Typical Curriculum

A "typical curriculum" in optometry, developed by the Committee on New Academic Facilities of the American Optometric Association is attached as Appendix A, together with brief descriptions of the courses in the curriculum. This curriculum is a "typical" one only in relation to its overall content and the general sequence of topical coverage. The present schools offer a wide range of variations from this format, and all schools have curriculum study committees that recommend changes in curriculum in response to changing needs and circumstances.

Optometry laws in some states contain specific requirements with regard to number of hours or length of coursework in certain subject areas, which occasionally act as constraints on major revision of curriculum for schools serving those states.

In general the curriculum proceed from basic courses in anatomy, physiology, optics, and physiological optics during the first year, through a combination of basic and clinical topics in the second year, to a nearly totally professional and clinical content in the final two years.

Class Sizes

It has been estimated in this study that Missouri needs approximately 35 new optometrists per year. A school of optometry in Missouri would also provide optometrists to other states. In view of national and regional needs, and recalling that the retention rate in the recent past has been less than two-thirds of the newly licensed optometrists, it seems safe to predict that not over half of the graduates of a Missouri optometry school would remain in the state to practice. On this basis, annual entering classes of at least 75 students would be needed.

To allow for orderly development of a new school, entering classes for the first few years might be much smaller, say 25 to 35 students, until facilities and faculty were developed to permit expansion to the desired size.

Less than half of the qualified applicants to optometry schools in 1968 and 1969 could be accepted for admission because of the limited capacities of those schools. The Association of Schools and Colleges of Optometry provide a clearinghouse service regarding applicants, which helps to assure that unnecessary vacancies in entering classes will not occur as a result of multiple acceptances of a student's multiple applications for admission to several schools. Thus there would appear to be no doubt that a Missouri Optometry school could fill its entering classes from the outset.

Personnel

Faculty and administrative personnel requirements for a new school, as estimated by the New Academic Facilities Committee of A.0.A, are listed in Appendix B, both as total numbers of positions, and as by needs for each of the first four years of the establishment of a school. The precautionary note in the "Faculty Requirements by the Year" regarding multiple duties of faculty should be emphasized, and should be applied to the list of overall needs as well. The estimates of numbers in both lists do not represent full-time-equivalents, but only the numbers of faculty required in each area. One faculty member might handle two or more of the requirements specified in these lists. As enrollment is increased, the proportional time required for each position would be larger, and the total number of faculty would then have to be increased.

According to a report of the Council on Optometric Education the average student/faculty ratio among the universityaffiliated schools of optometry in the 1967-68 academic year was 8.5, and the average teaching load was approximately 9 credit hours per faculty member.

Facilities

For the first few years it would be expected that a new school of optometry would operate its program in temporary quarters, which could vary widely, as has been shown by the

experiences of most of the existing schools. We shall simply describe the general nature of the space needs for the first = few years.

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In addition to offices for faculty and administration, the first-year classes would require one lecture room, one laboratory for the courses in general and ocular anatomy, laboratory for the physiology courses, and one laboratory for the geometric, physical, and physiological optics courses. The facilities of already existing courses in anatomy and physiology within the university might accommodate the first two of these laboratory requirements.

Second-year classes would require an additional laboratory for the ophthalmic optics courses, and another for the optometry courses. The special equipment required for both of these laboratories would not permit sharing their use with other classes. On the other hand, no additional laboratory space would be required for the second-year physiological optics courses, for these could share the use of the laboratory for the first-year courses.

Machine shop, carpentry shop, and electronics shop facilities would be required from the outset to provide for construction and maintenance of equipment in all laboratories.

Space requirements for third- and fourth-year classes are more complex because they include the development of suitable clinical facilities. In temporary quarters this would require, as a minimum, space approximately equivalent to four or five large laboratories. About a third of this space would be partitioned into small optometric examining rooms or booths, permanently equipped with standard ophthalmic refraction units for optometric examinations and for contact lens fitting. The rest of the space would be divided into larger areas appropriate to other clinical activities such as orthoptics, visual fields examinations, ophthalmic dispensing, visual skills and color vision testing, etc. Part of this space would be used for a patient reception area, and for clinic administration including space for records, clinic faculty offices, conference and

consultation rooms, etc.

During the initial years, it is presumed, plans for a permanent t facility would be developed through consultation with faculty, architects, and university planning personnel. Although no official guidelines for construction of optometry schools exist, a reasonable estimate of the size and cost of the facilities needed to house an optometry program with an eventual entering class size of about 75 students can be derived, at least to indicate the order of magnitude, from the pertinent data concerning Indiana University's new Optometry Building which was completed in 1968. Designed for entering classes of 64 students, the building contains 83,000 square feet, and construction costs approximated $2.2 million.

Operating Budget

As a starting point in considering the costs of implementing and operating a new school, reference can be made to an estimate developed by the A.0.A. Committee on New Academic Facilities in early 1968, which is included as Appendix C. This estimate is based on an entering class size of 25 students, and would therefore need to be scaled up if larger class sizes are to be admitted in the early years. Costs, particularly salaries, but also for equipment, have increased so that appropriate allowance needs to be made for this factor.

An important source of financial support for a school of optometry is presently provided by the Health Professions Educational Assistance Act, P.L. 88-129 and its subsequent amendments. In addition to providing funds for student loans and scholarships, the Act provides a Basic Improvement Grant annually on a formula basis of $25,000 plus $500 per student enrolled in optometry. The basic $25,000 can be awarded to a new institution for the planning year prior to admission of the first class. As shown in the budget in Appendix C, for classes of only 25 students this would amount to a total of $250,000 support over the first four years while enrollment was being increased by adding a new class each year. It would continue thereafter at

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the constant amount of $75,000 annually if all four classes remained at 25 students.

If initial entering enrollment is fixed at 35 students, the fourth year award would be $95,000 and the total received up to that time would amount to $300,000. With ultimate class sizes of 75 sutdents, the Basic Improvement Grant would eventually provide up to $175,000 annually toward the institution's operating costs.

Another important source of income for optometry schools is that derived from the operation of a teaching clinic in which patients receive optometric services, including eyeglasses and contact lenses. Fees for such services and materials are typically less than those charged by practitioners in the area, in order to attract patients to the clinic in sufficient numbers to meet the instructional needs of the school, and also to offer some compensation for the additional time spent by the patient. The budget of Appendix C shows a clinic income of $60,000 annually when the clinic is in full operation by the end of the fourth year. This amount can be scaled up almost directly in proportion to enrollment since its derivation did not take into account the fixed costs for maintenance and operation of the clinic, which would not be proportional to enrollment. Thus for classes of 35 students the estimated annual clinic income would be $84,000, and for 75 students it could be as high as $180,000.

With regard to the expense estimates in Appendix C, it seems probable that nearly all these figures should be revised upward by at least 10-15% just to allow for increases since they were derived, and by perhaps 30% or more if they are to be used for projection of costs into future years. Furthermore the allowances for equipment and furniture are ultra-minimal at best, totalling only slightly more than $85,000 for implementation of the total program. Wide variations are possible, of course, but this estimate is in sharp contrast with recent experiences in expanding the existing schools of optometry, where amounts several times this size have been required just for replacements and additions to an equipped existing facility.