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A staggering 64.7 million Americans speak a language other than English at home -- Spanish, Chinese and Tagalog are the top three, but there are many dialects and languages, especially among the AANHPI communities which are frequently not accounted for. Of those, an estimated 25.9 million American residents (9%) have limited English proficiency. Due to language barriers, patients have great difficulty in building effective relationships with the clinicians caring for them.

While it is impossible to be cognizant of all the cultural nuances, beliefs, and traditions, it is vital that clinicians recognize the impact of culture on the patient's health beliefs and behaviors. Currently, both women and minority groups (Black, LatinX, and Native Americans) are underrepresented as practicing ophthalmologists (22.7% and 6%, respectively), compared with the U.S. population (50.8% and 30.7%, respectively). Although there had been a modest increase in the proportion of female practicing ophthalmologists over the last decade, no increase was identified in URM ophthalmologists.

Similarly, the majority of optometrists in the United States are male (57.5%). U.S. optometrists are 80.3% white, 15.8% Asian, 1.4% Black, 0.3% American Indian, 1.7% multiracial and 0.5% of other racial or ethnic backgrounds.

California has three accredited optometry schools and ten accredited ophthalmology programs.

  • The University of California (UC), Berkeley School of Optometry is the state’s only public optometry program. Western University of Health Sciences, College of Optometry and the Southern California College of Optometry at Marshall B. Ketchum University are both private, not-for-profit programs. Though California’s fairing better with the balance of gender, it is attracting even fewer Black Americans to the field, with just 0.8% graduating from these schools.

  • UC Irvine, UC San Diego, UC Los Angeles, UC Davis and UC San Francisco are the state’s five public ophthalmology programs. Loma Linda, Stanford, Naval Medical. California Pacific and USC are private not-for-profit programs.

According to the California Employment Development Department (EDD), with California’s aging population, there is a great need for the expansion of the eye-care workforce. This includes, in particular, the “middle skill” positions that support ophthalmologists and optometrists. Due to a combination of low unemployment and lack of awareness of these middle-skill jobs, the pool of staff and experienced technicians is quite small. However, their need is great. A study conducted by the Veterans Affairs Health Care System found that an increase in the ratio of optometric technicians to optometrists was associated with increased visits to optometric clinics.

There are three accredited optician schools in California, and just one accredited in California that certifies ophthalmic technologists. Ophthalmic credentials include Certified Ophthalmic Assistant (COA), Certified Ophthalmic Technician (COT) and Certified Ophthalmic Medical Technologist (COMT). COAs have basic, entry-level knowledge with about one year of study. COTs have more skills and can also train to take tonometry and measure refraction. The COMT is the highest level of certification, indicating that an individual has been trained on all equipment in the office, can oversee staff and can even assist the ophthalmologist in surgery. The 2019 Salary Survey from the Association of Technical Personnel in Ophthalmology states the average annual salaries for COAs, COTs and COMTs are $47,000; $53,000; and $63,000 respectively. The Bureau of Labor Statistics projects 14.2 percent employment growth for ophthalmic medical technicians between 2019 and 2029. In that period, an estimated 8,500 jobs should open up.

Optical Technician programs are equally deserving of support as rapid growth is expected for optical lab technicians, with the market expanding by about 7% between 2019 and 2029. Optical technicians create eyeglasses and contact lenses as well as lenses for binoculars and other optical devices. They fill prescriptions from ophthalmologists and optometrists, ensuring that the lenses refract light at the proper angle to permit optimal vision. The median annual wage for clinical laboratory technologists and technicians was $54,180 in May 2020. The job outlook for optical technicians is 6% with 4,300 job openings between 2020 and 2030.

Research has provided empirical evidence that connecting coursework to a student’s values can impact academic success and persistence. In this context, FFF’s investment in cultivating a culturally competent workforce through educational programs that show a personal benefit to the participants’ families and communities will have the most impact.

By investing in the development of a high school curriculum that introduces students to Ophthalmic Assisting, FFF has created a pathway for students still enrolled in high school to participate in a 12-month credentialing Ophthalmic Technician Education Program (OTEP) developed by the Southern California Eye Institute (SCEI). With the exception of one other (in Texas), this is the first accredited program to accept students while they are still in high school.

In July 2021, two Big Picture school students concurrently enrolled in the SCEI’s inaugural OTEP while completing their final year of high school. Upon graduation, they will be given the opportunity to certify as an Ophthalmic Assistant (COA) or Technician (COT) and immediately step into the profession, if they are not innately college-bound.


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