|Year : 2016 | Volume
| Issue : 3 | Page : 127-136
Adequacy and relevance of Indian optometry curricula to practicing optometrists
Nilesh D Thite1, Parikshit Gogate2, Jyoti Jaggernath3, Gauri K Kunjeer4
1 International Association of Contact Lens Educators, Australia
2 Community Eye Care Foundation, Dr. Gogate's, Eye Clinic; Department of Ophthalmology, Padmashree D. Y. Patil Medical College, Pimpri, Pune; African Vision research Institute, Durban, Republic of South Africa
3 African Vision research Institute, Durban, Republic of South Africa
4 Nagar Chasmaghar and Patel Contact Lens Clinic, Ahmedabad, Gujarat, India
|Date of Submission||06-Oct-2016|
|Date of Acceptance||13-Apr-2016|
|Date of Web Publication||19-Sep-2016|
Gauri K Kunjeer
28, Shreenath Park Society, Opposite Punit Nagar, Satellite, Ahmedabad - 380 015, Gujarat
Source of Support: None, Conflict of Interest: None
Context: To ensure that future optometry graduates receive appropriate knowledge and skills to provide comprehensive primary eye care, it is important to evaluate the current optometry curricula. Aim: To evaluate the relevance of optometry curriculum in India by assessing the perceptions on the curriculum strengths and lacunae by practicing optometrists. Setting and Design: Questionnaire-based survey in India. Materials and Methods: A questionnaire was used to elicit the opinions of purposively selected, 4-year trained optometrists, on the adequacy, and relevance of the optometric curriculum subjects offered in the optometric institutions. Statistical Analysis Used: Descriptive analysis was used to show reported frequencies of single responses to questions. The Cronbach's alpha test was used to measure consistency of responses to questions. Results: One hundred and three valid complete responses were received. Fifty eight (56%) participating optometrists were females. The most adequately covered optometry subjects as reported by the participating optometrists were contact lenses (n = 87, 85%), refraction (n = 86, 84%), ocular investigation (n = 75, 73%), and ocular disease (n = 75, 73%). Ocular diseases, low vision, and dispensing optics were, reportedly, covered sufficiently in theory, but the participants lacked adequate practical exposure. Basic optics had a maximum score regarding practical exposure, among support subjects while communication skills, computer skills, and community optometry were rated very low. Business aspect and legal aspect were inadequately taught. The optometry curricula in India are considered as being adequate and relevant, some subjects need more practical demonstrations and teaching of support subjects needs amendments.
Keywords: Adequacy, core optometry subjects, curriculum, optometry practice, relevance/usefulness
|How to cite this article:|
Thite ND, Gogate P, Jaggernath J, Kunjeer GK. Adequacy and relevance of Indian optometry curricula to practicing optometrists. J Clin Ophthalmol Res 2016;4:127-36
|How to cite this URL:|
Thite ND, Gogate P, Jaggernath J, Kunjeer GK. Adequacy and relevance of Indian optometry curricula to practicing optometrists. J Clin Ophthalmol Res [serial online] 2016 [cited 2021 May 16];4:127-36. Available from: https://www.jcor.in/text.asp?2016/4/3/127/190793
The World Health Organization estimates that 21% of the global population who are blind and 22% who are visually impaired live in India. The future of optometry profession in India may depend on its response to alleviating this staggering need. It is therefore important that optometry graduates be able to address the current as well as emerging eye health challenges. Optometry training in India was introduced as far back as 1958. The level of optometric education and scope of practice varied significantly in the past. However, progress has been made over the past few years toward the establishment of an unified, standardized and regulated profession.
Today, the level of optometric education has reached a stage where the majority of the institutions offer 4-year graduate courses, and a few universities offer postgraduate courses. More than 9000 optometrists who have been trained over 4 years have graduated from optometric institutions in India. To ensure that the future optometry graduates receive appropriate knowledge and skills to provide comprehensive primary eye care, it is important to evaluate the current optometry curricula for content, coverage, depth, and relevance to the graduate optometrists practicing in various disciplines today.
Practicing optometrists are in a position to evaluate the utility of the education imparted. The aim of this study was to evaluate the relevance of optometry curriculum in India by assessing the opinions and perceptions of practicing optometrists on the curriculum strengths and lacunae.
| Materials and Methods|| |
A quantitative methodological approach, using a survey method, was employed to elicit the perceptions of trained optometric graduates on the adequacy and relevance of subjects offered in optometric institutions in India. The study included “experienced” young optometrists who were fresh enough to accurately remember their training yet exposed enough to the outside world to appreciate the skill set needed from them. A questionnaire (for details see Appendix) was designed for trained optometrists who completed a 4-year Bachelor of Optometry degree from Indian institutions in or before the year 2010. The questionnaire was tested by five experts in the field of optometry to check for any inconsistencies in the design, content, and application. A total of 326 qualified optometrists with a minimum of 1 year experience in their current role were included in the study. The study was conducted in accordance to the tenets of the Declaration of Helsinki. The study was approved by the Ethical Committee of the Lions NAB Eye Hospital, Miraj, India.
The questionnaire, which was electronically distributed to the proposed participants, consisted of four sections. Section one had demographic information – mode of practice, educational qualification, years of experience, and location of practice. The second and third sections collected information on depth and adequacy of theoretical and practical training received, including its usefulness in the current roles for core and support subjects, respectively. The concluding section (section four) required the optometrists to enlist the most valuable core and support subjects.
Trained personnel were employed to make telephonic contact with the optometrists to inform them about the study and provide instructions for completing the questionnaire before its administration. Information on the study, its objectives and expected outcomes were provided to the optometrists and consent was obtained. The optometrists were given the choice to remain anonymous.
Data collected from the questionnaire were entered into an electronic database by trained data entry technicians and was statistically analyzed using the Statistical Package for Social Sciences SPSS for Windows version 16.0 software (SPSS Inc., Chicago, IL, USA) and Stata version 11.1 (Statacorp LP, College Station, TX, USA).
For the descriptive analysis, the list of 4 most valuable core subjects was derived by allotting points to each options (a = 4, b = 3, c = 2, d = 1). For example, if subjects feature as an option (a) 6 times it receives 24 points (6 × 4). Thus, the subject whose sum was equivalent to the maximum was considered as the most valuable subject.
The Cronbach's alpha test was used to measure how well the different responses to questions were consistent in being combined into a single scale to measure the same concept. In this study, it refered to the adequacy and relevance of a core optometry or a supporting subject. However, these two concepts, adequacy and relevance/usefulness were ultimately measured by one overall score on a combination of responses to the relevant questions.
| Results|| |
A total of 103 completed questionnaires were received from 326 4-year trained optometrists working across India; representing 18 optometric training institutions of the 23 institutions that were contacted for the study. Fifty-eight optometrists (56%) were females. The median duration of practice was 2 years (inter quartile range: 1–4 years). [Table 1] shows demographic details of the participating optometrists.
In order for a measure to be regarded as good, the Cronbach's alpha test had to be at least 0.8. With regards to adequacy, optical dispensing (0.81), low vision (0.85), contact lenses (CLs) (0.86), and ocular investigations (0.86) showed that responses were consistent and highly correlated. This implied that questions could be combined to provide one measurement scale to measure adequacy. However, refraction (0.60), binocular vision and orthoptic evaluation (0.76), and ocular diseases (0.64) showed that responses were inconsistent indicating that although theory in classes may be more than adequate, practical training or supervised patient examination was less than adequate or otherwise. On the other hand, responses to relevancy/usefulness showed that CLs (0.93), optical dispensing (0.89), low vision (0.87), binocular vision and orthoptic evaluation (0.82), ocular diseases (0.87), and ocular investigations (0.88) had a high level of consistency. This means that if an optometrist stated that theoretical knowledge was very useful, and then practical exposure was deemed also very useful and the converse is true. Refraction (0.68) however revealed low levels of consistency. Therefore, the overall results were interpreted in cognizance of the results between these separate measures combined to make one scale.
Adequacy of training in CLs had the highest reporting in both theory and practicals among all core optometry subjects, with 92/103 (89%) reporting that they were taught CLs (theory) adequately or better [Figure 1]. Practical exposure was reported as being adequate or better by 86/103 (83%) of optometrists. Refraction and ocular investigations were considered to be taught satisfactorily regarding both theory and practical. Ocular diseases, low vision, and dispensing optics were, reportedly, covered sufficiently in theory, but the participants lacked adequate practical exposure.
|Figure 1: Adequacy of theory, practical/demonstrations and patient examination – core subjects X axis represents the core subjects and Y axis – the percentage of optometrists reporting adequate or better. The gray lines – dark, medium, and light represent adequacy of theory teaching, practical/demonstrations, and patient examination, respectively|
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Optometrists indicated that, during their training, an adequate number of patients had been examined (under supervision) for refraction, CLs, and ocular investigations, limited opportunity was available to examine patients with low vision and binocular vision anomaly.
Refraction emerged as the most useful and practical core subject for most of the optometrists and was closely followed by CLs [Table 2]. Knowledge and practical exposure to low vision and binocular vision were reported to be less than useful by at least 55% (57 out of 103) of the optometrists.
|Table 2: Usefulness of theory, practical/demonstrations, and patient examination-core subjects|
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In categorizing the most adequate support subjects in relation to theory, practical/demonstrations, and patient examination, optometrists felt that basic optics, Ocular anatomy, and pharmacology were taught adequately or more in theory [Table 3]. Basic optics had a maximum score regarding practical exposure, while communication skills, computer skills, and community optometry were rated very low. Business aspect and legal aspect were inadequately taught.
|Table 3: Adequacy of theory, practical/demonstrations, and patient examination support subjects|
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Basic optics emerged as the most useful support subjects regarding both practical and theory knowledge, followed by communication [Figure 2].
|Figure 2: Usefulness of theory, practical/demonstrations – support subjects X axis represents the support subjects and Y axis represents the percentage of optometrists reporting useful or very useful. The dark and light gray line represents usefulness of theory teaching and practical/demonstrations, respectively|
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The most valuable core optometry subjects (from higher to lower) indicated by the optometrists, were refraction; dispensing optics, CLs, and ocular investigations. The most valuable support optometry subjects reported were basic optics, communication, business aspect, and computers.
The most adequately covered optometry subjects were reported to be CLs (n = 87, 85%), refraction (n = 86, 84%), ocular investigation (n = 75, 73%), and ocular disease (n = 75, 73%) [Table 4].
Two questions in the survey questionnaire related to the relevancy/usefulness of theory and practical training of core optometry subjects. The maximum possible weight for relevancy/usefulness of each core subject was 8, which is a sum of response “very relevant” to the two questions. The overall results depict that the highest reporting's for relevancy/usefulness of core optometry subjects were received for refraction (n = 92, 89%), CLs (n = 85, 83%), and optical dispensing (n = 76, 74%) [Table 5].
|Table 5: The overall relevancy/usefulness of core optometry subjects (n=103)|
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| Discussion|| |
Optometric institutions that have a comprehensive curriculum inclusive of subjects relevant to India's eye health needs and are adequately taught to equip optometry graduates may be central to achieving essential eye health services.
The study revealed that majority of the optometrists believed that they were taught adequately or better in all core optometry subjects except in low vision. The highest rating for contact lens theory teaching and practical demonstrations may be attributed to the support received from the International Association of Contact Lens Educators to most of the represented institutes over many years. Refraction emerged as the most valuable subject with dispensing optics and CLs as close number two and three, respectively. Most optometrists also considered the knowledge of these subjects relevant. Many of the respondent optometrists (41%) were into optical practice where the main focus was on refraction, dispensing eyeglasses, and CLs. Binocular vision was taught well regarding both theory and practical application; however, this knowledge was considered less useful. It also did not feature in the list of most valuable subjects as perhaps not many optometrists practice binocular vision.
Providing low vision and rehabilitative services forms an integral part of services provided by an optometrist. However, low vision was covered marginally in theory teaching and lacked in its practical exposure. Furthermore, it was not considered useful by more than half of the optometrists. Many severely, visually impaired and blind individuals can perform various tasks of daily living if adequately assisted by low vision aids. The present curricula miss on this important contribution that optometry can make in the lives of visually impaired.
Ocular diseases and investigation were not considered relevant by 33/103 (32%) and 46/103 (45%) of optometrists, respectively, which was not an encouraging sign. It is necessary to stress the importance of these subjects if optometrists are to contribute substantially to the amelioration of avoidable blindness. The curriculum is biased hugely in favor of refractive errors, which form a very important, although not the only cause of visual impairment in the population., Glaucoma and diabetic retinopathy now form a major cause of blindness, and only a comprehensive eye care examination can help early detection and prevention of blindness., Optometrists play an important part in this in many European countries like the United Kingdom. If optometry as a profession has to contribute substantially to the prevention and control of avoidable blindness in India, the focus should be more on practical exposure and comprehensive patient care.,,
A similar study gauging the efficacy of ophthalmic residency training in India found the training to be sufficient by the residents in many aspects but lacked enough hands-on experience in crucial aspects such as surgery and investigations. Evaluations and studies of ophthalmology training have recommended more holistic and hands-on training for the budding ophthalmologists., A similar approach can be employed for training optometrists as well. Apart from basic optics, human anatomy, and pharmacology, optometrists felt that all other support subjects were not taught adequately.
Biochemistry and microbiology were considered as the least useful subjects. This can be attributed to the lack of laboratory research in optometry in India, which is supported by the fact that only 8/103 (8%) of the optometrists in this study were researchers. Communication, computers, and business aspect of optometry were rated as valuable, but respondents felt that they were not taught to the expected level. More emphasis should be given to these subjects as they are crucial to the success of every mode of optometry practice.
It is important to teach young optometry students the importance of detailed ocular investigations, overall patient care, and community optometry. A teaching program which sensitizes the students about the eye care needs of the community and encourages them to become socially conscious eye care professionals will be beneficial to meeting the goals of prevention and the treatment of avoidable blindness.
The authors would like to thank all the respondents for taking their time to complete the questionnaire, as well as Yeshwant Saoji, Lakshmi Shinde, Sonje Cronje, Dr. Shehzad Naroo, Dr. Tom Okello, and Judith Morris for their inputs. Acknowledgment is also extended to Farai Chinanayi and Shrivallabh Sane for statistical analysis and Aparna Thite for data entry.
Financial support and sponsorship
World Council of Optometry - support for travel, African Vision Institute - statistical support.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8.
De Souza N, Cui Y, Looi S, Paudel P, Shinde L, Kumar K, et al.
The role of optometrists in India: An integral part of an eye health team. Indian J Ophthalmol 2012;60:401-5.
International Centre for Eyecare Education. Delhi Declaration on Optometry and Blindness Prevention; 2009. Available from: . [Last cited on 2012 Mar 12].
World Medical Association, Inc. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc 2009;107:403Y5.
Shinde L, Lee C, Qu X, Kim D, Mahajan R, Naroo S, et al
. Poster Presentation: Status of Contact Lens Education in Asia. BCLA, Manchester; 2011.
Neena J, Rachel J, Praveen V, Murthy GV; Rapid Assessment of Avoidable Blindness India Study Group. Rapid assessment of avoidable blindness in India. PLoS One 2008;3:e2867.
Smith TS, Frick KD, Holden BA, Fricke TR, Naidoo KS. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ 2009;87:431-7.
Gogate P, Deshpande R, Chelerkar V, Deshpande S, Deshpande M. Is glaucoma blindness a disease of deprivation and ignorance? A case-control study for late presentation of glaucoma in India. Indian J Ophthalmol 2011;59:29-35.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.
Dandona R. Optometry and eye care in India. Indian J Ophthalmol 1998;46:175.
Rao GN. Human resource development. Community Eye Health 2000;13:42-3.
Gogate P, Deshpande M, Dharmadhikari S. Which is the best method to learn ophthalmology? Resident doctors' perspective of ophthalmology training. Indian J Ophthalmol 2008;56:409-12.
Gogate PM, Deshpande MD. The crisis in ophthalmology residency training programs. Indian J Ophthalmol 2009;57:74-5.
Thomas R, Dogra M. Residency training programs in India. Indian J Ophthalmol 2009;56:525.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]