Article Date: 9/1/2007

Why Can't I Find an O.D. Who Looks Like Me?
diversity

Why Can't I Find an O.D. Who Looks Like Me?

The absence of minority practitioners contributes to minority patients' lack of eye-disease awareness.

GULROOP S. HANSRA, O.D., Chicago

Almost one in five Hispanic patients reports seeking a Hispanic eyecare provider, and 14% of African Americans seek eye care from African-American providers, according to "Americans Attitudes and Perceptions About Vision Care," a nationwide survey, conduced by Harris Poll (a market research company) and published by The Vision Care Institute, LLC (TVCI) a Johnson & Johnson Company, which funded the study. (For a PDF of the study, go to www. harrisinteractive.com/news/newsletters.)

Also, the survey revealed that the majority of Americans rely on their trusted eye doctor for information on vision care. (The poll examined Caucasian, African-American, Hispanic-American and Asian-American's perceptions and behaviors in regards to eye care.)

A nationally representative cross section of 3,716 adults age 18 and older participated. This included a total of 690 Hispanics, 676 African Americans, 686 Asian Americans and 1,566 Caucasians. Asian-American perceptions and behaviors are not covered in this article, as the survey revealed this population is generally able to find an O.D.).

Several studies have shown that minority populations have an increased prevalence of many sight-threatening diseases, such as glaucoma and increased morbidity associated with those diseases.1-3 According to the National Optometric Association (NOA) — an organization dedicated to improving the quality and accessibility of eye care in minority and other historically underserved communities — minority populations have a profound lack of awareness of asymptomatic eye disease. The TVCI survey results clearly show that one way to prevent and properly treat eye disease in minority populationsis is to provide these communities with minority optometrists.

Here, I'll discuss the history of minority students in optometry and the steps optometry must take as a profession to ensure minority populations can find an O.D. with whom they are most comfortable.

Minority Student Challenges
When speaking with two dozen minority students about optometry school, many said they perceived they had to work harder to prove themselves in front of faculty and patients.
For instance, one student told me about an incident that occurred during a retina clinic in which the entire class, except for one student (who we'll call George), was huddled around a closed-circuit television eager to pick-up some clinical knowledge during the examination of an elderly diabetic-retinopathy patient.
George was assigned to take this patient's history prior to the exam. The patient asked George about his nationality. George replied, "I'm Pakistani."
In response, the patient, a cab driver, moaned and then began to chastise George: "You people come here after riding your elephants and camels, and don't know a thing about driving a cab…"
"I clearly remember how mortified the South Asian students were, as this elderly man continued on his monologue in front of our peers, only to have the attending ophthalmologist nod his head with approval," this student recalled.
Similarly, a student shared with me that patients continually ask questions to determine her race or nationality, apparently as a way of gauging her qualifications as an optometrist. This in turn, she says, makes her feel as if she has to work harder than her non-minority peers to prove her clinical skills.
Finally, several students told me they feel their actions as optometrists aren't just a reflection of themselves, but have larger implications for how society perceives their race or culture.
Tracy Falkner, advisor for the National Optometric Students Association (NOSA) chapter at the Illinois College of Optometry (ICO), stated the students perceive this cultural burden in part because of a lack of diversity among the faculty. "Colleges need to make an extended effort to hire more qualified minority faculty," she says.
Ms. Falkner plays a unique support and mentoring role for minority students, yet given the fact that ICO has one of the largest NOSA chapters in the country, she says she feels that under-represented minority students need more mentors.

Minority students in optometry: past and present

In 1972, optometrist Charles Comer, of the NAO, received a grant from the federal government to recruit minority students into optometry school.

"We had minority optometrists work with our regional trustees in going to the schools and colleges in five different regions and wherever we could find minorities who might be interested in optometry," Dr. Comer recalls.

The result: Dr. Comer, his NOA colleagues and several optometry schools helped increase the minority pool from 13 students at optometry schools across the country in 1972 to approximately 135 by 1981.

Another pioneer dedicated to making the optometric profession available to everyone: optometrist Edwin C. Marshall, associate dean of academic affairs and student administration at Indiana University School of Optometry, in Bloomington, Ind., and chairman of the Association of Schools and Colleges of Optometry (ASCO) Diversity task force.

"In just looking around I said to myself, 'Hey, there's a lack of diversity around here, and we need to do better.' So, I started the Indiana University Summer Institute program under the Health Careers Opportunity Program (HCOP), which was the federal program that provided funding," says Dr. Marshall. "The program brought 40 minority college students to campus for six weeks each year. Unfortunately, the federal funding became sparse, so the program was discontinued after 17 years." (The program ran from 1973 until 1990.)

Despite these optometrist's valiant efforts, the current enrollment percentages of African-American and Hispanic students in optometry school is dismal at best. In the United States, only 3.5% of currently enrolled optometry students are African American, according to ASCO. Hispanics do not fare much better at 5.7%. Further, when including the Inter-American University of Puerto Rico, the enrollment of Hispanics in U.S. optometry schools and Canada is even lower than that of African Americans, according to ASCO data.

Diversity vs. inclusion

Optometry can move from diversity to inclusion by following these seven steps, based on the feedback I received from students, college representatives and diversity experts:

  1. Promoting eye-health awareness in the underserved communities.
  2. Promoting optometry as a viable career option for minority populations.
  3. Recruiting underrepresented minority students, such as Division-1 athletes.
  4. Creating competitive scholarship money for qualified minority students.
  5. Establishing mentors or a support network for minority students (see "Minority Student Challenges".)
  6. Hiring more qualified minority faculty (see "Minority Challenges".)
  7. Aligning the diversity goals of ASCO, the American Optometric Association, NOA, the American Academy of Optometry (AAO), eyecare product manufacturers and the government.

If we, as a profession, work together to recognize that diversity in optometry is severely lacking, and we follow the seven steps mentioned above, optometry has an excellent chance of moving from the idea of diversity to the reality of inclusion. OM

  1. National Eye Institute. NEI Press Release. Vision Loss from Eye Diseases Will Increase as Americans Age. www. nei.nih.gov/news/pressreleases/041204.asp (Accessed June 12, 2007).
  2. United States Department of Health & Human Services. Diabetes Disparities Among Racial and Ethnic Minorities. www.ahrq.gov/research/diabdisp.htm (Accessed June 12, 2007).
  3. National Eye Institute. NEI Press Release. U.S. Latinos Have High Rates Of Eye Disease And Visual Impairment. www.nih.gov/news/pr/aug2004/nei-09.htm. (Accessed June 12, 2007).
Dr. Hansra is Director of Eye Care-Special Projects at Luxottica. You can contact him via e-mail at ghansra@luxotticaretail.com


Optometric Management, Issue: September 2007