Optometry’s reflection

April 7, 2021
Given the doors that were once closed and are now open to women and people of color in society, it might be expected that the faces of optometry would reflect the changing demographics of the nation. And with the nation’s reckoning over social injustice in 2020 stirring anew concerns over diversity and inclusiveness, the profession is asking whether optometry reflects the nation’s changing demographics—and why should that matter?
Erin Brooks, O.D.

Excerpted from page 22 of the March/April 2021 edition of AOA Focus.

Truth be told, Erin Brooks, O.D., M.S., had not wanted to be a doctor of optometry at all.

Growing up, she had liked her family’s eye doctor. But there were no eye doctors in her family. She simply had not seen anyone who looked like her in the profession. It was actually her father’s dream deferred—not hers—until the day she decided to humor him by attending a pre-optometry club meeting at the University of Missouri-St. Louis (UMSL), where she was a chemistry major.

Erin Brooks, O.D.
Erin Brooks, O.D.

“That day changed my life,” says Dr. Brooks, assistant clinical professor at UMSL. “While I was at the meeting, there was a workshop where the optometry students were showing us what they can do as doctors.

“I was hooked,” she says.

And now Dr. Brooks is the role model she never had. Pre-pandemic, she hosted hands-on workshops for prospective students considering optometry as a career. She spoke at job fairs at junior high and high schools.

“A lot of the students look at me like, ‘You’re a doctor?’” she says. “If you don’t have diversity, they don’t think of themselves as being part of the profession. Without my father, I don’t think I would have considered it.

“I also think diversity is important to patients,” Dr. Brooks says. “It’s no different than female patients wanting female doctors. Those patients may feel they can better identify with them. There’s a difference in our experiences.”

How diverse is optometry?

Based on a model derived from the AOA’s Doctors of Optometry Master Data File, National Eyecare Workforce Supply and Demand 2012 (years 2010-2013) report and projections for 2021-2025, the increasing number of women doctors reflects national trends. Women outnumber men in the United States. And a year ago, pre-pandemic, women passed men in the paid U.S. workforce, according to Department of Labor statistics.

Optometry reflects these changing demographics. Five of 11 seats on the AOA Board of Trustees are held by women.

“Every (optometry) school reported more full-time female students than male students in 2019-2020,” says the Association of Schools and Colleges of Optometry (ASCO) in its report of data on 23 regular professional optometry programs and Puerto Rico.

Whereas the rise of women in the profession has been steady, Black doctors remain underrepresented. Black individuals make up 13.4% of the U.S. population, yet a paltry 2% of practicing doctors of optometry, based on the Workforce Supply model. A total of 3.2% of full-time students in optometry schools are Black, ASCO reports.

Black underrepresentation is not a new quandary for the profession and optometry schools.

Amid reckoning, the AOA reflects and responds

The AOA took the opportunity during 2020’s nationwide protests to look inward and assess if it could do more to promote diversity and inclusivity in the AOA and the profession. On June 9, it issued a statement on the boiling dialogue on social justice, following the tragic deaths of Breonna Taylor and George Floyd at the hands of police. The statement reads in part: 

“… the AOA affirms its unyielding belief that there is no place in our country for racism, intolerance or hate. As America seeks a national understanding of the unacceptable harms that racism inflicts, the AOA stands with all of those affected by tragedies. We recognize, support and embrace our profession’s leadership role in helping communities, states and our country come together, heal and stand stronger than ever against inequality and injustice.”

Shortly thereafter, AOA President William T. Reynolds, O.D., appointed the board-level Diversity, Equity and Inclusion Task Force. It includes AOA Board of Trustees members Jacqueline M. Bowen, O.D., chair, Steven T. Reed, O.D.,  and Lori L. Grover, O.D., Ph.D.

“The AOA has long been a leader among national professional organizations in fighting for expanded patient access to the essential care our doctors provide, as well as for full adherence to a single standard of eye health and vision care,” Dr. Bowen says. “Now is exactly the right time to look at how we can be even more impactful as an organization focused on advocacy for doctors and our patients and as a profession, and that’s the charge our task force has begun pursuing over the past few months,” she says.

Not only did the task force engage member doctors of color in conversation to get their perspectives, but it also immediately announced a set of measures—for a start. Among them: 

  • Building greater diversity in its volunteer structure. AOA volunteer committees consist of members (primarily doctors, but also paraoptometrics and students) who lead and carry out such influential AOA initiatives as advocacy, professional development, evidence-based optometry and industry relations.
  • Undergoing additional training on diversity and inclusiveness by board members and AOA staff. AOA employment policies already contain strong protections against bias, discrimination, harassment and retaliation, says Michael Stokes, J.D., AOA general counsel. “For those policies to be most effective, it is essential employees feel comfortable bringing forth concerns,” Stokes says. “The message from AOA leadership is clear—we want the AOA to be a welcoming, inclusive and equitable workplace for everyone.”
  • Helping to promote participation by optometry schools and students in “Impact HBCU,” a virtual gathering held on Oct. 6 to inform and inspire high school students and undergraduates attending historically Black colleges and universities to strongly consider optometry as a career.

And in this new year, the AOA and American Optometric Student Association (AOSA) unveiled Opportunities in Optometry grants, $1,500 grants to underrepresented, minority, undergraduate students to help defray the costs associated with applying to optometry schools. The pre-optometry recipients also will be invited to attend Optometry’s Meeting ®, giving them an opportunity to immerse themselves in the profession. Grants will be funded jointly by the AOA and AOSA, plus donations from other organizations and individuals, and administered by Optometry Cares®—The AOA Foundation.

Pipeline to the profession

Dozens attended Impact HBCU, presented by Black Eyecare Perspective, founded by Adam Ramsey, O.D., and Darryl Glover, O.D. Held virtually, the event was meant to introduce pre-optometry students to the profession and the eye care industry. But it also served to inspire and support.

For a little over two hours, Essence Johnson, O.D., who practices in Texas and is Black Eyecare Perspective’s chief visionary officer, talked and interviewed professionals on several subjects—how doctors of color experience and succeed amid the current dearth of underrepresented minority students and professionals; how to prepare to get into optometry school; and opportunities to stretch themselves outside the clinical setting. During the first-ever event, Dr. Johnson clearly elucidated the challenge without role models who may inspire and may better understand where they are coming from.

“The percentage of future optometrists who look like me hasn’t changed much since I graduated over a decade ago,” she says. “It’s for this reason that we’re asking for 13% equity. Our 13% promise is a call for action and accountability, to increase the representation of Blacks and African Americans to at least match the U.S. Census. By 2025, we’d like to achieve 13% of students in optometry (schools) identifying as Black or African American.

Committed to access

Ida Chung, O.D.
Ida Chung, O.D.

Ida Chung, O.D., is associate dean of academic affairs at Western University College of Optometry. A graduate of the State University of New York (SUNY) College of Optometry in 1993, Dr. Chung recalls her SUNY graduating class as diverse when it came to gender but not when it came to race/ethnicity, though students of Asian descent were well represented.

“Even in a city as diverse as New York, there were no Latinx students,” Dr. Chung says. “It was ironic because so many of the patients we served spoke Spanish, and we didn’t have any native Spanish speakers. This is still a major concern today.”

In optometry school, as she mused about practicing after graduation, she hoped to serve patients from diverse neighborhoods; in particular, her underserved childhood community of Chinese immigrants.

Although myopia was familiar to many of the parents there, they were less aware of other vision problems, such as convergence insufficiency, accommodative dysfunction or visual perceptual dysfunction.

“I wanted to go back into my community and provide the high-quality eye care for those who spoke my dialect, Cantonese,” says Dr. Chung, who was chief of pediatrics at the SUNY University Eye Center before accepting a position at Western University.

“It was so rewarding for me to provide vision screenings at the elementary school that I graduated from. It was so rewarding to work in the Chinese community providing medical eye care, where I had the opportunity to utilize my language skills.

“It was so rewarding to provide mobile eye services to the underserved preschool children in the lower east side of Manhattan where I grew up,” she says. “I wanted to make a difference for these children who often were first-generation immigrants, like myself, whose parents were trying to make a living to survive and did not know to bring their children for preventive eye care services. I was driven to do what I could to improve the lives of children raised in low-income and disadvantaged neighborhoods, like I was.”

Whether for doctors or patients, access has long been on the AOA’s radar. In 1972, its House of Delegates passed a resolution making a high priority its process of recruitment, admission, enrollment and retention of individuals from diverse racial and ethnic backgrounds. In 2001, it sought to protect against potential bias in patient care based on health, gender, age, ethnicity, race, financial status or any other patient characteristic.

Just a few short years ago, the AOA rolled out AOA+—an outreach program aimed at engaging optometric students and young doctors of optometry in networking opportunities and advocacy for the profession. This includes AOA on Capitol Hill, where students and member doctors of optometry pay visits to congressional offices (virtually this year); Leadership Link, an opportunity for students to network with doctors about transitioning from school to practice; and popular and practical pop-up sessions at Optometry’s Meeting.

The AOA’s ongoing advocacy efforts to expand scope of practice for doctors of optometry are indicative of its commitment to equal access, ending health care disparities and elevating care for all patients. And on Feb. 24, after revisioning due to the COVID-19 crisis, the virtual AOA Leadership Institute, a project of the AOA Leadership Development Committee established in 2018, was launched. Nominations to the institute were sought from state affiliates and schools and colleges of optometry. Diversity—including gender, race/ethnicity, age (five to 10 years removed from optometry school) and even geography—was strongly considered along with leadership potential in selecting the inaugural class.

The institute’s objective? To grow a diverse group of leaders.

Says Andrea Thau, O.D., chair of the Leadership Development Committee and former AOA president, “The program is designed to give them the tools they need, the confidence they need and the background they need to become engaged leaders. We know that many people need the tap on the shoulder, the encouragement, the support to step forward and lead.

“Once they complete the yearlong program, we hope they will become more involved initially with their affiliates, bringing to them the skills they learned in the Leadership Institute,” she says. “But we also hope that a number of them will rise and lead on the national level.”

Expanding doctors’ professional networks and their spheres of influence also are aims of the institute, sponsored by AOA Visionary Supporters Johnson & Johnson Vision and Essilor of America.

With growth flat in the number of Black individuals in optometry schools and in the profession, many schools have sought solutions. For instance, some have created intensive programs to introduce underrepresented minorities to the profession. This summer, the Indiana University School of Optometry announced it was making the Optometry Admissions Test optional for applicants.

Says Alex Bennett, 2020-21 AOSA president: “We have formed a diversity project team committed to looking at ways for the association to recruit people of more diverse backgrounds and cultures into the field.

“The team has already identified areas to specifically increase equity among underrepresented people, and we are looking to assist anyone interested in the profession through educational resources and scholarships. It’s why we are working collaboratively with the AOA on the grants. We recognize that the work each association was doing independently had similar goals and we offered to work collaboratively in achieving our shared goals.”

Why it matters

Dr. Bowen cites three reasons why equal opportunity matters: 

  • Improved patient care. “No optometrist can be all things to all patients. A diverse profession is better equipped to serve our diverse population. Many patients will open up and be more likely to follow through on treatment from a doctor who shares their perspective and life experiences.”
  • Expanded creativity and problem-solving. “A diverse AOA membership brings a wide array of experiences, skills, perspectives and insights to advancement of the profession. Diversity increases innovation, creativity and strategic thinking. We are better informed and make sounder decisions, leading to improved results for optometry and our patients.”
  • Enhanced staff engagement and retention. “AOA staff are more engaged in welcoming work cultures. They are also more loyal and apt to stay longer in an organization where their unique contributions are recognized and respected.”

When she attended optometry meetings for doctors several years ago, Dr. Bowen says there was never a line to the ladies’ room. So few women doctors were in attendance. As more women graduated from optometry schools, the lines outside the ladies’ room grew, however. 

Dr. Bowen doesn’t mind waiting now. 

She observes, “Although that may appear to be a trivial anecdote, it always makes me feel a bit proud to stand in line now with so many women doctors. It’s a reflection of where we’ve come from and assurance that we will continue to change as a profession.”

Photography by Paul Nordmann

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