Ⅰ. Introduction

The increased use of computers and rapid urbanizing has brought about development of a number of health concerns. Specifically, the issue of eye health and vision has been constantly discussed in terms of working with digital devices. Many individuals, therefore, reported the complex of eye and vision problems such as ametropia and visual disorder.¹⁾ Korean government initially adopted optometry program in college in 1987 when it faced the increase of ametropia in population. The first college based ophthalmic Optics had a course of study of two years duration. Afterwards, the college with a three-year course for more professional education and university with four-year course opened sequently. Should the previous colleges focus on training dispensing optician, the current trend is to pay more attention on biological science such as ocular function test, which was the vocational requirements by WCO (world council of optometry).²⁾ As of 2015, the institutions that provided optometry program were 44 colleges i.e. 2 colleges with course of two years duration, 28 colleges with course of three years duration, 14 universities with course of four years duration and 10 graduate schools. Nearly 2,000 optometrist candidates who have completed all applicable coursework of which 1,537 passed the national licensing exam in 2015.³⁾ According to a domestic report published in 2015, 54.6% of the population had optical aids and 68.5% of those with optical aids visited optical shops for the eyesight checkup.⁴⁾ The rate of eyesight checks by Korean optometrist showed to keep increasing. The concept of Korean optometrist, as the status in Korean social layer, should be therefore revised and rearranged. Given the current wave of change, the study has been hardly done with respect to the scope of practice of Korean optometrist, education systems and the national licensing exams. The optometric system in UK and the US was originated from opticianary program, meanwhile the system Meister in Germany tries to adopt optometric system and improves it.

In the study, we will cover diverse national and international comparative point of views and propose the professional policies for the education system and licensing exam for optometrist, which can enhance the competence of optometrist contribute and eventually improve Korean public eye health care.

Ⅱ. Material and Methods

The information about scope of practice, educational system, curriculum and licensing exam for the countries, i.e. UK, US, Germany and Korea was collected and analyzed through the official reports and papers from the institutions and colleges. In case that the information was insufficient on the web, the institutions and colleges concerned were additionally asked by email.

A questionnaire on the education and licensing systems for optometrist was conducted by 1,175 participants (584 optometry students, 510 optometrists and 81 professors) across country and analyzed. Each item of the questionnaire was extracted from the questionnaire that was administrated by medical technicians for the public reports.

Ⅲ. Results

Eye experts were roughly composed by dispensing optician, optometrist and ophthalmologist in many countries. What they professionally did varied from country to country. Dispensing optician, for example, was qualified to manufacture and sell optical aids such as spectacles and contact lens following the prescription by optometrist. The reason that the scope of practice varied by countries was caused by many factors, e.g. cultural and political background and course period etc.

1. USA

In the US, the professionals in optometry were optometrist and dispensing optician within provincial jurisdiction. In 2014 the number of dispensing opticians was 75,200 (1:4,306). For optometrist 40,600 experts were registered (1:7,976). Considering the American population to the expert ratio, the roles of optometrist would be extended in the future.⁵⁾

As professional title optician was initially adopted by the education system. It started with two-year courses but extended to three-year and four-year courses later on that were equivalent to the Bachelor degree. It was also provided graduate program and culminated in doctor of optometry (OD) at last. As the school system and academic degree were developed and improved, superior opticians had a challenge to meet the demand of society to differentiate dispensing optician and optometrist. Each state was regulated by its own independent laws so that the scope of practice for optometrist developed in each way.

There were in total 20 colleges to offer optometry. The curriculum was certified by the ACOE (accreditation council on optometric education)⁶⁾ in accordance with the guidelines of the ASCO (association of schools and colleges of optometry)⁷⁾ and was designed with a four-year course in general.⁸⁾ The preliminary courses for three years was required prior to entrance to a college of optometry. OAT (optometry admission test) mostly focused on basic science.

Optometrist candidate had to pass all three parts of NBEO (the national board of examiners in optometry). Parts 1 and 2 covered theoretical area and part 3 was more about clinical practice.^9,10) Once a candidate passed all parts of NBEO exams a doctor of optometry would be conferred. Optometrist should mandatorily complete continuing education to maintain the authority and renewed it every two years.

2. UK (the United Kingdom)

In the UK, the professionals in optometry were optometrist and dispensing optician just same as in the US. As of 2014, the dispensing opticians were 5,655 in total (1:10,926) while the optometrists were much greater 12,702 (1:4,864).^1,11) The GOC (general optical council) was much in charge of the law drafting, educational institution certification, standard curriculum development and licensing management.¹²⁾ The College of Optometrist managed the certification tests and the continuing education programs.^13,14)

There were 12 institutions to offer optometry program with three-year course. Optometrist should be registered in the GOC and take one-year clinical practice at an authorized institution. The one having completed the clinical practice and the final practical test was authorized. To renew their qualifications, they had to complete complementary education courses.

3. Germany

In Germany, optometrist and Augenoptikermeister belonged to the German eye professional except for ophthalomogist. The number of certificate for these professions was 48,780 in total in 2014. ZVA (Zentralverband der Augenoptiker und Optometristen) had jurisdiction over education, testing and licensing for Augenoptikermeister in accordance with the handcraft industry regulations. Augenoptikermeister candidate was trained and taught by apprenticeship education at Meisterschule. Augenoptikermeister could be granted a certificate as optometrist after completing courses authorized by ZVA. However, the title optometrist was given no legal status in Germany.¹⁵⁾

ZVA controled the Meister certification test that consisted of part 1, 2, 3 and 4. Part 1 and 2 covered the theoretical and practical area, while parts 3 and 4 were mostly about the Meister system. Meanwhile, there were 4 colleges providing the bachelor program for optometry, which mostly took 3 years to graduate.¹⁶⁾ The scope of practice for college graduate was much wider than that of Augenoptikermeister.

4. Korea

As the department of ophthalmic optics was established at a college in 1984 for the first time, it successfully achieved the good reputation and recognition. Colleges have competitively rushed to establish the departments of ophthalmic optics across country because of their own funds. This let Korean optometry system trap in a vicious circle. Each college provided the course duration from two years to three or four years. This discrepancy in course duration ended up making tricky problems. For example, how long graduate studied did not play a role in scope of practice once he was qualified.

The enrollment numbers in colleges 2011 reached the peak that indicated 2,630 students. Meanwhile, 41,060 optometrists were registered in 2016 (1:1,233). As the increasing enrollment number in college was not based on the reasonable study about the workforce supply policy, the workforce supply for optometrist resulted in fail. It caused a mass production of competition and deterioration of the labor environment. That caused bad reputation and accelerating decrease of enrollment quota, although the social demand for the eye care became greater and greater.¹⁷⁾

The curriculum and licensing exam for optometry focused on mainly training and producing dispensing optician, although KHPLEI (Korea health personnel licensing examination institute) suggested the occupational duties of optometrist in 2000. The study conducted by KHPLEI in 2013 reported the new curricula and licensing exams content outline. Despite those two studies it lacked reflection of reality in terms of not only the occupational duties but also the curriculum. According to the survey results on the importance indices of each subject in licensing exams, oculomotor function testing was regarded as important and followed by contact lens(Table 6)¹⁷⁾ but those practices in reality were prohibited. The respondents mostly pointed out unified course duration, decreasing college number, laking reflection of reality in scope of practice and theoretical National exam etc(Table 7). Although optometrist obtained a certificate from the Minister of Health and Welfare, he was neither classified as health care provider nor medical technician in Korea.

Ⅳ. Discussion

Most institutions providing optometry program took the guidance of the professional competencies suggested by WCO. But it showed a slight difference in the duties of optometrist in countries(Table 8). The optometry program took four years duration in the US (excluded the undergraduate program of natural science), 3+1 years in the UK, 3.5 years in Germany and 2 to 4 years in Korea.¹⁾ Although Korean optometry program was designed by the guideline of WCO, it was not applied to the scope of practice.

The scope of practice was classified in 4 categories by WCO.²⁾

Each college in Korea provided diverse optometry programs in curriculum, field practice and licensing exams, which was regulated by a health professional organization. To qualify Korean optometrist, candidate should write the National written and practical exams. After passing the exam, optometrist was required to complete continuing education to maintain the licence yearly.

Since the law covering Korean optometrist was acted in 1987, many colleges and institutions started establishing optometry program entitled ‘ophthalmic optics’ from two-year to four-year courses. As the two-year course program was not sufficient for Korean society, Korean government permitted college to extend the course duration. The two-year course now, in fact, has been regarding as an accelerating course for the license acquisition. Meanwhile, the decrease of school-age population brought about a negative effect on the enrollment ratio in colleges. That might ironically result in shortening the course period for colleges with three-year course. Because the competition in colleges would increase but the graduate from the colleges regardless of course duration was on the same plane.

Looking back at the 90’s, faculty members in the ophthalmic optics were mostly specialized in basic science, e.g. biology and physics. Therefore, material-processing subjects such as dispensing eyeglasses and basic science were mainly taught and paid more attention rather than advanced knowledges in optometry, such as visual dysfunction. The curriculum today, on the other hand, reflects the practical reality of Optometrist. For example, the specialty contact lens evaluation and fitting were set by IACLE (international association of contact lens educators),¹⁸⁾ although those were still improving. The percentage of faculty members who specialized in ophthalmic optics estimated about 55%. This percentage was relative low compared to that of license holders in health and medical service. Some institutions did not recruit even a single faculty member who majored in ophthalmic optics. Therefore, such schools might not be active in reflecting demands in the practice or even not interested in expanding the scope of practice of optometrist.

A questionnaire on the general evaluation for departments of ophthalmic optics, educational system and licensing exams was conducted by 510 optometrists, 584 college students and 81 professors. All participants, in general, responded that there was the necessity to improve the current course works and the licensing exams, which showed in Table 9. According to the results of survey, there were huge demands for the expansion of practical training such as vision test. Optometrist licensing exam should consist of written and practical test sessions that would rather ask more about practical skills.

Optometrist training institutions from USA, UK and Germany made and followed their own standard for curriculum and educational policies to produce capable optometrist that could meet the demands of the field. In Korea, there was no agency to evaluate and certify ophthalmic optics in each school. The professionals in and around optometry, according to the survey, responded that there should be a need of agency to evaluate and certify Ophthalmic Optics in each college. In order to produce professionals with excellent practical performance such as nurse and emergency medical technician, for instance, the field practice should be one of obligatory subjects. The agency would be able to evaluate the curriculum, the qualification of faculty member and field practice in each college, which could provide some information whether students from the colleges were eligible to take the licensing exam.¹⁶⁾

Ⅴ. Conclusions

This study pointed out the problems in education system, field practice and optometry licensing system in Korea. It was reported that 74.1% of high school students took health examination and showed ametropia in 2016.¹⁾ Refraction done by Korean optometrist was 70% including in the clinics.¹⁹⁾ Although the oculomotor function disorder, for example, has not been often said by the general public in Korea, its certain symptom would be overlooked and caused to worsen. It would be finally diagnosed by ophthalmologist at the serious stage, which would socio-economically cost more. Around 9,000 optical shops nationwide are running where some certain symptoms could be found by optometrist. Optometrist who recently graduates from college tends to study more diversely than ever. If optometrist would have attained the legitimacy to do more than refraction, early discovery such as glaucoma would have been possible, which would consequently raise the quality of public health and socio-economically save the exchequer.

For the discrepancy between demand of the society and the current scope of practice of optometrist, not to mention being out of date of the legitimacy related optometrist, the current optometry education system should be entirely and solemnly revised. With the newly revised system, standardizing of the education system e.g. the curriculum from schools, workforce supply and field practice need to be accompanied. In order to produce optometrist with excellent practical performance, there should be established the agency that would be able to evaluate the curriculum, the qualification of faculty member and field practice in each college, which could provide some information whether students from the colleges were eligible to take the licensing exam.