Professional Documents
Culture Documents
Volume 21 Number 1 Fall 1995
Volume 21 Number 1 Fall 1995
Volume 21 Number 1 Fall 1995
OPTOM ETRIC
EDUCATION
Volume 21, Number 1 Fall 1995
Caring
for the
Geriatric
Patient
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VOL. 21
NO. 1
CONTENTS
The Journal of the Association of Schools and Colleges of Optometry
FALL
1995
COMMUNICATIONS ARTICLES
Nashville Notes 10 Faculty Preparedness in Geriatric Optometry
Education
Gary L. Mancil, O.D.,
Rosalie Gilford, Ph.D.,
Focus on the President Sheree J. Aston, O.D., Ph.D. and
An interview with ASCO's new Tanya L. Carter, O.D.
president,, Larry R. Clausen, O.D., Ed.D. 14 The authors examine the current status
of geriatric optometry education and propose
models for faculty training. 17
Including Optometric Services for the
Homebound Elderly in the Curriculum
Benjamin Freed, O.D. and
Mark Kirstein, O.D. DEPARTMENTS
A mobile primary eyecare service for the
homebound elderly sensitizes fourth year students
at the SUNY College of Optometry to the needs Guest Editorial: Faculty Training
of geriatric patients. 24 in Geriatric Optometry
Gary L. Mancil, O.D.
Sustaining Members
I'ri-sitk-nl •*Dr. Richard I.. Hopping, President Fiscal Year 1995-96
Dr. I..OITV K. t ICIUMTI, fYe-iiiU-nt Southern l alifornia College
W i v Ln^ljiid College of Optometry of Optometry Sponsors
Boston Massachusetts 0211^ Fullerlon. California l)2e>31 CIBA Vision Corporation
Vistakon, Inc.
I'ivsiJi-nl-1 Ic-cl Dr. Boyd I!. Banvvell, President
Illinois t ollege of Optometry
Dr. "Ihoniiis L. Lewis, Presidi-ni Patrons
Chicago, Illinois nOMo
1VHIT-\ Ivani.i C ollegi: of Optometry None
I'hiladolphi.i. I'lMinsylv.viM 1'H-l I
Dr. Kkhard M. Hill. Dean
"1 ho Ohio stale Univorsih Benefactors
\ ici'-l'ii'siik'n! College of Optometry Varilux Corporation
Dr. ler.ild W. Htrickl.md. Dean Columbus, Ohio 41210
t. nlli'go of Optometry
Members
L niwrsilv of I louston Dr. Ralph Gar/ia. Acting Dean
Alcon Laboratories, Inc.
I louston, Ti»\jf. rr204-H)=i2 l!nivi'Tsitv of .Missouri-St. I .mm
Allergan, Inc.
School of Optometry
SI. Louis. Missouri 03121 Bausch & Lomb, Inc.
Sccii'tarv- treasurer
Coming Incorporated
Al.in L. 1 evvis. Dean
Dr. Stewart Abel, Dean HPSC, Inc.
IvlTl's S t a t e I n'l\ iTMtV
College of Oplometrv MOVJ Southeastern University Humphrey Instruments, Inc.
Bi« Kapkk. Michigan 49307 Health Professions Division Luxottica Group
I ollege of Optometry Marchon/Marcolin Eyewear, Inc.
North Miami Bo.uh.'l-'lorida ."1"2 Polymer Technology Corporation
Immediate l\isl IVes-ideM
Reichert Ophthalmic Instruments
*Pr. Leslov L. Wall.-. Dean Dr. William A. Monaco. Dean Silor Optical
r.nilii L nivorsitv Northeastern State University
College of Optometry Sola Optical USA, Inc.
Collego of Optometry Storz Ophthalmic
lores! Crow, Orison 471 Id Tahlouuah. Oklahoma 74464 SunSoft Corporation
Transitions Optical, Inc.
I.MVIIIIVI' Director Dr. Arol l\. Augshurgor, Dean
Volk Optical, Inc.
Martin V Will. CAL Universitv of Alabama at Birmingham
Wesley Jessen
"school ol Optonietrv
Dr. |.ii k W. Bennett, Dean Birmingham. AI ir>2'H
Indiana University As of August, 1995
•school ot Optometry Affiliate Members
Bloomington, Indiana 47401 Dr. lacob Si\ ak, Diroctor
University ol Walorkjo-Optomotrv Editorial Review Board
*Dr. Williiini F. Cochran. I'ri'siileiU Waterloo, Ontario, Canada N21. K,\
Southern College of Optometry Editor: Felix M. Barker II, O.D., M.S.
Memphis. 1 \ isUH I )r. John \ . Lo\astk, Director
Linjvorsilv ol Monlreal-Optomelvv William Bobier, O.D., Ph.D.
Dr. Anthonv ]. Adams. Dean Montreal, Quebec, Canada HM' lj-'l Roger L. Boltz, O.D., Ph.D.
I nivcsilv ot California-Berkeley Nancy B. Carlson, O.D.
School of Optomelrv Dr. Carlos Hornando Mondo/.i. DIMII Linda Casser, O.D.
Berkeley Cahtornia9472U-2U20 HJCUIJ.KI do Oplonntri.i
David W. Davidson, O.D., M.S.
I'Tiivi-rsidnd dtf I.oSille William M. Dell, O.D., M.P.H.
"Dr. Alden \ . Halfnor. President Ellen Richter Ettinger, O.D., M.S.
Bu^ot.i. I'olomhki
Sl.iti' C ollege of Optometry Richard D. Hazlett, O.D., Ph.D.
Lester E. Janoff, O.D., M.S.Ed.
Slate Iniversitv nl \ i ' U Virk Dr. ("h,irk-s r. Mulk-n
Nada J. Lingel, O.D., M.S.
N i e w W k . \ e w \ o r k Infill) Dinvlor, Optoini'trv Sorvut' William A. Monaco, O.D., M.S.Ed., Ph.D.
rVp.irlmont of Nctfi'diis Alf.iirs James E. Paramore, O.D.
"Dr. Arthur I. Afanador. IVan U'cishin^ton. D.l . 20420 Hector Santiago, Ph.D., O.D.
Inli'i Amerkan L nivorsitv Paulette P. Schmidt, O.D., M.S.
ot Puerto Kii-o Dr. k. K<ivi;-liimkcir Julie A. Schornack, O.D., M.Ed.
School ot I'ptometry I'.litc Sdiool oi Oplomi.'lrv Leo P. Semes, O.D.
San Juan, I'liiTloKU-oiHNI" M.idiiis. India Dennis W Siemsen, O.D.
Pierre Simonet, O.D., M.Sc, Ph.D.
Tii-f l'i,--n1r»l-
Thomas M. Wiley, O.D., M.S.
4 Optometric Education
One Day,
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EDITORIAL
Faculty Training in
Geriatric Optometry
Gary L. Mancil, O.D.
T
he demographics of our
aging society are known to their concepts and use. The training legislation. At that time, Congress
us all...or are they? How manual, revised with input from the was in the process of debating legis-
many optometric faculty workshop participants and a distin- lation to reauthorize the Health
have an accurate and up-to-date guished advisory committee, was Professions Education Act. As a
knowledge of the principles of geri- widely disseminated and remains the result of this effort, the Health
atric optometry? How many practic- primary resource for faculty who are Professions Education Extension
ing optometrists are adequately developing courses in geriatric Amendments of 1992 (Public Law
trained in this area? Better stated, optometry. 102-408) legislation was passed, with
how many of us can truly fathom the $400,000 per each fiscal year 1993-
1995 authorized for expanded
A
implications of the aging society in second ASCO geriatric pro-
which we practice for our future ject was funded by the optometry faculty training in geri-
responsibilities? AoA in 1990 to add a new atrics.
In a related article in this issue of module on minority and
H
Optometric Education,1 an ASCO geri- low-income elderly to the original owever, authorization of
atric project team examined this training manual. This project resulted funds by Congress must
topic. This was actually the third in development of the new module be accompanied by equiv-
time ASCO convened a project team and two additional training confer- alent appropriation of
to examine the state of the profession ences targeting optometric faculty funds. While Public Law 102-408 and
in geriatric optometry education, and and, additionally, clinical preceptors. the appropriation law for DHHS
the third occasion during which The original manual with the new were completed, the agency has dis-
ASCO received federal funding to do module on minority and low-income cretionary authority over some bud-
so. elderly was again widely disseminat- geted items; in this instance, the geri-
In 1986, ASCO established an ed, including mailing the update to atric education funding. Funds were
Optometric Gerontology Curriculum those trained in the original project. never committed. Efforts have con-
Development Committee. As its pri- In 1994, an ASCO project team tinued by AOA staff (Mr. Dave
mary goal, the committee sought conducted a survey on faculty train- Danielson, in particular), ASCO
funding to support the development ing in geriatric optometry under con- Executive Director Martin Wall and
of a comprehensive, competency- tract from the Department of Health others to encourage appropriation of
based curriculum model and training and Human Services (DHHS), funds. As recently as June 1994, both
manual in optometric gerontology. Bureau of Health Professions, the House and Senate
Building on earlier work by such dis- Geriatric Initiative Branch (Note: This Appropriations Committees adopted
tinguished leaders as Rosenbloom,2 project is described in the companion language in their Reports specifically
an updated survey of member insti- article in this issue of JOE.) Unlike addressing the lack of appropriations
tutions was conducted which docu- the previous two federally funded in support of optometry faculty
mented the need for faculty develop- ASCO projects, which resulted from development in geriatrics. However,
ment.3 A proposal prepared by the the efforts of the geriatrics project in an era of deficit reduction, compe-
project team with support from team members, the impetus for this tition for federal funding for geriatric
ASCO staff was funded by the contract was Congressional action. faculty training programs for all dis-
Administration on Aging (AoA) in In 1991, the American Optometric ciplines has intensified. Even after
1987 and resulted in development of Association (AOA) had identified an ASCO's completion of the DHHS'
the modular textbook, Optometric opportunity to expand federal fund- own Bureau of Health Professions
Gerontology: A Resource Manual for ing for geriatric optometry education, contract — whose result would have
Educators,1 and the convening of four and ASCO joined in support of an been expected to support optome-
national workshops during which effort to include optometry among try's case — no new appropriations
the materials were field-tested and the disciplines (medicine and den- (Continued on page 9)
Optometric Education
THE OPTI-FREE* SYSTEM
Everything Your
Patients Need For
Comfortable
Contacts
A vision for tomorrow
through innovation and education toda^
mi
Among Optometry Students" by Bowyer et for the first patient contact. The "no"
Letters to the Editor al. The University of California, Berkeley,
School of Optometry began requiring the
should have been printed in "Mandatory
Hepatitis" column.
I enjoyed reading your informative Hepatitis B series of vaccinations for the Dr. Bowyer: I would like to acknowl-
summer 1995 article, "Requirements for students who entered our program in edge Sandy Jaeger of the University of
Hepatitis B Vaccinations Among August 1994. The cost of the series is car- Berkeley, California, School of Optometry,
Optometry Students." I strongly agree ried by the students and some students and Craig Millar of the University of
with the recommendation that all optome- may be covered by their health insurance. Waterloo for their careful reading of the
try students, and indeed all optometrists, In addition, Table 2: Hepatitis B article, "Requirements for Hepatitis B
should be vaccinated for Hepatitis B. Vaccination Requirements of Optometry Vaccinations among Optometry Students."
I am also pleased to relate a change in Students (p. 116) implies that students at The data for this article was collected in
one point of information presented in the Berkeley have no contact with patients dur- late 1993 and early 1994. This was prior to
article. It is stated that at the University of ing their schooling. In the second column August 1994 when the University of
Waterloo School of Optometry, Hepatitis B "First Patient Contact (which training year)" California-Berkeley began requiring the
vaccination of its students is not mandato- the answer [printed] for Berkeley is "No." Hapatitis B series of vaccinations of stu-
ry. In 1994, following many years of recom- Our students actually have their contact dents entering the UC-B program.
mending the vaccine to its students, the with patients in their second year of school. Additionally, this research was submitted
UW School of Optometry began requiring We agree with the authors that the HBV for publication prior to the University of
all of its students to provide proof of vaccine should be required and feel that if Waterloo School of Optometry's requiring
Hepatitis B vaccination by the time they the various schools were to be resurveyed in 1994 that all its students provide proof of
begin their clinical rotations in the third that the current results might be currently Hepatitis B vaccination by the time they
professional year. quite different than those published. began their clinical rotation in the third
Craig Millar Sandy laeger professional year.
Student Student Affairs Officer It is obvious that this is an area where
University of Waterloo University of California, Berkeley policies are being quickly revised. It may
be time to contact each school again for an
I recently read the summer 1995 issue of Editor: A computer coding problem update. The authors will contact the
Optometric Education and need to correct caused Table 2 to print "no" for the schools and the current information will be
information contained in the article University of California, Berkeley, and for published in the winter 1996 issue of
"Requirements for Hepatitis B Vaccinations the University of Montreal under the year Optometric Education.
10 Optometric Education
YouVe been watching for these —
Clinical Ocular Pharmacology
Third Edition
Jimmy D. Bartlett, O.D., and Siret D. Jaanus, Ph.D.
From a review of the previous edition:
"Those who passed up the first edition of Bartlett and Jaanus won't want to
repeat that mistake— the second edition is excellent... In short, the second
edition of Clinical Ocular Pharmacology should be a required text for the
ocular pharmacology courses of every school and college of optometry."
— Journal of Optometric Education
New to this edition:
• Features a revised format — more user-friendly and clinical
• The section on Pharmacology of Ocular Drugs is now organized by therapeutic rather than
pharmacologic drag classifications
• 16 new chapters including: Pharmaceutical and Regulatory Aspects of Ocular Drug Administra-
tion, Analgesics for Treatment of Acute Ocular Pain, Antiallergy Drugs and Decongestants, and
Antiglaucoma Drags
• Expanded coverage of: oral medications used in primary eye care, neuro-ophthalmic disorders,
allergic eye disease, postoperative care of the cataract patient, drug interactions, and life-threaten-
ing emergencies
Due September 1995, 0-7506-9448-3, 944 pp. est, Hardbound, $95.00 est.
Ordering information
U T T E R W O R T H Fulfillment Center Phone: 800-366-2665
225 Wildwood Avenue FAX: 800-446-6520
E I N E M A N N Woburn, MA 01801 E-Mail: orders@bh.com
- f o A member of the Reed Elsevier pic group
MS 14
OPHTHALMIC
INDUSTRY N
Companies appearing on these pages are members ofASCO's Sustaining Member Program. Sustaining Members are listed on the
inside front cover of each issue. Membership is open to manufacturers and distributors of ophthalmic equipment and supplies and
pharmaceutical companies.
Paul Harvey Encourages Varilux" in action as he broadcasts "Our objective in China will be
Use of Varilux Lenses his show. the same as it is worldwide — to
"Few people have the opportu- become the market leader in vision
One lucky consumer and his or
nity to meet a legendary figure," care," said Dr. Bradley at the recent
her independent eyecare profes-
Schlarb said. "It is our hope that opening of the Shanghai plant.
sional will each win an all-expenses
the excitement generated by this "China's open door, market driven
paid trip to Chicago to attend one
sweepstakes will not only educate economic policy has given us the
of Paul Harvey's exclusive broad-
consumers about the benefits of the opportunity to achieve that objec-
cast sessions.
Varilux Comfort lens but also help tive and at the same time con-
Paul Harvey, the most listened-
our loyal independent practitioners tribute to the prosperity of this
to radio personality in the country,
grow through our nationwide nation."
promotes the Varilux Comfort lens
referral program."
semi-weekly in his "News &
Comment" segments on over 1,300 Wesley-Jessen Changes
ABC-affiliate radio stations. His CIBA Vision Launches Overseas Hands, Plans Programs
skillful blend of news and views Initiative Practitioners soon will witness
has attracted over 23 million loyal CIBA Vision recently announced Wesley-Jessen launch some aggres-
listeners, many of whom trust his two significant developments in sive new marketing campaigns
opinion and listen to his endorse- the company's drive to seize the designed to create patient interest
ments. His experience with Varilux number one position in the vision in its lenses, according to the firm's
Comfort lenses has already gener- care industry worldwide. new parent company.
ated over 80,000 referrals. In Shanghai, CIBA Vision chief Bain Capital, Inc., of Boston, an
"It is always exciting to meet executive officer, Dr. C. Glen investment firm, purchased W-J in
celebrities, and Paul Harvey is no Bradley, recently participated in the late June from its corporate parent,
exception," said Scott Schlarb, opening of a new contact lens pro- Schering-Plough Corp., Madison,
manager, marketing communica- duction facility. The $4 million, NJ.
tions. "Many of his dedicated fans 30,000 square foot plant will sup- Bain has appointed industry vet-
would jump at the chance to meet port the Shanghai CIBA Vision eran Kevin Ryan as chief executive
him in person." Contact Lens Co., Ltd., which officer of W-J. Ryan, formerly pres-
Paul Harvey encourages his lis- recorded its first sales in the ident of Barnes Hind, succeeds
teners to call the Varilux toll-free Peoples Republic of China during Charles M. Stroupe.
referral line (800-VARILUX) that 1994. "Bain Capital plans to increase
identifies independent eyecare pro- Initial plans call for production spending immediately on con-
fessionals in their area who carry of both conventional and planned sumer advertising and promotion
Varilux Comfort lenses. Consumers replacement lenses in Shanghai. of W-J's FreshLook disposable lens-
are then mailed product informa- CIBA Vision, which expects to see es," said Ryan. "Wesley-Jessen will
tion as well as an entry form for the production in Shanghai rise as its increase demand for contact lenses
sweepstakes. business in China grows, also has through media advertising that
In order to enter, consumers plans to construct a lens care pro- causes patients to ask their eye care
must see one of the referred practi- duction facility in China within the practitioner about our products."
tioners for a free demonstration of next few years. CIBA Vision, A new blitz of consumer media
the lens. Following the demonstra- which currently ranks number one advertising is planned for this fall.
tion, the practitioner completes the in total soft contact lens patient fits Said Ryan, "Practitioners won't
entry form and mails it to Varilux. in the United States, is committed notice changes in our day-to-day
The winners and their guest will to providing quality products and operations, but this fall, they can
receive round-trip airfare, two excellent service to customers in expect to take notice of some major
nights in Chicago, transportation the United States and abroad, new investments in marketing pro-
expenses and $500 spending cash. according to Nancy Duden, grams focusing on our FreshLook
The highlight of the trip is the account supervisor. disposables."
opportunity to watch "the voice of
12 Optometric Education
Corning Receives Standard more familiar with Bausch & Lomb sive review of all current oph-
for Quality contact lenses and solutions." thalmic lens technology, is a
"When new graduates enter tremendous publication," Littel
John Van Zanten, marketing
practice, they want to quickly real- said. "Today, it has a circulation of
manager of optical products
ize the benefits of their rigorous over 100,000 and is recognized as
announced that Corning
education," said William T. the accepted industry reference
Incorporated has received the ISO-
Reindel, O.D., director of profes- source for up-to-date lens technolo-
9002 registration for its ophthalmic
sional market development for gy. Laboratory Technical Newsletters
lens blank manufacturing facility at
Bausch & Lomb's Personal focuses on the benefits and advan-
Harrodsburg, KY.
Products Division. "Each year, we tages of specialty lenses. They've
This world-recognized standard offer new graduates a head start resulted in an industry-wide
for quality adds a new level of con- with immediate access to some of increase in the understanding and
venience and confidence for all of the highest quality and most well use of specialty lenses."
Coming's customers in the optical known brands in the eye care field.
industry. In addition, Littel said, "ABO-
A practitioner can count on these approved slide seminars, the Lens
ISO-9000 is a series of quality products to satisfy patients, and Menus and Progressive Lens
standards which was originally this can give him or her added con- Identifier have helped to establish
designed to address the need for fidence," he added. the association as an impartial
uniform standards in Europe. It is
Information regarding program booster and advocate of modern
becoming a requirement today to
registration materials is available lens technology."
compete in global markets.
via a Bausch & Lomb representa-
The ISO-9002 standard sets qual-
tive, or by calling 1-800-828-9030. Allergan Co-Sponsors
ity system thresholds for the manu-
facture of products. Coming's goal Seminar for Goal Planning
is to add value above and beyond Allergan Inc., beginning this aca-
the recognized standard. demic year, will co-sponsor a spe-
cial workshop titled, "The Time is
Bausch & Lomb Offers Now - Plan for Your Ultimate
Career Goals," with the Irving
Gift to New Graduates
Bennett Business and Practice
Bausch & Lomb announced the Management Center of the
1995 availability of its "New Pennsylvania College of
Practitioner Program," an annual Optometry.
initiative designed to support
newly graduated optometrists and The seminar will be offered four
times throughout the year to reach
ophthalmologists as they enter into Transitions Honors OLA each group of fourth year students
practice. The program is available
Transitions Optical, Inc., recog- who rotate one quarter at the col-
for one year after a new practition-
nized the Optical Laboratories lege's Eye Institute. Students are at
er's graduation date. Association (OLA) with the compa- three different externship sites
The "New Practitioner Program" ny's "Pursuit of Excellence" award, throughout the county during the
provides information and materials honoring the 101-year-old organi- remaining three quarters of their
to help the professional meet the zation for its pivotal role in advanc- final year of study before receiving
needs of his/her patients. The pro- ing the technical knowledge of doc- their doctor of optometry degree.
gram also includes a variety of tors and dispensers about dynamic
sample products from Bausch & Workshop leaders are Debbie
changes in lens technology. Thomson, senior sales executive of
Lomb's Contact Lens, Personal
Leslie Littel, Transitions Optical Allergan, Ed P. Taylor, M.B.A.,
Products, Pharmaceutical and
vice president, presented the award president of Taylor Medical
Eyewear divisions, as well as to Jack Dougherty, OLA president, Practice Consulting, Inc., and Janice
Polymer Technology Corporation. at the association's summer board Mignogna, Bennett Center coordi-
"Industry support benefits new of directors meeting July 14. nator. They will lead the students
graduates, their patients, and pro- through a self-assessment program
"For the past five years, the OLA
vides a stepping stone to future has been actively involved in devel- designed to help define individual
success," said Carol Freihaut, exec- oping a variety of unbiased and goals and then to develop the
utive director, American impartial multimedia educational strategies to reach them.
Optometric Student Association. programs," Littel said. "As one of Other topics will include updat-
"Although I took over an estab- the newer members of the optical ing resumes, loan repayment, and
lished practice, the previous doctor industry, Transitions Optical under- an introduction to the college's
was not a frequent contact lens fit- stands the importance and difficul- "Perfect EyeSite" Placement
ter," said James Arlie Williams, Jr., ty of educating the profession about Network. This service matches eye
O.D., Glax, VA, a 1994 graduate of changes in lens technology." care professionals with employ-
the University of Alabama at In presenting the award to ment or partnership opportunities
Birmingham School of Optometry. Dougherty, Littel highlighted sever- with graduating students, alumni
"This program really saved me al projects for special recognition. and other practitioners from
time and enabled me to become "Perspective on Lenses, a comprehen- around the country.
L
arry R. Clausen, O.D., Ed.D., OPTOMETRIC EDUCATION: Dr.
began a one-year term as Clausen, as you begin your term financing of health care, the colleges
ASCO's president in June as ASCO's president, what goals will be increasingly faced with the
1995. Dr. Clausen has been have you set for the Association? growing problem of maintaining an
president of The New England appropriate base of patients within
College of Optometry (NEWENCO) Clausen: I have outlined three their clinical education programs.
since 1989. He served as dean of acad- goals for my year as president: Appropriately, ASCO has identified
emic affairs at NEWENCO from 1982- improve ASCO's responsiveness to its this issue for its first critical issues
1989. From 1978-1982 he was assistant core sustaining members, outline a seminar which will occur in 1996.
dean at the Pacific University College strategic plan and timeline for Another issue that I see of major
of Optometry. Dr. Clausen received responding to the recommendations importance is the whole issue of
his O.D. degree from Pacific of the Georgetown Summit on accreditation in higher education. It
University in 1970, an M.P.H. from the Optometric Education, and adopt a is unknown what course accreditation
University of Michigan in 1971 and an five-year dues budget. All are interre- will take over the remainder of the
Ed.D. from Harvard University in lated. The Summit recommendations decade, but the likelihood of greater
1994. He was employed by the U.S. which were assigned to ASCO involvement by state and federal gov-
Public Health Service and the approach 70 in number and far exceed ernment is high. We should be con-
National Institutes of Health for the current resources and energies of cerned about the role that the profes-
seven years. Dr. Clausen was inter- the association and its member sion will have in the accreditation
viewed recently by Patricia Coe schools. The recommendations must process, and we should be concerned
O'Rourke, managing editor of be evaluated regarding their congru- about subtle shifts in the purpose and
Optometric Education. ence with ASCO's mission and strate- use of professional accreditation.
14 Optometric Education
ASCO must be pro-active in respond- OPTOMETRIC EDUCATION: The made possible through the generous
ing to this. New England College of support of Vistakon.
Optometry is at the forefront of We have also conducted programs
OPTOMETRIC EDUCATION: Why in Spain, and we are currently explor-
establishing international pro-
did you decide to pursue educa- ing the possibility of working with
grams. Could you describe those university-based programs in Mexico.
tional administration? programs and discuss how you Collectively these represent our
Clausen: After I graduated see them evolving in the next five vision for the next five years. Major
from optometry school at the Pacific to ten years. expansion into other countries is not
University College of Optometry, I envisioned, although new programs
Clausen: I agree. I believe that could emerge in those countries
pursued a M.P.H. degree in medical The New England College of
care administration at the School of where we have established relation-
Optometry is at the forefront of inter- ships. The size of the Boston-based
Public Health at the University of national programs. The College has
Michigan. This eventually led to a program will also remain stable.
established a Center for the
position at the National Institutes of International Advancement of
Health, within the Bureau of Health Optometry through which we offer
Manpower Education. This was an several programs. We have a Boston- A rs>s\ n •
exciting opportunity and proved to be based accelerated program, two years /\OK.KJ Receives
the formative part of my career. I in length, for optometrists who have
worked directly with the deans and
Galileo Award
obtained their optometric training I'hi1 Association at Schools and
presidents of schools of optometry, as abroad. Entry into the program Colleges of Opiometn has
well as leadership in other health dis- requires graduation from a recog- received Ihe Galileo Award from
ciplines. I was employed by the U.S. nized program overseas, and at least I hi- American l o u n d a l i o n for
Public Health Service for seven years. two years of active practice or \ isinn Awareness (AFVA) for
These years became the critical factor research. We admit 6-10 students into
excellence in research.
in directing my career into one of this program each year. As a varia-
Ihe award was presented dur-
administration rather than clinical tion to this program we also conduct
ing Al VA's Annual Meeting in
practice. When federal support for educational programs overseas.
\ a s h \ i l l o , I'cnncssee, held in con-
optometric education waned in the Currently we are delivering course-
junction with the American
late 1970s, I returned to Pacific work in Italy and South Africa.
Faculty from our college, as well as Optometric Association Annual
University as assistant dean in the
contracted faculty from other institu- Congress. ASCO President, Dr.
College of Optometry. I am not so
tions, participate in these programs. I.arr\ R. Clausen, accepted the
sure that this was a pre-planned step
The program in Italy is nearing com- award from ATVA President I inda
in my career, but I found that I
pletion. Nine students will receive Wilkinson.
enjoyed the world of health profes-
their Doctor of Optometry degree Ihe Galileo award is presented
sions education administration and
next year. The program in South annually bv the foundation and
did not want to move into other are-
Africa focuses on expanding clinical honors individuals and organiza-
nas in or out of government. For me,
skills in the area of DPAs and the tions for their contributions to
it has been personally rewarding.
management of ocular disease. More optometric research, especially in
than two hundred optometrists have the area of children's vision and
OPTOMETRIC EDUCATION: What learning. In announcing the
enrolled in this course of study.
has been your focus as president award, A R ' A said that ASCO
of the New England College of The college has also entered into a plavs "a leading role in optometric
Optometry? twin college agreement with research, including emphasizing
Wenzhou Medical College in children's issues as demonstrated
Clausen: When I became presi- Wenzhou, China. We are assisting recently in I heir efforts on the
dent, I began to develop a long-range that college in developing the development and expansion of
institutional plan to guide the institu- National Optometry Research Center. oplomeiric curriculum in the
tion through the 1990s. Out of this This is the only formal program of United States. In addition, ASCO
process, in cooperation with the optometric education and research in has assisted the foundation in dis-
Board of Trustees, we established four China, and it has now gained formal tributing information regarding
major goals which we refer to as recognition by the Ministry of Public AlA'.Vs research grants, optomet-
breakthrough goals. In brief, these Health. Our agreement focuses on ric scholarships and the Children's
are: educational symposia, faculty Vision and Learning Campaign."
• Renovate the College buildings on exchanges, visiting scholars and ASCO is using the award
Beacon Street, research. Two members of their facul- monov to establish an annual
• Grow a $6 million unrestricted ty, Dr. Qu Jia, vice president of award for a research article in
endowment, Wenzhou Medical College and learning or children's vision pub-
• Develop a bioscience research cen- deputy director of the National
lished in Oi>h<iiiclric l.dihiilinii dur-
ter, and Optometry Research Center and Dr.
ing the preceding vear. Recipients
• Enhance clinical programs. Lu Fan, head of the contact lens
of the award will he chosen by
At the half-way point in our department, were hosted as visiting
members of the journal's review
timetable, we can report significant scholars at the New England College
board and presented at ASCO's
progress on all fronts. of Optometry this past year. This was
Annual Meeting.
T
he increase in the population
Chief academic offucr? iiiu1 i>riiiinni of older Americans is expect- mates are significantly higher within
conlncl fin ul111 in \SCC> member ed to continue well into the older age groups: 16 percent of those
21st century. Between 1990 75 to 84 years old and 27 percent of
institution" in Ihe Uuilctl State"
and 2020, the number of persons over those 85 and older are estimated to be
re>ponded to 11 mail "iirvey < omparing visually impaired. Current figures
the age of 65 is expected to increase by
Ihe current <lntii" ofgerialrk optome- 62 percent, from its now approximate- may be assumed to be underesti-
try ctlmillion to llml in / ' W . Result" ly 32 million constituting 13 percent mates 4 because of the general tenden-
~how if ~i pen cut increase in iii"litu- of the population, to over 52 million cy of older persons to under-report
constituting almost 18 percent of the vision impairment, and because most
tii'it- requiring course work ami on tf.i
estimates exclude the institutional-
penenl increase in thote offering 1011- ized elderly. Rates among nursing
linuiiig edmaiiou in geriatric optom- home residents are estimated to be at
etry. Institutional plant are for Dr. Mancil is chief, optometry section and research least four times as high. 5 Projections
health scientist at the Department of Veterans to the year 2000 and beyond indicate
im reaped fihiilln involvement in Medical Center, Salisbury, North Carolina. He his that the number of older people with
expanded didactic mnl clink ill Indu- a graduate certificate in gerontology and is residen-
cy trained in low vision rehabilitation. functional vision impairments is
ing of "Indents, lacully preparation expected to at least double.
in geriatric* and gcronlologu. howev- Dr. Gilford is professor of sociology at California
State University, Fullerton, (CSUF) and founding Thus, the optometric profession,
er. remain" at /"No level", with n7
director of the CSUF geroltology programs. She is like other health care professions,
pen cut reporting no formal training. adjunct professor at the Southern California College faces an urgent need to increase the
Iliree model* of facultu training in of Optometry. level of training in geriatric optome-
geriatric optometry are proposed for try. Both current optometric trainees
Dr. Aston is an associate professor at the and previous graduates alike will
implementation through funding Pennsylvania College of Optometry and has a grad- need to be better prepared in order to
authorized by the federally legislated uate degree in gerontology. She has published exten-
sively on the subject including a book, Clinical provide for the eye and vision care
Health l'roU"-sions lidtication Geriatric Eye Care. needs of the growing population of
I'NU'IIMOU Ami'ndmciils of 1CW2. older Americans.
Dr. Carter is an assistant professor at the State
University of New York State College of Optometry
Little is known, however, about the
where she serves as instructor of records for the geri- current ability of schools and colleges
Key Words: Geriatric", gerontology, atrics course and supervisor for the Geriatric of optometry to meet the challenge of
Residency Program. Dr. Carter is director of opto- providing the necessary training to
oplomelric cdiualion, optomelric fac- metric services at Coler Memorial Hospital and an sufficient numbers of personnel. In
ulty development associate and faculty member of the Geriatric
1984, Dr. Alfred Rosenbloom assessed
Education Center.
18 Optometric Education
assigning the value of 1 to the type of Centers (GECs), universities, and ed to vision and aging. That is, from
training that was selected by the most through the previously conducted 1986 to 1993, the number of schools
people, value of 2 to the training ASCO workshops, but the overall reporting no such continuing educa-
selected as second choice, etc. The extent of faculty formal training has tion courses declined from 10 to 5.
weighted choice gives a truer picture not improved. The number of schools that did offer
of preference. The results of the analy- Table 3 shows an almost doubling such courses increased by 5, from 6
sis are presented in the following sec- in the number of schools and colleges schools in 1986 to 11 in 1993, consti-
tion. reporting continuing education relat- tuting an 83 percent increase over the
Results
The significance of the present
results is best understood by compar- Table 1
ison with the 1986 results. In 1986, a
Formal and Separate Geriatric Optometry Course Work
trend within the ASCO member insti-
tutions toward expanding the geri-
atric content of their curriculums was Type of Course Number of Schools and Colleges
documented. However, despite insti- N=16
tutional emphasis on the topic, the 1986 1993
majority of the key individuals in No formal course 5 1
geriatrics had no formal training in Elective course 2 0
the subject. Furthermore, only half the Combined with low vision 1 1
respondent institutions maintained a Separate required course 8 14
required separate course in optomet-
ric gerontology and only a limited
number of clinical settings emphasiz-
ing geriatrics were provided to
optometry students, typically in off- Table 2
campus settings. Little attention was Geriatrics and Gerontology Training of Primary Contact Faculty
given to vision and aging in research
or continuing education programs. In
short, significant limitations in opto- Type of Training/Education Primary Contact Faculty
metric gerontology educational pro- N=16 N=27
grams and activities were identified No formal training 11 18
in 1986. ASCO Workshops N/A 13
Geriatric Education 3 4
Growth in Geriatric Optometry Table
Center (GEC) Rotation
1 compares the findings on geriatric
course work of the present study with Degree Training/Certificate
those of 1986. While in 1986,5 institu- (e.g., university-based
tions reported no formal course in certificate, formal grad. degree)
geriatric optometry, by 1993, only 1
school reported this status. In 1986, 8
of the schools offered a separate
required course in geriatric optome- Table 3
try, and this number increased by 6 to
total 14 schools by 1993, constituting a Continuing Education Courses on Vision and Aging
75 percent increase in the number of
schools and colleges offering a sepa- Type of Course Number of Schools and Colleges
rate required course over the seven- N=16
year period. 1986 1993
Table 2 presents the educational No specific courses 10 5
background in gerontology and geri- Specific course on vision 6 11
atrics of the primary contact faculty. and aging
The educational background of facul-
ty having teaching responsibilities in
geriatrics or gerontology remains lim-
ited. In 1986, 69 percent, or eleven pri-
mary contact faculty reported having Table 4
had no formal trainihg7and in 1993, Current Vision and Aging Research
there were still 67 percent, or 18 facul- Completed or On-going Research
ty in this category. There is some evi- N=16
dence that individual primary contact 1986 1993
faculty took advantage of resources No 10 10
for specialized informal training Yes 6 6
available at Geriatric Education
20 Optometric Education
activity accomplished (14 responses), institutions and programs. Discussion
followed by clinical services and train- As a final indicator of readiness,
ing (8), informal faculty training (7), primary optometric faculty were sur- The findings of the present study,
and formal faculty framing (4). The veyed regarding their preference for interpreted within the context of cur-
second column indicates that future faculty training format, absent the rent health policy and programs for
plans mentioned for faculty training usually perceived barriers to faculty the older population, call for a mas-
involve informal training (5 respons- involvement (e.g., the need for release sive training effort. A larger cadre of
es), followed by inter- and multidisci- time, funding limitations, etc.). Table 8 present faculty leaders in schools and
plinary training (4), clinical services presents the rank ordering of the fac- colleges of optometry must be trained
and framing (3), formal training (1), ulty's preferred training formats and in gerontology and geriatrics in order
and research (1). The third column durations. While 18 percent of the to conduct the education and training
shows the most prominent area of twenty-one respondents indicated a of future optometrists to deliver care
expansion in geriatric optometry edu- willingness to participate in an optom- to the aging population.
cation to be clinical services and train- etry fellowship program of longer Health Policy Trends and Implications
ing (10 responses), followed by inter- duration, the majority were interested Much of what is discussed in the cur-
and multidisciplinary education and in programs of shorter duration and rent health care debate centers on the
training (8), formal training (2), less time, 57 percent preferred short- growing needs of older patients, and
research (2), and knowledge of normal term training and 25 percent preferred optometry is a major provider in the
vs. abnormal vision changes with age a certificate program. health care industry's ability to meet
(1). Finally, the fourth column shows
that the most significant issues expect-
ed to emerge in geriatric optometry Table 8
are clinical services and training and
knowledge of social and health care Rank Order of Faculty Preferred Training Options
policy (7 responses each), inter- and
multidisciplinary education and train- Primary Contact Faculty
ing (5), knowledge of normal vs. N=21
abnormal vision changes with age (3),
Percent of
formal faculty training (2), and infor-
mal faculty training (1). Summing Faculty
responses across the columns, then, it Preferring
can be seen that three areas of geriatric Rank Rank Training Option Each Category of
optometry in which schools and col- Order Training Option Order Training Options
leges of optometry appear to be most
heavily invested are: inter- and multi- Raw Weighted**
disciplinary education (31 responses),
clinical services and training (28), and Short Term Training Short Term Training } 57
informal faculty training (13).
2 Certificate (0.25 FTE) Certificate (0.50 FTE)}
A second gauge of the schools and 3 Certificate (0.50 FTE) Certificate (1.0 FTE) } 25
colleges' capability of supporting 4 Certificate (1.0 FTE) Certificate (0.25 FTE)}
intense geriatric faculty training is the 5 Fellowship (0.50 FTE) 5 Fellowship (0.50 FTE)}
availability of appropriate resources 6 Fellowship (0.75 FTE) 6 Fellowship (1.0 FTE) } 18
within commuting distance. The 7 Fellowship (1.0 FTE) 7 Fellowship (0.75 FTE)}
Committee consulted listings from
the BHPr, the Association for 1 indicates most and 7 indicates least preferable
Gerontology in Higher Education :
Directory 11 , and survey responses The weighted score is arrived at by assigning the highest value to the num-
from primary faculty members to ber of people who select a category as first choice, second highest value to
ascertain the availability of local the number of people who select a category as second choice, and so on.
GECs, university-based training pro-
grams and other education and train-
ing resources (e.g., Veterans Affairs
Interdisciplinary Team Training in Table 9
Geriatrics (ITTG) or Geriatric Recommended Faculty Training Options in Geriatic Optometry
Research Education and Clinical Care
(GRECC) programs). Table VI shows
that the majority of schools and col- 1. Faculty Fellowship Training program in Geriatric Optometry (one year
leges have nearby resources available. with minimum of .5 FTE commitment)
A third factor that was considered
indicative of readiness was the cur- 2. Faculty Development Certificate Program in Geriatric Optometry (six
rent affiliation with outside geriatric months with a rninirnum of .25 FTE commitment)
clinical settings. Table VII shows that
two-thirds of the schools and colleges 3. Faculty Enhancement Short-term Training in Geriatric Optometry (100
not only had such an affiliation, they hour minimum commitment)
maintained affiliations-with-multiple
22 Optometric Education
clinical services .il Ihe Chicago
Former ASCO President I ighthouse fur People Who .ire Wind
or Visu.ilk Impaired. I le conlinues lo
Receives AOA A w a r d ser\ e .is d i n v l o r of low \ ision services.
Dr. Rosen bloom currenllv is on Ihe
bo.irds o\ the Anieric.in l-ound.ition
for the Mind, the Illinois Societv for
i". Alfred A. Rosenbloom. ihe Prevention of lilindness .ind the
\DIK The Leader in Aspheric Optics 7893 Enterprise Drive, Mentor, OH 44060 U.S.A.
Phone: 1-800-34S-8655 or (216)942-6161 • TLX: 211395 VOLK UR 'FAX: (216)942-2257
T
he College of Optometry of However, research has shown that
the State University of New the home alone 2
or taking care of per- the homebound are more than twice
York has conducted an sonal needs). Estimates range from as likely as the non-homebound to
optometry service for home- 1.6 million severely impaired elderly report difficulty in reading regular
bound residents of New York City as living at home, needing substantial print. 9 Furthermore, visual impair-
a part of its professional curriculum long-term care assistance 3
with the ment has been shown to be a signifi-
for three years. Primary eye examina- activities of daily living, to as many cant contributor to functional disabil-
tions, eyeglasses, and low vision as 9 to 11 million Americans in need ity in long term care patients.10 The
of home care services.4 The growth in homebound population therefore
the number of elderly people in need appears to present a greater demand
of long-term care at home has been for optometric services than the non-
Dr. Freed directs the Homebound Visitation and is projected to be greater than the
Program at the SUNY College of Optometry homebound. They are, however,
and is a staff member at the Lighthouse Inc. growth of the nursing home popula- underserved by eyecare professionals
tion.5 Since the population over 65 is due to the lack of financial incentive.
Dr. Kirstein is a faculty member of the SUNY predicted to nearly double by the year
College of Optometry and the New Jersey 20306, the demand for home-based Indeed, out of 50 cases chosen for
Medical School. review, only two had been seen previ-
24 Optometric Education
ously for a home visit by either an an out-of-pocket expense and are paid • visual status as it affects activities
optometrist or ophthalmologist. for at the time of the visit, although of daily living;
arrangements can be made to reduce • use of glasses and low vision aids
SUNY's Homebound Optometric fees if necessary. Eyeglass frames are for specific tasks;
Services adjusted at the site during the visit. • need for other professional inter-
To fill this gap of service in the The same frame has lenses inserted at vention, e.g., physicians, nurses,
the Optometric Center and is mailed social workers, etc.
community, the SUNY College of
to the patient along with instructions
Optometry provides homebound Conclusion
on its use. Low vision aids, if needed,
optometric services to the five bor-
are dispensed at the time of the visit. As the need for long term home
oughs of New York City. It has been
After the visit, reports are written health care grows, so too will the need
funded since 1992 by the Corporation back to the referral sources, and fol-
for optometry to play an essential role
for National and Community Service, low-up visits are made when neces-
as a part of the home health care team.
a federal program funding higher sary. Students are required to follow
Training optometry students in the
education learning-through-commu- up on their patients by telephone after
field sensitizes them to the medical
nity-service initiatives. In addition to the glasses are received.
and functional needs of both the
the provision of optometry services to
In addition to primary care, the homebound and non-homebound
homebound elderly, the mission of
program provides basic refractive and geriatric populations, while instilling
the program has been to:
appliance services to individuals in in them a sense of community service.
• instill a sense of community service
in fourth year optometry students; need of an update in their eyeglass
prescriptions, a much appreciated References
• teach the students the clinical skills 1. Orr A. Issues in the continuum of long-term
program benefit. (Of our fifty-case
required in the use of portable opto- care. In: Orr A, ed. Vision and aging, cross-
sample, 74% were in need of an roads for service delivery, New York, New
metric equipment; and
update in at least one pair of glasses.) York: American Foundation for the Blind,
• develop linkages with other med-
For example, a 68-year-old male, bed- 1992: 311.
ical and social service agencies that bound and without glasses for sever- 2. U.S. Department of Health and H u m a n
serve this population. al years had resigned himself to his Services/Public Health Service. Prevalence
Third year optometry students at "blindness." A simple refraction cor- of mobility and self-care disability —
the SUNY College of Optometry are rected him to 20/20 vision in each United States, 1990. In: Morbidity and
Mortality Weekly Report 1993 Oct:
introduced to the concepts of home- eye; new bifocals were mailed to him 42(39) -.760-767.
bound care and the use of portable which likely changed his quality of 3. Rowland, D. Help at home: long term care
equipment during their geriatrics life by enabling him to read normally. assistance for impaired elderly people, a
course. Trial frame refractions are report of the Commonwealth Fund
taught in a separate course in low An important distinguishing char- Commission on Elderly People Living
acteristic of the homebound popula- Alone. Baltimore, MD: The Commonwealth
vision care. For at least one day dur- Fund Commission, 1989:18.
ing their senior year, students partici- tion is their reluctance to consider sur-
4. Anonymous. Basic statistics about home
pate in the homebound program gical treatment of ocular conditions care. Washington, D.C.: National
such as cataract and retinal neovascu- Association for Home Care, 1994:5.
which operates two days per week.
larization. They either have "had 5. Anonymous. Aging America, trends and
Students are encouraged to perform projections. Prepared by the U.S. Senate
enough of doctors," can't cope with
as much as possible of the exam, Special Committee on Aging, The American
the prospect of surgery, or simply
which generally lasts one and one half Association of Retired Persons, the Federal
won't or can't make the trip to the Council on Aging and the U.S.
hours. office or hospital. Of a sample of 20 Administration on Aging, 1991:149.
The suggested examination proto- patients in our program who were
6. United States Bureau of the Census.
col and equipment needed for home recommended to have surgical evalu- Statistical Abstract of the U.S.: 1993.
visits has been described.11 The basic ations for cataract removal, 90% Washington,, D.C.: 1993:24.
portable equipment includes a trial refused, and the remaining 10% still 7. Orr A. Aging and Blindness: toward a sys-
lens set and frame, slit lamp, binocu- had not had the surgery at a one-year tems approach to service delivery. In Orr A,
ed. Vision and aging, crossroads for service
lar indirect ophthalmoscope with bat- follow-up. This reluctance to consider delivery, N e w York, NY: American
tery pack, direct ophthalmoscope, intervention must be taken into Foundation for the Blind, 1992:6.
retinoscope, battery-powered lenso- account when making clinical deci- 8. Siegel J. A Generation of change: a profile of
meter, frame assortment, low vision sions. The issue of patients' rights that America's older population. New York, NY:
Russel Sage Foundation, 1993:244.
aids, Goldman tonometer, eyecharts, arises for many homebound cases
9. Horowitz A, Teresi J, Cassels L.
and diagnostic pharmaceutical presents an excellent opportunity for Development of a vision screening ques-
agents. students to learn sensitivity to tionnaire for older people. In: Nancy Weber
Referrals for the visits are accepted patients' needs in the context of med- N, ed. Vision and aging: issues in social
from a variety of sources including ical ethics. work practice. Binghamton, New York: The
Haworth Press, 1991:46.
families, social workers, nurses, 10. Horowitz A. Vision impairment and func-
physicians, optometrists and opti- In addition to new clinical skills
tional disability among nursing home resi-
cians. Prior to the visit, the faculty learned, the home visit presents stu- dents. The Gerontologist 1994 Jun; 34(3);
member telephones the patients to dents with a unique opportunity to 316-323.
conduct a needs assessment, describe observe patients in their everyday 11. Windsor R. Management of low vision
patients who are homebound or in long-term
functional environment and make
the service, and schedule the appoint- care facilities. In: Cole R and Rosenthal B ed.
recommendations in the following
ment. Medicare and Medicaid reim- Problems in optometry, patient and practice
areas: management in low vision, vol. 4, no. 1,
bursements are accepted as payment
• illumination needs; Philadelphia, PA: JB Lippincott, 1992:139.
for examinations. Eyeglasses are often
T
Abstract he Association of Schools & optometric problems such as presby-
The *ize of the geriatric population Colleges of Optometry opia, impaired visual acuity, dry eye,
/•• iiurea*ing. Wore training of oplo- (ASCO) conducted a survey and eyelid anomalies. This increase in
melrit clinician* and educator* in of the 69 optometry residen- optometric problems is paralleled by
cies offered by 15 Schools of an increase in other physical, emo-
gcrintrii* i* needed to meet the
C Optometry in 1993.1 Primary care and tional, medical, and social problems.
ilemand* of llu* groxeing population.
family practice residencies accounted All of these problems make treatment
I'hi* paper describe* a residency pro- for slightly less than 40% of all resi- of an eye disease in an elderly patient
gram in geriatrii optometry combined dent positions, 22% were in pedi- more complicated than treatment of
zeitli a Matter of Science (MS.) in atrics/vision therapy, 17% in disease, that same disease in a younger,
Gerontology which i* designed to pro- 12% in contact lenses, and 7% in low healthier patient.
vide oplomelric training in geriatric*. vision. Only 3% were in geriatrics. In order to train optometrists to
Tin* program ha* three component-*: This is alarming given that 12% of better treat the elderly patient it is not
oplomelric care of elderly patient*. Ihe United States' population (25 mil- enough to simply increase the num-
*upcrvi*cil student leaching, and lion) are over the age of 652 and the ber of residencies in geriatrics. The
course ii'ork in geriatric*. The clinical number is expected to rise to 51 mil- type of training must change also. It is
component of the program i* iiicorp<>-
lion by the year 2020.3 The fastest not enough to train clinicians to treat
rated into the cour*ework require-
the optometric problems of the elder-
ly. They must be trained also to
ment* for the M.S. degree. lite leach-
understand the problems of being
ing component i> dc>ignal to train
elderly.
ilijiiciau* to be educator*. Thi* pro- This paper describes a two-year
Dr. Tumosa is an assistant professor at the
gram prox'iile* miillidi>ciplinary
L Diversity of Missouri - St. Louis School of residency program designed to edu-
training in the treatment of the geri- Optometry (UMSL) and chief of the Primary cate optometrists to better understand
atric patient. Such training make* I *ise Clinic. the challenges of growing old. A resi-
graduate* belter aware of how lo pro-
Dr. Wingert is an associate professor at UMSL
dency in geriatrics is combined with
vide medical, emotional, and *ocial School of Optometry and a fellow of the an academic program in gerontology.
care of the elderly. American Academy of Optometry. This combined program trains
optometrists to provide geriatric care
Dr. McAlister is an associate professor and the and also how to teach geriatrics to
Key Words: Oplomelric geriatric director of residencies at UMSL Optometry. He
is a fellow of the American Academy of optometry students. Thus, the dual
education, nursing home care,
Optometry and a diplomate in the Academy's role of training clinicians and educa-
Geriatrii. re-itlency program Public Health Section. tors is met.
Optometric Education
Description of the Program disease and pathology. The resident do a community service rotation in
The program has three compo- spends that day reviewing surgical one of the four nursing homes served
nents: 1) clinical responsibilities in cases and observing patients from the by the residency program. Every
nursing homes and in a co-manage- ophthalmology practice under the eight weeks a different group of 4th-
ment center, 2) student teaching of supervision of the staff ophthalmolo- year interns works at the nursing
geriatric topics in professional opto- gist and optometrist. home. During the first year of the res-
metric courses supervised by a resi- The resident, in conjunction with idency, one of the residency advisors
clinical faculty from the school of serves as the supervising doctor for
dent advisor, and 3) coursework in
optometry, provides 24-hour emer- both the resident and the interns.
the field of gerontology. The resi-
gency coverage to the nursing-home During the second year of the resi-
dent's time is not split equally among
patients. These emergencies have dency, the resident serves as the
the three items, but all are essential
ranged from such things as adverse supervising doctor for the interns.
components of the program. Each of
these components is discussed below. drug reactions and acute red eye to Academic Program: Over the two-
Clinical Program: The first compo- broken spectacles. Emergencies sel- year period of the program, the resi-
nent, the clinical program, teaches the dom arise more often than once a dent is also required to earn an M.S.
resident to provide patient care at month in any one nursing home. The degree in gerontology granted by the
nursing homes and to participate in most common emergency is a broken Gerontology Department at the
frame or a shattered lens. University of Missouri-St. Louis
co-management of surgical patients in
The resident is responsible for (UMSL). The resident takes course-
an ophthalmology practice. During
overseeing the third party billing for work in an interdisciplinary program
both years of the residency program,
all services. Because the four nursing that prepares him or her for manage-
the resident makes weekly visits,
homes are independent of one anoth- ment or direct service positions work-
under the supervision of a clinical fac- ing with the aged. The resident then
ulty member who is a licensed er, no uniform billing procedure can
be established. Sometimes billing is has not only an optometric career, but
optometrist, to four nursing homes. In also the credentials to interact with
year one of the program the supervi- done in cooperation with the billing
clerk at the nursing home and some- social service organizations in provid-
sion is direct, with that supervisor ing comprehensive medical care to
present at all patient encounters. In times the billing is done independent
of the nursing home. This manage- the elderly. The M.S. degree also pro-
year two the supervision is indirect vides the resident with academic cre-
with the supervisor reviewing all ment of the billing by the resident
allows the university's fiscal agent to dentials should he or she decide to
patient records with the resident after enter a teaching career in a school of
the encounters. track revenue resulting from the resi-
optometry or medicine. Several facul-
Each week at all four nursing dent's professional services at each of
ty at UMSL hold joint appointments
homes newly-admitted patients are the nursing homes.
in optometry and gerontology and
given a comprehensive optometric Teaching Program: The resident is
assist in instructing non-optometrists,
examination. If spectacles are pre- trained by the residency advisors to as well as optometrists, in optometric-
scribed the patient selects a frame and teach in the professional curriculum. based didactic courses.
the resident dispenses the glasses The residency advisors are
during his or her next visit. Former optometrists and other tenure-track The degree program consists of 45
patients are seen for follow-up on an faculty at UMSL. These people credit hours including 27 hours of
as-needed basis determined by rec- administer the residency program gerontology courses, a 3-hour
ommendations from the floor nurses and educate the resident in teaching research methods course, and 15
a n d / o r the resident. Pharmacological techniques. The resident is trained in hours of specialization. Courses may
agents are prescribed and monitored both didactic and clinical teaching. be selected from the fields of biology,
For didactic instruction, the advi- optometry, education, psychology,
as needed with each visit. For those
sors teach the resident how to social work, public policy, or anthro-
diseases which have progressed
research, develop, and organize a lec- pology. The area of specialization can
beyond the scope of optometric prac-
ture in weekly meetings. Practice lec- be in any of these areas but is expect-
tice, consultations are requested from
tures are critiqued by the advisors. ed to be in the student's area of pro-
ophthalmologists, other specialists, fessional training. The areas of
a n d / o r primary care physicians. The resident then delivers these
didactic lectures to optometry stu- emphasis for both required and elec-
These diseases include diabetic tive courses are listed in Table 1.
retinopathy, cataracts, macular degen- dents in both public health and geri-
atric optometry. There is no thesis requirement in this
eration, suspected tumors, and M.S. degree program.
detached retinas. Letters of referral The resident also delivers in-ser-
and consultation requests are handled vice lectures to nursing home aides, The combined residency/M.S. in
by the resident. Whenever possible, nurses, and administrative personnel. Gerontology takes two years to com-
ophthalmological consults for The topics of these in-service pro- plete. For the resident who cannot
patients from these four nursing grams include common ophthalmic devote two years to the program, a
homes are scheduled for one of the drugs and their use, as well as discus- one-year alternative has been devel-
two half-days that the resident is at sion of the effects of commonly pre- oped. In this program, the resident is
the co-management center. This scribed systemic drugs on the visual required to complete a minimum of
allows for continuity of care for the system. 18 credit hours in the gerontology
In addition to the didactic teaching, curriculum, instead of the 45 credit
nursing-home patients as well as for
the resident also does clinical teaching hours required for the Master's
co-management education for the res-
during the second year of the residen- degree. Upon completion of these 18
ident. The other half-day is devoted to
cy. Fourth-year optometric students credit hours, the resident receives a
furthering the resident's education in
28 Optometric Education
able contributions optometrists can SJ, DeSylvia-Valenti D, Mancil GL, eds. tine optometric care benefits nursing home
make to health care. Optometric Gerontology: A Resource residents. Optom Vis Sci 1992;69(l):886-888.
Manual for Educators. Association of 10. Whitmore WG. Eye disease in a geriatric
Schools and Colleges of Optometry, 1989. nursing home population. Ophthalmology
3. Thompson PG. Aging in the 1990s and (Rochester) 1989;96(3):393-8.
Acknowledgements beyond. Occupational Med 5:807. 11. Woodruff ME, Pozza M, Gagliardi M. Vision
We thank our dean, Dr. Jerry 4. Butler RN, Lewis ML and Sunderland T, ed., impairment and blindness in N e w
Aging and mental health, positive psy- Brunswick nursing homes. Can J Optom
Christensen, and our associate deans, chosocial and biomedical approaches. New 1985;47(l):ll-24.
Drs. David Davidson and Gerald York: Macmillan Publishing Company, 12. Kini MM, Leibowitz HN, Colton T,
FranzeL as well as Dr. Robert Calsyn, 1991. Nickerson MA. Prevalence of senile
director of gerontology, for their 5. U. S. Senate. Special Committee on Aging. cataract, diabetic retinopathy, senile macu-
Aging America: trends and projections. U.S. lar degeneration, and open-angle glaucoma
enthusiasm for this new program. in the Framingham eye study. Amer J
Government Printing Office, 1986:498-116-
Without them this residency would 814/42395. Ophthalmol 1978;85(l):28-34.
not have been developed. This work 6. The Marion Merrell Dow Managed Care 13. Pizzarello LD. The dimensions of the prob-
was supported by a grant from the Digest. Long Term Care Edition. Kansas lem of eye disease among the elderly.
Retirement Research Foundation. • City, MO. 1993:1-52. Ophthalmology 1987;94(9):1191-U95.
7. Morer JL. The nursing home comprehensive 14. Haronian E, Wheeler NC, Lee DA.
eye examination. J Am Optom Assoc Prevalence of eye disorders among the
References 1994;65(l):39-48. elderly in Los Angeles. Arch Gerontol
1. Barresi BJ. Viewpoint* new federal support 8. Mancil G. Delivery of optometric care in Geriatr 1993;17(l):25-36.
needed for residency programs. ASCO'S nontraditional settings: the long-term care 15. Haffner AN. Graduate education in optom-
Eye on Education. January/February 1994: facility. Opt Vis Sci 1989;66(1):9-U. etry-what do we need? Optom Vis Sci
1. 9. Wingert TA, Tumosa N, McAlister, WH. 1993;70(8):614-615.
2. Aston SJ. Demographics of aging. In: Aston, Epidemiological evidence that access to rou-
December 1995
8th Continuing Education Directors SIG Meeting ( \ e w Orleans I lillon)
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i
10th Residency Education SIG Breakfast (New Orleans I Ml ton)
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|
| February 1996
i
16th -18th Optics Faculty SIG Conference (Lansdowne Conference Resort, 1 eesburg, VA)
March 1996
15th Spring Board of Directors Meeting (Lansdowne Conference Resort, Leesburg. VA)
15th -17th Critical Issues Seminar (Lansdowne Conference Resort, Leesburg, VA)
June 1996
Annual Meeting - Portland Oregon
19th Executive Mooting
20th -21st Annual Meeting
21st Annual Luncheon
23rd Sustaining Member Breakfast
August 1996
9nd - 11th Residency Education SIG Conference (Lansdowne Conference Resort, Leesburg, VA)
IN REVIEW
Primary Care of the Cataract highly useful set of appendices geared towards practitioners or sci-
Patient, Cynthia Ann Murrill, including patient educational mate- entists interested in geometrical
David Lee Stanfield and Michael D. rial, examples of professional corre- and physiological optics. The man-
Van Brocklin, East Norwalk, Conn., spondence and informed consent agement of patients with cataracts
Appleton & Lange, 1994, 267 pages, forms used by the authors in their by practicing optometrists is not
index, illustrated, $80.00. comanagement system. enhanced by this text.
As the scope of optometric prac- The text has an opening section There are various facets within
tice expands, and as the population of high quality color plates. Each this book that provide pleasurable
ages, the need for cooperation chapter is illustrated with black and reading. Lens structure, biochem-
between ophthalmologists and white photographs and contains istry and transparency are covered
optometrists in the comanagement useful black and white figures and in a very concise and readable
of patients with cataracts is essen- tables. The references at the end of manner which will benefit
tial to provide cost effective, quali- each chapter are thorough, up to optometrists as an overview.
ty care. This text is a comprehen- date, and well organized by topic. Mechanisms of cataract formation
sive treatment of the subject of The one drawback I found with are reviewed in depth; this is help-
cataract comanagement. The edi- this text is the brevity of the chap- ful. Over 25 cataract types are
tors and contributing authors are ter on special instrumentation. For described by nature, location,
optometrists and ophthalmologists example, more detail on the perfor- cause, and correlation to systemic
who work together in a regional mance of A and B-Scan disease or condition. These well-
comanagement system delivering Ultrasonography would be helpful written sections would be better
cataract care in the state to those readers not already famil- served by color plates or diagrams.
Washington. The system has pro- iar with these techniques. The patient's perception of visu-
vided over 40,000 surgeries at the This text will be a welcome al disturbances is described in a
time of publication. This shared addition to the bookshelves of clear manner. Cataracts associated
experience and the spirit of cooper- optometrists who comanage with glare, color vision changes,
ation and teamwork among the patients with cataracts. It will also field loss, etc. are covered in detail.
providers provides the basis for an be useful to optometric students, The discussion of new clinical
excellent and detailed text on the residents and our ophthalmologic techniques to evaluate cataracts
subject that will be of great value to colleagues. provides optometrists with poten-
eye care students and practicing tial options to monitor cataract
clinicians alike. Reviewer: Dr. Neal N. Nyman changes. Current methods of evalu-
The text is divided logically into Pennsylvania College of ation such as contrast sensitivity,
five sections. It begins with general Optometry disability glare, and laser interfer-
considerations and reviews current ometry are reviewed. Useful to clin-
trends in cataract care along with a Cataract Detection, Measurement ical scientists includes the overview
description of comanagement and and Management in Optometric of A-/B-scan ultrasonography and
chapters on the anatomy and phys- Practice, William A. Douthwaite, electrodiagnostic testing of the
iology of cataracts. The concluding Ph.D. and Mark A. Hurst, Ph.D., cataract patient. Potential future use
chapter of this section presents use- Oxford, Butterworth-Heinemann, of evaluative techniques (including
ful and well-illustrated grading 1993,140 pages, including index, cataract photography, computer
systems that apply to the clinical hardbound, $39.95. image analysis, and fluorophotome-
findings described in the text. The Cataract is written by seven dis- try) are discussed as well.
next three sections deal thoroughly tinguished optometry faculty. Six Surgical management is limited
with preoperative, operative, and currently lecture in the United to the extracapsular cataract extrac-
postoperative care of the cataract Kingdom and one is located at the tion (ECCE) with intraocular lens
patient. The section on postopera- School of Optometry in Waterloo, (IOL) implantation. This one-page
tive care is extremely detailed, and Ontario, Canada. review does not assist optometrists
covers all possible complications This book is prefaced by stating, in understanding the various pro-
one might encounter from the day "It is apparent that the optometric cedures available. There is mention
of surgery onwards. The back- profession is in need of a publica- of the future availability of foldable
ground, clinical presentation and tion which describes the optometric IOLs. This is no help to a large per-
assessment, differential diagnosis, aspects of cataract detection and centage of optometrists in the
treatment, follow-up and prognosis management." While there are United States because foldable
are presented for each complica- chapters dedicated to these topics, IOLs are available and widely used
tion. The book concludes with a the main thrust of the book is in the U.S.
30 Optometric Education
Postoperative management of skills to specific patient groups. disease, metabolic disease, diabetes,
the cataract patient is a major topic One chapter is devoted to record connective tissue disorders, AIDS,
in the United States. This is dis- keeping, one to interdisciplinary and oncologic disease. There are
cussed only as a superficial review interactions and communication also chapters in the beginning of
without providing practitioners in- and one chapter to doctor-staff the book on laboratory tests and
depth medical management communications. Questions for diagnostic tests that set the tenor of
options of complications. The post- thought are presented at the end of the book.
operative aspects of patient man- each chapter along with an excel- This book was written by 18 dif-
agement include three intensive lent reference list and suggested ferent "experts" under the direction
chapters involving geometrical and additional readings. Appendices of Dr. Blaustein. Considering the
physiological optics of the intraocu- include specific interview questions number of authors involved, the
lar lens and of aphakic spectacles by exam type such as primary care, writing style is even throughout.
and contact lenses. contact lens, vision therapy, low The text is readable, in particular
Various aspects of Cataract may vision, pediatric and even a list of because most sections are several
prove to be beneficial to didactic interview questions for potential pages in length. In addition, there
course work in optometry. This office members. are ample tables throughout the
book is not a useful adjunct to clini- This book would make an excel- text that summarize the key infor-
cal practitioners in actually manag- lent text for a curriculum course or mation. Each chapter begins with a
ing patients with cataracts. portion of a course dealing with case report that reviews a condition
communication and/or the doctor- and details the ocular examination,
Reviewer: Dr. John B. Gelvin patient relationship. It would also diagnosis, and both ocular and sys-
Indiana University serve as an outstanding study temic treatment. More case reports
School of Optometry guide, if this topic were taught in a would have been useful. Photos
self-study format. Perhaps the best and other imaging tests that accom-
Professional Communications in use of the book would be in a first pany each case could have been
Eye Care, Ellen Richter Ettinger, year course such as an introduction included in the text in order to fully
O.D., M.S., Boston, Butterworth- to optometry, with its continued understand the case discussed.
Heinemann, 1994, 319 pages, use throughout the four years of One minor criticism is that cer-
$39.95. optometry school by all course and tain conditions are included in the
The practicing optometrist will clinic instructors in a "communica- text that I would consider rare in
most likely spend more time com- tion across the curriculum" con- its presentation to an optometrist
municating with patients, staff and cept. Since the study and improve- while others, such as Sarcoidosis
other professionals than doing tech- ment of communication skills are not included. Beyond this criti-
nical procedures. The doctor-patient should be a lifelong pursuit, cism, this book would be useful for
relationship based on the model of Professional Communication in Eye most students and practitioners to
the patient as a "partner" requires Care would also make an excellent have in that it reviews in a succinct
good communication. The concept addition the practitioner's library.
fashion the majority of systemic
of informed consent has both an conditions that affect the eye.
ethical and legal basis and necessi- Reviewer: Dr. James E.
tates effective communication. Yet, Paramore Reviewer: Dr. Murray Fingeret
we in education spend very little Ferris State University Department of Veterans Affairs
time in an admittedly very crowded College of Optometry Medical Center - Optometry
curriculum on communication. For Brooklyn/ St. Albans, New York
most of us, good communication is Ocular Manifestations of
not simply an intuitive skill, but, Systemic Disease, Bernard H.
like our technical skills, requires Blaustein, ed., New York, Churchill
study and practice. Livingstone, 1994, 321 pages, Optometric Faculty are invited to sub-
Dr. Ettinger has written an out- $105.00. mit computer based instruction pro-
standing book which helps to Ocular Manifestations of Systemic grams for review in a new department
address the need for study in the Disease is a text that reviews the that will be inaugurated in Optometric
area of communication. Because majority of systemic conditions that Education. Computer instruction pro-
she is a practicing optometrist, she have ocular implications. This book, grams will join resource reviews and
has been able to write a book intended for students and practi- abstracts as regular departments in
which is practical for the optomet- tioners alike, reviews a wealth of Optometric Education.
ric clinician. It is well organized material in a condensed fashion.
and contains numerous relevant Each area reviewed discusses the Please submit the programs to:
examples and clinical cases which Patricia C. O'Rourke
systemic condition in general
Association of Schools
provide models for good patient including the pathophysiology, tests and Colleges of Optometry
care through good communication. used to establish the diagnosis, ocu- 6110 Executive Blvd., Suite 690
The book is divided into two lar sequelae and treatment for those Rockville, MD 20852
parts, the first dealing with basic ocular disorders. Chapters included
communication skills and the sec- are on cardiovascular disease, cere- Include name of program, publisher
ond with the application of these brovascular disease, rheumatologic and instructions for obtaining copies.
material available s i n m i \i i c w i i
for \owr high power - 5 I "III II M i l l
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