Supply, distribution, and capacity of optometrists in Indiana.

BACKGROUND: The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. METHODS: Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. RESULTS: An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. CONCLUSIONS: Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.     

Why should optometric research be designated as a priority for the profession?

Research is the discovery of new information, ideas or theories that increases our knowledge and understanding of ourselves and our environment. Optometric research focuses on the health, functioning and performance of people with emphasis on their eyes and vision. The goal of optometric research is to enable optometrists to provide high quality eye and vision care for their patients.     

Optometric management of binocular dysfunctions secondary to head trauma: case reports.

Extropia, esotropia, hyper elements, visual sequencing problems, accommodative dysfunctions and inefficient Motor Planning are common consequences of head trauma. Optometric visual therapy is an effective treatment modality for these dysfunctions. Two case reports are presented in order to illustrate optometric management of patients exhibiting these problems secondary to head trauma.     

Practice standards for optometry and optometric practice accreditation

Background: To assist optometrists to deliver care more efficiently and effectively, in 1995 Optometrists Association Australia decided to develop standards that would assist optometrists in better managing their practices. Existing practice management standards for health professionals were thought to be either not specific enough for optometric practice or to have shortcomings in the context of optometric practice in Australia. Methods: Following a literature search, material previously developed by Optometrists Association Australia to assist practitioners with management of their practices and standards from other professions were used to assist with the development of a draft set of standards for optometric practices in Australia. Successive drafts were circulated for comment to optometrists in practice, non‐optometrists with experience in the development of practice standards for other health professions and to Australian General Practice Accreditation Limited. The comments were used to refine the standards and the accreditation guidelines to their final form. Results: Optometric Practice Standards suitable for use in a practice accreditation program were developed. The standards comprise seven sections—Practice administration, Quality assurance, Rights and needs of the patient, Practice services, Practice facilities, Communication and Patient records. These sections are divided into criteria that provide the detail of the requirements of the standard. Indicators describing how criteria can be assessed accompany the criteria.     

OPTOMETRIC TECHNICIANS IN THE UNITED STATES AN INTERVIEW WITH STEVEN BATES

Steven Bates, O. D., is director of the Optometric Technicians Program taught in conjunction with the School of Optometry at the University of Alabama in Birmingham. Optometric technicians are a new, somewhat radical development in the United States, reflecting some of the modern trends in optometry and in the health professions generally. Some Australian optometrists will know Dr. Bates through his book “Fundamentals for the Optometric Assistant”. I began our conversation by asking Dr. Bates about the relationship of this book with the optometric technician.     

Board certification in optometry.

BACKGROUND: In keeping with current expectations in the health care community, the purpose of the American Board of Optometric Practice (ABOP) is to enhance the quality of optometric care available to the public by fostering continued competence for practitioners through administering education and examinations for certification and re-certification. The formation of ABOP makes possible for the first time a board certification process for optometrists. METHODS: The optometry model for board certification and recertification emphasizes the breadth of the profession. ABOP certification will be accomplished through a combination of examinations and high-quality, tested Board Certified Continuing Education (BCCE). Specific requirements for practitioners at various stages of their careers are presented. RESULTS: Board certification provides one important mechanism for an optometrist to demonstrate commitment to quality, professionalism, and ongoing clinical competence. The optometrist benefits from high-quality continuing education designed for timeliness, importance, and breadth. The public benefits by the enhancement of continued competence within the optometric profession. Health care agencies benefit by being able to recognize providers who have elected to demonstrate their qualifications through certification. CONCLUSIONS: Through board certification, optometrists will be able to demonstrate their commitment to maintaining clinical competence through a nationally uniform program, and they will be able to comply with standards that are generally recognized and required throughout the health care community.     

Affiliations of community health centers with the accredited schools and colleges of optometry in the states and territories of the United States

BackgroundIn 2006, the American Optometric Association Community Health Center Committee surveyed schools/colleges of optometry in the United States and its territories to assess collaborations between community health centers and optometric institutions.MethodsThe survey investigated the number and structure of affiliations that existed between Federally Qualified Health Centers and schools/colleges of optometry in the United States. The survey reached the schools through the American Optometric Association Faculty Relations Committee or personal contact (Inter-American University of Puerto Rico).ResultsThe survey showed wide variation in affiliations of community health centers with optometry programs. Six schools had no affiliations, whereas the remaining 11 ranged from 1 to 14. Information relating to 37 community health centers was reported. Results showed that schools utilized community health centers for fourth-year students in 5 schools, and both third- and fourth-year students in the remaining 6 schools. Schools vary regarding how precepting is managed with either full-time faculty (64.9%) or adjunct faculty. Business models also vary between schools.ConclusionAffiliations between school/colleges of optometry and community health centers differ considerably. Optometric affiliations with community health centers can result in increased access to eye care for underserved populations and increased clinical experience for optometry students and residents. Opportunities exist to establish additional affiliations. Educational benefits and costs associated with affiliations should be explored before entering into a collaborative model of eye care delivery.     

Evaluation of a new cataract surgery referral pathway

AIMS: To compare the quality of referrals and listing rates of direct optometric referrals vs traditional GP referrals for cataract surgery. METHODS: A retrospective cohort of 124 patients referred for cataract surgery was identified (62 via optometric pathway and 62 via GP pathway). The quality of the referral was assessed by establishing if it contained adequate information relating to the College of Optometrists' referral framework document. Age, sex, drug history, listing rate, operative rate, and visual acuity (best corrected) at referral and at the postoperative visit were recorded and compared between the two referral pathways using the Fisher's exact test. RESULTS: Optometric referrals, relative to GP referrals, were more likely to include information relating to objective visual loss (100 vs 87%, P=0.0061) and to counsel the patient (97 vs 18%, P=0.0001). GP referrals, relative to optometric referrals, were more likely to comment on personal circumstances (32 vs 3%, P=0.0001), past medical history (95 vs 68%, P=0.0001), and drug history (94 vs 69%, P=0.0009). Operative rates were higher for the optometric direct referrals relative to GP referrals (87 vs 69%, P=0.0284). There was no difference in the visual acuity before or after surgery between the pathways. CONCLUSIONS: Optometric direct cataract referrals provide better information on objectively measured vision and better delivery of preoperative counselling. Traditional GP referrals contain better medical history, drug information, and details of personal circumstances. Rates of surgery were slightly higher with optometric referrals.     

The role of the technician in optometric practice.

Members of the Indiana Optometric Association were asked to rate each of the duties which Indiana University optometric technician students are currently taught to perform. Rated on a four point scale from most desirable to undesirable, the duties deemed most important by respondents were those having to do with the dispensing of glasses and contact lenses as well as the usual receptionist and secretarial duties. The duties receiving the lowest ratings were keratometry and tonometry. However, there is good general agreement between the school and the profession concerning the content of the optometric technician program.     

The importance of multiple treatment modalities in a case of divergence excess

Divergence excess strabismus is a fairly common anomaly of binocular vision, characterized by constant or intermittent exotropia at distance, absence of significant amblyopia, and normal stereopsis at near. Optometric vision therapy is often effective in treating this condition. In contrast to the emphasis orthoptists (under ophthalmologic supervision) place upon pathological diplopia awareness, optometric vision therapy emphasizes development of sensory fusion and proprioceptive cues to eye alignment. A case is presented in which pathological diplopia awareness and surgery were needed to produce a functional cure after the patient failed to achieve consistent eye alignment using the regimen commonly advocated by optometrists.     

ALDEN HAFFNER SPEAKS OUT ON OPTOMETRY

This is one of a series of interviews conducted by the Australian Journal of Optometry with some of the world's leaders in optometric education and research. Here Dr. Alden N. Haffner from the Optometric Centre of New York speaks with the Journal on the future of optometry and some of the problems facing optometry both today and in the near future,     

Content development of the Optometric Patient Anxiety Scale.

PURPOSE: Patient anxiety has been shown to be detrimental to many aspects of healthcare outcomes. To date, there is no method of evaluating anxiety in optometric practice. Therefore, the purpose of this study was the content development of a questionnaire to measure optometric patient anxiety. Such a tool will have both clinical and research application; allowing the identification of anxious patients in practice and as a method to establish the success of anxiety reducing interventions. METHODS: Selection of initial items was based on patient interviews, literature review, and focus group feedback. The initial 30-item Optometric Patient Anxiety Scale was piloted on 148 patients in optometric practice. Rasch analysis was used to analyze response category operation and to facilitate item removal to ensure a valid and unidimensional scale. Test-retest reliability (test-retest time, 2 weeks) was measured on 59 young adults to test the stability of the measure with time. RESULTS: Rasch analysis identified disordering of category thresholds and underutilization of the end-response category. Therefore, categories were merged to a three response solution. Item reduction was principally driven by infit and outfit statistics. The items in the final 10-item scale all had good infit and outfit values (infit: 0.80-1.20, outfit: 0.7-1.3), good person separation (>2) and high person and item reliability coefficients, 0.84 and 0.88, respectively. Test-retest reliability also demonstrated good stability of the measure with time (intraclass correlation; ICC = 0.85). CONCLUSIONS: The Optometric Patient Anxiety Scale is the first questionnaire to measure patient anxiety specific to optometric practice. The scale was developed using Rasch analysis to ensure that all the items work together to form a valid unidimensional interval scale.     

Optometry in nursing homes.

Studies predict a 50 percent increase in residential long-term care need by the year 2000. Statistics show that the age group served by these facilities is at a much higher risk for sight threatening eye conditions. A review of the current literature as well as original data collected in Ohio indicates that residents in long-term care facilities are underserved with regard to eye care. This paper discusses the need for increased optometric participation in the primary eye care services for residents of long-term care facilities.     

A current analysis of optometric residency programs

Optometric residency programs were introduced into the profession in the 1970's and have proliferated markedly since that time. The philosophy of residency programs in general is included as well as a summary of currently offered residencies in optometry. Additional information including areas of program emphasis, the "typical" residency program and compensation levels are provided. An assessment of the advantages for the continuance of current programs and future expansion of optometric residency opportunities is discussed.     

Geriatric educational programs

Information on the geriatric patient is needed in the curricula of all health professional programs. During the 1988 Academy Meeting a Symposium on the Graying of America: Optometric Considerations, was held. The following paper will: (1) summarize a recent survey of geriatric education in the United States schools and colleges of optometry, (2) describe two continuing education projects on gerontology conducted for practicing optometrists, and (3) discuss two recently completed projects involving the training of optometric faculty.     

The frequency of dilated diabetic eye examinations by optometrists in the state of ohio.

PURPOSE: The purpose of this study was to assess optometric care of diabetic patients. The American Optometric Association recommends dilated eye examinations at least once a year for people with diabetes. METHODS: Onsite chart reviews of 1497 diabetic patient charts were performed at a volunteer sample of Ohio-based optometric practices (n = 82). Four percent of all optometrists in the state of Ohio were surveyed. Data were collected from a 10-year period and included doctor age, membership in the Ohio Optometric Association (OOA) Diabetes Initiative, patient age, date of examinations, chief complaints, and dilation at examination. The primary outcome of the study was the frequency of dilated eye examination for diabetic patients by optometrists. RESULTS: Optometrists dilated 85.8% of diabetic patients at their last comprehensive examination. The percentage of diabetic patients dilated by optometrists increased from 40.0% in 1994 to 91.5% in 2003. The average time since last comprehensive eye examination for diabetic patients was 1.0 +/- 1.8 (mean +/- standard deviation) years. Diabetic patients who were dilated at a comprehensive eye examination returned to care on average 0.7 years sooner than those who were not dilated. Doctor-level factors related to a higher average percentage of dilations were younger doctor age (beta = -6.1%/10 years of doctor age; 95% confidence interval [CI], -10.1 to -2.1) and membership in the OOA Diabetes Initiative (beta = 11.6%; 95% CI, 2.3 to 20.8). CONCLUSIONS: There is variability in diabetic eye care by optometrists. However, the majority of optometrists surveyed in this study provided dilated eye examinations for their diabetic patients. Programs desiring to increase compliance to diabetic standard of care guidelines may benefit by targeting both doctors and patients.     

WORLD OPTOMETRY

The International Optometric and Optical League (IOOL) sent out a questionnaire to contacts in countries across the world in order to formulate an "Optometry Profile" on as many countries as possible. The information from the 58 replies is summarized. The very varied distribution of optometric services that is revealed is discussed in the light of experience gained by the author in his own visits and correspondence relating to the worldwide situation of optometry.     

Evaluation of motivating factors for selecting optometric residency education.

There are now more than 50 accredited optometric residency programs. We sought to learn the primary motivating factors for selecting residency education beyond the traditional 4-year professional program. Questionnaires addressing this issue were sent in May 1990 to directors of all Council on Optometric Education (COE)-accredited residency programs for distribution to currently participating residents. Of the 81 existing residency positions, 61 questionnaires (75 percent) were returned. Three residents (5 percent) accepted positions in residency programs because they had no definite practice plans following graduation. One resident (2 percent) could not take state board examinations and elected to enter a residency program until licensure could be obtained. Fifty-three (85 percent) selected residency education to enhance their clinical skills, and five residents (8 percent) cited other reasons, such as to prepare for a career in optometric education, to enhance long-term career objectives, and to mature. For 50 (83 percent) of the respondents, residency education was their first choice following graduation from optometry school. We conclude that optometric residency education is highly valued as a source of enrichment of clinical skills.     

Geriatric optometry questionnaire.

A national survey of American Optometric Association Low Vision Section members was conducted by the newly formed Geriatrics and Low Vision Committee during the fall of 1989. The "Geriatric Optometry Questionnaire" was designed to establish a greater understanding of the nature of comprehensive professional services for the unique needs of visually impaired older persons. Of the 481 surveys mailed, 289 were returned for a response rate of 60 percent. Seventy-eight percent of the respondents had completed their formal optometric education after 1970. Results indicated that geriatric optometric care is predominantly delivered in private practices and in low vision agencies. Approximately 69 percent of the patients are above the age of 65, with the majority of those being under 85. Although the average initial low vision appointment lasts 60-90 minutes, this generally represents the low vision examination and evaluation of low vision devices only. Complete ocular health assessments combined with low vision evaluations are provided by only 33.5 percent. While 80 percent of the optometrists responding take psychosocial histories, only 60 percent routinely refer patients for social services and rehabilitative training. Similarly, 57 percent of those responding referred patients for independent daily living skills instruction and only 53 percent for orientation and mobility training. These data suggest that optometrists have not yet completely incorporated the multidisciplinary approach to geriatric health care and that continuing education in this area is needed.