NYC school to let students pursue degree at Upstate

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Upstate Medical University and the SUNY College of Optometry are joining forces to help increase the number of trained eye doctors in Central and Western New York. This partnership provides an affordable option for aspiring eye care professionals. Here to tell us more about it is Dr. Robert Fechtner, professor and chair of ophthalmology and visual sciences at Upstate.

Welcome to "The Informed Patient," Dr. Fechtner.

Robert Fechtner, MD: Hi, Amber. I'm glad to be here with you today.

Host Amber Smith: Now, some listeners may not be familiar with the SUNY College of Optometry. It's actually in Manhattan.

What can you tell us about it?

Robert Fechtner, MD: Oh, my gosh. The SUNY College of Optometry in Manhattan has a gorgeous building overlooking one of the parks in the center of Manhattan. It is a fabulous location, tremendous training facilities, unless you don't want to be in Manhattan for your education. In that case, there is nowhere else in New York state to get education as an optometrist.

Host Amber Smith: It's been around since the 1970s, is that right?

Robert Fechtner, MD: I believe that's correct.

Host Amber Smith: And it does optometry and master's degree and doctoral degrees as well, right?

Robert Fechtner, MD: We're talking about optometry, and some of our listeners today may get a little confused because we have optometrists and ophthalmologists and just a whole slew of different specialties.

So, the optometrists are people who have had a college education, usually with a science background, and they want to go into health care. So rather than taking a pathway into medical school, which is one way to become an eye doctor, you can go directly into optometry school and have a four-year training program, perhaps even with an additional year afterwards, and you come out well trained to take care of many, many eye diseases.

Host Amber Smith: Is an optometrist the same thing as an optician?

Robert Fechtner, MD: The optician is the person in the eyeglass store who can fit you with lenses and do the glasses. Their background is limited there, and they don't take care of medical conditions. For example, they won't measure you for your glasses, but they ought to get you in a pretty good-looking pair of frames.

Host Amber Smith: But the optometrist would measure you and be able to diagnose some basic medical conditions.

Robert Fechtner, MD: The optometrists certainly are expert with refraction, with glasses, with contact lenses. In addition, they get medical training, so they know how to take care of many of the medical conditions of the eye, and interestingly, as an aside, it varies state by state what optometrists are allowed to do. That is a statewide scope of practice.

So I am at the next, perhaps, pathway, which is ophthalmology. I'm a medical doctor. After college, I went to medical school. I was trained in all different aspects of medicine and chose toward the end of medical school to become an ophthalmologist, which required four additional years of training after medical school.

So we are the doctors who get trained fully in the medical conditions, in surgical care of the eye, and then you can go beyond that for subspecialty training.

Host Amber Smith: How is a patient supposed to decide whether they need to see an ophthalmologist or an optometrist if they have an issue with their eye?

Robert Fechtner, MD: One of the nice things that happens is that despite a little bit of discussions over who should be doing what, the optometrists and ophthalmologists largely cooperate and collaborate. So for example, if you go into an eyeglass store, you're going to be seeing an optometrist. And if the optometrist's examination finds that you have a medical condition beyond their scope of practice, they will have a relationship with an ophthalmologist. They'll get you to the ophthalmologist for that level of care.

On the other hand, here at Upstate, in our department of ophthalmology, we have optometrists who are on the faculty. So if we do an exam and you are well, or if you have diabetes, need your routine annual exam, the optometrists are fully capable, and we will be moving patients to the proper level for the best appropriate care.

Host Amber Smith: Now getting back to the SUNY Upstate campus, here in Syracuse, there's about 1,600 students in medicine, nursing and a variety of health professions. On average, how many of those students go into eye care each year?

Robert Fechtner, MD: The number remains low, and the field is very competitive. For ophthalmology, you have to compete to get a residency slot, and we usually have only a handful of students each year introduced to ophthalmology during their career who want to pursue it.

For optometry, the pathway doesn't need to go through a health care university. You could do undergraduate, perhaps at one of the SUNY schools, take the required science courses, and then you would apply to optometry school, and that is a pathway in. You don't have to go to nursing school or physical therapy or one of these others as a prerequisite.

And I'd like to underline that anybody listening to this who thinks they might enjoy being an eye doctor and doesn't want to go through medical school, you have to look at optometry. It's a great career, it's a great pathway, and here in New York state, we have a fabulous college of optometry, who will soon be joining us here in Syracuse.

Host Amber Smith: Let me ask you: Back in medical school, what was it about ophthalmology that attracted you to the profession?

Robert Fechtner, MD: You might describe me as somebody who's a little bit OCD (someone who has obsessive-compulsive disorder). I love fine detail. Ophthalmology is a fabulous equipment practice. We have tremendous diagnostics. And it seems sometimes that the specialty picks the person.

Either you want to be in there with blood and guts, or perhaps you're a little fussy like me, and working on a tiny, tiny organ like the eye suits you. So, tremendous complexity, it's a beautiful sensory organ, and there's just so, so great a need for everybody to maintain their best vision.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast, with your host, Amber Smith. I'm talking with professor and chair of ophthalmology Dr. Robert Fechtner about a new optometry program at Upstate.

Now, I understand the first class for the Doctor of Optometry program at Upstate is likely to be fall 2025. What can you tell us about the program?

Robert Fechtner, MD: Amber, we're very excited to get this program launched.

As you know, the College of Optometry is based in Manhattan. One of the things we learned from COVID, that perhaps was a good thing to learn, is we can teach remotely. You don't have to be sitting in a classroom to learn. The first two years of optometric training are largely classroom and then simulation laboratory: You learn how to examine an eye.

So if we can launch in 2025, we'll be doing tele-teaching, having our students here working and learning alongside the students in Manhattan, and we will be building a facility here for training. By the time we get to the third year of the program, the optometry students are in a clinic working with actual patients under the direct supervision of an optometrist.

So starting in 2025 means two years later, we are hoping we will have a new eye institute here on the campus of SUNY Upstate.

Host Amber Smith: Do you know yet how many students you might enroll in Syracuse?

Robert Fechtner, MD: It's not certain, and I will make one distinction. These will not be SUNY Upstate students. These will be SUNY Optometry students, but the SUNY Optometry plan is to start small, perhaps with an initial class of eight. We're going to ramp up. We will make sure we get everything right. The students' education here has to be absolutely as good as going to Manhattan; personally, I think it could be better. And once we get that class, we'll bring the next class in, and then in year three, we will have the facility for these students to be doing the clinical portion of their education.

Hopefully, we will be up to about 30 students a year when we're fully up and running, and that's just about the right number for us to meet the needs in Central New York.

Host Amber Smith: So let's go over the prerequisites. Do you need to have a college degree to apply to this program, or what type of degree does it need to be?

Robert Fechtner, MD: There may be some exceptions, but generally everybody has gone to four-year college. If you go on the web and you look for SUNY Optometry, on their website, they have a list of the required classes and some additional recommended classes. It's a science background. It's going to be biology and physiology, chemistry, many of the courses that you might take if you were going into medical school. It is a competitive field, so not everybody who applies gets in. The last numbers I saw were for a class of nearly a hundred. There were over 500 applications.

Host Amber Smith: So what type of student will you be looking for? What would help someone stand out in this field?

What type of person would be good to become an optometrist?

Robert Fechtner, MD: What sort of person should be an optometrist? It should be a caring person, just like any other type of doctor or nurse or physical therapist. You have to want to be able to help people, so if you find in yourself that desire to be with people to do something meaningful, that's great.

If you have an inclination to be more of a science person, that's fabulous. You don't have to be a bench scientist. You just need to be able to understand how the body works and be able to learn about disease. So I think it's a very broad group of people who might enjoy being an optometrist.

And I'll tell you one other thing. I have young adult children, and we're concerned about what can you do where you have a secure career. If you are in a health care profession, you have a secure career. This is not a job that's going to be done offshore or over the internet. It is face-to-face, real people, and for me, that's one of the most rewarding things.

Every day I come in, I get to help someone.

Host Amber Smith: Well, let's talk about the type of salary and lifestyle a person who's a doctor of optometry might have. It's pretty much working weekdays, right?

Robert Fechtner, MD: This is a very manageable lifestyle. And I noticed when I looked at the Optometry website, very heavily weighted toward women.

And to me that implies that you can have a full life and have this career. Perhaps that's a little old-fashioned of me; I have gray hair. It is very much a weekday job. You can define your hours. You can be employed by a large corporation, or you can be in a one- or two-person office. So, tremendous range of what you could do.

There are very few optometrists who are doing night and weekend emergencies, so the quality of life can be fabulous. The income: Typically, you can be in six figures as an optometrist, and I have not met any unhappy optometrists.

Host Amber Smith: Well, that's good to know. Now, people somewhere along the way have probably heard that they need to have their eyes examined once a year.

Why is that so important?

Robert Fechtner, MD: We do make the recommendation that you need to get your eyes examined. When you're young, you have to have your eyes examined once before your teen years. When you're young, and if you're seeing well, perhaps it doesn't need to be every year, but by the time you're age 40, you ought to be getting your eyes examined every year or two.

Certain people need them examined every year, such as if you have diabetes, and the reason is, we can see problems as they're starting, before they affect the vision, and we can take care of them before there are any permanent effects of vision. Once you reach age 60, annual eye exam's a great idea. We can detect things like diabetes, we can detect glaucoma, we can detect macular degeneration.

And only your ophthalmologist or optometrist can look in your eyes and know what may be a future threat and address it before you have any loss of vision.

Host Amber Smith: I have not thought about diabetes showing up in the eyes. What happens to your eyes?

Robert Fechtner, MD: Diabetes is a disease that affects every part of the body, and it affects nerves and blood vessels.

The eye is basically nerves and blood vessels. So what we see in diabetes is often some changes in the blood vessels; they become weak, they become leaky, perhaps new blood vessels start growing that shouldn't be there. And if we see it early, we can treat it, perhaps with laser, perhaps with some medications, and slow down or even stop the diabetic eye disease.

Host Amber Smith: Dr. Fechtner, thank you so much for making time for this interview and telling us about this new optometry program.

Robert Fechtner, MD: Amber, it's a pleasure to be here, and I hope anybody who's thinking of a career in health care and is in college now will take a look at optometry and perhaps come to the program here at Upstate, in Syracuse.

Thanks for having me here.

Host Amber Smith: My guest has been Dr. Robert Fechtner. He's a professor and chair of ophthalmology and visual sciences at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.