Convenience also has had its effect on the optical marketplace. Small storefronts and optical shops run from converted garages have been made obsolete by huge superstores that are attached to shopping malls. Some large chain stores, like K-Mart and Sears, also have large optical shops. A wide selection of fashionable frames and lenses, one-stop shopping for no-appointment eye exams, and one-hour turnaround on finished frames are services that are commonly advertised. In order to provide this type of high-volume service, the superstores employ large numbers of optometrists, opticians, and other technicians. In both the ophthalmic and optometric marketplace, being an employee on any level means being on the payroll of a large company.
The Cost Factor
Cost has also been a major influence on the changes in the eye care delivery system. Eye care is now more accessible to almost every segment of the population because of health insurance. The government subsidizes eye care for the elderly and the disadvantaged through Medicare and Medicaid. Many working people receive vision care for themselves and their families as an employment benefit.
As increasing health care costs eat into the corporate bottom line, many companies have become very vocal about controlling medical costs. They often encourage their workers to enroll in health maintenance organizations (HMOs) that offer low-cost preventive health care as a means of deterring major illnesses and hospitalizations. Eye care for HMO members usually includes low-cost periodic visits to specified providers—ophthalmologists or optometrists who have contracted with the HMO. Members are encouraged to have regular eye exams so that they can be monitored for serious eye diseases and receive immediate intervention while the chances of recovery are optimal. This type of care is extremely efficient because the member must use eye care providers who have agreed to accept the HMO's predetermined fee for treatment. The doctors and other eye care providers who work with HMOs and similar health insurance organizations are considered contractors. The arrangement is mutually beneficial since it provides a secure income for providers and controlled costs for employers and patients.
Hospitals
Does the movement toward outpatient eye care mean that there will be fewer jobs in hospitals? It's possible. One thing is for sure: The eye care occupations for hospital workers are getting more interesting. Since routine care can be provided in suburban offices, hospitals have become true "tertiary care" centers. This means that hospitals are referral centers for problems that cannot be treated safely or effectively in the community. Eye care workers who choose the hospital setting face the challenge of applying cutting-edge knowledge and technology to the most difficult of cases. Often they are involved in researching new cures; they experiment with new equipment and techniques that are too expensive for private practices. Hospitals are still the best place to treat trauma victims, operate on high-risk patients with conditions like heart disease that might complicate eye surgery, or try an experimental treatment as a last resort to prevent blindness. They are still the best place for new professionals and technicians to train and learn to work well as a team.
One of the most exciting places to work in this field is an eye hospital. There are currently twenty eye hospitals in the United States that form a network of major research centers. Much of the work that is pioneered at these facilities is coordinated by the National Eye Institute.
Mobile Practice Settings
For those careerists who hate to be tied to an office, there are challenging opportunities in mobile screening and treatment units. Large vans that are equipped for vision testing and lens fitting bring care to rural communities, senior centers, nursing homes, and institutions. Some mobile units are sponsored by teaching institutions as a community outreach project with the added benefit of providing hands-on experience for ophthalmic or optometric trainees.
Perhaps one of the most exciting opportunities in eye care is Project ORBIS. This converted DC-8 jet is truly a hospital without walls. The crew of ophthalmologists, nurses, and biomedical engineers has traveled to fifty cities on five continents since take-off in 1982. Their mission is to exchange skills and disseminate surgical techniques to other eye care professionals throughout the world. The plane has a complete state-of-the-art operating suite. Much of the teaching that takes place on board has to do with introducing local doctors to ambulatory surgery, which is still uncommon in many places. Providing eye care services on a plane presents some unique problems. For instance, all linen has to be disposable, since there is no water supply. ORBIS is an extraordinary opportunity for crew members to serve on a one-year rotation, acting not only as eye care practitioners, but also as diplomats.
