The organic electrochemical transistor (OECT) is a unique device that shows great promise for sensing in biomedical applications such as monitoring of the integrity of epithelial tissue. It is a label-free sensor that is amenable to low-cost production by roll-to-roll or other printing technologies. Herein, the optimization of a planar OECT for the characterization of barrier tissue is presented. Evaluation of surface coating, gate biocompatibility and performance, and optimization of the geometry of the transistor are highlighted. The conducting polymer poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate), which is used as the active material in the transistor, has the added advantage of allowing significant light transmission compared to traditional electrode materials and thus permits high-quality optical microscopy. The combination of optical and electronic monitoring of cells shown herein provides the opportunity to couple two very complementary techniques to yield a low-cost method for in vitro cell sensing.