The Journal of the Association of Schools and Colleges of Optometry I

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Association of Schools and Colleges of Optometry The Association of Schools and Colleges of Optometry (ASCO) represents the professional programs of optometric education in the United States. ASCO is a non-profit, tax-exempt professional educational association with national headquarters in Rockville, MD.

ASCO Affiliate Members BOARD OF DIRECTORS Dr. Jack Gresset, Director / xeciitii'c ConiHiillcc University of Montreal — Optometry Montreal, Quebec H3C 3J7 President Secretary-'! rea.su ror Leland W . Carr, O.D. Larry J. Davis, O.D. Dr. William Bobier, Director I.V.in IV.ll'l University of Waterloo — Optometry I'diifii-l'niwr-iiy Lniw-rsiiy ni Missouri a I si. Louis Waterloo, Ontario, Canada N2L 3G1 College of Opluiivtiy College of Oplnmi'liA Inrest Grove. Oregon °7I Id SI. Louk MisM.uri (v^l2I-4J'-"-) Dr. Stephen Miller, Exec. Dir. College of Optometrists in President-Meet Immediate Past-President fix Officio) Vision Development George I.. Foster, O.D. 'David S. Loshin, O.D., Ph.D. St. Louis, Missouri 63141 Dean DlMtl \0rll1e.1Mem sink- L'nixer-ilv Nova Soullie.i-.lern l.nixersiiv Mr. Robert Williams, Exec. Dir. College of OplomelTi Health IVore-sion-Mix i-ion Optometric Extension Program I'.ilileuuali. Oklahoma 714(4 I'M .liulerdale. I'lmida Foundation Santa Ana, California 92705-5510 Ixeiulixe Director •Vl-I arge Member Martin A. Wall, C.A.L'. Dr. John Townsend, Director Hector Santiago, O.D., Ph.D., VA Optometry Service De.ui Veterans Health Administration Inter Amencm L nixor-ilv nf Puerto Kiio Fort Howard, Maryland 21052 Sihool nr Oplonielrx H.iln Kex. Puerto KiailHwii Dr. Jairo H. Garcia, Dean Universidad de la Salle BOARD MEMBERS Facultad de Optometria Bogota, Colombia Kevin L. Alexander, O.D., I'h.D.. Dean Thomas L. Lewis, O.D., Ph.D. Michigan (..ollege of Oplomeln President Al l-i.-iri~Sl.ili- L'nixer-ilx IVnn-x l\ »inic-" College ol I >ploinelr\ liig Rapids. MIL his-.^n N"iii7-27".s l-.lkin-. I'.irk. I'cniisvk.ini.i l"M27 I^JS

'Ami R. Augsburger, O.D., M.S. Gerald F. LmvLher, O.D., Ph.D., Dean Editorial Review Board I resilient IiiLli.111.1 L'nixvr^ilv Illinois I. ollege of Oplmiieliy Vhiiul nl Oplomelrv Editor: Lester E. Janoff, O.D., M.S.Ed. (. hicago. Illinois nlMn Dlooininglon. Indiana 474i!l ASCOTECH Coeditors: lohn I-. Amos, O.D., Dean Melvin Shipp, O.D., Dr. P.M. Dominick M. Maino, O.D., M.Ed. I ni\ersil\ nl AI.1L1.1nu1 .il I3inningh.ini (effective IIIIIL' I, 2HH4) Geoffrey W. Goodfellow, O.D. 1 School nl Optometry I'liL- C)|iin Stall l.niiersilv Communications Editor: College nt Oplomelrx Birmingham. \I.il\imj TO'M-lKUd Ellen Richter Ettinger, O.D., M.S. Columbus. Ohio 432IH-I24I) 'William F. Cochran, O.D., President Diane T. Adamczyk, O.D. Nmtlioni College iif Oplnmetrv Farl L. Smith III, O.D., Ph.D., Dean John Baker, O.D., M.S.Ed. Memphis. Tennessee .IS1114 Iniversilv nf I louslon Etty Bitton, O.D., M.Sc. College of Oplomelrv Nancy B. Carlson, O.D. ' A. Norman I laifner, O.D., Ph.D., I l.iu-liin. lexas 772H4-2H2H N. Scott Gorman, O.D., M.S., Ed.D. President Charles Haine, O.D., M.S. SL \Y. Stile College nl Opliimi'lrx -I esley L. Walls, O.D., M.D., President Nada J. Lingel, O.D., M.S. \eu York. Now York lllMII) Southern California LuMene nf Richard E. Meetz, O.D., M.S. Oplomelrv Jeffrey Nyman, O.D. Dennis M. l.exi, O.D., Ph.D., Dean I'ulk'iUiii. l'jlil'nrni.i«2h'l| Doug Periisten, O.D., Ph.D. l.-niviTsily (.f C.ililnrnia .it Berkeley David Perrigin, O.D. School nf Uplnmelrv Hector Santiago, Ph.D., O.D. 1 Berkeley. I'.ililumi.i >472H 2lU(> Paulette P. Schmidt, O.D., M.S. Julie A. Schornack, O.D., M.Ed. Alan I., lewis, O.D., Ph.D., President Leo P. Semes, O.D. I In- New Lngkiiul (. ullego nf Oplomeln Marlee M. Spafford, O.D., M.Sc, Ph.D. Boston. Massachusetts 021 |i Mark Swan, O.D., M.Ed. Wayne Verdon, O.D., Ph.D. Tim Wingert, O.D.

66 Optometric Education [•]j[«7iTiiaiNU EDUCATION ISSN 0098-6917

VOL 29 SPRING/ NO. 3 SUMMER CONTENTS 2004 The Journal of the Association of Schools and Colleges of Optometry

Optometric Education in the Himalayan Introduction to the International Kingdom of Nepal Optometric Education Issue Sandra Wang-Harris, O.D., F.A.A.O. Dennis Bassett With plans underway to place optometrists at the Bausch & Lomb, Inc. 74 district level in established Ministry of Health district hospitals, optometry in Nepal will play Optometric Education in the a major role in the implementation of Era of Globalization WHO'S Vision 2020. 90 Anthony F. Di Stefano, O.D., M.P.H., F.A.A.O. The author describes the wide variability in the scope Unification of Optometry in India of optometry practice and education worldwide and Satya B. Verma, O.D., F.A.A.O. the role of the World Council of Optometry (WCO) A "new beginning" has been generated by the joint in developing new strategies to address improving symposium sponsored by the Indian Optometric optometric education worldwide, especially Association and the World Council of Optometry within developing and emerging societies. and promises to provide a strategic foundation to positively impact the future of optometry in India. The Emergence of University Optometric 94 Education in Ghana Educators in Latin America John W. Randall, O.D., M.P.H. Unite Optometry David B. Kumah, B.Sc, P.G.Dip.Optom. Janet L. Leasher, O.D., M.P.H. The authors provide a historical context for the Optometric Education is characterized by significant evolution of optometry and optometric education variability across borders, reflecting the diversity in in Ghana and examine the possibilities for the legal, professional and scope of practice status of future development. 80 optometry in the region. The formation of Asociacion Latinamerica de Escuelas y Facultades de Optometria North American Center for Visual addresses a growing commitment to harmonization, Health and Development Offers reource-sharing and program development, and Training Courses for Educators innovation among countries in Latin America. 97 Janet L. Leasher, O.D., M.P.H. 85 The Development of Standards for Optometric Practitioners in Japan DEPARTMENTS R. Norman Bailey, O.D., M.B.A., M.P.H., F.A.A.O. Mitsuhisa Hayashi, O.D. Guest Editorial Recent renewed efforts of refracting opticians have led Global Perspectives on the Development of toward the implementation of a self-certification Optometric Education system and the development of common Anthony F. Di Stefano, O.D., M.P.H., standards for the delivery of vision care in ^* MT F.A.A.O. 68 Japan. 0 %# Industry News 73 Resource Reviews 100

OPTOMETRIC EDUCATION is published hv the Association of Schools and C 'ul legos of Optometry f AM/O). Managing Editor: I'dlriciii Cue O'Rourke. Art Director: C'.irol N'.uisol. N%hlh.nvk (..ommunic.ilions. Husinoss ,ind edite-ri.il offices .ire Incited .il MIO Fxeculivo lioulov.ird. Suite 510, Rockvillo, Ml") 2i)S32 1.301) l>l-5\>44. I he ASCO website is wivw.nptod.iirg Subscriptions: JOE is published three limes .1 ve.ir distributed .it no ch.irt;e to dues-p.ivinj; members of ASC'O. Individual subscriptions .ire .iv.iil.iblo .it sot UK I per year. S40.00 per war In foreign subscribers. Postage p.iid lor a non-profit. l.i\-e\empl organization .it Rockvillo. MD. Copyright •• 2004 bv The Association of Shook and Colleges of Oplomelrv. Advertising Mies .ire Liv.iil.ible upon rec|uest. ( UTOMr.TKK.' FT)UCATIO\ disclaims re-poiisihilitv lor opinions expressed by ihe authors. Indexed in Curreiil Index lo Journals in .'".duwilionUTxIC. ). EDITORA Global Perspectives on the Development of Optometric Education

Anthony F. Di Stefano, O.D., M.P.H., F.A.A.O.

ptometry's growth in North meaningful change in professional devel­ In Nepal, a Bachelor of Optometry America over the last 100 years opment and legal recognition. Program has been established within the has been driven by the increas­ Education provides the power of Tribhuvan University Institute of Medicine, ing needs of the public for qual­ knowledge and skill; education allows which trains optometrists alongside post­ Oity, cost-effective, and accessible eye and practitioners to be more responsive to pub­ graduate ophthalmology residents. It serves vision care. Underpinning optometry's lic health needs; education confers strate­ as an example of an interdisciplinary initia­ expanding scope of practice and its respon­ gic leverage for change; education rewards tive that is grounded in respect and cooper­ siveness to society's need for ophthalmic the individual with personal and profes­ ation between optometry and ophthalmolo­ services and products has been the contin­ sional satisfaction; education enables an gy and that promotes community-based uous and dramatic improvement in opto­ expansion in the economic base of prac­ strategies to address the severe access prob­ metric education. tice; and education grants political credi­ lems in Nepal. Notwithstanding the significant bility to grow as a profession. India, a country with no legal recogni­ improvements in access to vision and eye This issue of Optometric Education pre­ tion of Optometry, has severe variability in care in the United States, Healthy People sents a global perspective on the develop­ optometric education. The article highlights 2010 recently underscored the gaps and ment of optometric education. It features the recent formation of the Indian disparities that still exist in our own soci­ articles that underscore the significant vari­ Association of Schools and Colleges of ety. Nevertheless, the challenges in the ability in optometric education and the Optometry (IASCO) as a crucial step in har­ United States are dwarfed by the stagger­ challenges that this poses to a harmonized monizing optometric education in India ing dimensions of the disparities interna­ global model for optometric training. prior to legislative efforts for the legal tionally. The World Health Organization The lead article places the evolution of recognition of optometry. Lastly, an (WHO) recently concluded that inade­ optometric education within the context of overview of optometric education in Latin quate and unfairly distributed resources globalization and the emerging external America is presented. Our regional neigh­ worldwide threaten to potentially double forces, which will impact such issues as bor to the South, Latin America is poised the prevalence of blindness by 2020. international standards for accreditation, for significant improvements in optometric These disparities are compounded when assessment and pedagogy. The article intro­ education. Notwithstanding the significant "blindness" is defined in terms of a hand­ duces the World Council of Optometry variability in educational levels from coun­ icapping visual condition, such as uncor­ (WCO) and its fellowship program as an try to country, the recent formation of the rected refractive error or low vision, example of new strategies designed to Latin American Association of Optometric which preclude effective functioning in strengthen and expand optometric educa­ Education and Faculty (ALDEFO) promises the community. The resultant loss of pro­ tion infrastructure worldwide. It also pre­ to be an historical step in the advancement ductivity in both developed and develop­ sents the European region as an example of of optometric education in this region. ing countries is immeasurable. WHO's the significant diversity in educational lev­ We are grateful to Bausch & Lomb for VISION 2020 campaign is aimed at els, even within a developed region. Each its invaluable support of this special issue attacking these challenges globally and of the following articles is authored by a on international optometric education. This eliminating avoidable blindness by the WCO Fellow with firsthand insight into the issue of Optometric Education is designed year 2020. challenges and opportunities facing each to not only inform the reader, but more Given the disparities in resources country or region. importantly to serve as a call to North between developed and developing coun­ Ghana is presented as an example of a American optometrists and optometric tries, it is not surprising that optometric developing country that recently evolved educators to support the growth of optome­ education lags far behind in many coun­ through a four-year Bachelor of Science try internationally. Our shared values and tries. Global disparities in access to vision Program to a six-year Doctor of Optometry commitment to improving vision and eye and eye care are usually accompanied by Program offered at both the University of care globally demands a greater commit­ disparities in optometric education. the Cape Coast and the Kwame Nkrumah ment to strengthening optometric educa­ Certainly, the growth of the profession of University of Science and Technology. tion worldwide. optometry in these underserved countries Japan is profiled as an example of a devel­ is a function of the social, political and oped country in which optometry is not economic context in which it functions. legally recognized and in which the practi­ However, the one lesson that optometry tioners have taken the initiative to institute Dr. Di Stefano is executive director of the World has consistently learned worldwide, with an optometric "self-certification" system to Council of Optometry. He is also vice president and very few exceptions, is that advance­ standardize educational, experience and dean for academic affairs at the Pennsylvania ments in education must precede any competency levels. College of Optometry.

68 Optometric Education The Highest Level of Oxygen Trcmsmissibiiity Available in a Silicone Hydrogel Lens1

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REFERENCED NOTES: 1 Data on file. CiBA Vision. 2 Hsrvitt D, Bonanno j. Re-evaluation of trie oxygen diffusion model for predicting minimum contact lenrDI/t values needed to avoid cornea! anoxia Optometry and Vision Science. 1999; 76(10).712-719. 3 Keay L, etal. Bacterial Populations on 30-night Extended Wear Si! icone Hydrogel Lenses.-CtAO Journal 2001; 27(1): 30- 34. 4 Schafer J, Barr J, Mack C. A characterization of dryness symptoms with silicone hydrogel contact lenses Optometry and Vision Science 2003; 80(12S):T8?;- SDillehay S, Long B, et al. Patient experience and management in HDIc silicone hydrogel soft contact lenses Optometry and Vision Science 2003; 80(12S) 186

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John J. Crazier, O.D.# F.A.A.O.* 1926-2004

ptometry lost A" (Kensington and Allegheny Avenues, a notorious one of its finest neighborhood intersection). recently when Most memorials document the many accomplish­ Dr. John J. ments of the deceased, but I will leave that to other OCrozier passed away. memorial writers, of whom there will undoubtedly be John wasn't just a great many. For me the accomplishment of greatest signifi­ optometrist or a respect­ cance was the rock-solid advice he often provided to so ed optometric educator. many of us. After I left PCO in 1978,1 usually only saw Most importantly, he was John at national meetings or PCO alumni functions. I a fine human being. He could always count on a wide smile, a hearty greeting was kind, he was gentle, and sincere inquiry about my wife, my family and the and he devoted his life to progress of my career. He always made me feel like a his profession and the member of his family. college he so faithfully And so we say goodbye to "Dr. John." His passing served. leaves an empty space that will be impossible to fill. Although we were both born and raised in Philadelphia and our paths probably crossed many Lester E. Janoff, O.D., M.S., Ed. times, I didn't get to know John until I accepted a posi­ Editor tion at the Pennsylvania College of Optometry in the mid 1960's. We both attended the same high school although I was a few years behind him. We both graduated from PCO although, again, he graduated some years before *Dr. Crozier was emeritus vice president and dean for stu­ me. I also started practicing in the Kensington section of dent affairs at the Pennsylvania College of Optometry. In Philadelphia where John practiced. We had a lot in com­ 1974 he was a consultant to the Association of Schools and mon and during my time at PCO we often reminisced Colleges of Optometry and established ASCO's first office in about the good old days at Northeast High and "K and Washington, D.C.

Faculty Fast Forward Bookmark these sections of ASCO's Web site to access quick information!

...... "The newsletter, Eye on Education http://www.opted.org/newsletternew • Back issues of the journal, Optometric Education http://www.opted.org/teampublish/main/69_433_1398.cfm • The Faculty JobMart http://www.opted.org/facultyJobmart.cfm • The Faculty Directory http://www.opted.org/faculty/index.asp • Special Interest Groups http://www.opted.org/about_sigs.cfm • Meetings http://www.opted.org/meetings_main.cfm

70 Optometric Education Keeping the Promise

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If these articles don't sound familiar, you haven't been reading Optometric Education, ASCO's peer- review publication, published three times/year in the fall, winter and spring/summer. Future issues will explore: the role of self-assessment in optometric education, the implementation of Web CT, a comparison of learning styles, a curriculum comparison of U.S. schools. Don't miss this opportunity to be informed!

Foreign subscriptions - $40.00 Association of Schools/Colleges of Optometry Domestic subscriptions - $30.00 6110 Executive Blvd., #510 Checks payable in U.S. dollars drawn on a U.S. bank Rockville, MD 20852 USA (Please print) Name Title/Position

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been in a private group practice in refund consumers' purchase price if ASCO Corporate Wyoming since 1977 and has been they're not satisfied with the contact Contributors* active in the American Optometric lenses. The move is part of a two- Association, most recently serving as pronged effort by the company to Visionaries ($100,000+) president. The new director of acad­ attract new wearers of contact lenses Vistakon®, Division of Johnson & emic affairs is Dr. Cristina M. while reducing the number of con­ Johnson Vision Care, Inc. Schnider. Dr. Schnider has 20 years sumers who drop out of the CL mar­ experience in optometry including ketplace. Last year 3.3 million new Patrons ($50,000-$99,999) clinical practice, clinical and didactic consumers began wearing CLs, CIBA Vision Corporation/ teaching, academic and industry according to Andrea Saia, president Novartis Ophthalmics research management. She will fill of CIBA Vision's global lens busi­ the position left vacant by the death ness, but another 2.6 million people Benefactors ($30,000 - $49,999) of Dr. George Mertz. Dr. Derrick L. became "dropouts." The total uni­ Artis has joined the Professional verse of CL wearers in 2004 was 34.3 Supporters ($15,000 - $29,999) Affairs Division as director, profes­ million, Saia noted. Hoya Vision Care, North America sional affairs. He will be responsible The money-back Platinum AO.Sola for managing Vistakon's Guarantee is part of a stepped-up Essilor Lenses/Varilux Professional Affairs Speaker Bureau marketing program for Ciba's con­ Transitions Optical, Inc. and other programs developed for tact lens line in 2004. The company Alcon Laboratories practicing Eye Care Professionals. is increasing its investment in direct- to-consumer advertising by more Friends ($5,001 - $14,999) Vistakon Opens Vision Care than 60 percent this year after a sim­ Bausch & Lomb, Inc. Institute ilar 60 % increase last year over 2002 Advanced Medical Optics (AMO) Vistakon, Division of Johnson & according to Jeff Cohen, vice presi­ Volk Optical, Inc. Johnson Vision Care, Inc., introduced dent, North America marketing. The Vision Care Institute to enhance Contributors ($5,000) the technical training of students and Hoya Agreement Will Facilitate Carl Zeiss Optical /Carl Zeiss practitioners and to serve as a Direct Ordering Meditec, Inc. resource for the most current infor­ Hoya Vision Care and VisionWeb Coopervision mation in the field of vision care. have entered into an agreement to Marchon Eyewear "The mission of The Vision Care allow direct ordering of Rx- and Safilo Group Institute is to help prepare students ophthalmic-lens products through Santen, Inc. for their careers as ECPs," according Vision Web's electronic ordering plat­ Spectacle Lens Group to Howard B. Purcell, O.D., director form. Under their agreement, ECPs of the institute. "Putting partici­ will be able to order their prescrip­ The companies are listed within each pants in real world scenarios and tion lenses electronically from any of category in order of their total contribu­ guiding them through the technical the 16 Hoya laboratories, transmit­ tions. When companies contribute the same amounts, they are listed alphabeti­ and communication skills process ting Rx orders directly to Hoya via cally. ASCO Corporate Contributors sup­ will benefit the new ECP as well as www.visionweb.com Hoya also port national programs and activities their patients." announced an e-commerce partner­ benefiting the schools and colleges of In its first year, The Vision Care ship with Eyefinity, the optical optometry. For more information on the Institute will work in tandem with industry's most widely used Internet program, contact [email protected] optometry schools and colleges to portal to market Hoya's lens prod­ give fourth year students hands-on, ucts and to develop an integrated patient-focused experiences using laboratory Rx ordering program for Vistakon Welcomes the latest professional products, Hoya customers. Under the agree­ New Professional Affairs Team with a focus on Acuvue Brand ment, Hoya's advanced lens materi­ As Vistakon's Dr. Stan Yamane Contact Lenses. als, coatings and progressive lenses retired in April after twelve years as will be featured on eBuy, Eyefinity's online order center. vice president of professional rela­ CIBA Expands 2004 Marketing tions, he introduced "The Next Program "This agreement represents a Generation" of Vistakon leadership. Ciba Vision, the eyecare unit of great step forward in ease, speed Dr. J. Patrick Cummings was chosen Novartis, has so much confidence in and accuracy for the eye care practi­ as the new vice president of profes­ its Night & Day silicone-hydrogel tioners ordering Hoya lenses," said sional affairs. Dr. Cummings has contact lenses it is now offering to (Continued on page 89)

Volume 29, Number 3 I Spring/Summer 2004 73 BAUSCH &LOMB

Bausch & Lomb is proud to sponsor this issue of ASCO's journal on inter­ national optometric education. Celebrating its 150th anniversary in 2003, Bausch & Lomb employs approximately 11,500 people worldwide and its products are available in more than 100 countries, making Bausch and Lomb one of the best-known and most respected healthcare brands in the world. Its focus is clearly stated in its mission, "Perfecting Vision, Enhancing Life."

As a company with a strong global presence, Bausch & Lomb has fostered numerous international projects. Most recently the company donated a million dollar gift and became the first corporate patron of Vision 2020/the Right to Sight - a global effort to eradicate avoidable and treat­ able blindness by the year 2020.

Bausch & Lomb also recently launched its Visionaries Recognition Program to identify and honor individual eye care professionals - or 'Visionaries' - whose life's work has been committed to perfecting vision and enhancing life. These 'Visionaries' will be individuals who have demonstrated excellence and innovation in clinical care or research, schol­ arship, leadership in advancing eye care, and participation in volunteer or philanthropic activities that enhance life. The nominations have closed and the winners will be announced in June 2004.

In addition, Bausch & Lomb has long supported the International Contact Lens Educators, an association dedicated to raising the standard of con­ tact lens education and promoting the safe use of contact lenses world­ wide.

Bausch & Lomb is also pleased to support a number of ASCO's programs, including its Corporate Contributors Program and the annual meeting of its clinic directors/administrators' special interest group.

We salute Dr. Tony DiStefano for his coordination of this special issue of Optometric Education that expands our horizons to the needs and chal­ lenges of the wider world.

Dennis Bassett Professional Relations and Business Development Bausch & Lomb, Inc. Services.8 The communique asked for consultation on how our "internation­ al professional services associa­ tion" (WCO) viewed the applicability of the WTO Disciplines on Domestic Regulation in the Accountancy Sector to the profession of optometry. Similar letters were sent to global associations representing medicine, dentistry, nursing and other health professions. Globalization has now gone beyond the information technology, account­ Optometric Education in ing and construction sectors; global­ ization is knocking at the door of the The Era of Globalization health professions.2-3-4 But how does a young profession with significant variability in legal Anthony F. Di Stefano, O.D., M.P.H. recognition, educational levels and scope of practice respond to the chal­ lenge of global standards? Can curric­ ula be harmonized across countries and regions? Are there national or regional models that can serve to stimulate global convergence? Will accreditation, certification and assess­ ment systems that function within an individual country be transportable to the international level? What will be the roles of national, regional and world optometric bodies Introduction in responding to these challenges? Abstract lobalization is permeating Over the past ten years, the World The growth of optometric educa­ every aspect of the com­ Council of Optometry has anticipated tion worldwide is increasingly plex economic, social and the global trends in optometry and influenced by external forces such political fabric that covers the significant challenges that they as the World Trade Organization Gthe planet. The global marketplace is will pose for the harmonization of (WTO) and its General Agreement witnessing a transformation of histor­ optometric practice and education. on Trade in Services (GATS). The ical proportions. Advances in infor­ Notwithstanding the variability in subsequent demand for a harmo­ mation technology, mass marketing, scope of practice among states and nized approach to setting, monitor­ capital flow across borders, interna­ provinces in North America, our ing and evaluating international tional mobility of labor, have all set region has relatively uniform stan­ educational standards will chal­ the stage for the "globalization of the dards of education and clinical prac­ lenge the profession. The wide vari­ professions."1 tice. As will be quite evident in the ability in the scope of practice and The increasing international trade following articles, other regions are education across countries and in education and training has been characterized by significant variabili­ regions will call for coordinated fueled by bilateral and multilateral ty. The European Region, which is leadership to address future chal­ agreements among countries. Such presented in this article as an example lenges and opportunities. The agreements have been dwarfed by the of this variability, is also an excellent World Council of Optometry emergence of the World Trade example of regional strategies (WCO) has developed several Organization (WTO) and its General designed to harmonize optometric strategies to address the growing Agreement on Trade in Services education and practice. need for the improvement in opto­ (GATS), which have increasingly metric education, especially within necessitated the development of com­ developing and emerging societies. mon educational standards and the European Optometry and mutual recognition of professionals to Optometric Education KeyWords: Globalization, practice their discipline. The state of optometric education education, accreditation, compe­ These dynamics present both chal­ worldwide is in a dynamic state of tency-based education, and the lenges and opportunities for optome­ change. Each region has its own histo­ World Council of Optometry try and its educational and training ry and variability. The European programs. The immediacy of global­ Council of Optometry and Optics ization impacting optometry was (ECOO), the longest standing region­ underscored in December 2002 when al optometric body, has published Dr. Di Stefano is executive director of the World the World Council of Optometry extensive national comparisons, Council of Optometry. He is also vice president and dean for academic affairs at the Pennsylvania (WCO) received a formal inquiry which underscore this variability. College of Optometry. from the WTO Director of Trade in ECOO is the confederation of the

Volume 29, Number 3 / Spring/Summer 2004 75 leading professional bodies represent­ Significant changes are currently technical school after high school. Such ing optometrists and opticians in occurring in the scope of optometric courses can last from two to three twenty-three countries of Europe. practice in Europe. For example, the years and include a period of appren­ According to ECOO, the term 1999 Crown Report on the Review of ticeship with an optical firm.10 "optometrist" refers to those profes­ Prescribing, Supply and Administration of Significant changes in the European sionals who examine patients' eyes Medicines in the United Kingdom will Union over the past several years have and sell corrective spectacles; and the provide an increasing range of health provided external pressures for the term "optician" refers to those who professions, including optometrists, greater harmonization in higher edu­ make and sell spectacles only. with therapeutic prescribing privi­ cation across Europe. These forces Opticians, who examine patients' eyes leges.7 More recently, both the included: (1) the creation of the and perform refraction, are increasing­ Netherlands and Norway were grant­ European Credit Transfer System ly known either as optometrists or ed legal authority to utilize diagnostic (ECTS) by the European Commission sometimes optician-optometrists.5 pharmaceutical agents.8,9 to compare student workload across Consequently, the professions of Given the variability in the legal sta­ countries; (2) the call of the Sorbonne optometry and optics are intertwined tus and scope of optometric practice in Declaration of 1998 for a common in Europe. They are legally practiced Europe, it is not surprising that there is architecture such as the Anglo-Saxon in all European countries except the significant variability in the levels of BA, MA and PhD paradigm as a poten­ Czech Republic, Greece, and Slovenia. optometric education. According to tial tool for increasing commonality; Seven countries have legal recognition ECOO, European optometrists are and (3) the stimulus of the Bologna for "optician-optometrists"; seven trained increasingly at universities and Declaration of 1999 for the conver­ countries have legal recognition of institutes of an equivalent level. Such gence of a "European space of higher "optometrists"; and in five countries, courses generally last three or four education" in order to facilitate the optometrists have "de-facto" recogni­ years. This is the case in Finland, movement of students across borders." tion. This latter category refers to France, Germany, Ireland, Italy, the These catalysts for European har­ countries in which the law is silent, or Netherlands, Norway, Portugal, Spain, monization in education contributed is unclear on the matter, or is not Sweden and the United Kingdom to the development of the European applied consistently, for example in (Table 1). In other countries, Diploma in Optometry. The forces for France and Italy.6 optometrists are typically trained at a European standardization of optomet­ ric education and training had begun. The European Diploma is managed by Table 1 Training of optometrists and opticians in Europe ECOO. Its goal is to provide a stan­ dardized assessment of knowledge I •.aMWIilMIJMIAWIBWlW •.fflMBMMI JM^mMW IIB-MfflBBI and skills necessary for the practice of Austria optometry in Europe. The diploma X • • examination consists of three parts: Belgium A, • • 1. Visual perception and optical tech­ Site Croatia • • nology s§; Czech Republic • • 2. Management of visual problems A Denmark • 3. General health and ocular abnor­ mality X Finland • Successful candidates for the V* France • • European Diploma must pass a written Germany • • • multiple-choice question examination Greece • and a practical (patient care) examina­ *i* Hungary • • tion of all three parts. Completion of X Ireland • • the written portion of the examination Italy is a prerequisite for sitting for the cor­ A • • responding patient care examination.12 A Luxembourg • The successful implementation of the A Netherlands European Diploma will play an impor­ (opticians) • (optometrists) tant role in harmonizing optometric Norway ilfe • • education, and eventually, the scope of Poland • • • practice in Europe. X Portugal • If: Slovenia • World Council of Optometry Spain X- • Initiatives X Sweden • r~~i Switzerland The World Council of Optometry has long recognized that the contin­ United Kingdom (optometrists) • " ued professional development of Key to Symbols: optometry worldwide will depend on = European Union = Furopean Economic Area the improvement and harmonization of international optometric education. = FU Applicants = Other The variability in European optomet­ ric education is mirrored in most of

Optometric Education the other regions. Approximately 15 tion and provides a platform for pro­ WCO is governed by a 21-person years ago, the International moting legislation that achieves this Governing Board, which is organized Optometric and Optical League concept. to provide equal representation from (IOOL) — now the World Council of Today, the World Council of six international regions: Asia Pacific, Optometry (WCO) — recognized the Optometry is the voice of optometry Africa, Europe, Latin America, Middle need to establish a clear and concise worldwide. Its mission is to "facilitate East/Mediterranean, and North concept of optometry as the founda­ the enhancement and development of America. Figure 1, World Council of tion for the harmonization of the pro­ eye and vision care worldwide. It is Optometry International Regions, dis­ fession worldwide. the worldwide organization for the plays the geographic distribution of the In 1992 the IOOL organized the professionals working in the field of regions. The WCO is comprised of 53 Paris "Think Tank." Optometric lead­ optometry, their associations and associate /country members (voting) ers from around the world met to institutions."15 Its objectives are: and 25 affiliate members (non-voting). develop a common concept of optome­ 1. To plan strategically to achieve the The Education Committee of the try that would unify the organization's enhancement and development of WCO is entrusted with the responsibil­ purpose worldwide.13 The following primary eye and vision care by ity of advancing optometric education concept of optometry was formally optometrists worldwide. worldwide. Over several decades, adopted at the 1993 General Delegates 2. To promote high standards of edu­ WCO has provided direct and indirect Meeting of the IOOL in Venice Italy: cation and practice by optometrists support to developing programs. Optometry is a healthcare profession worldwide. Currently, WCO utilizes two principle that is autonomous, educated, and regulat­ 3. To unite and coordinate optometry strategies in improve optometric edu­ ed (licensed/registered), and optometrists worldwide. cation: (1) international conferences on are the primary healthcare practitioners of 4. To generally support aid programs optometric education; and (2) the WCO the eye and visual system who provide com­ directed at the provision of eye and Fellowship Program. prehensive eye and vision care, which vision care to societies in need. The WCO has sponsored a series of includes refraction and dispensing, detec­ 5. To cooperate with any other orga­ World Conferences on Optometric tion! diagnosis and management of disease nization concerned with the pro­ Education (WCOE). On a periodic basis, in the eye, and the rehabilitation of condi­ motion and development of prima­ these conferences bring educators from tions of the visual system.14 ry eye and vision care or the around the world together to share This concept now forms the founda­ prevention of blindness. recent advancements and address tion for describing optometry's role 6. To promote the advancement of the future needs in optometric education. and responsibilities in patient care. It science of optometry for the benefit The first WCOE conference was forms the basis for optometric educa­ of mankind. held in Houston, Texas, in 1990. This

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Volume 29, Number 3 / Spring/Summer 2004 77 inaugural meeting served as a template 1. Specific programs of didactic or Africa, Ghana, Mali, Brazil, Bahamas, for future meetings. Faculty interac­ clinical education for which an Vanuatu, Poland, Ecuador, Colombia tion, sharing of experiences and needs, optometric educator travels to a and Lebanon. The Fellowship and developing inter-institutional net­ country in need. Program plays a pivotal role in link­ works are essential ingredients of the 2. Educational administration and ing the advancement of educational conferences. The second session of the faculty and curricular develop­ programs with building the capacity WCOE was held in Hong Kong in 1993, ment. of the host country to support a prac­ and the third session was in Cologne, 3. Optometric community service titioner base to meet the public health Germany, in 1998. designed to bring necessary care to needs of the country. In February 2002, the fourth session needy populations while building More recently, the WCO, in associa­ of the WCOE was held in Atlanta, local self-sufficiency. tion with the Association of Georgia. The conference was hosted by 4. Instructional technology and Regulatory Boards of Optometry SECO International and provided par­ information systems designed to (ARBO) appointed a joint Committee ticipants an opportunity to take advan­ foster the sharing of optometric to develop an internationally accept­ tage of the SECO continuing education knowledge using new electronic able, global competency-based model programs after the completion of the systems such as the Internet, of optometry. Such a model would WCOE conference. That year, almost telemedicine, teleconferencing, etc. build on the WCO Concept of 250 educators from 41 countries attend­ Optometry and allow objective com­ ed the conference. Over 50 presenta­ parisons of optometric scope of prac­ tions and posters were presented. The tice between states and countries. This main themes included cooperative pro­ Global Competency-Based Model of Scope grams, faculty development, educa­ of Practice in Optometry will provide a tional technology, and curriculum rational framework for addressing the development. The presentations were challenges of increased practitioner complemented with discussion groups mobility across international borders. and hands-on clinical workshops. The The Committee will present its final session concluded with recommenda­ Today, the World Council report and recommendations at the tions for follow-up action and future of Optometry is the voice June 2004 World Congress on conferences. Optometric Globalization (WCOG) in Each of these four WCOE sessions of optometry worldwide. Orlando, Florida. has played a very important role in Its mission is to strengthening new optometric educa­ tional programs by creating a unique "facilitate the enhancement Future Directions opportunity for colleagues to interact, The future of optometric education network, and share knowledge and and development of globally will be determined by how resources. The next WCOE is sched­ eye and vision care well the profession positions itself for uled for Milan, Italy, in May 2006. the global forces impacting all sectors The second key educational strate­ worldwide. It is the of the optometric enterprise. gy of the WCO is the WCO Fellowship Optometric education, regulation, Program. The program was launched worldwide organization standards for products and services, in 2000 and is designed to foster an for the professionals and the industry itself are inextricably exchange of knowledge and expertise, interwoven. Progressive change will and to encourage international part­ working in the field of depend on how well these individual nerships of all kinds in the furtherance components fit together into an inte­ of the WCO mission. As a result, the optometry, their associations grated whole. The June 2004 Orlando program provides a basis for establish­ and institutions." World Congress on Optometric ing lasting ties among individuals, Globalization will provide a common institutions, and organizations that are stage for exploring these interrela­ committed to improving vision and tionships. It will be an environmental eye care globally. scan of the profession in the era of Fellowships are granted to candi­ globalization. It will help to frame the dates with a commitment to service in questions and the strategies for the both the public and private sectors, continued growth of optometric edu­ specifically in optometric education, 5. Professional development that cation and practice. Some of the key patient care and community service, addresses the need to build organi­ questions to be addressed include: and organizational development. zational, scholarly and institutional 1. Will international quality assur­ Fellowships are open to educators, stu­ capacity. ance standards be established to dents, practitioners and organizational The placement of WCO Fellows is take into account both the diversity leaders. The fellowship program aims based on the needs of the host coun­ of educational levels presently to work deliberately to build human try and the special expertise of the existing, and the need for attain­ networks that are dedicated to the Fellow. Each fellowship requires a able quality improvement strate­ vision and eye care needs of the world. pre-approved program plan with spe­ gies? WCO fellowships can range from one cific action plan and program evalua­ 2. Will a universal system for educa­ month to two years in duration. tion strategies. To date, Fellows have tional equivalency be established Examples include a fellowship in: been placed in India, Nepal, South in order to facilitate comparisons

78 Optometric Education among programs and ensure pub­ educational programs will be formida­ lenn.doc. Accessed 1 December 2003. lic health safety when practitioners ble challenges for world optometry. 2 Shanley DB, Dowling Pa, Claffey N, Nattestad A. European convergence towards move across borders? The World Council of Optometry, in higher standards in dental education: the 3. Is there a need for a world system cooperation with national, regional DentEd Thematic Network Project. Medical for optometric accreditation that and international strategic partners, Education 2002; 36:186-192. integrates the disparate systems must continue its efforts to respond to 3 Hays R. International Accreditation of med­ these challenges. The WCO Fellowship ical schools. Medical Education 2003; 37:662. and policies that exist between 4 Van Niekerk JP. WFME Global Standards countries and regions? Program is just one example of target­ receive ringing endorsement. Medical 4. What is the relationship between ed initiatives aimed at improving Education 2003; 37:585-586. institutional and program accredi­ optometric education and organiza­ 5 European Council of Optometry and Optics tation, and individual competence tional capacity especially in develop­ (ECOO). London: The profession of optome­ try and optics. Available at www.europ- assessments as required by some ing and emerging societies. This spe­ tom.com. Accessed 8 January 2004. licensing and registration boards cial issue of Optometric Education 6 European Council of Optometry and Optics (quality assurance versus compe­ highlights some of WCO's early fel­ (ECOO). London: Structure and regulatory tence assurance)? Are both needed lowship projects. Their impact will status of optometric and optical profession. Available at www.europtom.com. Accessed 9 to ensure public health safety? ultimately be measured by how well January 2004. 5. Will we bridge the disparity gap they contribute to sustainable changes 7 United Kingdom Department of Health. between developed and develop­ in each host country and institution. Review of Prescribing, Supply and ing optometric educational pro­ Lastly, the future of international Administration of Medicines (Final Crown grams through effective strategies optometric education offers exciting Report). London, United Kingdom: 1999. 8 Besluit van 4 juli 2000, opleidingseisen of resource sharing? and challenging opportunities. The en deskundigheidsgebied optometrist. 6. Will the increasing growth of many strategic questions raised by Staatsblad van het Koninkrijk der transnational educational providers globalization forces external to the Nederlanden 2000, 297. (Section 34 of the be a catalyst for educational profession will demand continued Individual Health Care Professions Act and by a number of Orders of Council. Section 5 improvement and capacity- coordinated leadership at all levels of of Order in Council 297 of July 4, 2000; an building within emerging the profession. Act regulating education and scope of prac­ countries with new optometric tice optometrist.) educational initiatives? 9 Norway Department of Health. Letter from 7. How can information technology Acknowledgements Bjorg Storesund of the Department of Health authorizing the use of diagnostic drugs by and new strategies such as tele- A great tribute needs to be paid to optometrists. Oslo, Norway: May 1,2004. health, distance learning and the the many individuals who guided and 10 European Council of Optometry and Optics Internet be used to address the maintained the WCO organization (ECOO). London: Training of optometrists resource disparities in internation­ during its developmental years; to the and opticians. Available at www.europ- al optometric education, while still unselfish leaders and advisors who tom.com. Accessed 16 January 2004. 11 Barblan A. International Quality Assurance. assuring the quality of education? brought creativity and perseverance Council for Higher Education Accreditation 8. How can we improve the quality of through the growth years; and to those (CHEA). Keynote speech at the CHEA 2001 optometric education in develop­ visionaries who saw the future and Annual Conference, New Orleans, LA., ing countries and not increase the laid the foundation for the new World January 23, 2001. CHEA, Washington DC, USA. risk of "brain drain"? Council of Optometry. A special 12 European Council of Optometry and Optics Coordinated leadership at interna­ thanks to Dr. Lester Janoff, editor of (ECOO). London: ECOO European Diploma tional, regional and country levels will Optometric Education, and Ms. Pat in Optometry. Available at www.europ- be necessary to address these ques­ O'Rourke, ASCO Director of tom.com. Accessed 14 December 2003. Communications, who saw the value 13 Report of the Paris "Think Tank." London: tions effectively. There will be no sim­ International Optometric and Optical ple solutions, only opportunities for of this special issue and provided the League, November 1992; 43. sustained growth and improvement. guidance and support that were neces­ 14 General Delegates Meeting. London: sary for its completion. Special thanks International Optometric and Optical also to Bausch & Lomb, which provid­ League, 1993, Venice Italy. Summary 15 Constitution of the World Council of ed a generous grant to sponsor this Optometry. Elkins Park, Pennsylvania: World The increasing need for quality eye special issue; to HOYA Corporation for Council of Optometry, April 1997. and vision care worldwide creates an its continuous support of the HOYA historic opportunity for the profession VISION 2020 Fellowship Program; and of optometry to continue its growth to the Kanai Fellowship Fund, which Footnote and responsiveness to community has helped to fund fellowships such as a Personal communication to the World needs. The improvement of optomet­ those reported in this special journal Council of Optometry from Abdel-Hamid ric education will be the foundation Mamdouh, Director of Trade in Services, issue. World Trade Organization. Geneva, for this continuous growth. Over the Switzerland. December 9,2002. next decades, external forces such as References the World Trade Organization and the General Agreement on Trade in 1 Peace Lenn M. Higher Education and the global marketplace: a practical guide to sus­ Services will hasten the demand for a taining quality. Center for Quality Assurance harmonized approach to setting, mon­ in International Education. UNESCO Global itoring and evaluating international Forum on Education Presentations: educational standards. Internationalization and Globalization. February 25, 2002. Available at www. The wide disparity in educational unesco.org / education/ studyingabroad / resources and the wide variability in highlights/ global_forum/ presentations/

Volume 29, Number 3 I Spring/Summer 2004 79 several other cars to come directly to my window to beg. His adult rel­ ative followed, gripping his shoul­ der. I could tell by the in-turned eyelashes that the cause of the man's blindness was probably trachoma. Neither one of them really looked at me while asking for money. I paid little attention at first but then gave the standard greeting. 'How are you?'The boy raised his face to gaze The Emergence of at me and responded the standard T am fine, thank you.' I extended my University Optometric right hand across my body, out the window, and motioned. The boy helped the man to reach and shake Education in Ghana. my hand. The man lifted his head and looked at me with scarred, John W. Randall, O.D., M.P.H. sightless eyes. I fumbled for a few coins and gave them to him with as David B. Kumah, B.Sc, P.G.Dip.Optom. much respect as I could in the hot street. The light turned and we sped off through the traffic to our desti­ nation. How I wished his blindness could have been prevented and the boy could be in school.

Socioeconomic and Cultural Context for Optometric Introduction Education and Practice Abstract hana is one of the few University-based optometric countries in Africa with Uni­ There are over 700 million people education began at Kwame versity-based Optometry in Sub-Saharan Africa. Those coun­ Nkrumah University of Science and education and a significant tries with the greatest number of Technology in Ghana in 1991. In Gnumber of optometric practitioners. optometrists are South Africa with order to meet the VISION 2020 But the eye care needs of the populace over 2,000 practitioners, Nigeria with goals of eliminating avoidable dwarf the ability to train professionals about 1,000 practitioners, and blindness in a developing nation and deliver eye care even now. Ghana­ Tanzania with over 300 practitioners. such as Ghana, optometric educa­ Ghana is next with over 50 practicing ian optometrists are making great 1 tion and practice must be improved efforts and the profession is poised to optometrists. Other Sub-Saharan and increased. make great improvements in the quan­ African countries have fewer than ten A second optometry school at the tity and quality of training of optometrists each. University of Cape Coast was estab­ optometrists and eye care practice by Ghana became the first indepen­ lished in 2002. Training has evolved the year 2020. The following experi­ dent African country in 1957. It is sim­ from a two-year Postgraduate ence introduced Dr. Randall to the state ilar to the State of Oregon in size. The Diploma in Optometry to a four- of eye care in Ghana as he arrived to land varies from coastal plains in the year Bachelor of Science in begin his fellowship: south to tropical rain forest to semi- Optometry to a six-year Doctor of arid savannah in the north. There are In early 2001, I pulled up to the Optometry degree. Improvements over twenty different languages and traffic light in Accra, the capitol in curricula, equipment, and faculty an equally large number of tribal city of Ghana. Several people have been made. groups. Christian, Muslim, and tradi­ approached cars to sell food and Further improvements are tional Animist beliefs are all common. other items, wash windows, or beg. needed in facilities, faculty, equip­ The two largest cities are Accra, the The young boy spotted my nice car ment, teaching materials, and clin­ capitol with over two million people and skin color quickly and ignored ical training. Ghanaian optometric and Kumasi, the seat of the Asante educational institutions are poised throne and culture with over one mil­ to greatly advance the quantity Dr. Randall is an assistant professor at Pacific lion people. and quality of eye care for the peo­ University College of Optometry and served as ple of Ghana and West Africa. World Council of Optometry Fellow at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana from 2001 to Public Health Context Key Words: VISION 2020, Pre­ 2003. Mr. Kumah is a lecturer in the The population of Ghana is over 20 vention of Blindness, Refractive Department of Optometry and Vision Science at Kwame Nkrumah University of Science and million and may be over 25 million by Error and Low Vision, Eye Care 2 Workforce Technology and a private practitioner in the year 2020 . Good statistics on the optometry in Kumasi, Ghana. causes of blindness and visual impair-

80 Optometric Education ment are lacking. Cataract is believed Most health care professionals are in 1990 before the establishment of the to be the leading cause of blindness. concentrated in Accra and a few other optometry program at Kwame Uncorrected refractive error is common cities. Smaller towns, cities, and rural Nkrumah University of Science and and there is little awareness of low areas often have little or no eye care Technology (KNUST). There is no law vision rehabilitation.3 Trachoma is en­ personnel. University-based training is regulating the practice of optometry demic to some areas of the country and available in medicine, nursing, den­ so that scope of practice varies widely. efforts to eradicate it are being made by tistry, pharmacy, public health, med­ public health agencies and non-govern­ ical technology, and optometry. mental organizations (NGOs). Specialty training is available in several Evolution of Optometry and River blindness has been greatly disciplines including ophthalmology. Optometric Education in reduced due to the Onchocerciasis Table I summarizes the number of Ghana — Historical Context Control Project and similar efforts but providers of eye and vision care. still remains a problem in some areas4. There are 46 ophthalmologists in Many of the eye care personnel who 6 were in Ghana before independence Glaucoma is often advanced when dis­ Ghana . About two residents com­ soon left. There were very few foreign covered. There is little awareness of eye plete training each year. There are also trained native or expatriate optometrists safety to prevent ocular trauma and approximately 200 ophthalmic nurs­ 7 in the 1980's . Francis K. Morny, a British impairment. There are few facilities es.6 Twenty to thirty are trained year­ trained optometrist and orthoptist, able to manufacture glasses from a doc­ ly. The number of ophthalmologists started Premier College of Optometry tor's prescription. An eye examination and ophthalmic nurses has been fairly in 1990. It was a one-year private course may only cost three dollars but glasses static due primarily to emigration. of study. Many lecturers came from will cost from $20 to $150. Per capita There are 52 optometrists.1 This has 5 the then University of Science and income is approximately $300 per year. slowly increased from fewer than ten Technology in Kumasi (UST). Dr. Morny was instrumental in the start of the Optometry Program in the Department of Physics at UST in 1991. Table I. Year 2002 Ghana Eye Care Workforce A two-year Postgraduate Diploma in Optometry (P.G.Dip.) was offered. Vision Aid Overseas, a British optomet­ Provider Type Ratio to Population Number ric NGO, assisted by providing equip­ ment, used spectacles, books, journals, Ophthalmologist 46 1:434,783 and by organizing outreaches/eye camps with faculty, students, and visit­ Optometrist 52 1:384,615 ing expatriate optometrists. Rotary Club International assisted by provid­ Ophthalmic Nurse 200 1:100,000 ing a rninivan, used spectacles, and by sponsoring outreaches/eye camps. Note: Population estimated at 20 million people.2 WorldVision International provided books, equipment, used spectacles, and sponsored outreaches/eye camps. The Table II. Mode of Practice, KNUST Graduates1 Voluntary Services Overseas of the British Council provided books and sponsored volunteer Isabel J. Brown to Mode of Practice Number of Graduates lecture from 1993 to 19958. Government, Military, or Mission Hospital 16 Applicants to the Diploma program KNUST faculty, Ghana Education Service, and were required to hold a science or nurs­ 8 ing Bachelors degree. The course Optical Technicians Faculty, Graduate Students required 72 semester hours for gradua­ Private Practice 17 tion. The program is designed to prepare graduates to perform basic Out of country 4 optometric practice including com­ prehensive eye examination, refraction, ocular disease recognition and referral, 1 and limited ocular disease treatment Table III. Practice location, KNUST Graduates required for the public's health. To date there have been 45 graduates of this pro­ Practice Location Number of Graduates gram. The last P.G.Dip. students will Accra Area 20 graduate in 2004. The diploma will not be offered after that time. Nearly all the Kumasi 8 past graduates are still in the country and practicing optometry because the Other Regional Centers 10 P.G.Dip. is not recognized in most other Rural 3 countries. Twenty-four graduates work in some educational or public health Out of Country 4 capacity (Table II). Most of these

Volume 29, Number 3 / Spring/Summer 2004 81 optometrists also maintain some part- ophthalmology and optometry clinics mologists, and two B.Sc.Optom. gradu­ time private practice also.1 Twenty-eight at Komfo Anokye Teaching Hospital. ate assistants on staff. Efforts are being graduates practice in the metropolitan All students attend several (4-8) out­ made to require B. Sc. graduates to per­ areas of Accra and Kumasi, ten gradu­ reach clinics per year at schools, clinics, form one year of internship or national ates practice in other regional centers, hospitals, missions, and other commu­ service in a government or mission and only three practice in rural locations nity sites. Most outreach clinics last hospital. (Table IE).1 from one to three days. Typically 100 to KNUST hopes to start a two-year Optometric education is provided in 200 patients are seen each day. With the O.D. program by 2006, which would government universities. KNUST is the greatly increased numbers of optome­ establish greater harmonization of second largest university in Ghana try students, opportunities for clinical degrees and education between the with about 13,000 students. KNUST experience need to increase. two Ghanaian optometry programs. also offers programs in medicine, phar­ The University of Cape Coast (UCC) Applicants will be required to have an macy, community health, and medical admitted five students to a new, six- appropriate Bachelors (optometry or technology. Students are admitted year combined B.Sc. in Vision vision science) degree and possible directly from high school into these Science/Doctor of Optometry course in internship. This course requires 75 programs. Education in health care 2002. UCC is the third largest govern­ semester hours for graduation. The B. professions varies from four to six ment supported university. Optometry Sc.Optom. degree at KNUST is con­ years in duration. The government is the first health care professional pro­ sidered sufficient minimum prepara­ pays most students' tuition. The stu­ gram offered by the University. All stu­ tion for general optometric practice. dent must pay for books, equipment, dents in this program are expected to Admission to the O.D. program may fees, room and board. A small number complete the full six years for the O.D. not be offered to all Bachelor's gradu­ of Ghanaian students with lower degree. ates. It is intended that O.D. gradu­ grades or test scores are admitted but UCC students receive a B.Sc. in ates will be prepared for careers as must pay tuition. There are small num­ Vision Science at four years but are not future optometric faculty, researchers, bers of foreign students from other prepared for clinical practice yet. administrators, and low vision, con­ African countries. These students must Almost all clinical instruction and prac­ tact lens, vision therapy, and ocular pay tuition. University graduates are tice will be conducted in the last two disease consultants. required to perform a year of National postgraduate years. The entire curricu­ Service. Efforts are being made to lum totals 205 semester hours (130 require optometry graduates to per­ undergraduate, 75 postgraduate). It Projected Impact on form this service in government or mis­ includes vision science, comprehensive Eye Care Needs sion hospitals as an internship. eye examination, refraction, ocular dis­ Optometric workforce goals of In 2001 KNUST admitted the first ease diagnosis and treatment, low VISION 2020 -The Right to Sight at students to the new four-year B. S. in vision, contact lens, and vision therapy. country, region, and international lev­ Optometry degree program. The first Almost all needed books, equipment, els vary from one optometrist per class will graduate in 2005 with 18 pos­ facilities, faculty, and clinical arrange­ 125,000 to one optometrist per 50,000 sible graduates. The subsequent class­ ments remain to be developed. The first people.9 Present workforce needs for es are projected to be 39 in 2006 and 34 optometrists joined the faculty in 2003. Ghana are projected to be 160 to 400 in 2007. optometrists. If the population increas­ The Bachelor's degree includes basic es to 26 million, workforce needs will science instruction and didactic and Future Development be 208 to 520 optometrists (Table IV). clinical optometry instruction. The pro­ Faculty development has been a The future number of optometrists gram is designed to prepare graduates prime goal of KNUST and the World could vary greatly. What seems cer­ to perform basic optometric practice Council of Optometry. In 1999 there tain is that with KNUST producing including comprehensive eye examina­ were only three optometrists much larger numbers of optometrists tion, refraction, ocular disease recogni- (P.G.Dip.), one ophthalmologist, and in the new B.Sc.Optom. Program and ' tion, referral, and limited ocular disease other supporting science faculty at the new Optometry Program at UCC, treatment required for the public's KNUST. By 2005 KNUST expects to the minimum goal of 208 optometrists health. More instruction is provided in have two optometrists with Ph.D., two in the year 2020 will be met. Table V areas such as low vision, contact lenses, to three optometrists with M.Sc, two shows the numbers of recent gradu­ ocular disease diagnosis and manage­ optometrists (P.G.Dip.), two ophthal­ ates, present optometry students, pro- ment, vision therapy, and clinical instruction. The course requires 155 semester hours for graduation. The fac­ ulty desires to limit admissions to 9 approximately 20 per year because of a Table IV. Year 2020 Ghana Eye Care Workforce Needs shortage of books, equipment, facilities, and faculty but the administration Provider Type Population Ratio Goal Provider Goal encourages the admission of larger Ophthalmologist 1:250,000 104 numbers. Optometrist 1:125,000 to 1:50,000 208 to 520 KNUST students attend patients in a campus-based optometric clinic. Ophthalmic Nurse 1:50,000 520 Anyone can attend but most patients Notes: Year 2020 population estimated at 26 million people.2 Country, region, are university students, faculty, and and international optometric workforce goals vary. farmlyTnembers. Students also attend

82 homelands, support VISION 2020 Table V. Projected Ghana Optometric Workforce efforts, and strengthen the optometric profession. Years 2002 to 2020 Year KNUST Graduates UCC Graduates Attrition Optometrists Role of World Council of 2002 48 Optometry Fellowship 2003 7 0 -1 54 John W. Randall, O.D., M.P.H. served as WCO Fellow and Senior 2004 6 0 -1 59 Lecturer in optometry at KNUST 2005 17 0 -1 75 from August 2001 to July 2003. Margaret O'Neill, an Australian 2006 39 0 -1 113 optometrist, also performed a WCO 2007 34 0 -2 145 Fellowship from January to March 2002. The WCO Fellowships 2008 35 5 -3 182 increased the prestige and visibility of 2009 35 10 -4 223 the optometry program within KNUST, the university community at 2010 35 15 -4 269 large, Ghana Health Service, other 2011 30 20 -5 314 government Ministries, and NGOs. Dr. Randall participated in the inter­ 2012 30 20 -6 358 nal development of the KNUST 2013 30 20 -7 401 optometry faculty. The Fellowships exposed other faculty and profession­ 2014 30 20 -8 443 als to the potential impact of a strong 2015 30 20 -9 484 optometric profession on eye health within Ghana. Many people were 2016 30 20 -10 524 benefited directly through internal 2017 30 20 -10 564 and outreach clinics supervised by the Fellow. Drs. Randall and O'Neill 2018 30 20 -11 603 advocated for future optometric edu­ cation and practice within the 2019 30 -12 641 20 University, Ministries, NGOs, the 2020 30 20 -13 678 West Africa Region VISION 2020 pro­ gram, African Council of Optometry, Notes: Future numbers of graduates are estimates. Attrition is estimated at 2% and the International Agency for the per year from all causes. Prevention of Blindness.

Conclusions jected optometry graduates and attri­ country in the past. With improve­ Access to eye care is not available tion through the year 2020. The num­ ments in Ghanaian optometric educa­ to the vast majority of people in ber of future KNUST graduates could tion, emigration may be more frequent. Africa. Ghana is fortunate to have a vary widely, from 25 to 45 per year. It is The assumption that the number of developing optometric profession difficult to estimate the number of optometric graduates will not increase and university based optometric edu­ future UCC graduates because of how in the years from 2010 to 2020 may be cation. Consequently, access to eye new the school is. Officials at UCC conservative. If the new optometric examination, correction of refractive have stated they wish to graduate 20 to educational programs are successful, error, diagnosis, treatment, and refer­ 25 optometrists per year. A minimum there may be more graduates. Reaching ral of eye disease should improve sig­ of 10 and maximum of 25 UCC gradu­ the most optimistic goals for optometric nificantly during the coming decades. ates may be a reasonable number. workforce may be possible by the year 2020. Even if optometric workforce Attrition of optometrists has not Acknowledgments been significant in the past because goals are met, there may be difficulties optometry has been a small, new, and if there is geographic maldistribution of Many people have contributed to young profession in Ghana. It will be optometrists (mostly in cities), inade­ my WCO Fellowship from 2001 to more significant in the future. Attrition quate involvement of optometry in 2003 at KNUST. I would like to thank is estimated at 2% per year in the table. public health activities, inadequate Hoya for its Hoya Vision 2020 This may overestimate attrition due to numbers of other eye care professionals Fellowship Program and the Kanai death or disability because of the such as ophthalmologists, ophthalmic Fellowship Fund that support this fel­ young age of the large numbers of nurses, and dispensing opticians, high lowship project. I would especially future graduates. Attrition due to cost of eye care and glasses, or limited like to thank Mohammed Abdul- change in occupation or emigration is access to appropriate drugs. Kabir, Nana Yaa Koomson, and David more difficult to predict. Almost no KNUST is recruiting students from Ben Kumah, my personal friends and Ghanaian optometrists have changed other West African countries. It is optometric colleagues on the KNUST occupation or emigrated to another hoped that they will return to their Faculty. The faculty, staff, and leader-

Volume 29, Number 3 / Spring/Summer 2004 83 Keep up the good work!

I( )Y.\ is proud to support the World Coundl of ()pi ometry Fellows through its HOYA 20/20 Fellowship Program. We salute the efforts of the Fellows to advance the optometric profession worldwide!

+JOYA

ship at KNUST, Tony Di Stefano and 9 World Health Organization, Global Initiative Human Resource Development, Fact Sheet No. 215, Feb 1999. the WCO staff were also very sup­ for the Elimination of Avoidable Blindness, portive. Margaret O'Neill, energetic optometrist from the Australian Outback, was a huge help on her short WCO Fellowship. A special Position Available thanks to Dr. F. K. Morny, the father of optometry at KNUST. National Board of Examiners in Optometry References Executive Director 1 Kumah DB. report to faculty, Department of Optometry and Vision Science, Kwame The National Board of Examiners in Optometry (NBEO) is seeking qualified Nkrumah University of Science and applicants for the position of Executive Director. The Executive Director is respon­ Technology, Kumasi, Ghana, 5 FEB 03. sible for the overall management of the National Board including representing the 2 U. S. Census Bureau, International Database NBEO both within the profession and externally, staff leadership and supervision, and World Factbook, 2002, www.census. the disbursement and collection of operating funds, the implementation of Board gov / ipc / www / world.html / policies, examination development and administration and other duties as may be 3 World Health Organization. Elimination of Avoidable Visual disability Due to Refractive assigned by the Board of Directors. Errors. (WHO/PBL/00.79). Geneva: WHO, 2000. Qualified applicants must have a minimum of ten years experience in 4 World Health Organization. Onchocerciasis Optometry or a related healthcare discipline; have management experience; and (River Blindness), Fact Sheet No. 95, Feb 2000. have knowledge of the examination, licensure and certification process. The Doctor 5 www.worldbank.org/depweb/english/ of Optometry (O.D.) degree is preferred although holders of other graduate degrees modules/economic/gap/dataa.html, 17 FEB will be considered. 04. 6 National Framework for Action, 2002-2006, A successful candidate must be available for employment no later than May 1, Ghana: The Right to Sight, Eye Care Secretariat, Ghana Health Service, Feb 2002. 2005, and will be required to locate in Charlotte, NC. Salary and benefits are com­ 7 Morny FK. Lectures, Department of mensurate with qualifications and experience. Interested applicants should send Optometry and Visual Science, Kwame resumes to Gerald Lowther, O.D., Ph.D., President NBEO, Indiana University Nkrumah University of Science and School of Optometry, 800 East Atwater Avenue, Bloomington, IN, 47405 no later Technology, Kumasi, Ghana, November 2001. than August 1, 2004. 8 Kumah DB. personal correspondence, 22 JAN04.

84 Optometric Education teach a 20-hour course in visual health and development. This course is an elective course, designed to sensitize future eye care practitioners on the political and socioeconomic aspects affecting international development and cooperation and the visual health North American Center situation in developing countries. The outcome of such a course is to produce For Visual Health and practitioners in developed countries who are sensitive to the situation in developing countries. These practition­ Development Offers ers should also be appropriately trained in correct development cooper­ Training Courses for ation in order to bring about sustain­ able improvement in global visual Educators health. At the end of the Train the Trainers course, the participants resolved to Janet L. Leasher, O.D., M.P.H. work together to improve access to eye care throughout the world. Essilor International provided support for the course. Concurrently, the UNESCO Chair in Visual Health and Development is cre­ ating an observatory of visual health care, starting with Central and North America, which looks at the interplay of access to visual health services and n 2003, for the first time in its his­ thalmology, but with many other med­ materials and international develop­ tory, the United Nations Educa­ ical and social fields as well. Although ment indicators on poverty, education, tional, Scientific and Cultural the headquarters for the UNESCO culture, technology, environment and Organization (UNESCO) devel­ Chair of Visual Health and health. Ioped a Chair for Vision and Develop­ Development is based in Barcelona, For further information, contact Dr. ment and awarded that chair, or pro­ there will be regional centers in North Janet Leasher at [email protected] fessorship, to the Polytechnic America, Central America, South at the North American center, or University of Catalonia School of America, Eastern Europe, Africa and Anna Rius or Laura Guisasola at Optics and Optometry at Terrassa, near Asia. Nova Southeastern University the Barcelona headquarters at Barcelona. The purpose of the College of Optometry in Fort [email protected] UNESCO Chair of Visual Health and Lauderdale, Florida houses the center Development is to conduct research in North America, which was inaugu­ and implement programs that support rated in February 2004. visual health in developing countries The first project of the North in a way that is directly related to the Dr. Leasher is the director of community outreach, American center included a training the North American regional coordinator for the level of development in a country or course for professors from 16 optome­ UNESCO Chair in Visual Health and region. try schools in the US and Canada in Development, and assistant professor at the Nova The UNESCO program which each attendee was trained to Southeastern University College of Optometry. recognizes that vision is one of the first steps in the literacy process and is essential for technological advances and their applica­ tions in development efforts. This belief is based on the premise that the enhancement of visual health in a region or coun­ try will improve a develop­ ing country's quality of life and its level of develop­ ment. Visual health is a broad concept that not only deals with the disciplines of optics, optometry and oph­

Volume 29, Number 3 / Spring!Summer 2004 85 There are two professional "opto­ metric" organizations representing Japanese refracting opticians in the World Council of Optometry (WCO) — the Japan Optometric Association (JOA) and the All Japan Optometric & Optical Association (AJOOA). The Japan Optometric Association The Development of developed from within the Kikuchi College of Optometry, which was orga­ nized in 1979. This organization strives Standards for "to facilitate the enhancement and development of eye and vision care in Optometric Practitioners Japan"; and, as of December 2002, there were 1,359 members. The JOA encour­ ages its members and other interested In Japan vision care providers to enhance pro­ fessional competence through partici­ R. Norman Bailey, O.D., M.B.A., M.P.H., F.A.A.O. pating in JOA sponsored continuing education courses.2 Mitsuhisa Hayashi, O.D. As of March 31, 2003, the All Japan Optometric and Optical Association had a membership that included 7,853 refracting opticians. This organization was structured so that its 7,853 refract­ ing opticians belonged to another Japanese professional organization that has also used the Japan Optometric Association 0OA) name for approxi­ Introduction mately forty years. However, this orga­ Abstract nization has typically used the AJOOA efracting opticians in Japan name to represent this group of refract­ Japanese refracting opticians have been struggling to gain (optometrists) have struggled for ing opticians in an effort to reduce con­ government recognition as an fusion on the international level over three-quarters of a century to independent health profes­ 1 between the two JOA organizations. obtain government recognition Rsion since the 1920s. Yet, no such recog­ and the subsequent licensing/reg­ nition currently exists. These efforts are The AJOOA has established a self- ulation that would set standards of similar to those of refracting opticians certification system, known as the education and practice for the (optometrists) in the United States dur­ AJOOA Self-certification System for independent delivery of competent ing the early years of the 20th century. Refracting Opticians, to upgrade the optometric services. The objections Government recognition would allow practice of refracting opticians/ of organized medicine and the lack for the establishment of nationwide optometrists. Over 7,000 refracting of consensus among the various standards for the education and train­ opticians have registered for this pro­ constituencies of opticians were ing of those who practice optometry in gram.1 This new self-certification pro­ the major factors in the failure of Japan. The diversity of opinions among gram offers Japanese opticians/ optometry to achieve government refracting opticians and the objections optometrists an opportunity to acknowledgement. Recent history of ophthalmology have played major advance their knowledge and skills in a has seen a convergence of purpose roles in defeating these efforts by standardized approach. among representative groups of Japanese refracting opticians. refracting opticians, which is lead­ ing toward the implementation of Currently, opticians include those Background who refract as well as those who dis­ a self-certification system and the Japan has been reported to have development of common stan­ pense, or who work only as sales clerks in the optical stores. It has been the longest life expectancy and among dards for the delivery of vision the lowest infant mortality rates in the care to Japanese citizens. estimated that there are approximately 40,000 opticians, including sales clerks, world. The government's mandated Key Words: Japan, optometry, universal health care insurance sys­ opticians, standards, certification working in approximately 20,000 opti­ tem that emphasizes preventive care World Council of Optometry cal shops. There are no reliable num­ bers to differentiate those who refract has been the major explanation for from those who dispense. Of the total Japan's health-status success. A large number of opticians, there are only percentage of the nation's hospitals about 10,000 who have graduated and provider clinics are privately Dr. Bailey is a WCO Fellow and a member of the from one of the formal optometry owned although they may not be Standards, Legal and Regulatory Committee of the schools. In addition, there are approxi­ investor-owned, for profit institu­ World Council of Optometry. He is a clinical pro­ mately 15 internationally trained tions. Patients are allowed to select fessor at the University of Houston College of 1 Optometry. Dr. Hayashi is a member of the faculty optometrists in Japan. their health care providers. Access to at the Tokyo Optometric College.

86 Optometric Education care is sufficient, except in some rural pathologies in the 70 percent of the optometrists. The professional role for areas.3 refractive patient population seeking optometry must be elucidated through Eye and vision care delivery in their services. Gaining this latter skill agreement on the necessary knowledge Japan is supplied by a mixture of would allow a timely referral to med­ and skills required to adequately pro­ physicians and refracting opticians/ ical eye care practitioners for diagnosis vide quality optometric eye and vision optometrists. About forty million peo­ and treatment of medical eye problems. care services to the public. ple, or one of every three individuals, There are four optometry schools in Both the Japan Optometric wear either spectacles or contact lenses. Japan. The Kikuchi College of Association (JOA) and the All Japan About 70% of university students are Optometry in Nagoya, established in Optometric and Optical Association estimated to be myopic. Professional 1978, has a four-year post-high school (AJOOA) acknowledge the need to eye and vision care is under the juris­ optometry course. The Tokyo upgrade refracting opticians with diction of the medical profession while Optometric College in Tokyo, estab­ common standards prior to seeking spectacles, including refracting for dis­ lished in 2000 by combining the Nihon government licensing in the future. In pensing purposes, may be legally pro­ Optometric Academy and the Waseda response to this striking need, the vided by optical shops. Only medical College of Ophthalmic Optics, expand­ AJOOA has initiated a self-certification practitioners, however, may legally ed to a three-year post-high school pro­ program for which the majority of its write a spectacle prescription for dis­ gram in 2001. The World Optical members have registered. The AJOOA, pensing by others. Since the govern­ College in Okayama, and the Nihon as a public-service organization, has ment does not provide eyewear, Gankyo Gijyutsu Senmon Gakko in been designated as the Certifying patients purchase spectacles and con­ Osaka have three-year post-high Board in this certification system. Its tact lenses from private providers.4 school optometry programs. At one goal is to protect the public interest It has been estimated that about 70% time, several of these schools had only and to assure fairness in the certifying of those needing refractive care go two-year programs. system. An advisory committee, directly to the optical shops for their With only about 10,000 of the including representatives from the eye care and are served by opticians approximately 40,000 opticians having consumer, scholastic, and journalistic rather than medical practitioners. graduated from one of the formal opto­ fields, works with the Certifying Board Refractions are provided by refracting metric education programs, it can be in this effort. The AJOOA plans to pro­ opticians for the purpose of dispensing seen that there is a significant need to mote the existence of the certification eyewear or contact lenses. The refract­ upgrade the education and tiaining of program with the public, thus increas­ ing opticians do not customarily charge many providing refractive and other ing the marketing value of the individ­ 6 for refractive services. The optician vision care services. ual refracting optician /optometrist provided refractions do not result in a who obtains this acknowledgement of written prescription that is given to the AJOOA Self-Certification competence. customer, the designation used for The AJOOA Self-Certification these consumers of optician services. System for Refracting Opticians System for Refracting Opticians is a In the absence of a licensed opto­ voluntary program aimed at increasing metric profession in Japan, there are no professional competency. It has two Current Status of Optometric national standards for the education separate categories; one for refracting Education and training of refracting opticians/ opticians/optometrists who have com- Continuous efforts, through the upgrading of basic and continuing edu­ cational programs, have been made over the years to improve the knowledge and Table 1: Classifications of the AJOOA Self-Certification System for practices of the refracting opticians/ Refracting Opticians optometrists. However, these efforts have not been consistent among the var­ Academic Course General Course ious groups representing opticians/ |S, SS, SSS) (A, AA, AAA) optometrists. The recommendations of the various professional organizations Class S Class A and schools are now converging toward Graduation from 2-year professional Five years of professional experiences common standards. It is believed that school plus one year of professional after high-school graduation with upgrading the education and training of experience. passing of exam for Class A. refracting opticians/optometrists to a given standard will produce a cadre of qualified refracting opticians/ Class SS Class AA optometrists, and will eventually lead to Graduation from 3- or 4-year profes­ Two years of professional experiences a licensed and regulated profession of sional school plus one year of profes­ after registering for Class A with pass­ optometry in Japan. sional experience. ing of exam for Class AA. Even though ophthalmology may be Class SSS Class AAA providing a high level of medical eye 1. Graduation from U.S. optometry One year of professional experience care, high quality functional eye care school or equivalent. after registering for Class AA with and related services by licensed 2. Passing exam for Class SSS. passing of exam for Class AAA. optometrists is needed. These Both with one year of professional optometrists should be educated and experience trained to recognize asymptomatic eye

Volume 29, Number 3 / Spring/Summer 2004 87 pleted an optometry (ophthalmic opti­ have been administered by the Japan who previously passed the prescribed cal) school curriculum successfully, Optometric Association over the last 10 entry-level examination were regis­ and one for those opticians who did to 15 years for those graduates from the tered at the Class A level of certifica­ not complete formal education at an Kikuchi College of Optometry seeking tion in April 2001 when the current optometry school. Table 1 summarizes the "JOA-certified optometrist" level. self-certification program was initiat­ the classification of refracting opticians These examinations are said to be ed. This group of opticians represents in this self-certification system. based on the National Board of the majority of current Class A certifi­ The vertical career ladder provides Examiners in Optometry examinations cations. Since April 2001, all opticians a structured approach to differentiat­ administered in the United States. The passing the Class A (entry-level) exam­ ing two classes of refracting opticians. examinations consist of the following ination have been registered at the The "S" levels of certification are for seven subject areas: Class A level. Once registered at the optometry school graduates and com­ • Theoretical Optics (Geometric and Class A level, opticians are expected to prise the "Academic Course." The Physical Optics) complete required continuing educa­ "A" levels of certification are for the • Ocular Anatomy tion and on-the-job professional expe­ non-optometry-school graduates and • Ophthalmic Optics rience in order to progress upward comprise the "General Course." Each • Visual Science I including Refrac­ through the "A" levels of certification. course is divided into three levels or tion, Accommodation, Basic Binoc­ Initially, the requirements to classes — S, SS, and SSS — for the ular Vision, and Contact Lenses progress through the "A" levels were Academic Course; and A, AA, and • Visual Science II including Case more demanding; on-the-job training AAA for the General Course. The level Analysis, Advanced Binocular experience, continuing education, or class of certification for which an Vision, Strabismus, Amblyopia, and examinations were required for optician is eligible to register depends and Low vision promotion to the AA or AAA certifi­ on the individual's education and • Physiological Optics including cation levels. However, a "special length of professional experience. Neuro-anatomy privilege" was subsequently granted The Class S level of certification is • Ophthalmology to those opticians who passed the for graduates from two-year optome­ The pass rate on these examina­ entry-level examination, as most of try schools, and the Class SS level of tions has been quite low. It has been them had been in the optical business certification is for those graduating suggested that the low pass rate is for many years. The privilege provid­ from three- and four-year optometry related to the post-high school, four- ed that after achieving a Class A certi­ schools. In addition to graduation year Kikuchi College of Optometry fication through having passed the from an optometry school, both the S program being somewhat shorter entry-level examination, these opti­ and the SS classes require one year of than the required seven to eight years cians would become eligible for a professional experience prior to regis­ of post-high school education needed Class AA certification by completing tration at these levels of certification. A to obtain the Doctor of Optometry the required continuing education in Class S certification may be upgraded degree in the U.S. Since the AJOOA three years, and then subsequently to the level of Class SS by taking the certification system was introduced in promoted to Class AAA certification required hours of continuing educa­ 2001, however, the AJOOA and the after successfully completing addi­ tion and acquiring the necessary years Affiliation of the Japanese Optometric tional requirements of continuing of experience by 2007. If a Class S cer­ Schools have decided to establish an education during the next three years; tification is not upgraded to a Class SS examination committee for both the no additional examinations would be by 2007, then a Class SS qualifying SS and SSS levels. This committee will required for promotion to either of the examination must be passed. This lat­ establish basic guidelines for the 2004 latter two levels. Initially, this 'special ter point is a definite incentive for examinations; however, the changes privilege' was to be effective only completing the required continuing from the current SSS examinations are until 2007. However, the challenge of education. The AJOOA considers the expected to be minor because the cur­ bringing the majority of refracting Class SS level of certification to be the rent SSS level is considered to be the opticians without formal optometric eventual standard, and only those who level closest to the international level, training into the self-certification sys­ will have graduated from an optome­ especially when compared to the level tem has required some modifications try school with three or more years of of optometric education in the U.S. of the original program. professional education will be eligible. Opticians who have not completed Those entering the self-certification In order to qualify for the Class SSS formal education and training at an program by passing the entry-level level of certification, the optometrist optometry school have been encour­ examination before 2000 were origi­ must be a graduate from an optometry aged to register for the self-certifica­ nally expected to complete the pro­ school outside of Japan that offers the tion program. The 'A' levels of certifi­ gression through the certification O.D. degree or similar high training as cation are reserved for this class of classes to the AAA level by 2007. in the U.S., Canada, Australia, and the opticians. Many opticians, with at least However, for those "special privi­ U.K. and have at least one year of prac­ five years of on-the-job training and leged" opticians who passed the Class tice experience; or they must pass a experience after their high-school edu­ A examination in the years 2001-2003, special examination for the Class SSS cation or one year of on-the-job train­ the completion date for progression level. In the future, these foreign edu­ ing and experience after college gradu­ through the classes of self-certifica­ cated and trained optometrists may ation, had taken an entry-level tion to AAA was extended to 2010 in also be required to take the SSS level examination for more than two order to allow adequate time to com­ examination, should the advisory com­ decades. Most qualifying for the "A" plete the continuing education and mittee so decide. The SSS examinations level are college graduates with one on-the-job experience requirements are based on the examinations that year of experience. Those opticians for progression. That is, upon passing

88 Optometric Education the Class A certification examination, expected demand for refracting opti­ Schools and Colleges of Optometry in the optician will be given three years cians / optometrists. North America, an effort for unity to gain eligibility for promotion to the The AJOOA considers the Class SS made by some developing optometry Class AA certification and another level of certification to be the eventu­ programs in other countries. three years for promotion to Class al standard for all Japanese AAA certification through on-the-job optometrists/refracting opticians. To Acknowledgements training and continuing education enhance the value of the certification, Information for this paper was courses. Once achieving the Class the AJOOA plans to inform the public obtained from the World Council of AAA certification, the optician/ about the certification program Optometry, the All Japan Optometric optometrist must renew the registra­ through various media. and Optical Association, the Japan tion of their certification every three Optometric Association, and Japanese years by completing required contin­ Summary optometrists, Drs. Akio Kanai, Shinji uing education. As the profession of optometry in Seki, and Setsuya Tsuda. Additional Beginning the summer of 2004, all Japan improves its professional com­ information was obtained from visits opticians without formal optometric petence through education and expe­ to Japan by U.S. optometrists, Drs. R. school education, who had not passed rience, it is expected to be better posi­ Norman Bailey, and Jerald W. an entry-level examination before tioned to achieve government Strickland. We would' like to thank 2000 nor taken the Class A entry-level recognition. This process should Hoya Corporation for its HOYA Vision examination offered during the sum­ include the establishment of licens­ 2020 Fellowship Program and the mers of 2001-2003, must enter the self- ing/registration standards. Once gov­ Kanai Fellowship Fund that helped to certification program by passing the ernment recognition is obtained, high make the fellowship a reality. Class AAA examination. educational standards can be required The standard for all refracting opti­ of all who seek to practice optometry. References cians/optometrists will be the Class This will benefit the Japanese public 1. Communication with Setsuya Tsuda of the AAA or Class SS levels of certification by ensuring competent optometric All Japan Optometric and Optical by 2007, with the exception as noted eye and vision care services provided Association above. Initially the plan was for all by well-educated and trained 2. Japan Optometric Association 2003 Country new registrants for self-certification optometrists. Report to the World Council of Optometry by 2007 to be graduates of 3- or 4-year 3. U.S. Department of State Geographic Bureaus: The challenge is great; however, East Asia and Pacific Bureau. Health Care in optometry schools. However, it is success will be achieved when there is Japan. July 1997. Available at: now believed that the Class AAA cer­ a consensus among all pertinent http: / / dosfan.lib.uic.edu / ERC /bureaus / eap tification examinations may need to groups in Japan. Curricular consensus / f actsheets / f s-japan_health_970731 .html. be provided for some years past the could be advanced by the Japanese Accessed 25 February 2004. 4. Notes obtained by Jerald Strickland, O.D., original deadline as, among other schools and colleges of optometry Ph.D., during visit to the Kikuchi College of considerations, the four optometry forming an academic organization Optometry April 2003. schools may be unable to meet the similar to that of the Association of

Industry News Essilor Launches Varilux PAL for treat glaucoma, were presented at the (Continued from page 73) Small Frames American Glaucoma Society's annual Syl Ghirardi, president and COO of Essilor of America introduced its meeting in Sarasota, Florida. Alcon Hoya Vision Care. "In combination first short-corridor progressive lens, has filed a New Drug Application with our recently introduced uniform Varilux Ellipse. The new lens provides with the U.S. Food and Drug nationwide pricing, the eye care pro­ the widest field of vision and the Administration for TTFC, which com­ fessional now has even more com­ shortest progression fitting height, bines travoprost 0.004% and timolol pelling reasons to make Hoya their according to Varilux. 0.5% into a once-daily medication. supplier of choice. We are committed "Varilux Ellipse opens new fron­ Stella Robertson, Ph.D., vice presi­ to making Hoya synonymous with tiers to serve the true needs of short dent of pharmaceutical products, top quality and prompt dependable corridor PALs. Varilux Ellipse comple­ research and development at Alcon, delivery." For more information, con­ ments the existing range of Varilux said, "In these clinical studies TTFC tact Steven Koufos, Hoya Vision Care. products by providing the best pro­ achieved similar IOP reduction as Renato Cappuccitti has joined Hoya gressive lens for small frames, allow­ travoprost 0.004% and timolol 0.5% Vision Care as director of marketing ing a fitting height as low as 14 mm," used concomitantly and reduced IOP and sales. With more than 15 years of said Mike Daley, president of Essilor compared to travoprost 0.004% alone. marketing, sales and vision care expe­ Lenses. "With its unique technology Importantly, it delivered these results rience, Cappuccitti will contribute his and trusted quality, Varilux Ellipse is without a medically significant technical expertise in ophthalmic lens­ the new standard in performance for increase in side effects to the patient. es and his knowledge as a licensed small frame wearers." ophthalmic dispenser and certified Coopervision Campaign On contact lens fitter to the Hoya Vision Contact Lens Comfort Care, North America team. Alcon Reports Data On Potential New Glaucoma Drug CooperVision recently launched a Cappuccitti brings experience as direc­ new nationwide educational cam­ tor of professional and customer Three-month data from several Phase III clinical trials on Travatan/ paign, "Contact lens comfort - Get the development for Vision Systems and conversation going," to raise aware- from Rodenstock as technical market­ Timolol Fixed Combination (TTFC), ing manager. Alcon's investigational new drug to (Continued on page 103)

Volume 29, Number 3 / Spring/Summer 2004 89 based, cannot sustain its population; 46% live below the poverty line. International monies fund 60% of Nepal's development budget. In recent years, the guerilla-based Maoist insur­ gency has limited international com­ munity aid, foreign investments and efforts in economic development.1

Nepal's Health Care and Eye Optometric Education Care System Currently Nepal is divided into 75 districts within 14 zones. The districts In the Himalayan are further divided into villages. At the district level, there are currently Kingdom of Nepal 67 district hospitals under the Ministry of Health. At the zonal level, there are nine hospitals under the Sandra Wang-Harris, O.D., F.A.A.O. Ministry.2 In 1991, the government formulated a new National Health Policy geared toward improving the primary health status of the rural population. The primary objective of the National Health Policy is to make available primary health care services at the grassroots level, the village level.3 Over 10 years later, Nepal has successfully opened thousands of sub health posts. Currently there are 3,179 Abstract Background of these sub health posts, located in he Kingdom of Nepal is a the most rural areas of the country.2 In order to meet the manpower landlocked country of needs of Nepal, optometrists play a Eye care in Nepal has seen tremen­ 140,800 square kilometers key role in the delivery of trained dous change in the last 32 years. In located in South Asia.1 Nepal health care. Eye care leaders of this 1971, there were only two ophthal­ Tis most known for having eight of the small landlocked country are not mologists for a population of over 16 world's tallest peaks including Mount ignorant of the obvious lack of million." In 1974, the first eye hospital, Everest. It consists of three major trained providers in the majority Nepal Eye Hospital, was built in the regions: the northern Himalayan or of the country. They have instituted capitol of Nepal, Kathmandu. In 1981, mountain region, the middle hills several strategies; one is the produc­ supported by the World Health region or Kathmandu valley region tion of mid-level professionals- Organization (WHO), the comprehen­ and the southernmost region or terai. optometrists. The intent of creat­ sive Nepal Blindness Survey was con­ These regions vary in altitude from ing the optometrist is to fill the gap ducted. It revealed the startling truth: the terai's highest altitude of 300 in the manpower structure. Nepal was severely deficient in eye meters all the way to the Himalayan Optometrists, being well suited for care services with a backlog of blind­ region of an altitude of 8648 meters.8 community work, are obvious key ness causing cataracts that vied for With a population of over 26 mil­ 5 players at the district level where 35 the highest in the world. lion, Nepal boasts of a people with a out of 75 districts are devoid of wide variety of ethnic backgrounds As a result of the Nepal Blindness basic eye care. The optometry cur­ and cultures. There are over 30 Survey of 1981, a plan of action began riculum and training at BPKLCOS dialects spoken in Nepal with Nepali that called for systematically building reflects the needs of the country. as the official language. English is also eye centers and eye hospitals. Today in Students learn not only theoretical­ widely spoken in education and gov­ the Kathmandu valley, there are four ly, but also practically with direct ernment institutions.1 The teaching comprehensive eye care centers along hands on patient care in the com­ medium is in English for university with two departments within medical munity. With plans underway to level education. colleges. Outside the valley there are place optometrists at the district 15 eye hospitals with another four eye level in established Ministry of Nepal is one of the poorest and least units in medical colleges.4 With the Health district hospitals, optometry developed countries in the world. The building of infrastructure, two impor­ will play a major role in the imple­ economy, which is 80% agriculturally tant manpower training programs mentation of WHO'S Vision 2020: began. These programs were the post­ The Right to Sight. graduate residency program in oph­ Keywords: optometry; low vision; thalmology and the ophthalmic assis­ Dr. Wang-Harris is a federal optometrist with the 6 refractive error; Nepal; Vision U.S. Army and chief optometrist at the Center for tant training program. Today with 110 2020: The Right to Sight Sight in Huntsville, Alabama. She was WCO's ophthalmologists and 174 ophthalmic Senior Fellow in Nepal for one year. assistants, Nepal has gained much in

90 Optometric Education eye care manpower, but still lacks Institute of Medicine signed a the BPKLCOS that from the first day of essential human resources in many Memorandum of Understanding with matriculation, all BOptom students are areas in primary and mid level care.4,6 the purpose of developing the optom­ required to be in clinics with patients. etry program in Nepal. After a two- Classes and clinics are taught using a The Birth of Optometry in Nepal day workshop to develop the optome­ combination of ophthalmology faculty try curriculum in September 1998, the and optometry faculty. In the mid-1990's the eye care lead­ first class of Nepali optometry stu­ ers of the BP Koirala Lions Centre for dents was accepted into the new pro­ Ophthalmic Studies (BPKLCOS) at the gram for the academic year beginning Tribhuvan University Institute of November 19987 Using the available Medicine began to realize the acute resources of Tribhuvan University shortage of mid-level manpower to fill Institute of Medicine, the Bachelor of Figure 1: Course Outline of the the gap between ophthalmologists and Optometry (BOptom) degree program Four Phases ophthalmic assistants. The projected is conducted by BPKLCOS alongside Bachelor of Optometry need of nearly 700 ophthalmologists in the postgraduate ophthalmology resi­ the next 20 years exceeded the produc­ Program BP Koirala Centre for 10 dency. The course was then a three- 9 tion capability of this country. With year program.12 Ophthalmic Studies the foresight of the leadership at the Currently six students are accepted BPKLCOS and help from the each year into the BOptom degree pro­ Phase 1 University of Auckland, New Zealand, gram. Eligible candidates must com­ 1 -Basic concepts of Basic ASIA 2000 Foundation and the World plete successfully 10 years of school, a Sciences Council of Optometry, the Tribhuvan school leaving examination and a two- 2- -Basic concepts of optics University Institute of Medicine offi­ year certificate, called a 10+2 with cially launched the start of its new and visual science 7,13 Biology. Candidates fulfilling these cri­ optometry training program in 1998. teria may sit for an entrance examina­ 3 -Organ Systems The establishment of this new level eye tion. Candidates with the highest 4- Ocular Systems care was to produce ophthalmic man­ scores on the entrance examination are power in the shortest possible time admitted to the program.9 Presently, 5 -Visual Science and to allow optometrists to share in there are 17 students enrolled in the 6 -Optometric Science the responsibilities of eye care in the BOptom program. 7 -Introduction to community nation.1011 Tribhuvan University health Institute of Medicine's program is not only the first optometry training pro­ Description of the Existing 8 -Foundation Courses gram in the country, but also the first Curriculum Phase II optometry training program in the In the fall of 2002, the BOptom entire region of northern India, 1 -Ocular diseases 10 degree was officially changed from the 2 -Optometry 1 Bangladesh, and Bhutan. three-year program to the four-year program currently used. There are four 3 -Optometry II Curriculum and Training at the phases (see Figure 1). Each phases is 4 -Ophthalmic Optics 1 currently of one-year duration and all 5 -Advanced Visual Science BP Koirala Lions Centre for four phases stress direct community Ophthalmic Studies patient care through hospital outpa­ 6 -Binocular vision 1 On April 10, 1997, the Vice tient visits, community outreach and 7 -Contact Lens 1 satellite clinics. Direct patient care is Chancellors of the University of 8 -Low vision 1 Auckland and Tribhuvan University such an important learning activity at Phase III 1 -Ophthalmic Optics II 2 -Contact lens II & ocular prosthesis 3 -Binocular vision II 1 4 -Pediatric Optometry 5 -Low vision II 6 -Geriatric Optometry 7- Community Optometry 8 -Practical Paper Phase IV 1 -Applied Community optom­ L etry 2 -Optometry Project r<^: 3 -Clinical Optometry practice *:. rtSr-^TLJ 4 -Practical Paper Volume 29, Number 3 I Spring/Summer 2004 Phase I mately 35 hours per week seeing strategies; one strategy is the produc­ This phase incorporates the basics patients in a clinical setting. tion of mid-level professionals — of visual and optical science, as well optometrists. The intent of creating as a foundation in physiology, anato­ the position of optometrist is to fill the my and an introduction to communi­ Optometry's Role in Vision 2020: gap in the manpower structure. ty health. The Right to Sight in Nepal Optometrists, being well suited for Phase II Since the humble beginnings of eye community work, are obvious key In this phase, the student is care services in Nepal 32 years ago, this players at the district level where 35 out of 75 districts are devoid of basic exposed to optometric techniques and country has developed a good infra­ 8 practices that are relevant to special­ structure of eye hospitals and clinics eye care. The second strategy is to ized eye care such as low vision, con­ through the help of the WHO and plan and conduct mobile eye camps to go to the districts that need the tact lenses and binocular vision. They many international organizations dedi­ 4 further build on the foundation of cated to the eradication of blindness. most care. Key to any cost-effective patient care with extended hours of However, due to the rough terrain and eye care system is the provision of ser­ clinical duty as well as community remote geographic locations of Nepal's vices like refractive care, supply of outreach clinics. population, millions of people still go spectacles and detection and treat­ without basic eye care. Currently out of ment of minor problems and referral Phase III 75 districts in Nepal, eye care is avail­ of serious problems at the community The third year student in this phase 14 able in only 40 of these districts.8 level. Current political tensions in expounds on techniques and knowl­ Eye care leaders of Nepal are not Nepal have made it very difficult to edge learned from phase II. Further ignorant of the obvious lack of trained implement these mobile eye camps specialization and coursework leads providers in the majority of the coun­ where the people need them most— the student to detailed knowledge of try. They have instituted several the remotest areas of Nepal. binocular vision treatment and man­ agement, low vision treatment and management and contact lenses for Figure 2: Current Status and Projected Need of disease applications. Pediatrics and 6 geriatrics is formally taught during Optometrists in Nepal this phase as well as community health in preparation for the final phase. It is during phase III that the Present Status Projected Need In 5 Years Produced In 5 Years student begins his preliminary work on a research project in optometry. 12 41 29 Phase IV It is during this final year that the B. of Optometry student applies their knowledge of community health and research to the optometry project. The Figure 3: Lv Prasad Eye Institute in Hyderabad student prepares and executes commu­ Current Model of Community Eyecare "Team"14 nity mapping, networks with commu­ nity leaders and prepares and imple­ ments eye care programs. This field training permits the student to fully EVERY 1,000,000 POPULATION utilize skills outside of the university hospital setting. Students successfully passing the final practical paper and presentation of the research project are awarded the B. of Optometry degree 1 ophthalmologist from the Institute of Medicine. Community ophthalmic services are an integral daily part of the I optometry student's training. At pre­ 4 optometrists sent, optometry students from BPKL- COS accompany a team of ophthal­ mologists, residents and technicians to satellite clinics throughout the I i Kathmandu valley throughout the 8 eyecare workers 8 ophthalmic assistants week. At these satellite clinics, hun­ dreds of patients are seen and, if fur­ ther care is needed, the patients are referred to BPKLCOS in Kathmandu. With community field postings and hospital outpatient clinic postings, 16 ophthalmic nurses optometry students average approxi­

92 Optometric Education etry carved a permanent place on the battlefield to fight blindness in Nepal.

Acknowledgements I want to give special thanks to Suraj Shakya, M.D., for her help dur­ ing my fellowship and Mr. Basanta Khadka for his help through the World Health Organization (WHO) office in Kathmandu, Nepal. I would also like to thank HOYA Corporation for its HOYA Vision 2020 Fellowship Program and the Kanai Fellowship Fund that helped to make my fellow­ Nonetheless, optometrists play an and low vision specialist for the ship a reality. important role within the eye care younger population.17 In Nepal's team in these mobile eye camps. National Plan of Action for VISION With the determination to continue 2020, goals stated for the provision of References the fight against blindness, the health­ optometrists include establishing eye 1. World Fact Book 2003. Central Intelligence care leaders of Nepal launched care services such as refraction, low Agency. Washington, D.C.: U.S. WHO's global initiative Vision 2020: vision, school screenings, and dissem­ Government Printing Office. The Right to Sight in November 1999.4 ination of low-cost affordable specta­ 2. Annual Report MoH/DoHS1999/2000 and 8 2000/2001. Kathmandu, Nepal: Ministry of This initiative is paving the way in cles at the district level. Health. health care reforms and key decisions At present, Nepal has 12 3. National Health Policy of His Majesty's impacting the future of Nepal's optometrists who work in the public Government of Nepal, 1991. Kathmandu, trained optometrists. hospital sector in only two districts of Nepal: Ministry of Health, 1991. 4. Pokhrel RP. Eye care in Nepal then and now. Today, Nepal is in the process of the country. It is projected that the Kathmandu, Nepal: Vision 2020 Workshop, formulating a National Eye Care need for optometrists in the next five Nepal, July 2003. Policy with the Ministry of Health. years will be 416 (see Figure 2). It is 5. Nepal blindness survey, His Majesty's Because optometry is a relatively new also recommended that Nepali Government, Ministry of Health, WHO:1981. player, optometry services in past optometrists be placed strategically in 6. Koirala S. Human resources: Present status policies were not fully realized in the districts devoid of eye care in the next and future perspective. Kathmandu, Nepal: planning of manpower resources. As five years.6 An effective model devel­ Vision 2020 Workshop, Nepal, July 2003. stated under the Strategic Plan for oped by the LV Prasad Eye Institute in 7. Garner L. Productive partnerships: 2002-2019, some of the leading causes Hyderabad, India, recommends a Collaborations. Kathmandu, Nepal: BP Koirala Lions Centre for Ophthalmic of blindness in Nepal are refractive ratio of four optometrists per Studies Annual Report, October 2001. 14 error, amblyopia, and low vision. A 1,000,000 people (see Figure 3) in 8. National plan of action for eye care services survey of the Mechi zone in Nepal order to produce an efficient and cost in Nepal, (Strategic Plans for 2002-2013). found 22% of children with refractive effective community eye care team. Apex Body for Eye Health, HMG Ministry of Health, September 2001. error with 92% uncorrected at presen­ Under the LV Prasad model, Nepal's 15 9. Curriculum. Bachelor of Optometry, tation. Optometrists play key roles in population of 26 million people Tribhuvan University Institute of Medicine, eradicating these causes as well as would ideally need 104 optometrists; BPKLCOS. 2002 prevention and diagnosis of other this number if 63 optometrists short of 10. Koirala S. Years of progress, problems and emerging causes of blindness such as partnership. Kathmandu, Nepal: BP Koirala the projected need of 41 (see Figure 2). Lions Centre for Ophthalmic Studies diabetic retinopathy and glaucoma. Annual Report, October 2000. Elimination of childhood blindness, 11. Shah DN. Realizing the importance of one of the causes of disease burden in Conclusion human medical resource in development. Nepal, is another priority under the In order to meet the manpower Kathmandu, Nepal: BP Koirala Lions Centre for Ophthalmic Studies Annual National Plan of Action for VISION needs of this small landlocked country, Report, October 2000. 8 2020. A recent study by Nepal et al optometrists play a key role in the 12. Curriculum. Bachelor of Optometry, further proves the high rate of child­ delivery of trained health care. The Tribhuvan University Institute of Medicine, hood blindness in the Kathmandu val­ optometry curriculum and training at BPKLCOS, 1998. ley. This study showed 11% of BPKLCOS reflects the needs of the 13. Cole BL. Leon Garner: Profile. Clin Exp Optom 2003; 86:2:127-130. Kathmandu's 1100 schoolchildren country. Students learn not only theo­ 14. Holden,B. The role of optometry in Vision examined in the study have ocular retically, but also practically with 2020. Community Eye Health 2002; 15(43): morbidity, 97% (117 out of 121) of direct hands-on patient care in the 33-36. which is preventable or treatable.16 community. With plans underway to 15. Pokharel GP et al. Refractive error study in place optometrists at the district level children: results from Mechi Zone, Nepal. The WHO recommends a pediatric Am J Ophthalmol 2000; 129(4): 436-444. eye care team to be a part of a high in established Ministry of Health dis­ 16. Nepal BP et al. Ocular morbidity in school volume eye center of a hospital.17 trict hospitals, optometry will play a children in Kathmandu. Br. J. Ophthalmol. Optometrists, interested in pediatrics, major role in the implementation of May 2003; 87: 531 - 534. are an important asset as multiskilled WHO's Vision 2020: The Right to 17. World Health Organization. A five-year Sight.8 With the launching of WHO's project for the prevention of childhood professionals; optometrists can fill the blindness (WHO/PBL/02.88). roles of refractionist, binocular vision Vision 2020: The Right to Sight, optom­

Volume 29, Number 3 / Spring/Summer 2004 93 Ophthalmic Professions in India Eye care practitioners in India include ophthalmologists, optome­ trists, opticians, orthoptists, and other ophthalmic technicians and assistants. Ophthalmologists: The process of becoming an ophthalmologist in India involves a basic degree in medicine (MBBS) followed by ophthalmology training of two or more years leading to a DO (diploma in ophthalmology), MS (ophthalmology) or MD (ophthal­ Unification of mology). In addition, there are others who did not graduate as MBBS but had other degrees and were trained in oph­ Optometry in India thalmology. Ophthalmologists practice in three different modes. Some are employed by federal, state and local Satya B. Verma, O.D., F.A.A.O. hospitals or by other hospitals run by private charitable trusts and organiza­ tions. Others have their own private practices and clinics. There are still oth­ ers who have practices affiliated with optical show rooms and shops. Optometrists: Over the last forty years, optometrists have been trained in two-, three- or four-year programs. The earlier two-year programs were started by the state governments in affiliation with reputed eye hospitals, Introduction run by ophthalmologists. The later Abstract three- and four-year programs have ndia accounts for 25 percent of been affiliated with universities and are Optometry in India is character­ the world's blind population, run by optometrists. Optometrists, like ized by marked diversity in pro­ with approximately 12 million ophthalmologists, practice in similar fessional organization and signifi­ people with avoidable blind­ three modes. cant disparity in educational Iness. This does not take into account Opticians: There have not been any millions of others who have refrac­ programs. This has been brought formal training programs for opticians tive problems but are unaware of about by the lack of legal recogni­ in India. However, there are several them. The India Ministry of Health tion and no harmonized standards state opticians/optical associations that of optometric education. As a reports that the prevalence of bilater­ have conducted some short continuing result, optometry has struggled for al blindness is 1.10 percent or 11.5 education courses for their members. professional recognition within a million persons. Among these, 22 Opticians are self trained or trained myriad of eye care practitioners percent above 50 years of age have under apprenticeship and are involved serving over one billion people. In low vision. These vision impair­ March 2003, the Indian Optometric ments are defined in four categories: in dispensing of glasses and also pro­ Association (IOA) and the World normal or near normal with the best viding examinations and contact lenses. Council of Optometry (WCO) corrected vision of 20/60 or better; Others: In addition, there are some jointly sponsored symposia and low vision between 20/60 and ophthalmic technicians and orthop­ organizational meetings to unify 20/200; economic blindness between tists who have provided eye care and both the profession and its educa­ 20/200 and 20/400; and social blind­ are often included under the title of tional and training programs. This ness with acuity of less than 20/400.1 "optometrists." This group, however, "new beginning" promises to pro­ According to Dr. Gullapalli N. is typically not engaged in private vide a strategic foundation to pos­ Rao, medical director of the LV practice. itively impact the future of optom­ Prasad Eye Institute and president­ etry in India. elect of the International Agency for Optometric Education in India the Prevention of Blindness (IAPB), India has between 10,000 and 13,000 Optometry was born in India in Key Words: Optometry, Education, ophthalmologists, unequally distrib­ 1958. Two schools of optometry, one Vision Care, India, Blindness, and uted and underutilized, and between at Gandhi Eye Hospital, Aligarh, and the World Council of Optometry 6000 and 8000 "optometrists" and the other at Sarojini Devi Eye other professionals.2 The exact num­ Hospital, Hyderabad, were started ber of opticians and others who take that year. These were two-year pro­ care of the visual needs of the over grams with enrollment of 20 students Dr. Verma is assistant professor at the at each school. These schools were Pennsylvania College of Optometry, WCO Fellow one billion lives is unknown. and Presidential Envoy to India. started by prominent ophthalmolo-

94 Optometric Education gists and were affiliated with very Notification, the Union Ministry of the need for regulating the profession; reputed eye hospitals. The curriculum Social Justice and Employment made however, because of the lack of their was built on the British model. For it mandatory for all ophthalmic tech­ own knowledge and pressure from a reasons unknown, they did not use nicians with stipulated qualifications strong ophthalmology presence, it has the title of ophthalmic optician, but to become registered with the not yet materialized. This has resulted chose optometry instead; hence, the Rehabilitation Council of India, after in frustration and sometimes disen­ beginning of optometry in India. classifying them as Rehabilitation chantment with the optometric lead­ The first group of optometrists grad­ professionals. This was a far cry from ership and may have been the reason uated from these schools with a Diplo­ having an optometric regulating for the formation of several splinter ma in Optometry, i.e., D.Opt. However, body. In the year 2000, one of the groups. The different levels of educa­ in some schools the word "R" was largest states in India, Uttar Pradesh tion and training among the added to reflect the diploma as Diplo­ (UP) Government, gave notice that optometrists has been an additional ma in Refraction and Optometry, i.e., beginning in the year 2000, all quali­ factor that is responsible for the his­ DR.Opt. In 1959, a third school was fied optometrists, ophthalmic assis­ torical disunity among the profession. opened in affiliation with Sitapur Eye tants, ophthalmic technicians and Hospital. Simultaneously, a school of orthoptists would be designated as orthoptics was also started at the same optometrists for registration with the The New Beginning hospital. Later, a few more schools state government. One other state, the After over forty years of existence opened in affiliation with different hos­ Madhya Pradesh (MP) Government, and ongoing struggle to get recogni­ pitals in different parts of the country. went a step further when it notified tion of the profession among eye care It was in the seventies that the BS opticians without proper qualifica­ providers, state and federal govern­ degree in optometry program was tions that they would not be allowed ment agencies and legislative bodies, started at the Elite School of optometry to refract and prescribe glasses.5 Indian optometry made little progress. in Chennai and the All India Institute In 2001, the World Council of of Medical Sciences optometry pro­ Optometry (WCO) and the Asia Pacific gram became a BS in ophthalmic tech­ Professional Organizations in Council on Optometry (APCO) agreed nology degree program. At present, India to hold their General Delegates Meetings (GDM) in India in 2003 in there are about 20 optometric institu­ In 1964, four years after India's first conjunction with the annual confer­ tions granting diplomas and degrees educational programs produced their ence of the Indian Optometric with a duration ranging from two to first graduates, some of these gradu­ Association. A delegation of Indian four years. ates felt the need to have an organiza­ optometrists attended a WCO meeting tion to represent them. This was the held in Atlanta in February 2001 with birth of the Indian Optometric the SECO annual meeting. They had Optometric Legislation Association. The first meeting was held made a convincing argument that the Optometry in India is not a state reg­ at the residence of one of the WCO 2003 GDM meeting should be istered or licensed profession; hence optometrists. Thus began the move­ held in India. And then came 9/11, cre­ anyone, regardless of education and ment of organized optometry in the ating fear and anxiety among the trav­ training, can examine eyes. Organized Northern part of India. Concurrently, eling public. As a result of that fear and optometry under the banner of the there was organizational movement in other reasons, APCO decided to pull Indian Optometric Association (IOA) the Eastern part, especially in the out of the India meeting. WCO, how­ and other state and regional organiza­ Calcutta area where some practitioners ever, thanks to its leadership under tions has been struggling to have some had been trained through an Optical President Dr. Damien Smith and other form of registration. The call that was Institute and Refraction Hospital Trust. executive body members, decided to made 30 years ago on the eve of the In 1967-68, the author was elected as stay the course and gave its blessings 10th Annual Conference of the Indian the Secretary of the Indian Optometric to hold the meeting in India. Optometric Association in 1974 is still Association. For the next three years 3 being made today. It was Professor B. efforts were made with the state The decision that WCO would meet R. Shukla , director, AMU Institute of authorities to provide registration of in Delhi and Agra in March 2003 was Ophthalmology, Aligarh, who very optometrists without much success. the "new beginning" for optometry in strongly urged that optometrists must This effort has continued to this day. India. While the Indian Optometric be registered and encouraged liberally Association was busy in preparations to spread their knowledge and exper­ During all these years, the Indian Optometric Association has become a to host optometrists from around the tise in the service of rural India. He fur­ world, WCO started looking at ways to ther stated that they should be accepted stronger organization; however, there has been no paid staff working for the create an impact that its visit to India as important co-workers to ophthal­ could make. As a part of my WCO mologists in the field of ophthalmic organization. All the work is done by the volunteers, some of whom may not Fellowship, I was appointed as planning. He also encouraged the Presidential Envoy and visited India in optometrists to remain positive and not have the luxury of time, financial and other resources to get actively involved. November 2002. The objective of this give up in spite of the environmental visit was to determine the current Several regional organizations darkness, as the struggle between the needs and growth opportunities for have come into existence when link­ right and wrong would one day fall in optometry and eye care in India. 4 ages with the national organizations their favor and justice would prevail. Initially it was decided that the became very thin. There has been lack Presidential Envoy would visit There has been some movement in of organization, planning and follow Mumbai (Bombay), Kolkotta (Calcutta) this regard, but it has taken over thir­ through among the organizations. and Delhi, but at the insistence of the ty years. In 1998, through the Gazette The government authorities realize

Volume 29, Number 3 / Spring/Summer 2004 95 hosts, Hyderabad and Chennai optometry. The draft was then circulat­ of Indian optometric education is (Madras) were added to the itinerary. ed among the ad hoc committees for essential. There is agreement that the These cities were selected, one because comments and additional input. strategic plan should include a number these are metropolitan cities with the These drafts formed the basis of of strategies. For example, each school majority of the practicing optometrists MOUs that were signed on March of optometry in the United States could and, secondly, because each of these 30th in New Delhi as part of two days adopt one school in India and serve as cities also had optometric educational of historical meetings, political action the "big brother" providing guidance institutions. planning, compromise and good will and resources that can improve the During these visits, the Presidential among a large and diverse mix of standard of optometric education in Envoy met separately with Indian optometrists and educators. India. WCO Fellowships would pro­ optometrists representing various These were organized into two steps. vide continuity for professional devel­ organizations and the faculty from Step One included Impact Day and opment and educational growth. optometry schools and made the fol­ Unification Day; Step Two included With improved education, guidance lowing observations: the beginning framework for a long- and resources from the international 1. Several educational institutions that term strategic follow-up plan. optometric community and, above all, were started in the 1960's with a two- with united efforts and dedication from year training program still existed, but Step One the Indian leadership, Indian optome­ no significant improvement was in try can grow and play an invaluable sight. Step One involved bringing together role in serving the visual needs of the 2. There were now several newer insti­ leaders from within the profession and over one billion people in India. tutions with a four-year degree pro­ outside the profession to underscore the monumental unmet need for vision grams, producing well-trained Acknowledgements optometrists, some of whom have been and eye care in India. The WCO pres­ able to successfully complete masters ence in India witnessed Impact Day on My sincere appreciation and thanks and PhD degrees in the United States. March 29, 2003 whereby dignitaries to Dr. Damien Smith, president of 3. There are some private and quasi- from government, non-governmental WCO, and Dr. Anthony Di Stefano, government training centers offering organizations (NGOs) and ophthalmol­ executive director, WCO, for their trust various levels of training. ogy groups were invited and exposed and guidance during my Fellowship. 4. The disparity in the educational to the "case for optometry" as an indis­ Their true desires and commitment to institutions was also very much appar­ pensable part of solving India's vision help optometry grow in India will cer­ ent among the practicing optometrists and eye care problems. The following tainly bear fruit one day. Thanks also as they are the by-products of one of day was celebrated as the Unification to Dr. Dan Sheni, president-elect of these schools or the other. Day. In two separate sessions, memo­ WCO, for his ongoing efforts to 5. These disparities have resulted in a randa of understandings for the forma­ improve the standard of the optomet­ fractured profession, further hurting tion of the Indian Association of ric profession in India. Special thanks the cause of the profession. Schools and Colleges of Optometry to HOYA Corporation for its continu­ This visit made it quite evident that (IASCO) and National Association of ous support of the HOYA VISION 2020 the first and foremost need of Indian Indian Optometric Organizations Fellowship Program and to the Kanai optometry was for unity and thinking (NAIO) were signed. Fourteen schools Fellowship Fund, which have helped on common grounds. The Presidential signed an MOU to be a part of IASCO to fund my WCO Fellowship. Envoy made it very clear to all the key and eleven organizations signed on to players that they needed to join hands be a part of NAIO on March 30, 2003. References The date will be an historical turning and work together and pool their limit­ 1. Bachani D. Ministry of Health Government of point in the development of optometry ed resources for any success. It was 6 India. VISION 2020: The Right to Sight strongly suggested that two organiza­ and optometric education in India. Initiative in India. Presentation on Impact Day tions be formed at the national level, Since April 2003, both the groups have — Joint Conference of World Council of been at work to strengthen these Optometry and the Indian Optometric one representing all the teaching insti­ Association. New Delhi, India: March 29, tutions (similar to the North American national organizations. 2003. Association of Schools and Colleges of 2. Rao GN. Eye Care in India. Presentation on Optometry — ASCO) and the other Step Two Impact Day — Joint Conference of World representing the professional organiza­ Council of Optometry and the Indian The formation of IASCO and NAIO Optometric Association. New Delhi, India: tions. A representative from each orga­ March 29, 2003. nization and each of the schools was was a new beginning, and it will remain a beginning unless giant steps 3. Singh VP. Let us wake up now. Souvenir, appointed to two ad hoc committees to Indian Optometric Association Tenth draft by-laws within a Memorandum are taken to strengthen these organiza­ Congress. March 23-24,1974. of Understanding (MOU) for the new tions and the optometric profession in 4. Shukla BR. Optometrists in ophthalmic plan­ India. Nothing will happen until the ning. Souvenir, Indian Optometric organizations. They were given a dead­ Association, Tenth Congress, March 23-24, line of January 26, 2003 (India's leadership among Indian optometrists commits its resources to implement the 1974. Republic Day) to come up with the 5. Editorial: Other states should follow UP and draft document, but this deadline was vision expressed on Unification Day. MP. The Indian Optician. May-June 2001. not met. The Presidential Envoy then It is clear that WCO will need to con­ 6. Agarwala KR, Gogate AS, Bhardwaj A, reviewed several countries' by-laws tinue to provide support, guidance and Wadhwa R; New Directions for Optometry leadership with full force until the next in India: Observations at an International and drafted two documents consistent Conference, Optometry Today, vol 29, First with and sensitive to the environment, steps are reached; otherwise all its pre­ Quarter 2003. background and needs of Indian vious efforts may have little long-term impact. A strategic plan for the future

96 Optometric Education ties. Seven observers from outside the region and fifteen deans and faculty from Latin American optometry pro­ grams tackled workshop discussions and plenary sessions covering: • The definition of optometry: the role of an optometrist and the public's perception of an optometrist • Minimum curriculum: faculty devel­ opment, student evaluation, teach­ Educators in ing methodology, continuing educa­ tion, research and student visual health campaigns Latin America • Legal aspects of optometry: Ministry of Health and Ministry of Unite Optometry Education recognition of the optom­ etry career, regulation, the legisla­ tive power of educational programs Janet L Leasher, O.D., M.P.H. • Student issues: recruitment and retention, postgraduate employ­ ment opportunities, traditional lec­ ture teaching vs. distance or semi- distance learning • Formation of the constitution and bylaws of ALDEFO, the executive committee, financial issues, country by country requirements San Jose, Costa Rica, November 5, 2003: Fifteen deans of Latin American This report summarizes general informa­ optometry schools and 14 deans and tion from the inaugural meetings of ALDE­ observers from North America and Spain participated in the writing of the Abstract FO, attended by the author as the World Constitutional Statutes of ALDEFO. Council of Optometry presidential envoy. Optometric Education in Latin The founding group adopted the America is currently characterized Statutes and voted for the first by significant variability across bor­ The Formation of the Governing Board. The ALDEFO ders, reflecting the diversity in the Governing Board for 2003-2005 is: Latin American Association of legal, professional, and scope of • President: Jairo Garcia Touchie, practice status of optometry in the Schools and Faculty of dean, Universidad de La Salle, region. There are over 30 universi­ Optometry Colombia ties or training centers offering opto­ he newly formed associa­ • President-Elect: Julio Torres metric programs in ten countries. tion of schools and pro­ Fuentes, dean, Instituto Politecnico The formation of Asociacion grams of optometric educa­ National, Mexico Latinoamerica de Escuelas y tion in Latin America, • Secretary-Treasurer: Margarita Facultades de Optometria (ALDE- TALDEFO (Asociacion Latinoamerica Ayala, dean, Universidad Santo FO, the Association of Latin de Escuelas y Facultades de Tomas, Colombia American Education and Faculties Optometria) is an event of great his­ • Trustees: Pilar Contreras, dean, in Optometry), in 2003 addresses the torical significance in the evolution of Universidad Autonoma de growing commitment to harmoniza­ optometric education in the region. Aguascalientes, Mexico and Jorge tion, resource-sharing, and program Quito, Ecuador, February 5, 2003. Cherusse, faculty at Universidad La development and innovation. University faculty and leaders in opto­ Plata, Argentina. metric education in the region met for • Executive Director: Andre Pagan, Keywords: Optometry, Education, the first time in conjunction with the dean of academic affairs, Inter. - Vision Care, Latin America biannual congress of the Asociacion American University School of Latinoamericana de Optometria y Optometry, Puerto Rico Optica (ALDOO) with the theme In the constitutional statutes, "Latin America United." They gath­ ALDEFO recognizes optometry as "a ered to contemplate the formation of healthcare profession that is an international entity that would join autonomous, educated, regulated, the optometry schools together so that (licensed and registered), and [that] optometry could work as a unified optometrists are the primary health­ Dr. Leasher is the director of community outreach, academic front, to fortify the ties care practitioners who are the primary the North American regional coordinator for the between Latin America and North professionals of the visual system that UNESCO Chair in Visual Health and Development America, and to optimize academic provide the comprehensive eye and and assistant professor at the Nova Southeastern resources among different universi­ vision care, which includes refraction University College of Optometry.

Volume 29, Number 3 I Spring/Summer 2004 97 and dispensing, detection, diagnosis grams, to 4-5 year professional pro­ exchange between North America and management of disease in the eye, grams. Some programs are develop­ and Latin America can further create and the rehabilitation of conditions of ing Master's level training. Anyone the coordination, integration and the visual system.t2 seeking PhD level training in optome­ globalization of the profession. The The objectives of the organization try must go outside the region. The intent to have open regionalism in the are multi-fold: Doctor of Optometry degree (known aspect of education will hopefully • To organize, unify, and represent to USA and Canada standards) is not bring about scientific and technologi­ the legal and professional optome­ granted, although there are many cal development on the educational try programs in Latin America. Latin American practitioners who level that will influence policy and • To orient the member programs and have trained in the United States or planning on the federal level in each faculties on curriculum aspects, Canada to obtain this title. country. A systematic analysis of the standards of academic competen­ Established Latin American techni­ wide array of optometric educational cies, length of duration and academ­ cal and professional programs deserve programs in Latin America shall be ic credits required for the prepara­ recognition for their efforts to develop one of the outcomes of ALDEFO. tion of a professional in optometry, quality optometric education. At the While information and education in accordance with the international ALDEFO meetings, many deans crosses national borders, measures trends. reported one of the obstacles to quality may be taken to ensure that interna­ • To foster opportunities for the optometric education were the tional professional standards are exchange and academic coopera­ 'escuelitas' or little schools opened by developed and met. The analysis of tion among the member programs optical companies needing refraction- the barriers that significantly under­ and faculties. This includes the ists to work in their opticals. These cer­ mine the quality of and optometric exchange of bibliographical mater­ tificate-training programs (reportedly care for inhabitants of the region ial, magazines and newsletters. from two weeks to two months) grant should lead to initiatives to breech • To support the development of for­ job skills to trainees, then offer them some of those barriers. Exploring dif­ mative and scientific investigation employment in their company and call ferent modes of practice and service among the member programs and them optometrists. When there were delivery, licensing of professionals, faculties of optometry. enough optometrists to work for said mutual recognition of diplomas, regu­ • To establish protocols that support company, the company would close lation based on the need to meet legit­ development of vision promotion the school, potentially opening again imate objectives such as consumer/ and prevention programs with years later when the need for refrac- patient protection /rights are all issues active participation of the members tionists became evident. These practi­ that can be addressed by having a to impact the region. tioners usually do not have the same solid organization in regional opto­ • To promote the creation of an inde­ quality education as a graduate from a metric education. Optometric educa­ pendent accreditation agency that professional optometry program. tors can look at the barriers that limit stands for guaranteeing the quality These 'empiricists' or 'empiricos' as entry into the study of optometry, the of the programs and faculties of they are called in Spanish, do not or ethics of health and optometric prac­ optometry at the Latin-American cannot apply for licensure or register tice, the health and medical responsi­ level. to practice in many cases. They under­ bility, norms and standards of quality mine the quality of care given by the of care that affect the entire region. professionally trained optometrists As the profession grows in Latin Historical Considerations for the and their presence undermines the America, it has become much more Formation of Aldefo quality reputation and respect for the diverse, from optical schools to pro­ Latin America's oldest optometry optometric profession. fessional schools. ALDEFO can work school is the Instituto Politecnico The improvement of the profes­ toward harmonizing international Nacional Escuela Superior de sional education system in optometry legislation on educational qualifica­ * Medicina in Mexico City — the first and the deterioration of the empiricist tions, and assess the health impact of university to train optometrists in training system presently coexist to its decisions according to effective­ 1950.3-5 La Salle University in Bogota, various degrees in most countries in ness, quality and efficiency. Colombia, opened its doors to the Latin America. The challenge for Ultimately, transparency in the study of optometry next and became ALDEFO is the development of pro­ development of programs with the a leader in optometric education in fessional education to ensure equi­ exchange of ideas should lead to South America.4-5 Today there are over table access to appropriate quality modernization and institutional 30 universities or training centers care. While professional optometric change in the region. offering professional programs in service may not yet be broadly avail­ optometry in ten different countries able, the empiricist system still flour­ from Mexico to Brazil. Latin ishes with the justification that per­ Acknowledgements American optometry programs are haps in areas where no quality vision The author wishes to acknowledge generally undergraduate programs, care exists, one could argue that any the World Council of Optometry accepting students directly from high service is better than no service. (WCO) for the opportunity to travel school. Upon completion of the pro­ to the ALDEFO meetings; and WCO gram, the school may grant the title of Educational Committee member Dr. Optometrist, or Optometric-Optical Implications for the Future Bina Patel of the New England Technician, or Medical Technologist The changes that unfold as a result College of Optometry for developing in Optometry. Programs vary in of the formation of ALDEFO will be the database on the optometry educa­ length from 2-3 year technical pro­ historical. Hemispheric change and tional institutions in Latin America.

98 Optometric Education Special thanks to HOYA Corporation 1. Universidad Catolica de Valparaiso, Number of Ophthalmologists: for its continuous support of the Valparaiso Website: www.ucv.cl unavailable HOYA VISION 2020 Fellowship Colombia Number of Opticians: unavailable Program; and to the Kanai Fellowship Population: 43,070,703 1. Universidad Galileo, Guatemala Fund, which have helped to fund my Number of Optometrists: approx City WCO Fellowship. 2,500 2. Universidad Rafael Landivar, Number of Ophthalmologists: Guatemala City References approx 1,500 1. Translation by the author of the Number of Opticians: none Peru Constitution of ALDEFO, Chapter 1, Article 1. Universidad Santo Tomas, Population: 27,012,899 1, Paragraph 1. Ratified in San Jose, Costa Bucaramanga Web Page: Number of Optometrists: approx: 250 Rica on November 6, 2003. 2. General Delegates Meeting. World Council www.ustabuca.edu.co Number of Ophthalmologists: of Optometry Constitution. Concept state­ 2. Universidad Metropolitana de approx 700 ment of optometry. London: International Barranquilla, Bucaramanga Web Number of Opticians: approx 650 Optometric and Optical League, 1993, Venice Italy. Page: www.unimetro.edu.co 1. Escuela Superior Privada De Optica 3. Instituto Politecnico Nacional ESM 3. Fundacion Universitaria San Martin, y Optometria, Lima Antecedentes de la escuela. Available at: Bogota Web page: 2. Universidad Nacional Federico http: / /www.cenac.ipn.mx/planes/ESM/e www.sanrnartin.edu.co Villarreal, Lima sm.htm Accessed 12/02/03. 4. Universidad de la Salle Available at: 4. Fundacion Universitaria Del Area 3. Instituto Education Superior http:/ / www.lasalle.edu.co/frames/fhisto- Andina, Bogota Web Page: Barraquer del Peru, Lima ria.htm Accessed 12/07/2003. www.areaandina.edu.co / Website: www.optometriaperu.org 5. Valverde Solis DS. Optometria Legal. Primera Edicion 2001. Guayaquil-Ecuador: 5. Universidad de la Salle, Bogota Imprenta JR. Website: www.lasalle.edu.co Mexico 6. Universidad Antonio Narifio, Population: 100,349,766 Bogota Web Page: Number of Optometrists: unavail­ www.uanarino.edu.co / able Appendix 7. Fundacion Universitaria del Area Number of Ophthalmologists: Andina de Perieira, Pereira Web unavailable Optometric Educational Institutions Page: www.funandi.edu.co / Number of Opticians: unavailable in Latin America programs / optometria.html 1. Universidad Nacional Autonoma de Argentina Mexico, Mexico City Web Page: Population: 36,955,182 Costa Rica www.iztacala.unam.mx /www Number of Optometrists: approx 200 Population: 3,710,558 campus / lrnks.html Number of Ophthalmologists: Number of Optometrists: ~ 320 2. Instituto Politecnico Nacional approx 5,000 Number of Ophthalmologists: 22 CICSA-Sto Tomas and Milpa Alta, Number of Opticians: approx 5,000 Number of Opticians: 0 Mexico City Web Page: www.ipn.mx 1. Escuela Superior de Optometria, 1. Universidad Latina, San Pedro Web 3. Universidad Autonoma de Buenos Aires Page: www.ulatina.ac.cr/pl Aguascalientes, Mexico City 2. Universidad Nacional de La Plata, optometria.html Web Page: www.uaa.mx:8001 / La Plata Web Page: Universidad Autonoma de Ciudad http: / / www.unlp.edu.ar Ecuador Juarez, Chihuahua Web Page: www. Population: 12,920,092 uacj.mx /icb / carreras /optometria Brazil Number of Optometrists: approx 210 4. Centro de Estudios Universitarios Population: 172,860,370 -350 Xochicalco Web-Page: Number of Optometrists: unavailable Number of Ophthalmologists: http: / / www.ceux.mx / Number of Ophthalmologists: Number of Opticians: 100 unavailable 1. Universidad Cristiana de Venezuela Number of Opticians: unavailable Guayaquil, Guayaquil Population: 23,542,649 1. Universida de Luterana do Brasil, 2. Pontificia Universidad Catolica del Number of Optometrists: 500 Ciudad Canoas, Rio Grande do Sul Ecuador-Sede Ambata, Ambata Number of Ophthalmologists: 1035 Web Page: http: / Zwww.ulbra.br Web Page: www.puce.edu.ee Number of Opticians: 1500 non acad­ 2. Universidade do Contestado, Santa 3. Universidad San Francisco de Quito, emically trained refractionist/opti- Catarina Web Page: Quito Web Page: www.usfq.edu.ee / cians www.unc-cni.rct-sc.br 4. Escuela Politecnica Javeriana 1. Instituto Universitario de 5. Universidad Estatal de Guayaquil, Optometria (IUO) Chile Guayaquil Web Page: www.ug.edu.ee Population: 15,153,797 Number of Optometrists: unavailable Guatemala Number of Ophthalmologists: Population: 12,639,939 approx 500 Number of Optometrists: unavail­ Number of Opticians: approx: 800 able

Volume 29, Number 3 / Spring/Summer 2004 99 Resources IN REVIEW

Primary Care Optometry, fourth be used again and again. contemporary issues such as adding edition. T. Grosvenor: Butterworth- an associate or partner, design needs Heinemann, 2002, 649pp, $90.00. Guest Reviewer: Dr. John E. Larcabal for electronic medical records, return Like the three previous editions, Assistant Professor on investment analysis in space allo­ Primary Care Optometry continues Southern California College of cation and design, as well as man­ to be an exceptional clinical guide. Optometry aged care concerns. I think this book Its pages are easy to read and its would fill a valuable space on every material is clear, succinct and easily Maximizing the Potential of Your optometrist's bookshelf. understood. While the traditional Ophthalmic Office: What You nuts and bolts of optometry have Need to Know About Planning Guest Reviewer: Dr. Stuart Rothman not been forgotten or dimished, new and Design. Fred L. Kahn: Associate Clinical Professor SUNY State College of Optometry topics have been added to reflect the Butterworth Heinemann, 2002, 385 Private practitioner, Livingston, expanding role of optometry. A pp., $46.95. chapter on Nonsurgical Methods of New Jersey When I first heard the title of this Myopia Control or Reduction has book I only heard the main title and been included. The chapter on assumed it was going to be about Visual & Vestibular Consequences Refractive Surgery has been updated maximizing office potential through of Acquired Brain Injury. Irwin B. with the most current information. marketing. The secondary title Suchoff, Kenneth J. Ciuffreda, and The chapter on Low Vision has been explains more about the subject of Neera Kapoor, eds., Optometric expanded to meet the growing need this book. The title really should be of an aging population. Extension Program Foundation, Maximizing the Potential of Your Santa Ana, CA., 2001,244 pp., For the student, this comprehen­ Ophthalmic Office Space. $35.00. sive text covers the meat of optome­ Fred L Kahn grew up in the opti­ This book is a compilation of try in an easy-to-understand man­ cal supply business. He has been papers from the Academy 1999 sym­ ner. Study questions at the end of involved in ophthalmic design for posium in Seattle and a few other each chapter reinforce important over 50 years, most recently with articles from other authors that the points and concepts. For the practi­ Zeiss Optical. In the preface of the editors had felt rounded out the dis­ tioner, this book is one-stop shop­ book, Mr. Kahn states that "you will cussion well. The topic is ambitious ping. Grosvenor takes four years of learn the essentials of the complex for two reasons: there are untold optometry school and condenses it and time consuming process of relo­ visual and vestibular consequences into one tome. If s a great resource of cating or renovating an existing of brain injuries and there is very lit­ information that we once knew for office, or planning a startup." He tle known and even less that is pub­ the Boards, but forgot soon there­ delivers on that promise. This is the lished on this topic. Traditionally, after. most comprehensive and inclusive almost every ophthalmologist and Prior to writing this review, I guide to ophthalmic office space I far too many optometrists are con­ decided to put Grosvenor to the test have seen. It is filled with easy-to- tent to patch an eye to manage with two patients that I had recent­ follow lists, photos, office plans and diplopia, ignore any other symp­ ly seen in my office. The first had a practical solutions to office space toms, and wait for six months. If the varying vertical deviation. So I and design issues. The middle chap­ symptoms have resolved, that is searched for Parks Three Step test. I ters on design criteria include fea­ wonderful; if not, then there is noth­ found it on page 302. The next had tures on most clinical functions, eye­ ing else to be done. This attitude is keratoconus with corneal powers wear delivery, specialty care such as far too pervasive for a syndrome in beyond my keratometer. I wanted contact lenses and vision therapy, which almost every other area is to know what trial lens power I computerization, and advanced aggressively treated, not passively could place in front of the ker­ clinical procedures. As Mr. Kahn ignored. The visual system is the atometer and what additional promises, there is useful information only one traditional medicine power it would yield. Page 452 for the optometric startup, renova­ expects to get better on its own, informed me that a +1.25 would tion of space, relocation, purchase vs. which implies that they respect the give me an additional 9.0 OD. lease, and even new construction. power of that system for recovery. Grosvenor had passed the test. To say that, in this kind of system, if The book is fast reading, yet valu­ there is no spontaneous recovery, then I highly recommend this book.. able as a reference resource both for Primary Care Optometry is an there can be no recovery strikes me the existing practitioner, student, as seriously flawed logic that is cer- exceptional reference guide that will and new graduate. Mr. Kahn covers

100 Optometric Education tainly not backed up by research. able health profession, despite the sive references to assist the reader in This book should serve as a call challenges we face from third party obtaining more detailed information to action for optometry to halt the payers and some medical specialties. if desired. Additional areas of spe­ undue suffering these patients cur­ This book brings together view­ cialized contact lens care, such as rently have to undergo in waiting points from several different disci­ pediatric and multifocal contact for spontaneous recovery. It is a plines, sometimes within the same lenses, are not addressed. well-researched, multidisciplinary chapter, and shows how these view­ manifesto for patients who deserve points can combine to create a pow­ Guest Reviewers: Dr. Jennifer Jung better. The foreword by Freeman erful team for the treatment of a dif­ Dr. Tim Edrington sets the tone wonderfully. He writes ficult set of conditions. It is my hope Southern California College of about his experience with a patient that every optometrist, and indeed Optometry who had suffered traumatic brain every staff member in every rehabili­ tation center in the country, would injury in a way that will resonate for Genetics for Ophthalmologists - read this book and understand what anyone who has worked with these The Molecular Genetic Basis of optometry can offer to patients who challenging and rewarding cases. He Ophthalmic Disorders. Graeme may have a best-corrected visual writes an apology for the "catch as CM Black: Remedica Publishing, acuity of 20/20 but nonetheless suf­ catch can" nature of the book and he 2002,352 pp., $40.00. is absolutely correct when he states fer from disabling visual conditions. This book, written by Dr. Graeme that this "is not offered as a text­ The Optometric Extension Program Black, an authority in the area of book." In the beginnings of the first has performed our profession an genetic ocular disease, is a concise six chapters, there are multiple defi­ important service by publishing this compendium of eye disorders that nitions of acquired brain injury book. have a genetic basis and inherited (ABI), traumatic brain injury (TBI), systemic metabolic disease with ocu­ etc. The same diagram to illustrate Guest Reviewer: Dr. David Damari lar manifestations. It includes dis­ coup and contracoup injury to the Assistant Professor eases of the cornea, lens and retina; brain is shown in two different Southern College of Optometry glaucoma; vitreoretinal disease; chapters. However, if you can look optic nerve disorders; and several of past the unusual editorial choice of Clinical Manual of Specialized the more common inborn errors of letting these redundancies stand, Contact Lens Prescribing. TR metabolism. It includes as well a you will find much that is challeng­ Scheid, ed. Boston: Butterworth- very complete glossary, which can ing and useful. Heinemann, 2002, 222 pages, $45.00. be especially helpful to eye care The preface lays out the goals of This book is enjoyable reading practitioners who are not conversant this book very succinctly: "...to pro­ from cover to cover for optometric with up-to-date genetic concepts vide optometrists with a broad students, recent graduates and expe­ and terminology. understanding of ABI, its ocular and rienced practitioners alike. The In addition to presenting the visual consequences, the developing authors break down complex fitting genetic information (e.g., inheritance clinical strategies that address these philosophies into clinically relevant pattern, chromosomal location, spe­ consequences, and some of the cur­ information. The reader is not over­ cific gene involved and the effect of rent pertinent research." The book whelmed with theory found in more a missense mutation) to the extent meets these goals and more. Among academically oriented textbooks. known for each condition consid­ the highlights are the first chapter, Dr. Terry Scheid, the book's editor, ered, the author presents a thorough which lays out the groundwork and collaborated with ten contributing description of the clinical character­ what is known about ABI. It is authors to write eight chapters rang­ istics of each disease. High quality accompanied by several useful ing from basic contact lens fitting to ocular photographs (fundus and tables and diagrams. The second more advanced topics. Therefore, otherwise) are often part of the pre­ chapter should be required reading each chapter has a slightly different sentation. for every optometrist and every format and writing style. There are This book is clearly a wonderful member of the health care team who 31 color plates in the middle of the reference source for clinical ophthal­ will ever see a patient who has suf­ book along with several black-and- mologists who are dealing with fered a brain injury. The author, white photographs and drawings genetic eye disorders. Since, to my Edwin Richter, M.D., presents the located throughout the book. knowledge, there are very few clini­ financial and social costs of head Chapters provide overviews of cal optometrists in the U.S. working trauma. The clinical considerations rigid gas permeable contact lens fit­ in this area, my guess is this book he outlines are important for anyone ting, rigid lens modification, toric will have little appeal in the opto­ who is testing this population to soft contact lenses, keratoconus, toric metric community. remember. He illustrates a good rigid lens design, optics and fitting, model of the interdisciplinary reha­ post-surgical contact lens fitting and Guest Reviewer: Dr. Jerry Rapp bilitation team and the appropriate orthokeratology. A soft contact lens Professor role for the optometrist in that team. identification chart is one of three SUNY State College of Optometry I believe that this is one of the helpful appendices. most important books for our pro­ A few of the topics could have fession. It shows why optometry been covered in more detail, but the continues to be a viable and valu­ majority of chapters contain exten­

Volume 29, Number 3 / Spring/Summer 2004 101 Ophthalmic Photography: Retinal Christopher Rapuano Ed., New technologies reviews recent and Photography, Angiography, and York: McGraw-Hill Professional - emerging technology for glaucoma Electronic Imaging, second edition. paperback. 1,613 pp., diagnosis and management. This PJ Saine, ME Tyler: Butterworth- $275.00/Library, $65.00/Volume. section also reviews how to interpret Heinemann, 2002,368 pp, $150.00. I found this series to be an easy to the test results from each instru­ This well-thought-out and orga­ use text and an excellent clinical ment. nized text was written with a large resource. As a faculty member who I believe the volume on retina audience in mind including profes­ teaches both optometry students would be very beneficial to the pri­ sional ophthalmic photographers as and private practitioners, I am mary care provider. The format is well as optometrists, ophthalmolo­ repeatedly asked to recommend a similar to the other volumes in pro­ gists, and students. The intent of the reference text that provides both pic­ viding a brief background of the dis­ second edition of this text is to meld tures of an ocular disease condition, order, pathophysiology, clinical the basics of ophthalmic photogra­ as well as a synopsis of how to man­ signs, diagnostic evaluation, prog­ phy with the new technology of dig­ age the condition. This series pro­ nosis and management It is divided ital imaging with the hope of mak­ vides both of these requirements. into ten chapters which include cate­ ing one a better ophthalmic The library is divided into the fol­ gories such as macular diseases, dia­ photographer. The scope of this text lowing topic areas: cornea, glauco­ betic retinopathy, retinal degenera­ spans from the very basic to very ma, neuro-ophthalmology, oculo­ tion and dystrophies, chorioretinal advanced. Principles and tech­ plastics and retina. The first thing inflammatory diseases and peripher­ niques of stereo fundus photogra­ that will strike the reader is the al retinal disease to name a few. For phy, fluorescein angiography, indo- exquisite photography that is dis­ practitioners or students looking for cyanine green angiography, played in the series. In each of the a good reference in posterior seg­ electronic imaging, analog and digi­ volumes, the clarity and detail of the ment disorders, this volume will tal videography, and scanning laser pictures is superb. The text or syn­ serve them well. The pictures and ophthalmoscopes are meticulously opsis for each ocular disease condi­ clinical synopses will provide the detailed in the 9 chapters of this text. tion is clinically relevant, giving the user with an excellent foundation of Accompanying this are high quality reader a quick overview of the dis­ the posterior segment disease color and black/white images, ease and how to evaluate, treat and processes. There are several tables descriptive interpretation of sample manage the disease entity. If the at the end of the text which provide cases, emergency intervention, step- reader requires a more in-depth a differential diagnosis of common by-step guide in trouble shooting, explanation of a particular ocular retinal entities which the clinician and film processing and printing. In disease, he would have to utilize will find helpful as well. addition, an extensive discussion on other reference materials. The volume on Neuro-ophthal­ basic topics is presented. Subjects The volume on cornea covers the mology is broken into thirteen chap­ such as dilation, ocular and retinal areas of conjunctiva and sclera as ters. I found the section on Magnetic anatomy, documentation, patient well as cornea. The majority of the Resonance Imaging for the ophthal­ positioning, film and lens selection, volume is dedicated to cornea and mologist to be a very good review and alternate languages are covered. covers developmental anomalies, with excellent pictures of orbital dis­ This is an exceptional text and dystrophies, degenerations, infec­ ease and intracranial lesions. resource tool for the student and tious diseases, inflammatory disor­ Practitioners in a hospital and/or doctor learning how to capture ders, ocular surface disease and sys­ multi-disciplinary setting will find stereo retinal photos with either tra­ temic conditions affecting the this to be a great reference source. ditional film or digital/computer cornea. Corneal surgery and com­ This volume should also be helpful imaging. It is also an excellent plications are included at the end of to practitioners with a large pedi­ instructional text on performing, the volume. I believe the reader atric practice. There is a very good reading, and interpreting the various who is in a refractive co-manage­ chapter on ocular misalignment and angiographies. The only fault of this ment setting will find this to be an other ocular motor disorders. This text is that it indiscriminately covers excellent review and helpful refer­ text provides common neurological too many topics, some of which ence resource. ocular disorders that one might might be better relegated to more The glaucoma volume was one of encounter in a general practice as basic sources. the best clinical texts on the disease well. that I have had the pleasure of read­ Finally, one would imagine that Guest Reviewer: Dr. Judy Tong ing. The text is broken into four sec­ the volume series on oculoplastics Assistant Professor tions: glaucoma diagnosis, glaucoma would not be utilized much by Consultant, Ocular Disease and management, disease syndromes Optometry. One would be wrong. Special Testing and imaging technologies. I found There are three sections in this vol­ Southern California College of this volume to provide an excellent ume divided into eyelids, lacrimal Optometry clinical review for the individual apparatus and orbit. I believe that comfortable with managing glauco­ the practitioner might utilize this ma patients, as well as a very good volume more frequently due to the Color Atlas and Synopsis of foundational text for those who are day to day lid and lacrimal disease Clinical Ophthalmology 5-Volume less experienced in managing the entities that one might encounter in Library (Wills Eye Hospital Series). disease. The final section on imaging practice. The pictures and clinical

102 Optometric Education description of the various anterior description of the visual field, local­ email newsletter. Other articles in the segment disorders are very good ization, diagnosis, brain scan and/or most recent issue of Connected were: and provide the user with an excel­ fundus photos. The Discussion for "Fitting Tip: Proclear Compatibles lent reference source. each case covers the differential Solves Dry Eye Concern"; In summary, I found the Color diagnoses, which had been consid­ "CooperVision's Frequency 55 Atlas & Synopsis of Clinical ered, and management. The next 20 Multifocal: A Balancing Act that Ophthalmology (Wills Eye Hospital cases are presented in random order Works"; and "Fitting Stock Prosthetic Series) to be one that would fit nice­ so that one can test his skills. More Lenses". For more information, con­ ly into any practice setting. I would than half of the cases have tact Connected@Coopervision advise purchasing the entire set as I Goldmann fields. Connected.com believe that all five volumes will be One of the best aspects of the utilized by the practitioner. This book is that it demonstrates and New Varilux Aids For small paperback series can be easily explains the variabilities and irregu­ Optometrists larities in visual field testing which stored on a desk top for quick and R. Michael Daley, president of are encountered in clinical practice. easy reference. Essilor Lenses, inaugurated Varilux' The numerous MRIs are quite help­ new electronic newsletter - "See ful in learning to interpret brain Guest Reviewer: Dr. David What's Ahead." Daley underscored scans, particularly to recognize small Sendrowski Essilor's number one goal - to help normal structures and subtle abnor­ Chief, Ophthalmology eye care professionals grow their malities. The Discussions provide Consultation/Special Testing Service business through the most popular many clinical pearls. I would have Associate Professor brands and highest quality products liked to see more photographs and Southern California College of like the new Crizal Alize lenses. Humphrey fields in the case presen­ Optometry Varilux has also created Paramount by tations. Varilux, a program designed to Field of Vision: A Manual and I don't think the textbook is advise eye care professionals about Arias of Perimetry. JJS Barton and appropriate as an introduction to various business building opportuni­ visual field testing for optometric M Benatar: Totowa, New Jersey: ties for their practice. The program students, and private practitioners Humana Press 2003, 334 pp., $150. covers a variety of topics including might feel it is not sufficiently rele­ This textbook is the seventh in a "How to build patient satisfaction vant to their work, given the empha­ series entitled Current Clinical with Varilux Panamic, How to sis on Goldmann fields and radiolo­ Neurology. Its purpose is to address achieve higher profits in your dispen­ gy. I think it would make a useful measurement of the visual field and sary, Marketing your practice from library resource for fourth-year interpretation of test results, along the inside and How to capitalize on with assessment of the history and interns. I heartily endorse it as a marketing your practice externally. other findings, in the context of learning tool for trainees in ocular disease, geriatric, or hospital-based neuro-ophthalmic disease. The book Voile Names New Regional is for those who are already familiar optometric residency programs, where they may frequently Manager with visual field testing and visual Volk Optical, the industry leader pathway disorders. encounter neurological conditions, and have access to Goldmann in aspheric optics, is pleased to The first chapter, An Introduction perimetry and radiology. announce that Amanda Mechem has to Perimetry and the Normal Visual Optometric educators and those joined the company as regional Field, provides a general review of who work in hospital settings would account manager, West/Central U.S., perimetry. Functional Visual Anatomy likely enjoy testing and fine-tuning providing sales and customer service describes the visual pathway and their diagnostic skills. support for Volk's complete line of includes many illustrations, brain diagnostic, therapeutic and surgical sections, and magnetic resonance ophthalmic lenses, equipment and images. Perimetry at the Bedside and Guest Reviewer: Dr. Pauline F. Ilsen West Los Angeles VA Healthcare accessories. Meechem's territory Clinic emphasizes the importance of includes the Western United states, Center the central field and discusses con­ Arizona, Illinois, Indiana, Kansas, Southern California College of frontation, Amsler grid, and tangent Michigan, Missouri and Ohio. Optometry screen testing. Goldmann Perimetry Meechem joins Volk with a great Los Angeles, CA and Automated Perimetry (Humphrey deal of field sales experience from Field Analyzer) describe each tech­ her most recent position with IKON nique and interpretation of results, Office Solutions. with case examples demonstrating Industry News Volk Optical is an industry various artifacts. (Continued from page 89) leader in the design and manufac­ Following the chapters is the ness of lens discomfort and to help ture of aspheric optics. Glass lens atlas, where 100 cases are presented spread the word that we can in fact construction and the company's in anatomical order. The reader is do something about contact lens patented double aspheric technolo­ challenged to develop his diagnostic comfort, according to Dr. Nikki gy result in the highest quality skills by first reviewing History and Iravani, director of clinical research imaging for precision diagnostic Exam, then turning the page to see and professional relations, in and laser work. The company is the Discussion, which includes a Connected, Coopervision's monthly based in Mentor, Ohio.

Volume 29, Number 3 I Spring/Summer 2004 103 For 150 years.

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