The scope of eyecare practice has grown dramatically in recent decades. For example, optometry now encompasses diagnostic and therapeutic drugs, surgical comanagement and much more, yet the length of schooling has not drastically changed. With all the complex information students need to absorb in four years or 14 quarters, some of the everyday aspects of practice such as patient communication and contact lens fitting can become lower priorities.

Vistakon realized that it had an opportunity to partner with students and practitioners to build professional relationships and to foster more confident and proactive vision care. Helping eyecare professionals be better contact lens fitters is good for practitioners, good for their patients and in the long run, good for the industry, says Phil Keefer, President, The Vision Care Institute. With that idea, The Vision Care Institute, LLC (TVCI), a Johnson & Johnson Company, was born.

From the beginning, our goal at TVCI has been to support academic and professional achievement, independent of commercial interest. Although educators use Acuvue lenses in fitting sessions, the didactic lectures cover a range of options. In this, we modeled TVCI after another Johnson & Johnson initiative, the Ethicon Endosurgical Institute, which has been educating doctors on laparoscopic procedures for more than 20 years.

Today, TVCI boasts a state-of-the-art facility in Jacksonville, Fla., along with seven sister facilities worldwide. There are about two dozen faculty members in the United States and many more around the world. Cumulatively, they've served 10,000 students and professionals since 2004 and, this year alone, another 10,000 eyecare providers will participate in the program.

TVCI's program in Jacksonville is open to all fourth-year optometry students in North America, as well as to opticianry students and ophthalmology residents. A maximum of 36 students participate in each session, with about 40 sessions scheduled for 2007. The program is free, and TVCI also covers travel, lodging and meal expenses for participants.

TVCI doesn't seek to replace the education that students receive in their schools. Rather, its purpose is to set the stage for students to build on their education, improve their clinical skills and develop the confidence to bridge that transition from student to practicing doctor.

The optometry schools have been supportive partners. George Foster, OD, the Dean of the Northeastern State University-Oklahoma College of Optometry (NSU-OCO), has attended the program with his students and views it as an important head start as they prepare to embark on their own careers.

One of Dr. Foster's missions is to make sure his students can earn a living when they graduate. He says TVCI has provided an empowering experience for his students and that partnering with industry to help them develop their communication skills and network with industry leaders has been a great opportunity.

TVCI presents an intensive three-day program during which the students spend almost all of their waking hours together. After an introductory session, students break out into three smaller groups that rotate among modules on patient communication, fitting presbyopes and fitting astigmats.

Communication Skills Doctor-patient communication is a major aspect of modern practice, yet it's one of the toughest skills to teach. TVCI instructor Kelly Kerksick, OD, a private practitioner in Columbia, Ill., tries to stress to students that being a good communicator can make them more efficient. If young eyecare professionals can learn to make an assertive professional recommendation, she told a recent class, they will find that patients have more confidence in them and are more likely to move forward with the recommended course of action.

Students start the communications module with a confidential personality assessment to give them insight into how peers and patients are likely to perceive them. A didactic session with Dr. Kerksick or another faculty member is a chance to review basic concepts. From there, students go right into mock patient encounters in which they are asked to deliver bad news to a patient or explain presbyopia to a contact lens wearer who is having trouble reading.

The encounters are videotaped so that students can later review their initial presentation, their coach's recommendations and their follow-up presentation. Most students show a significant improvement in their body language, tone and clarity of the information after their coaching session. Students leave with their video on a DVD that also contains plenty of constructive feedback.

Students consistently tell us this communications module is one of the most memorable aspects of the program. Caleb Schoonover, an NSU-OCO optometry student and outgoing president of the American Optometric Student Association, says the experience was intimidating at first because it pushes students out of their comfort zone. But he says he learned some valuable lessons about how posture or hand gestures can affect patients' perceptions. Schoonover says he still catches himself doing some of the things that he saw himself doing initially on the DVD, but he's now much more aware of his body language during patient encounters.

Fitting Astigmatic Patients Although contact lens education is part of the curriculum at all optometry schools, actual experience with fitting more complex cases is often limited. One of our goals at TVCI is to ensure that new practitioners take with them skills that will add value to a practice and will help them eventually build their own patient base.

Being comfortable fitting specialty lenses is one such skill. In fact, given the percentage of people who have astigmatism and/or presbyopia, the day will come when multifocal and toric IOLs aren't even considered a specialty. But for now, practitioners who know how to fit these lenses and aren't hesitant to prescribe them are still in the minority.

In the astigmatic fitting module, students learn about toric lens design and fitting principles, learn to identify scribe marks on toric lenses from a variety of manufacturers and have an opportunity to fit several patients.

Melissa Frank, a fourth-year student at Pennsylvania College of Optometry, says that the exposure to astigmatic patients was a huge benefit to her because her contact lens fitting experience in school was limited. The whole experience was based on providing the best care for the patient, whether that involved an Acuvue lens or not, she says, adding that the course really built her confidence in her own ability to fit these challenging patients.

Fitting Presbyopic Patients In the presbyopia module, students have a didactic lecture on changes in the aging eye and then head into the exam rooms to fit several presbyopic patients. Afterward, they receive feedback from faculty, peers and from the patients, then get a chance to try multifocal lenses themselves.

Schoonover says he got some great tips on how to make the transition through presbyopia easier for patients and how to set patient expectations.

Indiana University student Tim Birtwhistle says the experience is helpful for anyone who hopes to have a strong contact lens practice after graduation. Many people start out with preconceived notions of how they're going to fit presbyopic patients, but the Institute did a great job of presenting all the options, from monovision and modified monovision to multifocal contact lenses, he says. Birtwhistle left the course with some tools he can use in practice, such as an algorithm of steps to take in fitting presbyopes that provides an 80 percent or better success rate.

The Big Picture We also try to expose students to a broader view of the future of optometry. Not only will these students be implementing what they learned in optometry school once they're out in practice, but they'll also face new challenges such as incorporating higher-order aberrations into refractive correction and integrating thousands of digital diagnostic images into patients' medical records.

We've pulled many of the latest diagnostic devices and other new technologies together in a lab we call the exam room of the future. Here, students can get a sneak peak at some of the technologies they may be using routinely in practice someday.

We're proud of the world-class faculty who teach at TVCI while maintaining busy practices of their own. We ask each of them to serve more as a coach or mentor to the students who visit TVCI, modeling appropriate communications and providing feedback.

Dr. Kerksick says that teaching at the Institute is one of the most rewarding things she does. I feel that I've grown tremendously as a practitioner because the students constantly challenge me to be my best, she says.

We actively seek out faculty members like Dr. Kerksick who have distinguished themselves in the eyecare professions, are natural teachers and have a strong interest in mentoring young people. Many of them field calls or e-mails from former TVCI participants inquiring about clinical matters, contract negotiations or equipment purchases. Some have hosted students at their practices or even hired young optometrists they met through TVCI.

As the program has evolved, we've sought out younger faculty members that students can easily relate to, and we've tried to keep our faculty mix diverse in terms of region, gender, race and practice modality so that the faculty is representative of the audience we serve.

There seems to be a veil of mystery between what students learn in school and what practitioners know but weren't taught. Our faculty's job is to pull back that veil for a little while, so that students can learn from seasoned practitioners who are willing to speak to them like colleagues.

One of the most exciting new initiatives for the Institute is our commitment to build satellite TVCI conference rooms at optometry schools around the country. The conference rooms will mirror those at the Jacksonville TVCI, with multimedia screens on every wall, high-speed Internet connections and built-in audio and video communication systems.

We envision that optometry students in California or Michigan or ophthalmologists in China will be able to watch a patient encounter in Jacksonville without leaving town. They'll see on the screens in their conference room exactly what the instructor sees at the slit lamp in our patient exam room.

Dr. Foster, whose school will be receiving one of the first of the new facilities, agrees that there are many ways the schools can benefit from these conference centers. He foresees linking up his students in rural Tahlequah to faculty presenters at other schools or to professionals around Oklahoma for ongoing communication, education and networking.

He'll also be partnering with TVCI to deliver practice management education to young practitioners in his region, and he says it's a great opportunity to bring them back to the school for education that meets their needs. When it comes to the business of running a practice, Dr. Foster points out that practitioners don't really know what they don't know until they're actually trying to run a practice.

A major emphasis for TVCI in the coming years will be developing more programs for practicing eyecare professionals, including the university-based seminars and distance learning. As Dr. Foster notes, once practitioners get beyond their first year or two in practice, they face a whole new set of hurdles and knowledge requirements to be effective. We're creating a curriculum now that will help young practitioners take their practice to the next level. We also want to reach back in the other direction and offer more education to younger students to augment what they obtain in school.

We like to think of TVCI as something unique in our industry. Over the past three years, we've worked hard to provide insight and inspiration for students across North America and practitioners worldwide. In the years to come, we anticipate more opportunities to help eyecare professionals enhance their patient and professional satisfaction, productivity and profitability.

Beyond the main campus in Jacksonville, Fla., The Vision Care Institute also has seven international branches:

* Shanghai, China

* Taipei, Taiwan

* Bangkok, Thailand

* Seoul, Korea

* Tokyo, Japan

* Prague, Czech Republic

* Sao Paulo, Brazil

Additional centers will open soon in Milan, Italy, and in other major population centers.

Each of the international TVCIs shares the same core mission as the Institute in the United States, but caters to local needs as determined by local professionals. TVCI in Prague, for example, has served participants from 12 European countries in their own languages. In Japan, most of the participants are fourth-year ophthalmology residents, who've typically had no education or training in fitting contact lenses even though they're expected to do this professionally. In emerging markets like China and India, contact lens penetration in the marketplace is very low but the potential for growth is enormous. In these countries, TVCI focuses on more basic information about the role of eyecare providers and the importance of routine primary eye care and vision correction.