If you were to ask the attendees of the 1901 AAO meeting—the very serious, mustachioed gentlemen shown below in Figure 1—or any of the clean-shaven-but-still-heavily-male group displayed in Figure 2a who they believed their successors might be, it’s likely that they would not have been able to picture the diverse and all-inclusive group of 2016 college graduates in Figure 2b. Overall, today’s optometrists are a far cry from the founding members of the profession, both demographically and in mindset.
Initially run as an apprenticeship in which candidates were selected mostly on the basis of familial connections, optometry’s earliest practitioners at the turn of the 20th century were predominantly sons from upper class families who could afford the fees associated with private colleges and tutors.
Beginning around this time, however, the country as a whole was entering a dramatic shift in demographic makeup, with immigration into the United States exploding in conjunction with world events. More significantly, women’s rights and desires were also evolving with changes in the nation’s legislature and culture.
|Fig. 1. The attendees of the 1901 American Association of Opticians meeting.|
By 1939, female optometrists in attendance at that year’s convention of the American Optometric Association in Los Angeles were discussing the feasibility and desirability of forming an optometric women’s society along the lines of similar organizations among the women physicians and osteopaths. At the time, only 35% of the total number of registered optometrists belonged to the AOA, with only 3.6% of the number of registrants being women (out of 631 members total).
“Although optometry as a vocation holds many attractions for women, the statistics clearly indicate that the number of women entering the profession has been woefully small,” Arene Wray, OD, wrote in September 1956.1 Dr. Wray had been chronicling the progression of women—or lack thereof—for Review of Optometry since at least 1940. That year, “the classified directory of the City of Los Angeles listed twenty-two women optometrists,” she wrote. “This figure dropped to 19 in 1950, and in 1955 the number dropped again to 10, which is less than 3% of the total number of optometrists in Los Angeles.”2 This number jumped to 6.2% in 1950 but then dipped down to 4% in 1954, the author added. Minorities too, also, may have had difficulties entering the profession due to the presence of Jim Crow and Chinese American exclusionary laws.
|Fig. 2. (a) On top, alumni from the University of California Berkeley School of Optometry sit in the school’s library in 1931. (b) On bottom, the UC Berkeley class of 2016 stands proud on graduation day.|
So how, then, did we reach the level of diversity we experience in the profession today? The answer is a combination of outside legal, economic and population demands as well as the growing space within the profession itself for new individuals to join. “In 1920 there were in the United States, 17,294 practicing optometrists for a population of 105,710,620. The population had grown to 122,775,046 by 1930 and the number of practicing optometrists had increased to 17,765, yet on a comparative basis this represented an actual loss of 13% in the 10-year period,” commented a Review of Optometry article in 1942.3
A separate article in December 1942 noted the shortage of “medical men for both civilian and war purposes,” suggesting the place to look for the necessary students to fill the vacuum was among “young women looking for a career; young men in high schools who have some minor physical defect that will keep them out of strenuous occupations, and older men who have found themselves misfits in the profession they first chose.”4 Medical school dropouts might also make good optometrists as well, one indelicate writer suggested: “there is one source that has always been overlooked by us, but not by osteopathy. All medical schools allow about twice the enrollment in the freshman year that they graduate in the senior year,” the author of the article noted.4
General opinion may also have helped to sway the profession’s acceptance of female members. “Optometry offers an excellent profession for women with scientific, biological interests who possess the required intellectual endowment, and it holds forth reasonable expectation for an interesting successful vocation,” commented Dr. Wray in a January 1951 article.5 Furthermore, “optometry calls for painstaking detailed work for which women are temperamentally well-suited. Children are less fearful of women doctors than they are of men. Moreover, women optometrists are extremely enthusiastic about their work and convey this feeling to their patients,” she added in 1956.1
Perceptions such as these demonstrated the changing attitudes towards the inclusion of women in the profession, concluding that “we shall have to look to the young women in high schools and colleges to help maintain the supply of optometrists necessary to take care of an increasing population, both of school children and of older people, and to fill the vacancies in our ranks caused by retirement and death.”1
The war effort shifted the demographic and workforce patterns as well, creating new opportunities for both male and female optometrists. As male ODs were drafted or enlisted, more women entered the field, paralleling the experience of other professions. “A very respectable amount of research was done on accommodation and convergence in the American Expeditionary Force laboratories at Mineola, Long Island, New York, during and following World War I,” wrote HW Hoffsteader, editor of the Optometric Historical Society newsletter, in October 1971. “Someone, somewhere a few years ago told me that there was an optometrist or two or three on the research staff.”6
Global ImpactOnce secluded to Europe, optometry is now recognized around the world as a formal profession, bringing new individuals into the fold. Over 90 countries now report the existence of some form of the job, with varying requirements for recognition.15 Australia, for example, offers five recognized course tracks in optometry at varying universities. France, however, does not have any regulatory framework in place for the profession, with interested parties simply required to complete an apprenticeship at an ophthalmologist’s private office.16 Additionally, other countries limit the scope of practice to simply refraction or other services, while some prohibit optometrists from examining patients under or over a certain age.17 In still other parts of the world, eye care is simply provided by foreign optometrists who are temporarily in residence, suggesting the need for more licensed individuals may still be there.18
Government organizations also began to ask optometrists to provide refraction services and assist with surgical procedures, which may have drawn many practitioners away from their initial plans to open a private practice. One of the first optometrists in the US Army in World War II wrote, “during the absence of our commissioned eye physician, which lasted almost three weeks, I carried on the work of the department, diagnosing and treating eye diseases and performing minor surgical operations. Even though my training as an optometrist did not qualify me for the practice of medicine, nevertheless, the results were entirely satisfactory and I was generously complimented for the services rendered.”7
The role of ODs in the armed forces weighed heavily by both the government and those involved. “On the one hand, we have optometrists serving in their professional capacity in the Navy and with commissioned rank; on the other hand, there are optometrists serving equally well as refractionists in the Army but with non-commissioned rating the best they can get and that only in some instances. On the one hand, we find high medical officers who are not entitled to commissions; on the other hand, we know that many ophthalmologists are far from attaching such secondary importance to refraction, some even holding it to be part of medical practice,” wrote Maurice E. Cox in the 1942 issue of The Optical Journal and Review of Optometry.8
In addition to diversifying its ranks, the profession also faced—albeit much earlier—the problem of distinguishing itself from now-opticians and also authenticating itself in the eyes of the government.
“Any MD can set himself up as an ‘oculist’; and because so many incompetents did just that, the Guild of Prescription Opticians of America invented the ‘eye physician’ title to designate men considered deserving of its goodwill and sponsorship,” Herbert S. Marshutz wrote in the 1943 issue of The Optical Journal and Review of Optometry. “The point we are endeavoring to make is simply this: that any graduate and licensee in optometry can and does (with minor exception) call himself ‘optometrist.’ But unlike the eye physician, a majority of the registered optometrists of the United States do not affiliate with organized optometry, are not members of the official organization and do not enjoy the inspiration of its ideals and ethics. As merchandisers of spectacleware, calling attention to their establishments through undignified, unethical advertising of one type or another—and all too much of it smelling of quackery with bait-alluring copy—it is this majority that America knows as optometrists.”9
The problem of legitimacy continued long into the years of the profession, with comments like “his only objective was to make as much money as possible, as quickly as possible” and “no training in optics or eye care” characterizing some of the more concerning representations of the profession. “We in the service of our country are taking a beating that we aren’t going to forget,” Cpl. G. L. Lang wrote in an open letter in 1944 to the unethical members of the optometric profession.10 A separate piece in 1941 noted “there were, unfortunately, too many optometrists who were unable to distinguish between truth and sophistry, between sincerity and deception and between education and camouflage.”12Furthermore, the separation from ophthalmology was also an issue. “British optometrists were certainly used during the war, but generally as assistants to ophthalmologists rather than in their own right. But we did get other recognition; I was asked to take charge of a newly created eye clinic in a huge ammunition factory (34,000 workers) during the early months of the war. I built up a team of optometrists and we ran a daily attendance at this clinic, which was part of the medical setup,” wrote optometrist Frank Dickinson from England in the January 1973 issue of the Optometric Historical Society’s newsletter, while another account, in June 1942 Review of Optometry, noted that “the first matter to come up [at the AOA meeting] was the attempt then being made by New York optometrists to have the State Workmen’s Compensation Act amended to give them a measure of recognition. The ophthalmologists were displeased because they felt the wording of the bill appeared to give optometrists a right to ‘treat’ eye injuries.”13,14
The Veteran’s Administration hospital system began hiring optometrists to serve on staff in 1940, later formally approving and funding the country’s first program to train optometry students in 1972. As patient demand for services also continued to increase, the concept of private practice gained traction, with more and more optometrists moving to open their own businesses independent of one another.
Today, according to a summary put together by the American Optometric Association in 2011, there actually appears to be an adequate supply of optometrists, with the estimated amount of practitioners recorded at 39,580 individuals at the time of the study: 60% of males with a mean age of 51, and 40% of females with a mean age of 40. This number is expected to remain adequate to meet the projected demand through 2025 as young women continue to enter the workforce from optometry school. An eye must be kept, however, on the proposed growth and aging of the US population, increase in prevalence of diabetes among patients, and expected expansions in US healthcare coverage and scope of federal law.
Once excluded from the ranks of optometry, women now comprise the majority of new grads and over half of all current practitioners. Recognizing the changing composition of the optometric audience, the publication Women in Optometry was launched in 2006 to celebrate the achievements of female optometrists and to assist with networking opportunities. The election of Andrea P. Thau, OD, the American Academy of Optometry’s 95th—and only second female—president was highlighted in the June 2016 issue.
1. Wray AT. Women in Optometry. Optical Journal-Review. 1956 Sept;45-46.
2. Wray AT. About the Women in Optometry. Optical Journal-Review. 1940 May;21-22.
3. Cox ME. The immediate problem. Optical Journal-Review. 1942 Nov:36.
4. Rogers JD. More Manpower for Optometry. Optical Journal-Review. 1942:32.
5. Wray AT. Optometry’s Attractions for Women. Optical Journal-Review.1951:90-94.
6. Hofstetter HW. Newsletter of the Optometric Historical Society. 1971 Oct;2(4).
7. Hofstetter HW. Corporal Engelmann, OD. Newsletter of the Optometric Historical Society. 1973 Jan;4(1):13-14.
8. Cox ME. Expert service, poor recognition. The Optical Journal-Review. 1942 Oct;79(19):28.
9. Marshutz HS. Thoughts on optometry—today and tomorrow. Optical Journal-Review. 1943 Mar:20.
10. X. I was a Chain Store Doctor. Rev Optom. 1987 Feb:124(2):43-44.
11. Lang GL. An open letter to the unethical. Optical Journal-Review. 1944 Nov;26.
12. Aronsfeld GH. Optometry’s Past and Present; A Program for Its Future. Optical Journal-Review. 1941 Feb:20-44.
13. Hofstetter HW. British optometrists in WW II. Newsletter of the Optometric Historical Society. 1973 Jan;4(1):14.
14. Cox ME. Interprofessional Developments. The Optical Journal and Rev Optom. 1942 Jun;79(11):20-21.
15. World Council of Optometry. Who We Are. Available at: www.worldoptometry.org/en/about-wco/. Accessed June 8, 2016.
16. EurActiv.com. French move to create new eye professionals. Available at: http://www.euractiv.com/section/health-consumers/news/french-move-to-create-new-eye-professionals/. Accessed June 8, 2016.
17. Padilla MA and Stefano AFD. A Snapshot of Optometry Around the World. Available at: https://www.reviewofoptometry.com/article/a-snapshot-of-optometry-around-the-world. Accessed June 8, 2016.18. Fleming L. Practicing in South Africa. Rev Optom. 1987 Mar;124(3):52-56.