The Unconventional Optometrist: Eye Care Behind Bars

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DID YOU KNOW?

The United States has incarcerated more people than any other country in the world. Currently, there are approximately 2 million inmates in state, federal and private prisons across the country. To put this into perspective, the United States holds 25 percent of the world’s prison population, but only 5 percent of the world’s people. From less than 300,000 inmates in 1972, the prison population grew to 2 million by the year 2000. Ten years ago, there were only five private prisons in the country, with 2,000 inmates. Now, there are 100 housing 62,000 inmates and in the next decade, it is expect that this number will reach 360,000 [1].

Prisoners forfeit many privileges while serving out their sentences. They lose their right to vote, their right to privacy, and their right to any possessions, among other things [2]. However, prisoners retain their right to health care, and given the growing prison population, there is an increasing demand for optometrists to meet their eye care needs.

NOT YOUR TRADITIONAL PRACTICE SETTING

Optometrists have traditionally worked in private practices, corporate offices, hospitals, and other clinical settings. In the past, when an inmate was due for an eye exam, the individual in question would be referred out to an off-site location. This posed a problem as inmates represented a transient population, making it difficult for the same doctor to follow-up on a particular case, unless the inmate was fortunate enough to have a family optometrist. An inmate could easily be seen by more than one optometrist for the same complaint and very few of those optometrists would likely see the same inmate again.

In the 1970s, there were very few prison optometrists providing in-house care [4]. However, over the years as the number of prisoners grew, it was no longer economical to continue sending inmates out for eye care services [5]. Now, more and more optometrists are contracted to visit correctional facilities to provide on-site examinations and dispensing.

WORKING AS A PRISON OPTOMETRIST:

Interview with Dr. Jeffrey R. Lose, OD

OptometryStudents.com had the opportunity to speak with Dr. Jeffrey R. Lose who is the founder and owner of Institutional Eye Care, the largest provider of correctional eye care and vision services in the country.  The company subcontracts local optometrists to see inmates on a weekly, bi-weekly, or monthly basis at a facility in their area.  Many of these optometrists are either new graduates who are looking for additional work or are retiring optometrists who would still like to provide care every now and then. Each subcontracted optometrist must pass criminal background checks and obtain security clearance. In some high security facilities, Homeland Security background checks are required.

At state and federal facilities, dedicated exam rooms with all the necessary equipment needed for a comprehensive eye examination are provided.  However, at the county level, optometrists are required to bring portable equipment at each visit.

A typical day working in a correctional facility is similar to any other institutional setting, with one additional challenge:

“Unlike a VA or a hospital, correctional facilities have counts throughout the day to keep track of the number of inmates in the morning, mid-day, and afternoon. If you are holding a full-day clinic and a mid-day count doesn’t go well, you can end up with a significant delay in your schedule. They have to call everybody back and count them in their individual cell, which can take hours.”

According to Dr. Lose, the treatment philosophy and standards of care remain the same whether you are seeing patients in a correctional facility or in your office, but there are some benefits to working in a correctional facility too:

“A nice difference between private practice and corrections is that we always have access to the patient’s full medical history. Thirty-one years ago, correctional facilities were already using electronic health records and that in a way put corrections way ahead of the game.  Even then, [prison] optometrists were considered to be a part of a medical team and we were treated as part of the medical team, whereas optometrists in private practice were seen only as secondary providers at the time.”

Over the years as the scope of optometry expanded, the focus of correctional eye care changed as well.  Primary care not only meant managing general eye health and performing refractions, but prison optometrists, like many other optometrists, are now expected to manage certain ocular diseases therapeutically, which provided a new set of challenges.

“In correctional settings, we don’t have access to ancillary testing like OCTs and visual fields, and if you have a glaucoma patient, special arrangements need to be made to have these tests done. For the most part, diseases need an off-site provider to manage. Protocols are also in place in cases of emergencies, like trauma or acute conditions that require immediate care when no optometrists are on duty.”

Talc RetinopathyCOMMON CONDITIONS ENCOUNTERED

Research has shown that there is a higher incidence of ocular conditions and disease in prisons than in the general population [2]. These include:

Hyperopes and astigmats are also more common among inmates [4]. In Dr. Lose’s experience, glaucoma, diabetic retinopathy and presbyopia rank the highest in terms of the most common conditions encountered, in part due to the aging inmate population.

ADVICE TO STUDENTS

“Do a rotation in a correctional facility to see if you like it,” says Dr. Lose.

If you do, join a practice with an optometrist who is subcontracted to provide care to local facilities.  Often times when such a practice takes on a new associate, they will dedicate the new doctor to do some correctional work on a monthly basis in order to build their side of the practice. It’s a great experience to have while earning some extra income.

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ACKNOWLEDGEMENTS

Thank you to Dr. Jeffery R. Lose for taking the time out to speak with me and to answer my questions!  I learned a lot from writing this article, and speaking with Dr. Lose opened my eyes to a different side of optometry that I never really considered before.

Thank you to Dr. Matt Geller for the article idea. It took a while but I hope this was worth the wait!

REFERENCES

  1. Pelaez, V. “The Prision Industry in the United States: Big Business or a New Form of Slavery?” Global Research, January 2013. Web. July 27, 2013. <http://www.globalresearch.ca/the-prison-industry-in-the-united-states-big-business-or-a-new-form-of-slavery/8289>
  2. Boughton, B. “A Look Inside Prison Eye Care,” EyeNet Magazine. American Academy of Ophthalmology, February 2009. Web. July 27, 2013. <http://www.aao.org/publications/eyenet/200902/comprehensive.cfm>
  3. Hatch, S. W. “Visual Acuity in a Prison Population,” Optometry & Vision Science. American Academy of Optometry, May 1990. Vol. 67, No. 5, pp. 382-384. Print.
  4. Verma, S. B. “Optometric Services in the Prison System,” Optometry & Vision Science. American Academy of Optometry, January 1989. Vol. 66, No. 1, pp. 6-8. Print.
  5. Withers, N. “Vision in prison.” Optometry Today, May 2013. Web. July 27, 2013. <http://www.optometry.co.uk/news-and-features/features/?article=4708>
  6. Samuels Jr., C.E. “Program Statement: Patient Care,” Federal Bureau of Prisons. U.S. Department of Justice, August 2012. Web. August 8, 2013. <http://www.bop.gov/DataSource/execute/dsPolicyLoc>
  7. Friedman O.D., E. “Eye Care for Inmates,” Eye Care Professional Magazine, March 2009. Web. August 8, 2013. <http://www.ecpmag.com/1webmagazine/2009/03mar/content/second_glance/eyecare-for-inmates.asp>

 

 

 

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