorders of the visual system. Optometrists examine

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both the external and internal structures of the eye to diagnose diseases and disorders of the eye,
like glaucoma, cataracts, hypertension, and astigmatisms. They diagnose these diseases and
disorders through eye exams, dilations, and in some states, non-invasive laser surgery. Since
optometrists can administer eye exams, they also acquire the power to write prescriptions for
corrective devices as well as for vision therapy and medicines to treat eye diseases such as dry
eye, red eye, and glaucoma (USAEyes; American Association for Pediatric Ophthalmology and
Strabismus).
Out

of

the

previous

two

professions,

ophthalmologists

remain

superior.

Ophthalmologists, medical or osteopathic doctors who specialize in eye and vision care, differ
from opticians and optometrists by their level of training and ability (Columbia Electronic
Encyclopedia). As ophthalmologists, the National Board of Examiners in Optometry required
that they complete their undergraduate degree as well as completing an additional eight years of
additional years of medical training.

Not only do they differ in just educational aspects,

ophthalmologists must also become certified to perform eye surgery on top of having
certification to diagnose and treat eye diseases, prescribe medication, and fit eyeglasses and
contact lenses.

Since ophthalmologists persorm surgery on top of typical eye exams and

treatments, they receive an average net income of $249,000 to $354,900 depending on the
amount of time within the field (American Association for Pediatric Ophthalmology and
Strabismus; USAEyes; Bureau of Labor Statistics; Columbia Electronic Encyclopedia).
Many ophthalmologists specialize in specific areas of medical or surgical eye care as well
as generic eye conditions and problems too. Subspecialists, those who specialize in specific
areas of medical or surgical eye care, usually complete one to two additional years of schooling.
This additional training prepares an ophthalmologist to treat more complex and specific

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conditions in that specific area that they specialize in (American Association for Pediatric
Ophthalmology and Strabismus; USAEyes; Columbia Electronic Encyclopedia).
When an optometrist, not only do you have to comply with the American Optometric
Association guidelines, but also with national HIPAA guidelines. HIPAA, the Health Insurance
Portability and Accountability Act, dictates the amount of privacy a patient requires. The Privacy
Rule gives individuals rights over their health information and sets rules and limits on who can
look at and receive health information.

The HIPAA guidelines mandates that individuals,

organizations, and agencies that meet the definition of a covered entity must comply with these
guidelines. One of the main guidelines states that covered entities must have a Notice of Privacy
Practices (NPPs). NPPs describe the uses and disclosures of protected health information that a
covered entity can make. Failure to comply with the guidelines or a breech in any personal
information of a patient requires specific precautionary measures to evaluate the situation and
determine the consequences (U.S. Department of Health & Human Services Office for Civil
Right).
The research has concluded that over the years, optometry has developed into a
respectable career that provides an income large enough to sustain a family as well as pay off
student loans with. The profession of optometry allows a challenging career, ability to achieve
personal growth and financial success, as well as having job flexibility (Monson). This everchanging career creates a constant shift in pace allowing for long-lived interest within the field.
The constant increase in innovations as well as the continuously expanding demand for eye care
will ensure sufficient employment opportunities and an always-interesting profession.

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Work Cited
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Admission Requirements 2013. Rockville: Association of Schools and Colleges of
Optometry, 2013. PDF.
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2015.

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