Optometry is getting bigger all the time. More ODs, more responsibilities, more patients, more products. Also, more optometry schools. We learned last month that the University of Texas Rio Grande Valley is gearing up to add a school of optometry. Two others have been in the works in North Carolina for a while, too. If all three come to pass, the US will have 27 schools and colleges of optometry in a few years. 

Predictably, this news set off another round of hand-wringing about oversupply of ODs. I think rising workforce levels are worth being cognizant of—especially at the local level, where increased competition puts downward pressure on salaries and earnings—but mostly aren’t the existential threat some make them out to be. As I harp on all the time in this column, ophthalmology’s ranks are in decline, so optometry’s growth is both necessary and welcome.

Many also express concern over perceived softness in the college acceptance process, pointing out that the ratio of applicants to matriculated students is pretty much 1:1 every year. If you want a spot, you’ll get it. That’s not a recipe for bringing the best and brightest into optometry’s ranks, detractors say.  The recurring bouts of collective panic over that also strike me as sort of a knee-jerk reaction. It’s not exactly a welcome circumstance, but at face value it doesn’t mean those new students aren’t up to the task. 

Critics will point to the declining NBEO board exam pass rates as evidence that too many subpar students do in fact get accepted. Admittedly, this one does strike a nerve. A whole lot of schools have first-time pass rates south of 50%. It would be an oversimplification to point the finger at any one college—old, new or on the drawing board. But I think it’s also unfair to pin that on the students themselves. Widespread failure rates point to a systemic problem more so than any individual student’s shortcomings.

Rather, school curricula and teaching methods profession-wide need an upgrade, or at least a candid reappraisal, especially given the high cost of tuition. Optometry schools are enrolling ambitious young people who come in with the expectation that the institution’s vetting process indicates they’re fairly likely to succeed—then the school saddles them with six-figure debts. To me, this puts the onus on the schools to deliver on that bargain. Recent grads and current students complain of uninspiring lecturers who sometimes just flip through a slide deck and call it a lesson. 

The NBEO itself comes in for its share of criticism for administering an exam process that is opaque to its applicants and too focused on esoterica than the applied clinical skills that new ODs will need. It certainly doesn’t help that the footprint of what could/should be learned keeps growing as optometric scope expands. I know it keeps us at Review on our toes. For instance, just five years ago myopia control barely got a mention. This month, we have Langis Michaud giving us a 6,500-word summation of this burgeoning field and where it fits in optometric practice. What will we be publishing five years from now? Stick around and let’s find out together.

But, that's the thing. A field as dynamic as optometry needs to evolve its methods and culture of education to remain nimble. I would love to see a summit of all the stakeholders in optometric education held to hash it out. ASCO, NBEO and the societies for a start. Who’s in?