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OD，FAAO，FNAP，Professor
Salus University Pennsylvania College of Optometry
Coordinator of Interprofessional Educational（IPE）Initiatives for Salus University
lcasser@salus.edu
Likemany healthcare professions in the United States，the profession of optometry developed substantially in the early part of the 20 th century.The profession of optometry evolved from opticianry，and the state of Minnesota in the United States passed the first law that defined optometry as a health profession in 1901.Relatedly，the education，training，credentials，and scope of practice of optometry have also changed over the course ofmany years.In 1923，the Pennsylvania College of Optometry at Salus University awarded the first Doctor of Optometry（OD）degree.In 1971，the state of Rhode Island in the United States passed the first law that allowed Doctors of Optometry to utilize diagnostic pharmaceutical agents such as topical ophthalmic anesthetic drops and mydriatic/cycloplegic drops in the examination of their patients;by 1989，all states in the U-nited States had similar laws in place.In 1976，the state ofWest Virginia in the United States passed the first law that allowed Doctors of Optometry to utilize therapeutic pharmaceutical agents，such as topical ophthalmic anti-infective agents and topical ophthalmic anti-inflammatory agents，in the care of their patients. 1
Today，the American Optometric Association（AOA）defines Doctors of Optometry and the profession as follows:
Doctors of Optometry（ODs/optometrists）are the independent primary health care professionals for the eye.Optometrists examine，diagnose，treat，and manage diseases，injuries，and disorders of the visual system，the eye，and associated structures as well as identify related systemic conditions affecting the eye.
●Doctors of Optometry prescribe medications，low vision rehabilitation，vision therapy，spectacle lenses，contact lenses，and perform certain surgical procedures.
●Optometrists counsel their patients regarding surgical and non-surgical options thatmeet their visual needs related to their occupations，avocations，and lifestyle.
●An optometristhas completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry，leading to the doctor of optometry（O.D.）degree.Some optometrists complete an optional residency in a specific area of practice.
●Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
-Approved by the AOA Board of Trustees ， June 2012 2
Individualswho have been awarded the“OD”degree by a school or college of optometry in the United States（US）are referred to as“Doctors of Optometry，”“Optometrists，”and，in some states in the US depending upon the individual laws that have been enacted，“Optometric Physicians.”
Doctors of optometry，through their clinical education，training，experience，and broad geographic distribution in the United States，have the knowledge，skills，and attributes to provide effective primary eye and vision care services to patients in the United States 3 .Primary care has been defined as“coordinated，comprehensive，and personal care，available on both a firstcontact and a continuous basis.” 4 Primary care is comprised of several essential components，including diagnosis and treatment;assessment and management;personal support;and，patient counseling and education about disease conditions，disease prevention，and health maintenance. 4，5 Eye and vision care serves as an important pointof entry into the health care system because: 6
●Virtually all people need eye and vision care services at some time in their lives.
●By its very nature，eye and vision care provides for the evaluation，assessment，management，and coordination of a broad spectrum of health care needs.
●Eye and vision care is a non-threatening form of health care，particularly to patients who are reluctant to seek general or preventivemedical care. 6
As described in“ Optometry : A Career Guide ”published by the Association of Schools and Colleges of Optometry（ASCO）， 7 Doctors of Optometry are trained to evaluate any patient's visual condition and to determine the best treatment for that condition.ODs are viewed increasingly as primary care providers for patients seeking ocular or visual care.Conditions typically cared for by ODs are:
●Corneal abrasions，ulcers，or infections;glaucoma;and other eye diseases that require treatmentwith pharmaceutical agents，management，and referralwhen necessary;
●Visual skill and perception problems such as the inability tomove，align，fixate，and focus the ocularmechanism in such tasks as reading，driving，computer use，and in tasks related to hobbies and employment;
●Clarity problems such as simple nearsightedness or farsightedness or complications due to the aging process，disease，accident，ormalfunction.ODs also work to:
●Diagnose，manage，and refer systemic diseases such as hypertension，diabetes，and others that are often first detected in the eye;
●Provide presurgical and postsurgical care of cataracts，refractive laser treatment，retinal problems，and other conditions that require presurgical and postsurgical care;and
●Encourage preventativemeasures such asmonitoring infants'and children's visual development，evaluating job/school/hobby-related tasks，and promoting nutrition and hygiene education. 7
Most Doctors of Optometry are“generalists”and when they provide full-scope primary optometric care，their day can be quite varied and challenging.Patient interaction can include performing comprehensive eye and vision examinations，removing a foreign body from the cornea，evaluating a child who is not performingwell in school，fitting and evaluating contact lenses，prescribingmedication for glaucoma，providing follow-up care after refractive surgery，and/or fitting a patientwho is legally blind with amagnifying device that enables the patient to read.Typically，the doctor works with a technician who administers preliminary tests，advises patients on the use and care of contact lenses，and assists patients in selecting spectacle frames.The doctor spends time with the patient，gatheringmore information，testing，making a diagnosis，determining the treatment required，and discussing the treatment regimen with the patient.The doctor records all information into the patient's record，dictating letters of referral if conditions such as diabetes or hypertension are detected or letters to schools reporting on a child's visual status.An officemanager or receptionist（depending on the size of the practice）may take care of completing information required by the patient's health insurance provider. 8
Doctors of Optometry practice in many different healthcare settings that include private and group practice，within hospitals，Accountable Care Organizations，Federally Qualified Health Centers，School Based Health Centers，Rural Health Clinics，Certified Nursing Facilities，Rehabilitation Facilities，U.S.Armed Forces，Veterans Health Administration，Indian Health Service，Civil Service，and other settings. 9
Most ODs practice“full-scope，”primary care optometry and treat and manage all forms of visual and ocular conditions.However，a practitioner may choose to concentrate his/her practice on treating a selected population or visual condition 10 .These areas of practice emphasismay include vision therapy and perception，pre-and post-operative care，specialty contact lenses，low vision rehabilitation，ocular disease，concussion and traumatic brain injury，neuro-optometry，sports vision，environmental vision，pediatric optometry，geriatric optometry，and clinical research.
Interdisciplinary education and health care is becoming increasingly common，recognized，and valued in the United States. 11 Doctors of Optometry play a primary and integral role in interdisciplinary health care by examining，diagnosing，treating，and managing diseases，injuries，and disorders of the visual system，the eye，and associated structures.Doctors of Optometry are involved in the coordination of care of associated systemic diseases and serve a sentinel role in the identification of ocular side effects of systemic medications. 9 In addition，Doctors of Optometry:
●Assistwith improving overall population health and quality of life through prevention and early diagnosis of vision and eye health problems and prevention of chronic disease，
●Detect systemic diseases through identification of associated eye findings during a comprehensive face-to-face eye examination，and
●Coordinate the vision，eye health，and wellness of their patients with fellow optometrists and other health care providers. 9
As described in“ Optometry : A Career Guide ”published by the Association of Schools and Colleges of Optometry（ASCO），new technologies have helped the profession of optometry to expand both the scope and the efficiency of practice.Optometrists and their patients are benefiting from themany advances in eye care and medical technology.There has been a significant increase in the use of new and relatively new lens treatments，designs，and corrective materials such as contact lenses.Today，millions of people wear contact lenses. 12
Lasers have been used formany years for treating eye diseases（e.g.，diabetic retinopathy，macular degeneration，glaucoma，and some forms of cataracts）and for help with diagnosing visual problems.In recent years，the use of lasers to correct forms of refractive errors（near-sightedness，farsightedness，or astigmatism）has been increasing.Traditionally，these conditions were correctable only with glasses，contact lenses，and invasive surgery.ODs play a key role in helping patients determine whether they are candidates for new procedures in laser surgery.When laser surgery is appropriate for a patient，optometrists provide nearly all preoperative and postoperative care.Kentucky，Oklahoma，and Louisiana were the first three states in the US to allow optometrists to perform certain laser surgeries. 12
Technology is rapidly improving diagnostic instruments used by all health care practitioners.More accurate and efficient test results enable ODs to better diagnose，manage，and treat eye disorders and diseases.Technology also helps optometrists educate patients about their conditions—long a hallmark of the profession—and allows patients to participate in their care and treatment decisions. 12
New medications are developed each year that optometrists use to treat diseases of the human eye.This area，perhapsmore than any other，reinforces the need for a well-rounded continuing education because it serves as the foundation of an OD's lifelong service in amodern health care delivery system. 12
In these contexts of a brief history of optometry in the United States（US），the definition of the profession provided by the American Optometric Association，and the scope of practice of Doctors of Optometry in the US，it is important to now describe how an individual is trained and educated to become a Doctor of Optometry and becomes qualified to practice in the United States.This information will be covered in chronological order in which it is ultimately completed by qualified Doctors of Optometry.
In the United States，the Doctor of Optometry（O.D.）degree is pursued following completion of pre-requisite courses at the undergraduate（baccalaureate）university level and successful admission to a school or college of optometry.In the fulfillment of the pre-requisite courses，many schools and colleges of optometry in the United States require completion of a university baccalaureate degree（Bachelor of Science，B.S.，or Bachelor of Arts，B.A.）;some schools and colleges require completion of at least90 semester hours or 135 quarter hours of undergraduate credits but do not require，but prefer，completion of the baccalaureate degree.
Each school or college of optometry in the US provides information on specific application deadlines，additional policies and procedures，class size，grade point average（GPA），Optometry Admissions Test（OAT）averages，international requirements，and tuition and fees considerations. 13
In general，schools and colleges of optometry admit students who have demonstrated strong academic commitment and who exhibit the potential to excel in deductive reasoning，interpersonal communication，and empathy.Optometry schools are looking for well-rounded candidates who have achieved notonly in the classroom but also in other areas.Leadership ability，a disposition to serve others，and a work ethic characterized by dedication and persistence are just a few of the qualities thatmost admissions committees view favorably. 13
During the admissions process，a student's academic evaluation is based on overall Grade Point Average（GPA），science GPA，college attended，degree progress，and course load difficulty.Most studentsmajor in the natural sciences in college（e.g.，biology，chemistry）because the prerequisites for optometry school are science intensive.However，prospective students can major in any degree discipline as long as they comp lete all of the prerequisite courses for optometry.Listed below are the common prerequisite courses for most optometry schools: 14
●General biology with labs，
●General chemistry with labs，
●Organic chemistry/biochemistry with labs，
●General physicswith labs，
●Microbiology with labs，
●Calculus，
●Psychology，
●Statistics，
●English，
●Social science，and
●Other humanities. 14
Most schools and colleges of optometry in the US consider an applicant's exposure to，and understanding of，the profession of optometry to be of vital importance.Each applicant should become acquainted with at least one optometrist and，if possible，gain some firsthand experience to see what optometrists do on a daily basis.Most schools require personal interviews for admission，and experience/exposure to the field is often a topic for discussion. 14
The admissions requirements that are completed by undergraduate students who are admitted to schools and colleges of optometry in the United States（US）are similar to the pre-requisites completed by applicants tomedical and dental programs in the US.
Likemost healthcare professions in the United States，students seeking admission to a school or college of optometry are required to take and successfully pass a computer-based standardized examination.For prospective optometry students in the United States，this examination is the Optometry Admission Test（OAT）.
The OAT is sponsored by Association of Schools and Colleges of Optometry（ASCO）for applicants seeking admission to an optometry program.The OAT is a standardized computer-based examination designed tomeasure general academic ability and comprehension of scientific information.It consists of four subtests: 15，16
●Survey of the Natural Sciences（Biology，General Chemistry，and OrganicChemistry），
●Reading Comprehension，
●Physics，and
●Quantitative Reasoning. 15，16
The Board of Directors of the Association of Schools and Colleges of Optometry（ASCO）developed Functional Standards for Didactic and Clinical Optometric Education in 1998 and revised them in 2009.Although developed for several reasons，the functional standards give prospective students an accurate idea of the skills required to perform the duties of an optometrist.The ability tomeet these guidelines，along with other criteria established by individual optometric institutions，is necessary for graduation from an optometric professional degree program. 17
One of themissions of each school and college of optometry is to produce graduateswho provide quality comprehensive eye care services to the public.To fulfill thismission，each institution must ensure that students demonstrate satisfactory knowledge and skill in the provision of optometric care.The functional guidelines in optometric education require that the candidate/student possess appropriate abilities in the following areas: 17
1.observation;
2.communication;
3.sensory and motor coordination;
4.intellectual-conceptual，integrative and quantitative abilities;and
5.behavioral and social attributes. 17
Following completion of the pre-requisite requirements，students apply to one ormore of the 23 schools and colleges of optometry in North America（the United States，Puerto Rico，and Canada）. 18
Optometry's centralized application service（OptomCAS）was launched in July 2009.OptomCAS allows optometry school applicants to use a singleweb-based application and one set of materials to apply to multiple schools and colleges of optometry.Applicants who apply through OptomCAS submit a completed web-based application comprised of biographical data，colleges and universities attended，academic course history，letters of recommendation，work experience，extracurricular activities，honors，and a personal essay. 14，19
Studentsmust successfully complete a four-year accredited degree program at a school or college of optometry to earn the OD degree in the United States.The sequence of course work varies from one program to another，but some general characteristics are shared by all.In the first and second year of the professional program，course work is concentrated in the basic health sciences（anatomy，physiology，pathology，biochemistry，pharmacology，and public health），optics，and vision science.Students begin their clinical experience in a clinical simulation laboratory，with classmates serving as patients，and then proceed to clinical trainingwith actual patients.This simulated patient care training includes taking case histories，performing examinations，learning diagnostic techniques，and discussing treatment services. 20
In the third year，students spend part of their time in the classroom and part of their time in the clinic examining patients. 20 Schools and colleges of optometry in the United States have oncampus and community-based clinics to which the students are assigned for their patient care experiences.
Fourth-year students continue their clinical training，which may include off-campus clinical externship rotations.Sites for rotation are available in the United States and abroad.Clinic settings include military facilities，Veterans Administration hospitals，public health service hospitals，and various specialty and private practices.The lengths of the external rotations vary from eight to 16 weeks.After successfully completing the fourth year，students graduatewith a Doctor of Optometry degree. 20
The schools and colleges of optometry in North America are reviewed for accreditation by the Accreditation Council on Optometric Education（ACOE）.Both the United States Department of Education and the Council on Higher Education Accreditation recognize the ACOE as a reliable authority concerning the quality of education of the programs the Council accredits.ACOE accreditationmeans the programs that have attained accredited statusmeet the Council's standards of educational effectiveness;and show a demonstrated commitment to quality assessment and improvement. 21 In addition，the campus on which the school or college of optometry is located is periodically reviewed by a regional accreditation body in higher education.
The National Board of Examiners in Optometry（NBEO），established in 1951，is an independent，non-governmental，non-profitorganization whosemission is to protect the public by accurately assessing the competence of practicing optometrists.NBEO examinations are universally accepted for optometric licensure in the United States，and also by several international jurisdictions.Those involved in examination development，review，and implementation advance NBEO's mission of protecting the public with high quality test development and administration，standard setting and equating，and test innovation. 22
In the United States，Doctors of Optometry are required to be licensed by the board of optometry in each state in which they wish to practice.Licensing assures that optometrists havemet established standards of knowledge and are able to effectively and competently provide patient care.All states either accept or require passage of PartsⅠandⅡ of the examinations offered by the National Board of Examiners in Optometry（NBEO）.NBEO PartⅠ—Applied Basic Scienceis a computer-based multiple choice examination that tests epidemiology，patient's history，presenting symptoms and signs，clinical testing，diagnosis，and pathophysiology knowledge.Students take NBEO PartⅠ in the spring of their third professional year.The computerbased NBEO PartⅡ—Patient Assessment and Management tests knowledge of clinical science through written patient scenarios and associated multiple choice examination items.Students take NBEO PartⅡin the fall of their fourth professional year. 22，23
Optometry student candidateswho are enrolled in the fourth professional year of study at an accredited institution are eligible to take the NBEO PartⅢ—Clinical Skills Examination.NBEO PartⅢis a hands-on，station-based examination administeredat the National Center of Clinical Testing in Optometry（NCCTO）located at the NBEO headquarters in Charlotte，North Carolina，USA. 22，24
Each state in the UShas its own set of laws and regulations governing the practice of optometry，and many states also require an optometrist to take an examination that tests the applicant's knowledge of the laws of that state.Periodic renewal of a license to practice optometry is required，depending on the state.Requirements for re-licensure can be fulfilled through completing continuing education courses or othermodes. 23
Since 1919，themission of the Association of Regulatory Boards of Optometry（ARBO）has been to represent and assistmember licensing agencies in regulating the practice of optometry for the public welfare. 25 State boards of optometry serve as the licensing and regulatory arm of the optometric profession by formulating rules or regulations that govern and enforce the laws that grant the privilege to practice optometry，which are enacted by state legislatures.Throughout its history，ARBO has been the forum for all optometry licensing and regulatory agencies to meet，develop，and exchange ideas. 26
Currently，ARBO's membership consists of 66 regulatory boards throughout the United States，Canada，Australia，and New Zealand.ARBO provides programs to accredit optometric continuing education courses，to track and audit continuing education attendance of licensed optometrists，and to assistwith licensemobility. 26
Following the awarding of the Doctor of Optometry（OD）degree，residency programs in the profession of optometry are optional and not required either for licensure or for the establishment of a specialty practice.The four-year OD degree encompasses all areas in which optometrists are licensed to practice.After a student receives the OD degree，residency programs are typically one year in duration and the resident receives a salary during this course of clinical training.Most often，residency programsare located within hospitals，Veterans Administration facilities，outpatient clinics，or the clinical facilities of the various colleges and schools of optometry.Residency programs vary within areas of emphasis and are typically identified by one of the following specific areas: 23
Family Practice Optometry
Primary Eye Care
Cornea and Contact Lenses
Geriatric Optometry
Pediatric Optometry
Vision Therapy and Rehabilitation
Low Vision Rehabilitation
Ocular Disease
Refractive and Ocular Surgery
Community Health Optometry
Brain Injury Rehabilitation 27
Following successful completion，the resident receives a certification of completion from the academic affiliate of the residency program.Residency programs in optometry in the United States are reviewed for accreditation by the Accreditation Council on Optometric Education（ACOE）. 21
Following awarding of the Doctor of Optometry（OD）degree，completion of a graduate program is not required to be licensed to practice optometry.In the United States，graduate degree programs usually are research-oriented.A Master of Science（MS）degree can be sought by someone who has an OD degree orwho is simultaneously working on the OD degree.This individual often plans to practice optometry but also wishes to become familiarwith the basics of research and/or to pursue a faculty position. 28 In some optometry programs，a Master of Science in Clinical Optometry is also offered;the degree program content is oriented toward individualswho are trained as optometrists internationally.
A Doctor of Philosophy（PhD）degree ismost often sought by someone intending to go into full-time research and/or teaching.For those possessing a PhD，opportunities exist not only to teach and do research at a college or university but to engage in research within the corporate and government sectors.Individuals can enter these PhD graduate programs in optometry with or without an OD degree.Some choose towork on both the OD and the PhD at the same time，taking approximately six to seven years to complete both degrees.Graduate degree programs at schools and colleges of optometry are identified by different names，but all emphasize and explore some aspect of biomedicine，vision，and the visual and ocular system. 28 Following appropriate admission and courses of study，additional academic credentials available to Doctors of Optometry include the Master of Public Health（MPH）degree，the Master of Education（MEd）degree，the Doctor of Education（EdD），to name a few.
Board certification is currently a voluntary process for practicing Doctors of Optometry in the United States.In general，a board certification process is comprised of specific above entry-level requirements and credentials that the practicing Doctor of Optometry must demonstrate and successfully accomplish before an established agency grants board certification.Typically，ongoing requirements are established in order tomaintain and renew board certification after a specified period of time.Three pathways to board certification in the United States，the American Board of Optometry，the American Board of Certification in Medical Optometry，and the NBEO-Board Certification are briefly described below:
American Board of Optometry（ABO）board certification is a process that allows Doctors of Optometry to demonstrate that they exceed entry level requirements and aremaintaining the appropriate knowledge，skills，and experience to deliver quality eye care.The American Board of Optometry was created in 2009 to provide optometristswith a voluntary pathway to earn ameaningful Board Certification credential. 29
The American Board of Certification in Medical Optometry（ABCMO）is an independent，nonprofit organization that provides recognition and certification of US licensed optometrists who have chosen to specialize in medical optometry after receiving their professionaldegree（OD）and license to practice.Medical Optometry encompasses themedical diagnosis，management and treatment of primary and secondary diseases and disorders of the human eye，adnexa，and visual tracts.Successful applicants for board certification by ABCMOmust complete a full-time，Accreditation Council on Optometric Education（or equivalent）accredited，postgraduate clinical residency training program having major emphasis on medical optometry;must pass the Advanced Competence in Medical Optometry examination（or equivalent）offered by the National Board of Examiners in Optometry;and，must document the significant practice ofmedical optometry for a minimum of two years immediately prior to application for certification. 30
NBEO-Board Certification，Inc.（NBEO-BC©）is a private，nonprofit organization that strives，in conjunction with the National Board of Examiners in Optometry（NBEO），to documentmilestones of achievement throughout an optometrist's professional career.The NBEO-BC TM program acknowledges the importance of optometrists maintaining their certification to augment their efforts to keep up with developments in optometric knowledge and technology that ultimately provide the highest quality of vision and eye care to patients.The goals of NBEO-Board Certification dovetail with the exam development/scoring activities of the NBEO.The NBEO-BC TM board certification andmaintenance of certification（MOC）programs commencewhere traditional NBEO functions conclude，in regard to the NBEO ® PartsⅠ，Ⅱ，andⅢ examinations.Once practitioners have passed these entry-level exams，they subsequently focus on the mission to promote professional lifelong learning. 31
In the United States，studentsmust successfully complete undergraduate requirements to be considered for admission to a school or college of optometry.They then complete a 4-year Doctor of Optometry degree program that is comprised of courses in basic and biomedical sciences，optics and visual science，clinical skills and procedures，monocular and binocular vision，ocular disease，systemic disease，on-campus patient care，off-campus patient care，and business aspects of optometry.After receiving the Doctor of Optometry（OD）degree and in order to practice optometry in the United States，optometristsmust successfully pass national standardized examinations and be licensed by the individual state（s）in which they practice.Optional additional credentials for Doctors of Optometry in the United States include residency programs，graduate degree programs，and board certification.Optometrists practice in a variety of clinical settings and serve as members of interdisciplinary healthcare teams.Practicing optometrists stay current in their profession by completing continuing education requirements for relicensure.
Given their important roles and responsibilities in the healthcare arena as primary eye and vision care providers in the United States，it is essential that Doctors of Optometry be effectively trained，educated，and credentialed to deliver high quality services to the patients who have entrusted their care to them.
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19.Welcome to OptomCAS.www.optomcas.org
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