How Did You Know You Wanted To Be an Optometrist?

It’s a question you hear countless times, both before and after you enter the New England College of Optometry. When you’re talking to a friend, or a relative, or anyone you meet in Boston, people are curious — either because the idea of touching other peoples’ eyes makes them queasy, or that they’ve heard it’s a great field to be entering right now, or because they wonder what made you choose eye care out of all the different health care specialties that are available.

It’s a question that you’ve thought of a variety of different answers to, because you don’t have just one reason why you decided you want to be an optometrist. It’s because you’ve worn glasses since you were seven and contacts since you were thirteen, and because in eighth grade health class you wrote an extra credit paper called “Intermittent Exotropia and What it Means” to help you understand why your eye turns out and you see double when you’re trying to study. It’s because you had eye surgery that helped your eye stop turning so much, but that  started back up again when your workload increased later in high school and in college, and because one eye doctor suggested to you something called “vision therapy” that you’d never heard of before but were immediately fascinated with.

It’s because when, in college, you sat yourself down and forced yourself to think, “What do I want to do with the rest of my life?” you were sure about two things: that you want to do something that will make a positive impact on the lives of others, and that you want to do something you are passionate about.

It’s because you’ve always wondered how it’s possible for people to see, to take images from the world around us and use our eyes to transmit the information to our brains, because you wonder why some people can see more clearly than others, how it’s possible for two people to perceive colors differently, and what causes someone to lose their sight.

So you begin the research process, exploring the internet to find out how you become an optometrist. You’re worried that because you’ve already started your sophomore year of college and switched majors from writing to environmental studies, that it’s too late, that the classes you’ve taken so far are too random to facilitate acceptance into optometry school. But it doesn’t matter what you major in, the website says, although most people choose biology or another science. You’re relieved, and you like the idea that you can return to a major in writing and explore learning to tell stories and communicate in a way that could one day help you as an eye doctor. But, the website says, you need to be sure, when you apply, that optometry is where your interests lie. And to be sure, you need to shadow an optometrist, or several.

So you call the optometrists in your town, any that aren’t too far away or who specialize in something that sounds interesting to you, like pediatrics or vision therapy. And one of them calls you back and you stress about whether your clothing choices are professional enough, and you feel uncertain as you tell the receptionist you’re not a patient, you’re a student, well, not a student yet, not really, but you’d like to be one. The optometrist emerges and saves you from further awkwardness by inviting you to his office and answering your hesitant questions about what optometry school is like (“Hard work, but you’re going to love it!”) and where they went to school (“This is where I went, but it depends on what you’re looking for–where do you want to go the most?”) and you nervously stutter out that you want to go to NECO. He sounds so certain that you will get into a school and that you will love it and you’re nervous, because as far as you know you’re the only pre-optometry student at your small liberal arts college, and this is the first optometry school graduate you’ve actually ever spoken to since you started the research process.

He says he doesn’t mind if you shadow him while he sees patients, and you watch as he brings their vision from blurred to clear, as he shines different lights at their eyes and explains to you what he is looking for, the responses of their pupils and how their eyes move. And he looks at one patient’s eyes through a slit lamp, and he uses the phrase “slit lamp” so casually and you nod like you know what that means, and then he tells you to come look inside and you’re not sure what you’re looking at, only that it looks like dozens of yellow points of light like the night sky and he smiles and says that it’s called epicapsular stars, that he only sees one patient or so a month with this and that it still makes him smile every time he sees it, that it’s an abnormality but not something that usually bothers a patient.

That night you go home and think about the person with stars in their eyes and you think, yes, I could get up every day and do this. I could help people see, and I could learn to look inside their eyes and understand the problems with their eyes and vision and work with patients to solve them, like my optometrists have worked with me. You think that it’s not something that will be easy, but that it will be worth it.

And that is how I knew I wanted to be an optometrist.

It’s only been three weeks, and I can’t believe how much I’ve learned.

Clinic in third year begins abruptly; you rapidly move from the chaos of second year final exams to the relaxing break of summer to a completely new environment with a different set of responsibilities and expectations. Increasing clinic time from one afternoon per week to two or three days may not sound like a drastic change, but in addition to the increased time, we also have increased responsibility. We are now expected to give each patient a full eye exam, from entrance tests to refraction to a slit lamp exam and tonometry through dilation, examination with a 90D lens and BIO. We speak with our preceptors before tonometry, dilation, and after the full exam has been given to discuss how to manage each case, what the diagnosis is, how we should treat the patient, and when they should return.

Learning in clinic is completely different than learning in class. Classroom learning means learning from notes and pictures, studying and introducing ourselves to new concepts. Learning in clinic means learning from experience, from speaking with people and learning about their individual visual needs and problems, from examining the eyes of a variety of different people and understanding how to adapt clinical skills to new challenges. In class you get feedback about how well you’re learning from your grades on midterms and finals, but feedback in clinical situations is more immediate. Preceptors are able to see how you interact with and test patients and can give you advice on how to improve your clinical skills as well as how to deal with different types of situations. I find it very helpful to get quick feedback and feel like it helps make things more memorable; I use what I learn from experiences and am able to try to make improvements with each consecutive patient.
In the past three weeks I’ve been able to see 24 patients ranging from age 3 to 80, and I’ve been able to see new conditions that I haven’t seen outside of class like refractive amblyopia, concretions, pterygium, diabetic retinopathy, a branch retinal vein occlusion, and several glaucoma suspects. I’ve gotten a lot more experience performing dilated eye exams on different pupil sizes, and I feel like I’m starting to improve my skills with BIO and the 90D lens. I feel like I am also developing better communication skills and trying to adapt my exam to specific patients. It’s very different interacting with a five-year-old who needs to wear glasses but doesn’t want to as opposed to an elderly person who is unhappy with their reading glasses.

I’m also working on developing my communication skills in Spanish. I took French in high school and college and never had the opportunity before to learn to speak Spanish; if I had known how important it would be as an optometrist to be able to communicate with my patients, I would have. I discovered on my first day of clinic that I needed to immediately start learning to speak Spanish when my first patient spoke no English at all, so I asked a friend for help and with a few other students was able to start learning key phrases from her. I’m not able to take a case history in Spanish yet, but my clinic has a translator service that we can call for case history if needed. For now, I’m learning to give instructions and how to explain the different optometric tests to patients, as well as brief conversational phrases. I hope to keep learning and to reach a point where I’m able to speak and comprehend enough to take case histories.

Overall, I’m thrilled with how much I feel like I’m learning in only a few short weeks. As new clinicians, we all make mistakes, but the important thing is that we are able to learn from those mistakes to improve for the next patient and keep learning throughout our clinical education.