This category covers establishments of licensed practitioners having the degree of O.D. (Doctor of Optometry) and engaged in the practice of optometry. Establishments operating as clinics of optometrists also are included in this industry.
621320 (Offices of Optometrists)
According to the Association of Schools and Colleges of Optometry (ASCO), there were nearly 30,000 full-time equivalent practicing doctors of optometry in the United States during the late 1990s. These optometrists served in 7,084 communities across the country and in more than 4,300 of those communities were the only primary eye-care providers. Doctors of optometry examine, diagnose, and treat a variety of diseases and disorders of the vision system, the eye, and associated structures. Services rendered by optometrists include the prescription of glasses and contact lenses, rehabilitation of the visually impaired, and the diagnosis and treatment of ocular disease. According to ASCO data, the mean net income for optometrists in the late 1990s was $88,690.
Figures supplied by the American Optometric Association indicated that approximately $17.5 billion was spent in 1995 on vision care and prescription eyewear. That figure did not include costs for eye surgery or treatment for eye injuries and disease. ASCO statistics showed that in 1995 some 86 million Americans had their eyes examined and more than half of all Americans wore either glasses or contact lenses.
Sixty-eight percent of optometrists worked out of their own clinics or offices and were self-employed. They, unlike ophthalmologists, are not medical doctors. Optometrists examine the eyes to evaluate eye health and visual acuity and to diagnose eye diseases and eye conditions. Optometrists are not qualified to perform eye surgery, but they can prescribe corrective treatment: glasses, contact lenses, vision therapy, and low-vision aids. As of June 1996, 48 states had passed legislation that authorized optometrists to use drugs to treat diseases of the eye, allowing them to compete with ophthalmologists who have traditionally performed this service. Industry experts predicted that all doctors of optometry (ODs) would soon be given this right. Optometrists are also lobbying for the right to perform photorefractive keratectomies. Most states require that a licensed doctor perform the surgery, but Idaho allows optometrists to do the procedure.
Some optometrists held more than one job or worked out of more than one office or clinic. Commercial vision-care centers serve as another option for optometrists establishing their practices. According to the Occupational Outlook Handbook, optometrists were increasingly buying franchises from large retail optical chains and operating them as independent businesses. Younger optometrists also tended to join partners or form group practices. The Handbook noted that working optometrists also earned salaries as employees of health maintenance organizations (HMOs), health centers and eye clinics, public and private health agencies, insurance companies, or schools of optometry. The majority of optometric practitioners worked full time.
Like others in the health care profession, some optometrists worked in a general practice, while others chose to specialize. Some areas of specialty in the field of optometry include geriatrics, contact lenses, low-vision services, occupational vision, pediatrics, sports vision, and vision therapy. Still other doctors of optometry chose to devote their careers to teaching or scientific research.
All 50 states and the District of Columbia require optometrists to be licensed upon obtaining a doctor of optometry degree from an accredited school or college. Doctors of Optometry must either pass a state board examination or the National Board of Examiners in Optometry exam. There is some reciprocity between states concerning licenses; 46 states, however, require that optometrists complete a specified number of continuing education hours to renew their licenses.
Training consists of a four-year undergraduate degree and two-to-three years of pre-optometric study at an accredited school. As of the late 1990s, there were 17 colleges of optometry in the United States and Puerto Rico accredited by the Council on Optometric Education of the American Optometric Association. Those applying to an optometric program must take the Optometry Admission Test, which measures academic ability and scientific comprehension. Competition to gain admittance to these schools is fierce.
Optometrists wishing to teach or do research may study for master's or Ph.D. degrees in visual science, physiological optics, neurophysiology, public health, health administration, health information and communication, or health education. One-year postgraduate clinical residency programs are available for optometrists who wish to specialize in family practice optometry, pediatric optometry, geriatric optometry, vision therapy, contact lenses, hospital based optometry, primary care optometry, or ocular disease.
The practice of optometry began with the invention and subsequent refinement of eyeglasses in the early nineteenth century. Optometry guilds were formed at this time, and the practice eventually was regulated under statutory law. Jewelers were actually some of the first professionals to use eye charts and sell glasses to the public.
The industry in the United States expanded during the Civil War when the government purchased large quantities of binoculars and microscopes for the war effort. Eyeglasses became plentiful and, by the end of the nineteenth century, schools were teaching the science of optics, often in combination with instruction in watch repair.
Door-to-door peddlers, jewelers, and optometrists all sold eyeglasses in the late 1800s. At the beginning of the twentieth century, however, physicians conducted most of the eye examinations. "Refracting opticians," who provided the same service, later became known as the present-day optometrists. In some fairly fundamental ways, optometry practices have operated the same way for decades. That is, clients still visit optometry offices to secure eyeglass prescriptions, which are sent to an optical laboratory. The lab makes the glasses according to specifications and sends the frames to the officiating optometrist, who subsequently fits them to the client.
In the late 1960s, however, mass marketing of optical products and services changed some optometry practices. Vision-care chain stores emerged, but many states prohibited doctors from working in them. Some chain stores such as Sears and Kmart circumvented these restrictions by leasing space to optometrists, who worked independently but were able to lease space at below market rates. Doctors often profited from discounted rent and equipment. This partnership enabled chain stores to advertise that they provided full-service vision care at their facilities.
Competitive Structure. The advent of vision-care chain stores contributed to a loss of market share for private doctors of optometry. Private practitioners sell their businesses on the quality care and services they provide and emphasize personal service and attention. Often this is communicated by word of mouth and not through the aggressive marketing techniques that chain stores use. According to the Journal of Commercial Lending, "Repeated surveys have also shown that people feel they get a 'better' examination from a private OD compared with one received in a 'commercial environment.' "
The Journal also cited a study conducted by Robert R. Nathan Associates, Inc., a Washington, D.C.-area private economics consulting firm that found that "vision problems other than routine nearsightedness were detected almost twice as frequently by noncommercial ODs than commercial ODs." Optometrists in the study also spent an average of 30 minutes per exam compared to their commercial counterparts, who spent an average of 15 minutes in examining a patient.
Vision-care chain stores have resorted to coupons and other special deals to attract customers. Some also promoted their quick turnaround time in filling eyeglass and contact lens prescriptions. Private practitioners also began to reduce the waiting time for glasses and contacts, in an effort to remain competitive. They also expanded their private practices to include lab services, which enabled them to fill prescriptions in a shorter time.
Financial Structure. Overhead costs for maintaining an optometric practice increased since the mid 1980s. According to the "State of the Profession 1996" in Optometric Economics, the ratio of net income to gross income declined. Expenses for staff totaled 14.7 percent of gross income, while total laboratory expenses made up 28.9 percent. Other costs included rent and utilities (6.6 percent), contributions to retirement plans (1.7 percent), and miscellaneous office expenses (15.9 percent). The average net percentage for a practitioner was only 32.2 percent of the gross income. As a whole, expenses took a higher percentage (77 percent) of gross revenues of optometrists practicing in the eastern region of the United States; expenses were lowest in the South (63 percent).
The leading U.S. vision-care services chains as of the late 1990s were Cole National; Lens Crafters, a wholly owned subsidiary of Italy's Luxottica; and Vista Eyecare. Cole operated some 2,800 retail locations under the brand names of Pearle Vision, Sears Optical, Target Optical, and B.J.'s Optical. With 13,100 employees, Cole National reported revenue of nearly $1.1 billion in 1998. Lens Crafters, as of March 31, 1999, operated 853 retail outlets throughout the United States and Canada. Lens-Crafters' 1998 revenue was estimated at $1.1 billion. Vista Eyecare, headquartered in Lawrenceville, Georgia, was a relative newcomer to the field, but it moved quickly to establish a foothold in the market. As of late 1999, it operated some 300 retail outlets under the Vista Optical trade name as well as 600 leased vision-care centers inside Wal-Mart and other major retail stores. Vista's 1998 revenue topped $245 million.
Optometrists earned an average of about $27,000 in their first full year of practice in 1984. By the mid 1990s, the mean net income for optometrists had risen to almost $89,000. Optometrists who were self-employed earned an average of $95,707 in 1994. That same year female ODs reported a median net income of $59,500, while male ODs reported $83,500. This discrepancy was partly due to the length of time in the field, but even accounting for that, females, in general, earned 16 percent less than males. The Occupational Outlook Handbook, however, noted that salaries were also dependent upon specialization and location of the practice.
Increasingly, more optometrists joined HMOs and managed-care organizations. In 1996, more than twothirds of optometrists were providers for some managed-care program. Medicare, too, began to cover examinations, treatment of eye diseases, and postoperative eye care services provided by optometrists to cataract surgery patients.
The American Optometric Association (AOA) was the largest trade association in the industry, representing more than 32,000 optometrists, students of optometry, and optometric technicians in the United States. Founded in 1898, the association aimed to make available and improve the quality of eye and vision care for all. The group focused on helping their members achieve the highest standards of efficiency and patient care. It also represented the industry to government and other health care organizations.
Future Expectations. As the AOA pointed out, 54 percent (145 million people) of all Americans needed prescription eyewear. Employment of optometrists was expected to grow about as fast as the average for all occupations through the year 2005 in response to the vision-care needs of a growing and aging population. By the year 2000, estimates suggested that there would be 32,000 optometrists in the United States (2,000 more than in 1998). The maturing of the baby-boom generation, together with rapid growth in the oldest age group would drive this growth. As baby boomers reached the age of 45 they would be more likely to visit optometrists and ophthalmologists because of the onset of vision problems in middle age. The demand for optometric services would also increase because of growth in the oldest age group, with their increased likelihood of cataracts, glaucoma, diabetes, and hypertension. Employment of optometrists would also grow due to greater recognition of the importance of vision care, rising personal incomes, and growth in employee vision-care plans.
Employment of optometrists would grow more rapidly were it not for anticipated productivity gains that will allow each optometrist to see more patients. These gains would result from greater use of optometric assistants and other support personnel, and the introduction of new equipment and procedures.
Replacement needs were low. In this occupation, replacement needs arose almost entirely from retirements. Optometrists generally remained in practice until they retired; few transferred to other occupations.
Association of Schools and Colleges of Optometry. "What Is a Doctor of Optometry?" Available from http://home.opted.org/asco/faq2.html .
Bennett, Irving, Richard Edlow, and Farrell Aron. "State of the Profession 1996." Optometric Economics, Winter 1996.
"Facts and Figures About …" Media Information Kit. American Optometric Association, 1996.
"LCA-Vision and Cole National to Make Available Laser Vision Correction to 50 Million Members of Cole Managed Vision." Business Wire, 12 July 1999.
"Luxottica Group Completes Purchase of Bausch & Lomb's Sunglass Business." Business Wire, 28 June 1999.
U.S. Department of Commerce. Bureau of the Census. Statistical Abstract of the United States. Washington, DC: GPO, 1995.
U.S. Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook, 1998-99 ed. Washington, DC: GPO, 1998. Available from http://stats.bls.gov/ocohome.htm .
Wandycz, Katarzyna. "Seeing-Eye Ads." Forbes, 17 June 1996.
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