NECO celebrates 50 years of commitment to community-based training

Student gives young boy a vision screening.

In 2022, New England College of Optometry recognizes 50 years of training students and serving patients in community health centers throughout the region. As the first optometry school to conceive and create such a clinical training model, NECO has influenced thousands of optometrists and optometry itself. Here’s the story of how it all began.

Transformation: Creation of a new clinical training model

On the eve of the 1970s, the practice of optometry was ripe for change. Progressive optometrists were pushing back against the tradition of optometry and leaning toward a broader scope of practice that included the detection, diagnosis, and treatment of ocular diseases.

New England College of Optometry capitalized on the momentum. It responded in 1972 when embarking on a transformational update to its clinical curriculum with the goal of developing optometry students to become primary eye care providers.

For NECO, this meant creating a new clinical training model that would move optometry education beyond refraction and on-campus clinical experiences into a new educational realm: multidisciplinary co-management of patients with other healthcare professionals in a community-based setting.

No other optometry school or college offered anything like it.

“NECO chose a wise path: to go to the people, where they lived, and where they sought care and other services,” said Roger Wilson, OD ‘80, who spent 33 years at NECO expanding its affiliations with the health centers and working in their communities.

Forward-thinking administrators saw benefit of affiliations

Community health centers (CHCs) were created to provide health and social services to low-income and medically underserved communities. (America’s very first CHC was founded in Dorchester, Massachusetts in 1965.) That made them an ideal training ground for NECO’s eager optometrists-in-training. Professional headshot of Dr. Charles Mullen

Forward-thinking administrators and faculty, including NECO President William Baldwin and NECO graduate Charles F. Mullen, OD ‘69, Baldwin’s special assistant for clinical development, recognized the multiple advantages that collaborating with CHCs could offer the students. Dr. Mullen, the clinical architect of the health center training model that sets NECO apart from other optometry schools and colleges in the nation, went on to become National Director of the VA Optometry Services and President of Illinois College of Optometry.

“Optometry students at the time were only seeing a very narrow patient type. The clinical education program needed to be enriched with quantity and diversity of eye conditions such as glaucoma, cataracts and macular degeneration,” wrote Dr. Mullen.

Coincident with NECO’s educational mission was a commitment to provide eye care services to underserved communities.

In 1972, NECO established the first formal clinical training agreement with Dorchester House. A year later, it signed agreements with The Dimock Center and South End Community Health Center.

A catalyst for change in optometry

Student giving vision screening to young student in Boston schools

From vision screenings to patient care in community health centers, NECO students start their clinical training within the first few weeks. Relationships with community organizations and health centers make it possible to expand access to care while providing top notch clinical training.

By transforming what traditionally was a micro focus on the eye into a macro view of the health of the whole patient, the NECO and health center collaborations ensured that students gained mastery not just in fundamental skills, but also in the critical thinking needed to competently diagnose, prescribe, and treat any type of optical patient or condition they encountered, in any type of clinical setting they choose, anywhere in the world.

The opportunity to work alongside other healthcare professionals as peers did more than help change the practice of optometry itself: it raised the level of recognition and respect the profession eventually received.

Overcoming hurdles, creating believers

Change wasn’t easy. Some health center administrators were reluctant to work with students; some doctors and nurses declined to work directly with optometrists; an ophthalmological society opposed cooperation between optometry and ophthalmology; and private optometrists even worried that the new model would threaten their businesses.

Dr. Mullen also noted the importance of a few bold ophthalmologists who withstood the political pressure and helped establish the new optometric-ophthalmological interactional model, which has since been adopted throughout the country.

Positive word of mouth brought support from other organizations who wanted to work with NECO’s optometry students and the services they provided. Soon enough, skeptics became strong supporters.

Expanding and diversifying the clinical network

In 1974, NECO alum Kenneth Myers, OD ‘74, was appointed as Veterans Health Administration’s first director of optometry. He invited NECO to set up clinical training and residency programs in Boston-area VA medical centers.

faculty points at computer screen with student listening to instruction next to them

Dr. Amy Moy leads the NECO Clinical Network; partnerships with community health centers and many other community care locations that NECO believes is essential for clinical training and to fulfill its commitment to expanding access to care.

The VA added a new dimension to the NECO clinical training model. Students gained exposure to a full range of complex ocular and systemic health conditions like diabetes, hypertension, and neurological and cardiac disease. Two decades later, in 1995, NECO also began its first residency programs based at health centers.

It was the first time optometric faculty worked collaboratively with academic ophthalmologists in community health centers in providing patient care and clinical instruction to optometry students. The principles of this model were adopted by the Department of Veterans Affairs, and later applied in affiliations between Hahnemann University Medical School and the Pennsylvania College of Optometry; and the University Of Chicago Department of Ophthalmology and the Illinois College of Optometry.

Impact that continues beyond training

Youth in red shirt points to a card the optometrist is holding as part of an eye exam

Dr. Barry Kran oversees a collaborative eye clinic with the Perkins School for the Blind where students get experience working with special populations in the low vision clinic.

Today, NECO offers residencies at 14 different community health centers and VA medical centers. NECO students also receive training and externship opportunities through a diverse list of affiliations with teaching hospitals such as Tufts Health Center and Boston Children’s Hospital and with organizations like Perkins School for the Blind, Seamark Vision Clinic at the Cotting School, Pine Street Inn, Army & Navy Health Clinics, and Boston Public Schools.

NECO now requires students to complete at least one rotation at a community health center and one VA center to graduate. Students embark on their optometric careers knowing what it’s like to be part of the community and to provide vital eye care services to its members. They learn critical skills in diversity, social determinants of health, and cultural humility and competence. Many change their career aspirations toward multidisciplinary, medical-based optometry or even decide to practice at community health centers.

The impact on neighborhood residents has been just as positive. NECO clinics in CHCs enhance access to vital eye care services for thousands of patients every year – at lower cost and closer to where they live and work.

The NECO Legacy

What NECO started 50 years ago has changed optometry education today:

The community-based clinical training model is the gold standard, with many optometry schools and colleges affiliating with CHCs and VAs for clinical training.
NECO’s model for optometric-ophthalmological collaboration is widely used, so much so that it’s hard to recall a time without it.
NECO added momentum to the efforts to broaden the scope of practice in optometry. This included training the first optometrist in the use of pharmaceutical agents.
Eye care is now integral to overall health care delivery.
Future optometrists see a wider and more fulfilling array of paths

“Community-based clinical training is quintessentially NECO. We believe in providing vital eye care in community health centers as part of a patient’s overall health care and providing unique, in-depth clinical training to students at the same time. Everyone wins.”
— President Howard Purcell, OD ’82

NECO’s network with CHCs today

“I am so proud of NECO’s legacy in raising up new optometrists to provide equitable eye care to the underserved in our communities,” says Dr. Amy Moy, the current Director of NECO’s Health Center Network and Chief Compliance Officer. “We have the ideal stage in our health centers to teach NECO’s students about culturally competent eye care and social determinants of health, as well as how to advocate for equitable healthcare for all.”

NECO alums inspired by clinical experiences. From changing to an area of expertise to leading an eye clinic at a community health center, NECO alums continue to be inspired by their clinical training experience at NECO. The impact goes well beyond learning clinical skills and is a testament to one reason why NECO continues iwth its commitment to its unique model.

NECO’s commitment to community health centers continues today. Dr. Amy Moy explains the passion and commitment to community-based clinical training.

Beyond the eye exam: Cultural competency and compassion at the core of training. Meng Meng Xu, OD, is the Director of Eye Care Services and a preceptor at South Boston Community Health Center, one of the community health centers in NECO’s where student interns learn much more than clinical skills.