Charles F. Mullen

Challenges and Opportunities in Optometry and Optometric Education

Optometry Specialty Certification Boards Provide a Uniform Indicator of Advanced Knowledge and Skills

Background

There is a need for increased postgraduate clinical training capacity, and Optometry Specialty Certification Boards to manage the rapid expansion of the Scope of Optometric Practice. See: Three Critical Components for Expanded Scope of Optometric Practice.

Board Certification is understood by the health care community, and general public that a physician has acquired advanced knowledge and skills in a specialty area such as Internal Medicine, Family Medicine, Pediatrics, etc.

Although there are more than ten different types of Optometry Residency Programs, only ABCMO offers enrolled residents the opportunity to be Board Certified in an Optometry Specialty. This leaves many other residents without the opportunity for Board Certification in their respective Specialties. This deficiency can be addressed by the further development of Specialty Certification Boards as outlined in this paper.

This paper details an approach for Optometry to develop Board Certification capabilities similar to medicine in the specialties of Family Optometry, Low Vision and Pediatric Optometry in addition to the currently successfully operating American Board of Certification in Medical Optometry (ABCMO).

In order to facilitate the development of Optometry Specialty Boards, and to ensure high standards for all specialties, the American Board of Optometry Specialties (ABOS) was implemented. ABOS is the optometric analog of the American Board of Medical Specialties (ABMS).

The State of Optometry Specialty Certification Boards and Associated Specialties and Subspecialties

The following is a synthesis of information contained on ASCO, ABCMO, ABOS and the American Academy of Optometry websites pertaining to postgraduate clinical training, specialties, subspecialties and Certification Boards into four Optometry Specialty Certification Boards with their associated specialties and subspecialties.

ABO promotes advancement beyond the entry level, but does not promote nor certify specialization. The below guidance framework requires further development and refinements.

Optometry Specialty Board Currently Operating

American Board of Certification in Medical Optometry (ABCMO)

Medical optometrists diagnose, treat and manage a wide range of conditions of the eye. They prescribe medications, diagnostic tests, eyeglasses and contact lenses.

Specialty Certification in Medical Optometry Administered by the American Board of Certification in Medical Optometry (ABCMO) Requirements

  1. Completion of a full-time, ACOE (or equivalent) accredited, postgraduate clinical residency training program having major emphasis on medical optometry.
  2. Passage of the Advanced Competence in Medical Optometry (ACMO) exam offered by the National Board of Examiners in Optometry (NBEO).
  3. Documented significant practice of medical optometry for a minimum of two years immediately prior to application for certification.

Subspecialty Certification Requirements

To become certified in a particular Subspecialty, an optometrist must

  1. Receive certification by the parent Specialty Board such as the ABCMO.
  2. Achieve Diplomate status in a relevant American Academy of Optometry Section or Membership in a Special Interest Group.
  3. Complete two years of a subspecialty clinical fellowship or equivalent.
  4. Passage of Subspecialty Examination offered by the NBEO.

Subspecialties of Medical Optometry (Under Consideration)

Cornea and External Disease

Subspecialty includes the diagnosis, treatment and management of diseases of the cornea, sclera, conjunctiva and eyelids.

Glaucoma

Subspecialty includes the diagnosis, treatment and management of glaucoma and other disorders usually associated with increased intraocular pressure.

Neuro-Ophthalmic Disorders

Subspecialty includes the relationship between neurologic and ophthalmic diseases. Manages local pathology affecting the optic nerve and visual pathways and the visual effects of traumatic brain injury. Includes the evaluation and management of problems that involve the afferent and efferent visual and visual-motor systems.

Vitreoretinal Diseases

Subspecialty includes the diagnosis and management of various diseases that affect the retina and vitreous.

For more information regarding the Specialty of Medical Optometry and associated subspecialties please visit ABCMO.org

The Following Specialties Require Further Development and Establishment of Certification Boards

See: Principles to Follow in Developing Specialties and Subspecialties.

Family Optometry

American Board of Certification in Family Optometry (ABCFO)

The Family Optometrist provides front line, primary eye care to all members of the family that is accessible and continuous over time for all ages and stages of life. When necessary, the Family Optometrist arranges for diagnostic tests and referrals to other health care providers and coordinates the care.

Specifically, the Family Optometrist diagnoses, treats and manages disorders of the eye including prescription of eyeglasses, contact lenses, optical aids and medications.

Certification Requirements

  1. Residency training as required by ABCFO.
  2. Practice as required by ABCFO.
  3. Passage of an Examination in the Specialty of Family Optometry.
  4. Passage of the Advanced Competence in Medical Optometry Exam or Residency Training in Medical Eye Care.

Subspecialties in Family Optometry (Require Further Development)

Adolescent Vision

Advanced Contact Lens Care

Geriatric Vision

Infant Vision

Sports Vision

Pediatric Optometry

American Board of Certification in Pediatric Optometry (ABCPO)

The management of ocular motility disorders, strabismus, amblyopia, developmental and perceptual abnormalities in children.

Certification Requirements

  1. Achieve Diplomate status in the Binocular Vision, Perception and Pediatric Optometry Section of the American Academy of Optometry (AAO).
  2. One year residency training or two years of pediatric practice.
  3. Passage of an Examination in the Specialty of Pediatric Optometry.
  4. Passage of the Advanced Competence in Medical Optometry Exam or Residency Training in Medical Eye Care.

Subspecialties in Pediatric Optometry

To Be Determined

Low Vision Optometry

American Board of Certification in Low Vision Optometry (ABCLVO)

Low Vision Optometry deals with the diagnosis and treatment of low vision. Management includes prescription of optical aids and other devices. Also, includes training and counseling of patients.

Certification Requirements

  1. Achieve Diplomate status in the Low Vision Section of the American Academy of Optometry.
  2. One year of residency training or two years of low vision practice.
  3. Passage of an Examination in the Specialty of Low Vision Optometry.
  4. Passage of the Advanced Competence in Medical Optometry Exam or Residency Training in Medical Eye Care.

Subspecialties in Low Vision Optometry

To Be Determined

Criteria for the Establishment of an Optometry Specialty Board

The specialty board issuing certifications in a specialty shall be an independent, not-for-profit entity with a board of directors and officers of up to 7 individuals of which the majority of voting members are licensed practitioners of the specialty and two non-voting members who will represent the public interest.

The board may have ex officio members representing the Accreditation Council on Optometric Education (ACOE), the Association of Schools and Colleges of Optometry (ASCO) and the independent entity preparing and administering its national written specialty examination testing competence in the specialty required to apply for specialty certification.

American Board of Optometry Specialties (ABOS)

The development and administration of all Specialty Boards is overseen and assisted by the American Board of Optometry Specialties (ABOS).

by Charles F. Mullen

Principles for Optometry to Follow in Developing Specialties and Subspecialties

The following principles have proven to be effective by Medicine in the administration of Specialties and Subspecialties. The principles are widely recognized by accrediting groups, insurance carriers, health care institutions and providers:

  • Nomenclature
    • The name of the Residency Program must be the same as the Clinical Specialty, e.g. Family Optometry, Pediatric Optometry, Low Vision Optometry, and Medical Optometry.
    • The name of the Post-Residency Fellowship must be the same as the Clinical Subspecialty, e.g. Glaucoma, Retina, Cornea/External Disease, Neuro-Ophthamic, Sports Vision, Geriatric Vision, Adolescent Vision, etc.
  • Each Specialty must have its own Certification Board.
  • The Certification Board determines the requirements for Specialty and associated Subspecialty certifications.
  • Only the Specialty Certification Board can grant Specialty and Subspecialty Certifications.
  • Residency Trained clinicians must first be certified in the Specialty by the parent Specialty Board before qualifying for Subspecialty Certification.
  • Only clinicians who are Board Certified in a Specialty may use the title, Specialist, and only those certified in a Subspecialty may use the designation of Subspecialist.
  • Each Specialty Certifications Board submits to oversight by an independent third party*.

*In Medicine, Specialty Boards are overseen by the American Board of Medical Specialties (ABMS). In Optometry, Specialty Boards are overseen by the American Board of Optometry Specialties (ABOS).

by Charles F. Mullen

Three Critical Components for Expanded Scope of Optometric Practice

Introduction

Medical Education leads the Medical Profession by developing the educational structure and clinical training programs in advance of new patient care initiatives. In contrast, State Optometric societies lead the Optometric Profession with Optometric Education reacting to the States’ expanded scope of practice initiatives with specific educational programs. Consequently, there is not a comprehensive educational structure nor a uniform indicator of an optometrist’s knowledge and clinical skills to support all of the States’ expanded scope of practice initiatives.

Requiring postgraduate clinical training in medical eye care for optometrists is not only essential preparation for Expanded Scope of Practice, but also positions optometry for inclusion in the $18 billion Graduate Medical Education Program (GME).

These are the three missing components that need to be developed:

1) Necessary Capacity for Advanced Clinical Training in Medical Eye Care

  • In 1931 Medicine acknowledged that clerkships contained within the four year medical school curriculum were inadequate preparation for rapidly changing medical practice, and instituted mandatory postgraduate clinical training.
  • Even though optometric practice has dramatically and rapidly expanded encompassing medical eye care, clerkships within the four year optometry curriculum remain the only required clinical training component.
  • The current four year curriculum does not provide optometry graduates with the types and quantity of clinical teaching encounters necessary to practice expanded scope of practice in all States.
  • Postgraduate clinical training in medical eye care is now essential preparation for advanced optometric practice.

2) Federal Funding to Support Advanced Clinical Training

  • Optometry is not included in the $18 Billion Graduate Medical Education Program (GME) because clinical education takes place primarily within the four year curriculum, and not in postgraduate residencies.
  • Inclusion in GME, the educational component of Medicare, would not only encourage the development of new residency positions in Medical Eye Care by providing funding to host facilities, but also by providing funding to directly support advanced clinical training.
  • Optometric Education needs to change from providing clinical education within the current four year curriculum to a Postgraduate Clinical Training Model to qualify for GME.
  • Like medicine, clinical clerkships or rotations would take place within the final years of the curriculum.

3) Nationally Recognized Certification Board to Provide a Uniform Indicator of an Optometrist’s Advanced Knowledge and Skills to Practice Expanded Scope of Practice Optometry

  • The American Board for Certification in Medical Optometry (ABCMO) is a well-established Board that meets GME expectations. However, ABCMO serves mostly Department of Veterans Affairs (VA) optometrists, and needs to be recognized by the entire Optometric Profession.

More Information

 

by Charles F. Mullen

Six Required GME Structural Elements – Postgraduate Clinical Programs/Residencies in the Specialty of Medical Optometry

1. Inclusion In the Graduate Medical Education (GME) Program

2. Mandatory Postgraduate Residencies Facilitate Specialty Training Followed by Board Certification

3. Accreditation

4. Definition of the Specialty of Medical Optometry and Associated Subspecialties

5. Medical Optometry Specialty Certification Board

6. Oversight Board for All Specialties

by Charles F. Mullen