Optometric Education

The Journal of the Association of Schools and Colleges of Optometry

Optometric Education: Volume 47 Number 3 (Summer 2022)


Learning and Teaching about Diversity and Cultural Competence: a Continuum

Aurora Denial, OD, FAAO, DAAO (OE)

Aurora Denial, OD, FAAO, DAAO (OE)

It is projected that by 2050, the minority population in the United States will increase to the point of representing the majority.1,2 Additionally, a growing number of Americans identify as lesbian, gay, bisexual, transgender/transexual, queer/questioning (LGBTQ).3 Along with recognition of these changes, our awareness of disparities in health care and systemic racism has been heightened by the recent COVID-19 pandemic and other events of the past few years.

As the population continues to become more diverse, the profession of optometry must be able to meet the cultural, ethnic, racial, gender and linguistic needs of its patients. We must not lose sight of the fact that each patient is unique and presents with an individual worldview influenced by culture, life experiences, age and other attributes. As clinicians and educators we are not only responsible for providing the highest level of care to our patients but but also for teaching and modeling this care to our students.

Learning and teaching about diversity, cultural competence and cultural awareness is a continuum. This themed edition of the journal is intended to move educators along in the journey. It touches on many of the topics that arise in our day-to-day work. It includes scholarly papers as well as hands-on, practical guidelines.

In This Edition of the Journal

In this edition of the journal:

  • Justice and Disparity – a Defining Cause for Diversity, Equity and Inclusion in Optometric Education and Practice. Edwin C. Marshall, OD, MS, MPH, FAAO, FNAP, Professor Emeritus from Indiana University School of Optometry, focuses on the Black American experience with racism and injustice within the frame of diversity, equity and inclusion in optometric education and practice. He provides strategies for addressing continuing challenges and shaping optometry’s journey toward a more diverse, equitable and inclusive future. In his correspondence with the journal, Dr. Marshall reflected on his manuscript, which “takes an in-depth look at the rationalization for diversity, equity and inclusion (DEI) from the context of a history of racial injustice and its effect on racial disparities in health and health outcomes. My intent is to connect the past with the present in setting the rationale for contemporary efforts around DEI from the perspective of both representational diversity and the elimination of racial/ethnic health disparities. I also provide an overview of what currently is occurring in the eyecare world to promote a more diverse, equitable and inclusive profession along with a series of recommendations for optometric education and the profession.”
  • Cross-Cultural Communication in Optometry: a Teaching Case Report. Meng Meng Xu, OD, FAAO, and Crystal Lewandowski, OD, FAA, present two cases, which demonstrate optometrists’ daily challenges in diagnosis and management in relation to providing culturally competent patient care. They address implicit bias and provide practice models to help with communication and providing culturally responsive care.
  • Cultural Competence for Serving Veterans: an Overview and Practical Considerations for Optometrists. Angelina Tran, OD, FAAO, and Yun-Ting Lisa Huang, OD, FAAO, discuss diversity in the military veteran population. This diversity includes racial and ethnic diversity alongside increases in the number of younger veterans and LGBTQ veterans. They provide many practical guidelines for properly addressing the unique concerns of the veteran population, such as trauma, post-traumatic stress disorder and traumatic brain injury.
  • Use of a Town Hall Focus Group to Assess Mentorship, Sense of Belonging and Self-Efficacy in Black Students in Optometry School. This study by Ruth Y. Shoge, OD, MPH, FAAO, James M. Caldwell, OD, EdM, EdD, and Anne Frankel, PhD, provides insight into the experiences of under-represented minority students, which can lead to better recruitment and retention rates.
  • Training Implicit Bias and Awareness of the Impact of Systemic Racism on Health: a Preliminary Study of Second-Year Optometry Students. For this study, Melissa Zarn Urankar, OD, FAAO, Gregory S. Wolfe, OD, MPH, and Janette D. Pepper, OD, FCOVD, FAAO, integrated principles of DEI, including communication skills, empathy and implicit bias awareness, into coursework. They assessed students’ perspectives ― understanding of the role of race in health disparities and confidence in providing fair and equitable treatment ― before, during and after completion of the coursework.
  • Navigating the Gray Area of Mental Illness in Health Care. The winning entry in the 2021 ASCO Cultural Competency Case Study Competition, by Quan Dao, OD, is featured, along with a link to the complilation of previous winning case studies, which is a useful resource for faculty.
  • On Diversity in Optometry, Progress, but More Work to Be Done. Keshia S. Elder, OD, MS, MS, FAAO, reviews the state of diversity in optometric education and the profession.


  1. Day JC. Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050. Current Population Reports, p25-1130 [Internet]. Washington, DC: U.S. Bureau of the Census; 1996 [cited June 15, 2022]. Available from: https://www.census.gov/content/dam/Census/library/publications/1996/demo/p25-1130.pdf.
  2. Ortman JM, Guarneri CE. United States Population Projections: 2000 to 2050 [Internet]. Washington, DC: U.S. Bureau of the Census; 2009 [cited June 15, 2022]. Available from: https://www.census.gov/content/dam/Census/library/working-papers/2009/demo/us-pop-proj-2000-2050/analytical-document09.pdf.
  3. Quinn GP, Sutton SK, Winfield B, et al. Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) perceptions and health care experiences. J Gay Lesbian Soc Serv. 2015;27(2):246-261.
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Dr. Denial [deniala@neco.edu], Editor of Optometric Education, is a Professor and Chair of the Department of Primary Care at New England College of Optometry and a Clinical Instructor at a community health center in Boston.