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PubMed1992

What are the pros and cons of requiring postgraduate residency training as an entry level practice requirement?

The technological and knowledge explosion that has occurred in this century has created a curriculum crunch within all health professional schools. The various optometric institutions are dealing with this crunch and important decisions need to be made in order to provide the best entry-level practitioners possible. This paper provides some of the pros and cons of requiring a year of postgraduate training as a requirement for entry level optometry practice.

Clinical Competence↗
PubMed1992

The need to incorporate professional principles, attitudes and ethics in optometric education.

This paper reviews the development of ethical principles for the profession of optometry over the past 90 years, and how these principles have been modified and expanded in conjunction with the scope of practice during that period. The author discusses the mandated principles of licensing boards as well as Medicare and Medicaid requirements. In addition, areas of "non-mandated" ethical principles are reviewed such as the aging and AIDS patient, over testing, continuing education, corporate employment, patient records and referrals. The author suggests that ethical issues should be incorporated into all optometric courses in the curriculum and not just in a specific ethics course in order that many role models offer their input to students in the development of an ethical model for their professional lives.

Attitude of Health Personnel↗
PubMed1992

What should be the proper size and number of optometric schools?

The Health Professions Educational Assistance Act brought infusion of millions of dollars into optometric education at a time when the profession was ill prepared with inadequate space standards and cost studies. The profession presently faces the need to make major curricular changes at a time of severely constricted resources. Optometry, in a dynamic mode, needs to establish acceptable standards consistent with the profession's demands and goals for the 21st century.

Health Workforce↗
PubMed1992

Evaluation of motivating factors for selecting optometric residency education.

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

Career Choice↗
PubMed1991

Standards of care.

The health care community is quickly progressing in the direction of the development and acceptance of the concept of standards of care. Optometry has lagged behind other health disciplines in this process and must develop its own or face the likelihood of having to conform to standards created by others. The argument is no longer whether standards should be created, but rather the creation of appropriate standards and guidelines that will best serve the profession and the public.

Humans↗
PubMed1991

A comparison of charges by optometrists and ophthalmologists under the Medicare program.

Medicare data obtained from the Health Care Financing Administration was analyzed in relation to average allowed charges by optometrists and ophthalmologists. Optometric charges are considerably lower than ophthalmological charges for all services compared. The policy of different reimbursement levels is currently a major issue being considered by the Physician Payment Review Commission. Optometry must demonstrate that the procedure codes for which they submit Medicare claims are comparable and identical in service content to those provided by ophthalmologists.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

The delivery of health care and eye care in Japan.

Japan has developed a socialized system of health care delivery operated under a governmental social insurance plan. It is all inclusive in that no matter what the working status, each individual is covered. Outcomes of the system are impressive, reporting the highest life expectancy and the lowest infant mortality rates in the world. Optometry as a legalized profession is not presently recognized in Japan, even though it is common practice for the public to visit optical shops to receive routine eye examinations and lens prescriptions. There is a movement in Japan to provide optometric education and qualifying examinations comparable to international standards.

Delivery of Health Care↗
PubMed1991

Standard setting in optometric clinical skills examinations.

Objective-based clinical skills examinations have become an accepted method of assessing minimal competency for licensure in optometry. This paper reviews key elements of Clinical Skills Examination (CSE), and how standard setting for CSEs can be improved.

Clinical Competence↗
PubMed1991

Applications of expert computer systems.

An expert system is a computer program which uses artificial intelligence to make logical decisions on the basis of input data. The rules the system uses to make its decisions are called heuristics which can be provided in the form of IF . . . THEN statements, or they can be learned by the system from examples. The term "expert" is used because the rules or examples come from human experts and the program is considered to have captured their expertise. Currently there are many expert systems in business and medical use but few, if any, are used in optometry. The rule-oriented nature of many ophthalmic procedures suggests a future role for these systems, but their cost-effectiveness may not yet be favorable enough to justify development of expert systems for optometric practice.

Diagnosis, Computer-Assisted↗
PubMed1990

Comprehensive vision care under third party programs: increased services and increased scrutiny.

Physician reimbursement under Medicare has been rising by about 15 percent each year. Part of this increase is due to an increase in unnecessary tests and procedures. To control provider billing, Congress passed legislation that will establish a Medicare fees schedule and expenditure targets. Increased surveillance and monitoring of Medicare claims are taking place. Diagnostic procedures are being questioned and denied when deemed inappropriate in relation to a diagnosis. Managed care techniques also are being implemented by private insurance carriers to prevent overutilization. Clinic practice guidelines are being developed by the health professions. Optometry, as well as all other health professions, will be subject to increased utilization and quality review.

Delivery of Health Care↗
PubMed1990

Therapeutic pharmaceutical utilization by military optometrists.

The Air Force, Army, and Navy have instituted regulations that authorize optometrists to use therapeutic pharmaceutical agents (TPAs). A survey of clinical optometrists on active duty was conducted to evaluate the impact of these regulations on military optometry. The results indicate that the majority of optometrists support the regulations and are utilizing TPAs to treat a wide variety of ocular disorders. However, the survey also found a number of optometrists in each service who were dissatisfied with certain aspects of the regulations. Some Air Force and Navy optometrists expressed concern that their regulations did not allow access to TPAs which they felt qualified to use. Some Army respondents felt that their regulation was unduly influenced by local policy and was not an equitable means of granting therapeutic privileges. These concerns suggest that a reevaluation of the therapeutic regulations might be required in the future.

Anti-Infective Agents↗
PubMed1989

Expanded eye care in the Veterans Administration hospital setting.

Over the past decade a greater number of optometrists can be found practicing in hospitals, health maintenance organizations, health clinics and other multipractitioner group settings. The impetus enabling optometry to practice in such settings is based in part on cost effectivity. Optometrists in Veterans Administration (VA) hospitals have been in the forefront in this movement to provide the full range of primary eye care services, and in becoming an integral part of the hospital/medical community.

Health Services↗
PubMed1989

Assurance of quality vision care in alternative health care delivery systems.

The continuing evolution of competitive arrangements in the marketing and delivery of health care services can have an adverse effect upon the quality of care. Traditional modes of health care delivery are being replaced by the more competitive alternative delivery and managed care systems. Practitioners, consumers, administrators and legislators are finding it increasingly difficult to balance the various issues that surround the desire for quality and the necessity of cost containment. Optometry must be able to establish its own standards and methods of evaluation for the assurance of quality eye care within the alternative delivery and managed care systems.

Delivery of Health Care↗
PubMed1989

Relationship between test performance in ocular therapeutics and year of graduation.

Practitioner performance on a national, standardized examination in ocular therapeutics was analyzed. The majority of the practitioners were from one state and had graduated from the same college of optometry. The homogeneity of their background fostered an analysis of the relationship between year of graduation and test performance. The data indicated that less recent graduates did not perform as well as more recent graduates, but that the best performance was attained by practitioners with considerable clinical experience.

Education, Medical, Continuing↗
PubMed1978

Senescent changes of the cornea.

In clinical optometry the practitioner often encounters that "gray area" concerning corneal changes of a senescent nature versus those that are not within normal limits and warrant referral. This paper provides a base line of information on corneal architecture and the physiology of the aging processes which take place within the tissue. This is followed by descriptions of the more commonly encountered senescent corneal changes and their clinical presentation.

Adult↗
PubMedDate not supplied

Integrating ophthalmological and optometric services in a VA hospital program.

Basic eye care has been available at the Veterans Administration Medical Center (VAMC), Northport, NY, for the past 20 years. The demand for these services increased as the mission of this medical center was broadened to include major medical and surgery services. Increased migration of veterans to Long Island and their subsequent aging further increased the demand for eye-vision care. Originally, primary eye-vision care was provided independently by optometry and ophthalmology services. There was unnecessary duplication of equipment and inappropriate utilization of providers. Consequently, the services provided were quite limited in scope and sophistication. Both patients and providers became disenchanted with this practice mode. In December 1983, the administration of the Northport VAMC approved the establishment of a coordinated eye-vision care program that integrates ophthalmological and optometric services in a matrix structure. Since the program became operational in April 1984, patient satisfaction has increased, the working relationships between optometrists and ophthalmologists have improved, the ophthalmology residency program has been upgraded, and the combined staff productivity has increased.

Consumer Behavior↗
PubMed1988

Interrater and test-retest reliability of pursuits and saccades.

Pursuit and saccade testing have long been used by optometry to evaluate oculomotor efficiency. The literature is not consistent as to an acceptable grading system for these tests. An oculomotor test is described which grades pursuit and saccade skills in four major areas of function. Interrater and test-retest reliability data are reported which indicate that this test has clinically acceptable grading consistency. Implications for the field of optometric measurement are discussed.

Child↗