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  1. #1
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    Opticianry and Optometry

    May I ask why an optometrist needs to understand lens design? Do you work with opticians? Have you made the wrong career choice?

    I suspect if I wanted to learn ophthalmoscopy from an optometry forum you'd have issues? Sorry if it sounds jaded, it isn't meant to. I'm trying to understand how a clinician, trained in diagnosis of eye health disease has the desire to work with spectacle lenses.

    I do believe the Canadians have it right - optometry is about medical care, whereas opticianry is about dispensing prescriptions. Go Canucks!

    What do you think?


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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by MarySue View Post
    May I ask why an optometrist needs to understand lens design? Do you work with opticians? Have you made the wrong career choice?

    I suspect if I wanted to learn ophthalmoscopy from an optometry forum you'd have issues? Sorry if it sounds jaded, it isn't meant to. I'm trying to understand how a clinician, trained in diagnosis of eye health disease has the desire to work with spectacle lenses.

    I do believe the Canadians have it right - optometry is about medical care, whereas opticianry is about dispensing prescriptions. Go Canucks!

    What do you think?

    I imagine that the practice of optometry, in a wholistic fashion, demands a working knowledge of ophthalmic optics, eyewear fabrication and ophthalmic dispensing.

    my 2 cents.

    Barry

    PS - Mary, I find your posts *always* informative and illuminating

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    Master OptiBoarder Darryl Meister's Avatar
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    I'm trying to understand how a clinician, trained in diagnosis of eye health disease has the desire to work with spectacle lenses.
    Keep in mind that writing a spectacle prescription requires at least a basic undestanding of ophthalmic optics. In a perfect world, where every optician has been trained extensively in ophthalmic optics, lenses, and dispensing, independent optometry might be less reluctant to completely entrust opticians with their patients after the exam.

    But, as it stands at the now, optometrists in the US undergo considerably more training in ophthalmic optics and dispensing than the majority of practicing opticians due to lack of education standards and requirements. Besides, clinicians in most branches of healthcare are generally "taught the basics," whether or not these are later entrusted to a nurse or technician.

    Remember that OptiBoard is a forum for eyecare professionals of all ilk, not just opticians.
    Darryl J. Meister, ABOM

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    Quote Originally Posted by Darryl Meister View Post

    Remember that OptiBoard is a forum for eyecare professionals of all ilk, not just opticians.
    I stand corrected Darryl. Right as per your usual --- I think you might see from my response to Barry, the whole thing is a personal frustration, and shouldn't be aired online :)

    Thanks to both you and Barry for pulling my head in!
    Cheers

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    Master OptiBoarder Darryl Meister's Avatar
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    MarySue, I completely understand your frustrations. Just keep in mind that they're not optometry's fault, at least not in the US. ;)
    Darryl J. Meister, ABOM

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by Darryl Meister View Post
    MarySue, I completely understand your frustrations. Just keep in mind that they're not optometry's fault, at least not in the US. ;)


    Darryl, this is the first thing I've read of yours that I disagree with. Name me one local, state or national optometric society that promotes encourages or helps support licensure in non-licensed states. I know many OD's that support it personally, but their organizations do not. They fight it.

    I'm also the first one to say that opticians have put themselves in their position. Many enter the field because it is relatively easy to get into. Many more enter it only until they "get a real" job. The apathy of opticians is pathetic. But what put them in their apathetic state? It's the constant David vs Goliath state of mind that has set in from consistantly getting shot down. I'll echo what I hear from seasoned opticians in my state and others. "Why try? We don't have the money or political clout to fight". Why do we have to "fight" for licensure?

    The only way opticianry will rise to a professional level is with manditory education and licensure. But how many opticians actively standup for this? I can tell you that in my state, very, very few do...

    The sad fact is that when licensure comes, it will be because a few dedicated people work for it. And then those people will be more despised by their states fellow "opticians" (re: frame stylists) than by the other two "O's" because they will be forced to actually learn and demonstrate their competence to stay in the field.



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    Quote Originally Posted by Barry Santini View Post
    I imagine that the practice of optometry, in a wholistic fashion, demands a working knowledge of ophthalmic optics, eyewear fabrication and ophthalmic dispensing.

    my 2 cents.

    Barry

    PS - Mary, I find your posts *always* informative and illuminating
    Thanks Barry - I hope I've hidden my frustration at the lack of cooperation between professions (optometry and opticianry). Unfortunately, I've had first hand experience of optometry wanting to utilise the training and experience of a qualified d.o., but not wanting to support their advancement in any field. It feels a bit ... "servant know thy place" at times.

    My own training allows contact lens fitting and refraction training -which I believe makes me a better dispenser. I have never seen an optometrist lose his or her job because of my additional training.

    My real question I guess - is when will we opticians standardise our training world wide?

    :) Cheeky eh? Your posts are great - btw - hardly ever comment because you leave nothing unsaid. :cheers:

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    Master OptiBoarder Striderswife's Avatar
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    Quote Originally Posted by MarySue View Post
    May I ask why an optometrist needs to understand lens design? Do you work with opticians? Have you made the wrong career choice?
    I know I'm a little late to join this thread, but I just came across it, and had a view to share. It may be simple and may sound naive, but I think it fits.

    I've always kind of thought of myself as a pharmacist for vision correction. Just the same as you go to your physician to diagnose you, then he gives you a prescription, and you take it to the pharmacist who fills it. I worked in a pharmacy for a year in college (the only thing I've ever done besides opticianry), and for the most part, the pharmacist knows more about the drugs he provides than the doctor. The doctor definately needs to know the ins and outs of the medications he prescribes, but with new drugs coming out all the time, they mostly get this from reps that stop by to drop off pens and pads of paper and other trinkets. If I have a question about a medication, I call my pharmacist first.

    In the same light, ODs and MDs will need to know how the patient is expected to see out of the correction, but it's up to the optician to communicate with the patient to help decide the style of lens (Prog? FT?) and other aspects of their eyewear that are optional. We all have to work together. I depend on the doctors to write me an accurate prescription that's going to work. The doctors depend on me to fill the prescription in such a way that the patient achieves their best correction. The patient just wants to see clearly (and might as well look great, too).
    It's nice to be important, but it's more important to be nice.

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    Master OptiBoarder optical24/7's Avatar
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    We have a unique situation in Texas. Arguably, we are the closest state to getting mandatory licensure next. We have voluntary registration in the state. We got that out of a compromise 10 years ago after an interim study done by the state showed the importance of educating and registering opticianry tasks. We went from a high of almost 3000 (most thought this would lead to Licensure, thus the large number) opticians registered to little more than 300 today. It is clear that voluntary registration does not accomplish the intended goal of insuring competence in the field.

    We also have other unique things going on here. Lens duplication, CL fittings and refraction ability with MD write off. I know many opticians that fit CL’s out of their location, referred by an MD that doesn’t want to fool with them. Many of these same opticians are allowed to re-refract for fitting reasons or trouble-shooting patients that are non-adapting to the MD’s Rx. All perfectly legal here. Unlike the case in Missouri, why would any profession wish to legislate itself out of the opportunity to expand scope or take away abilities already practiced?

    Barry is quite right. Even the states that have licensure today don’t agree enough to have reciprocity between themselves. We are a long way from having anything meaningful or united on a national basis.

    So, we states are left to fend for ourselves. We must take a page from Optometry…Educate, then legislate. And to be honest with you, I have nothing personal to gain from licensure. In fact, a seasoned and educated optician has an edge in non-licensed states. I can point to my credentials and point out my expertise to clients, and ask if they have seen the same elsewhere. With the mediocrity of opticianry out there today, it’s tough not to stand out.

    I am thankful for this meaningful and respectful discussion.

  10. #10
    Master OptiBoarder Darryl Meister's Avatar
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    CL fittings and refraction ability with MD write off. I know many opticians that fit CL’s out of their location, referred by an MD that doesn’t want to fool with them. Many of these same opticians are allowed to re-refract for fitting reasons or trouble-shooting patients that are non-adapting to the MD’s Rx...All perfectly legal here.
    The presence or lack of a license for opticians does not preclude anyone from continuing to work under the supervision of a licensed ophthalmologist. Even in your example with Texas, opticians are not legally permitted to sign off on the final contact lens fitting specifications, themselves. Otherwise, this would represent prescribing contact lenses.

    Unlike the case in Missouri, why would any profession wish to legislate itself out of the opportunity to expand scope or take away abilities already practiced?
    Removing a contact lens fitting provision from such a bill would not be changing the status quo one way or the other. If opticians could fit contact lenses under the supervision of another professional in the first place, which they often can, this would continue to be the case had such a bill been enacted. It is not limiting the scope of opticianry, it is just not expanding it to include independently prescribing contact lenses.

    Optometry became licensed professionals with a limited scope of practice first. Then, eventually, and only after establishing a significiant base of specially trained optometrists, optometrists fought successfully to expand their scope of practice. They did not start demanding concessions such as DPA and TPA right out of the gate.
    Darryl J. Meister, ABOM

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by Darryl Meister View Post
    .....
    Optometry became licensed professionals with a limited scope of practice first. Then, eventually, and only after establishing a significiant base of specially trained optometrists, optometrists fought successfully to expand their scope of practice. They did not start demanding concessions such as DPA and TPA right out of the gate.

    I agree with you Darryl. We're not looking to expand scope with our bill. Simply amending our volunary bill to mandatory. Sounds simple, right? Since you've been there, I won't get into the resistance to change that goes into all politics, concessions are expected. We can't step backwards on what we already can do.

    When politicians and the public are told that opticians are not licensed in your state, or require even a high school education...That only a pulse is required to call yourself an optician, their mouths drop. Most think opticianry is a degreed position.

    I've done some informal polling, and opticians make the vast majority of lens design reccommendations for their patients. Also measure, order and verify final product, fit and confirm patient satisfaction with the result. Is it not common sense that a person with this responsibilty have accountable training, certification, and licensure? ( I know, in here, I'm preachin' to the choir..)

    And Harry, you'd be surprised by what big chain would like to see licensure, and reciprocity between states. I even attended a recent CE class that a walmart employee was taking. Their district manager is encouraging all personel to get an ABOC. So there are at least 2 chains promoting education.

    Licensure will come. But, unfortunately, there will be a fight...On such a common sense issue...

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by optical24/7 View Post
    And Harry, you'd be surprised by what big chain would like to see licensure, and reciprocity between states. I even attended a recent CE class that a walmart employee was taking. Their district manager is encouraging all personel to get an ABOC. So there are at least 2 chains promoting education.
    No I wouldn't be suprised, they're not looking for more licensed states they are looking for reciprocity and the ability to move their people across state lines to fill voids. I heard it from the horses mouth so it comes as no suprise to me.

    If I was to ever believe these corporations I would have to say what has stopped them in their fight for licensure? They have squashed every bill introduced in every non-licensed state for decades now, they have bankrupted legislative coffers across the country. What are they waiting for?

    They want the ability to move their licensed professionals around the country, reciprocity. The current state of licensure doesn't allow that, and certain states are much stricter in their licensing than others. These corporations want the LCD the lowest common denominator, they would want the ABO as the licensing standard. I don't know enough about the ABO organization like their bylaws, their current staff, directors, and officers to put faith in them holding the keys to the promise land.
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    What do physicians, pharmacists, nurses, lawyers... have that we don't ?
    Just think about it...
    Licenses only ? Really ?

    I live in a province (Quebec) in Canada with quite strong laws regarding opticians, full-time 3 years program, reserved title, reserved acts and so on, but we are treated about at the same level than those in unlicensed US states, why ?

    Some hints :

    1-Standardized education (QC opticians have it)

    2-High and respected level of education (QC opticians have it)

    3-Known by the public. Nobody would ever think of dealing with someone that falsly pretend to be one. It should be EVIDENT and OBVIOUS to see a ***** about their ***** and NO ONE ELSE. (QC opticians DON'T have it)

    4-What these professionnals are offering is considered as IMPORTANT (QC opticians DON'T have it)

    That was just some suggestions...

    So points 1 and 2 are useless without points 3 and 4.
    QC opticians are a good exemple of this.

    So education is just the first step. It worths NOTHING without recognition.
    Even with all the licenses you can dream about.

    What did opticians do to promote their own profession ?

    We are just living the consequences of many decades of laziness, at almost all levels.
    We took the easy way, so we are now easily replacable.
    Who else are to blame ?
    The other O's just took the place we let them take.

    We are simply 40 years too late, imho

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    Master OptiBoarder Darryl Meister's Avatar
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    Oddly enough, Optometry has the most to gain by pushing opticianry licensure, in my opinion. After all, it places minimal burden on optometrists, financial or otherwise, since their dispensers would operate under their own optometry license in most cases.

    Independent opticians and chain retail locations, on the other hand, would need to employ a sufficient number of licensed opticians, who generally command a higher salary compared to unlicensed opticians, which will impact overhead -- and, consequently, net profit -- at these businesses.

    I don't know that anyone has ever actually posed such an argument to optometrists, however. At least I've never seen opticians express licensure, myself, in terms that would actually appeal to optometrists.
    Darryl J. Meister, ABOM

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    It's only my opinion, but any physician must have a general understanding of the chemical make up of prescription medications and how they interact with the body, in order to accurately prescribe medicine to solve a medical problem. In the same way, Optometrists ought to have at least a working knowledge of how various prescription lens designs, materials and treatment technologies work, in order to PRESCRIBE the proper solution for the eye conditions that they diagnose. It's only my opinion...
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    Quote Originally Posted by Darryl Meister View Post
    Removing a contact lens fitting provision from such a bill would not be changing the status quo one way or the other. If opticians could fit contact lenses under the supervision of another professional in the first place, which they often can, this would continue to be the case had such a bill been enacted. It is not limiting the scope of opticianry, it is just not expanding it to include independently prescribing contact lenses.

    Optometry became licensed professionals with a limited scope of practice first. Then, eventually, and only after establishing a significiant base of specially trained optometrists, optometrists fought successfully to expand their scope of practice. They did not start demanding concessions such as DPA and TPA right out of the gate.
    I still think the problems lie within opticianry. You have two sides on this debate, imho. First the die hards who insist on all or nothing (your experience it appears was controlled by this first group.) The others who say, "don't rock the boat, at least we're working.)

    In NZ, we approached the optometry association asking for their advice and assistance on applying for an increase in scopes of practice. We were met with polite replies and positive nods from most, however the outcome wasn't didn't match the response from the optometry association's board.

    To sum up our position: we hoped to be able to 'refract under supervision' - no contact fitting, and no prescribing. The benefit would be to the rural areas where one day visits often see an optometrist faced with 100 people waiting to be seen.

    In eight years time, approximately 8 graduates were estimated.

    With the Durban Declaration announcing:

    • 153 million people in the world have impaired distance vision because of Uncorrected Refractive Error;
    • Many millions more people over the age of 45 years have impaired near vision (presbyopia) due to Uncorrected Refractive Error;
    • Persons with blindness and vision impairment are entitled to the same basic human rights as are enshrined in all national and international standards, declarations and conventions;
    • Uncorrected Refractive Error drives children and adults further into poverty by limiting their opportunities to education, employment, and seriously impacts their quality of life and productivity;
    • The link between poverty and visual impairment due to Uncorrected Refractive Error places a heavy economic burden on individuals, their families and communities;
    • The paucity of services, personnel, training institutions, affordable glasses especially in the developing countries are the main contributing factors to Uncorrected Refractive Error.
    The course on refraction we wanted to us was already being taught by a reputible institution to dispensing opticians in Asia. We even wrote to the World Council for Optometry, and they reviewed our proposal. We again had asked for their input to help create a workable collegiate environment between opticianry and optometry, offering our country as a trial run, so to speak. We thought our timing was right.

    We were wrong.

    .

    Our country has 180 Dispensing Opticians, over 600 optometrists, and yet - we still failed in our attempt to work together and create something valuable.

    I have the utmost respect for optometry, and their right to fight for what they believe is beneficial to the public. But, what will it take for opticians to realise that we need standards of care which are consistent: state to state, country to country?

    If anyone has any ideas - I'd love to hear about "what we should do" not "why it won't work"

    :cheers:
    Last edited by MarySue; 12-30-2009 at 01:22 AM.

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    A great thread....

    I wish I could add something. But I can't. Politics almost always leads people to wonder why they even bothered. I wish you luck, although here in the U.S. I think Opticianry has some much more basic things to be concerned about. I can tell you're driven in your field. Don't let it drive you nuts! Remember what my old football coach said- "all anyone can ever ask is that you do your best". I hope your best is appreciated by the professionals you work alongside. :)
    Last edited by FVCCHRIS; 01-02-2010 at 10:28 PM.
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    ATO Member HarryChiling's Avatar
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    If I may add there is also major divides in many areas of our profession. Educated/Certified/Uneducated, even among different schools; licensed/unlicensed states; old opticians/ new opticians; I could go on. Their is only retail chains as opposition now, they are stronger as a group and at this point I don't see optometry as opposition because they really don't need to be why would they waste one iota of energy on a group that has been legislatively stagnant for decades. At this point the profession needs support in my opinion. Education is a pipe dream since no school will offer a program without people to fill classes and no people will fill classes since you can get into the field without an education. Classic chicken and egg conundrum.
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