*** "During February 1959, many of our stores because of an intensified advertising effort have improved their 1958 ranking considerably. Pasadena 1048 is notable in this regard and have improved its 1958 ranking by 20 positions. Minneapolis 1002 also did a fine job by improving its 1958 ranking by 14 positions. Chicago 1030 improved by 13 positions, Chicago 1000 and Sacramento improved by 12 positions, St. Louis 1190 improved by 10. There are others that did a fine job, but space precludes mentioning them.

"I think this ranking report is deserving of your attention, and as you will agree, it contains plenty of 'food for thought.'

"How does your store compare? How does your optical ranking compare to your store ranking? Do 'poorer' stores have a 'better' optical ranking than you? "We are in the process of discussing this report with the various optical concessionaires with a view of planning a program for each of the stores to help achieve the sales potential that admittedly exists in your particular area. You will hear of this program as it concerns your store in due time. In the meantime, if you have any suggestions that have as their purpose the increasing of the optical sales and profits in your store kindly let me have them.

"It is intended that this type of 'Glory Sheet' be repeated each month ***.” "Most of you, at one time or another, have prepared advertising stuffers that have been included in SRC and various other credit mailings. Results of these mailings have been good and your only objection has been that there have been too many other departments buying for this service and as a result you could not use this means to advertise your department as often as you would like.

"Bruce Anderson of Department 733A comes up with an excellent suggestionone that I think you should pursue as quickly and forcibly as possible. 'Utilize the back flap of the envelope that the Sears store uses for its customer mailing service.'***"

***"the Lansing store has joined the select $10,000 monthly sales club Congratulations."

"The month of March, as you would gather, was a good one saleswise and the optical operation as a whole enjoyed a sales increase of 24.7 percent, April, however, promises to be an even better month.

"The optical business is big business at our store and if your store does not already include an optical department, you are forgoing the numerous advantages of this fine business ******

"On April 17 I wrote you concerning the problem of selling an additional pair of glasses to each of your customers.

"It is interesting to note that in recent edition of Printers' Ink, a leading advertising and marketing magazine, an article is printed which deals with this same subject matter.

"This fine article points out that authorities in the optical field have been ever mindful that the optical business, for the most part, has been stagnating through lack of even rudimentary advertising and sales promotion, but-and this is important-all of this is changing. It is pointed out that the reason for this change is mainly due to the activities of a special promotional committee of the recently formed Optical Manufacturers Association.

"This promotional committee makes it known that the 80 million Americans who wear glasses do not realize that one pair of glasses is seldom satisfactory to meet their needs. This committee points out that everyone who regularly wears glasses needs a pair with glare absorbing lenses for outdoor use. It also points out that those who engage in manual work or active sports need a second pair of toughened lenses. This committee also makes it known that presbyopes, who include almost every man and woman over 40 years old, often need, in addition to conventional bifocals, special-focus lenses for use at prescribed distances.

"It is also pointed out that fashion aspects of glass styling provides still another reason for owning two or more pairs of glasses. In this direction the OMA was responsible for the advertisement promoting high fashion eyewear that appeared in the March 14 issue of the Saturday Evening Post.

"This dynamic and eye-catching ad would have been considered unthinkable a year ago. Aimed directly at the consumer it was a bold, bold bid for multiple sales of spectacles.

"The OMA promises more ads of this type and it is obvious that something new and exciting is happening in a staid industry. In the past the suggesting of a second pair of glasses was not made because such suggestions might smack of unprofessionalism. This thinking is definitely out of style and it is agreed that it is in the patient's best interest to own more than one pair of glasses.

"It has also been found that another factor holding back multiple prescribing has been the lack of a financing arrangement. If the patient balked at the thought of more than one pair of glasses because of the cash, the prescriber would suggest all-purpose lenses (this objection should never be present at our store because of our easy credit terms) ***.

"So, once again 'work on' that second pair of glasses. By so doing you will be doing everyone a favor-and that means yourself, our store and most of all our boss-the customer.

"The results are in for April-Cleveland No. 1060 continues its sales domination. Who is going to dethrone the champion?

"The remaining Cleveland stores, namely, No. 1070 and No. 1260, continue with their good sales performance as do Baltimore No. 1204, Buffalo No. 1024, and San Diego No. 1078.

"Philadelphia No. 1004 bettered its 1958 yearend ranking by 12 positions, Fresno by 13, Sacramento by 8, and Lansing by 5. Nice work.

"Gate City, under the guidance of Mel Greenberg, has stepped up its overall promotional and advertising effort, and it is evident that their work is paying off. They bettered their April 1958 performance by 34.6 percent. * * *

"Our April sales were at an alltime high and it is apparent that those of you that have aggressively advertised and promoted are getting the sales results. Let's all get our share of this ready business.

"Hail the champ. It's Cleveland No. 1060.

"This fine operation repeated its stellar performance of 1958, and 1959 found them ranking No. 1 again.

"Our congratulations to this fine optical department and its guiding light— Maurice Stonehill.

"Incidentally, Maurice Stonehill and Colston Optical had 10 stores in the first 13 ranking positions-a most creditable job. ***

"I'd like to say here that 1959 was a good optical sales year for Sears and all of you are to be congratulated. The nationwide increase over 1958 was 25.2 percent. "I salute you.

"*** As you will note, Cleveland stores No. 1060 and No. 1070 have been playing tag with the No. 1 sales position and both are to be complimented for an exceptional sales job.

"The leaders for these same 3 months were pretty constant, however, it is interesting to note the progress of that B store operation in Youngstown, Ohio.

"If you will recall, this operation ranked 19 in October. In November they jumped to the No. 10 spot and in December they achieved the No. 9 position. In January this same store climbed to the No. 4 position and their battle cry is 'Watch out, Cleveland.'

"Maurice Stonehill of Colston, who championed this operation, also alerts one and all of his new B store operation in Huntington, W. Va. He is convinced that it will rival the sales performance of Youngstown and numerous of the bigger A stores. ***

"Our Retail Shopping Service visited New York's Lord & Taylor, as a result of the attached advertisement which ran in the New York Tribune on January 4. "The shopper indicated that the items offered were plastic framed sunglasses with optically ground lenses. The decor of these same frames included floral glitter, jewels, and novelty designs.

"These same frames were available in a variety of colors and styles. The price range was from $5 to $11. All of the advertised styles were displayed on a counter stand with other styles as offered by the same source. The source for this merchandise was A. A. Sutain of 29 West 37th Street, New York City.

"The reason that this information is being passed on to you is that our shopper reports an exceptionally strong customer response to this ad and to the merchandise offered.

"You are undoubtedly making your summer promotional and merchandise plans at this time and it is strongly recommended that you not overlook this type of merchandise. It might pay also to investigate this particular source.

"I'm pleased to report that October was another sales peak and topped September, which was our previous sales high. * **

"Attention should be called to the fact that our sales champ Cleveland No. 1060 who has been 'top dog' for each of the months during the past year, was finally dethroned **** Who did it? Cleveland No. 1070. It seems as though they are keeping it in the family. It would be interesting to note what happens in November regarding these two stores.

"In my optical ranking report for August we said that we would keep an eye on Youngstown, a B store, who during that month opened an optical department.

It is interesting to note that this B store ranked 19 during the month of October and promises even better things in the months to come. Port Huron, another B store, ranked 53.

"During these past months I have been commenting on the good performance of several of our stores, however, there are many other stores whose sales performance show the need for improvement. Let's pick them up! * * *”

"The month of September was a good sales month. It saw the attainment of an alltime sales high which accounted for an increase of 25.5 percent over September of last year.

"A fine job, and all of you concessionaires are deserving of a word of commendation ***"

I ask you, gentlemen: Is it possible for a patient in need of vision care to receive the professional care and attention he needs in this type of crass, commercial, sales-oriented atmosphere?

When an interested third party-an individual or a corporation-interposes himself between the doctor and his patient-the professional man is not free to place the welfare of the patient above all else. If the optometrist's income depends on the volume of patients he sees in the day and on the number of lenses and frames which he "sells," the professional vision care of the patient must certainly suffer. Corporate practice does not allow this freedom of judgment.

I know of one individual who practices optometry under about 20 different names in 9 States in 200 offices. In fact, he has multiple optical outlets in the same city which compete with each other, each aiming their advertising campaign at different levels of the vision "market."

With respect to section 10(a) of the proposed bill, I would like to point out that the codes of ethics of medicine, dentistry, and optometry declare that advertising to the public is unethical. The practitioner can offer only his reputation, skill, training, ability, experience, and the trust and confidence of his patients. These are not matters to be offered via the usual means of advertising.

The argument is sometimes raised that the optometrist dispenses to his patient an article of personal property such as eyeglasses and it is claimed that, therefore, advertising should be permitted. A simple analogy refutes this argument. When the orthopedist furnishes his patient with the neck collar or the brace to support a limb or a back, these, too, are articles of personal property; but they may not ethically be advertised. When the dentist supplies his patient with dentures, bridgework or similar dental appliances, he, too, is furnishing articles of personal property; but these likewise do not fall in the category of being ethically advertised. Likewise, in optometry. Eyeglasses are not optometry per se; they are incidents of the practice of optometry, the results which may be indicated. The practice of optometry is primarily and basically the exercises of training, talent, discretion, and professional judgment involved in the examination of a person's eyes to determine whether anything is needed, and just what it shall be, for the purpose of correcting, improving, and making comfortable the vision of the patient.

When a package price is offered in advertisements, profit-oriented companies must turn over a high volume of patients and, therefore, are unable to give the professional, detailed personal attention which the patients require. There is a very definite danger in shortcut quickie eye examinations, especially those for contact lenses.

The poor, the uneducated, and the elderly are ready prey for these unethical charlatans who lure them with advertisements and seem to have no compunction in taking advantage of their gullibility to make a quick profit. Advertisements by these purveyors of vision goods are often misleading and serve as "bait" for those who feel they must look for a bargain. Too often it turns out to be a very costly bargain. Unfortunately, it is the poor, the uneducated, and the elderly who are most likely to choose someone to help them with their vision problems on the basis of advertising, low price, or the personality of some salesman. It is imperative that only well-trained, properly licensed professional vision specialists be called upon to help these people overcome their vision problems. Each patient, and indeed, each eye of each patient, is unique unto itself, presenting problems which require the total time, training, skill, and energy of a professionally trained, licensed and experienced optometrist or physician. The responsibility for such a delicate and complex procedure cannot be delegated to nonprofessionals who have, at best, only a superficial knowledge of the physiological, psychological, and anatomical principles involved.

To protect the public against unscrupulous persons, the proposed licensing law is urgently needed and essential to make certain that those prescribing eye care meet qualifications of training competence and character.

CONTACT LENSES ARE A SPECIAL PROBLEM

It has long been the position of AOA that unlicensed, untrained laymen should not be permitted to fit contact lenses and instruct patients in their use, handling, and hygiene. It is imperative that only licensed optometrists or physicians prescribe and fit them. All persons cannot wear contact lenses and it takes a well-trained, competent vision specialist to know who should and should not wear them. Furthermore, in order to properly design a pair of contact lenses so that they will be visually correct, physiologically sound, psychologically acceptable, and physically useful, the professional person responsible must spend a great deal of time with the patient. Fitting a person for contact lenses is a complex, tedious process, requiring from 5 to 20 visits and return visits thereafter at least once a year.

The examination for contact lenses involves much more than that for spectacles. A number of different instruments must be used because contact lenses must be fitted to minute, exacting tolerances. As I have pointed out, no two eyes are alike. Not only do eyes differ from person to person, but it is exceptionally rare when a person's own two eyes are alike. The differences may be measurable only in thousandths part of an inch. Consequently, contact lenses must be made individually for each eye according to carefully worked out details of a complex prescription. Aside from the question of competence, a person who depends for his livelihood on the sale of merchandise is unlikely to have the time or inclination to give the patient the time and attention which is required to adequately instruct and supervise the contact lens patient.

Contact lenses should be prescribed and fitted only by licensed optometrists. No part of this practice should be delegated to the untrained and unlicensed so-called contact lens fitter. In all States and the District of Columbia, only optometrists and physicians are licensed to prescribe contact lenses. In actual practice, however, unlicensed, untrained, and unsupervised laymen are fitting contact lenses for a tremendous number of patients. This currently prevalent health hazard would be corrected by H.R. 12937.

Applicants for examination for optometry license must have at least 2 years of preoptometry training and 4 years in a school of optometry. They must have received complete training both didactic and practical, in physiological optics, geometric optics, ocular anatomy and pathology, general anatomy, diagnosis of ocular pathology, vision training, refraction, subnormal vision practice, contact lenses, ocular histopathology, physiology, psychology, general human anatomy, etc. Before being licensed they are required to pass rigid State board examinations covering all of the above subjects and must demonstrate their proficiency in refraction, vision training, visual field studies, subnormal vision, contact lens practice, and diagnosis of ocular pathology. Laymen who have not received this extensive type of training and background are simply not qualified to fit contact lenses.

An interesting point to illustrate this is that malpractice liability insurance rates for opticians (that is, laymen) are 50 percent higher than for optometrists, according to insurance specialists. I would like to quote from an article which was by Arthur Schwartz, a contact lens insurance specialist, entitled "Some Observations About Contact Lens Fitting by Technicians." Mr. Schwartz said, "There is an interesting relationship between the rates charged optometrists and those charged opticians for malpractice liability insurance. The optometrist bears a heavy professional responsibility-for which he is thoroughly trained, examined, and State-licensed-without supervision, or the need thereof. The optician, in theory, exercises no judgment. In theory, the optician has no function except to complete the work begun by the physician and to do so under the physician's personal supervision. Despite this great disparity in duties and, in consequence, exposure to acts or omissions which could lead to malpractice suits, the base rate charged optometrists is $10 per year. The base rate charged opticians who maintain "one-man" establishments grossing under $75,000 per year is $15-50 percent higher. That is, the National Bureau of Casualty and Surety Companies, which makes rates for most insurers, has found that its members' claim experience with opticians, despite the reduced exposure described, is much greater than among optometrists. This would indicate a higher frequency and severity of claims, claim reserves and claim payments among opticians."

Mr. Chairman, I am most appreciative of this opportunity to appear before this subcommittee to point out some of the evils which H. R. 12937 is designed to corWe earnestly request your approval of this vitally needed legislation.

rect.

At this point, and with the permission of the Chair, I would like to introduce the president of the Optometric Society of the District of Columbia, Dr. Henry J. Hoff.

Mr. DOWDY. Dr. Hoff.

STATEMENT OF HENRY J. HOFF, O.D., PRESIDENT, THE
OPTOMETRIC SOCIETY OF THE DISTRICT OF COLUMBIA

Dr. HoFF. Mr. Chairman and members of the subcommittee, my name is Henry J. Hoff, an optometrist with offices at 1212 I Street NW., Washington, D.C.

In regulating the practice of optometry in the District of Columbia, Congress is dealing with the vital interests of the public health and safety, and is entrusted with the responsibilities of protecting and enhancing the special gift of sight. The standards of conduct of such a profession obviously must be different from those which are traditional in the marketplace where the rule of caveat emptor prevails among traders in commodities.

We are not only concerned with providing safeguards against fraud, ignorance, incompetence, and deception, but also against practices which would tend to demoralize a profession by forcing its practitioners into a commercial rivalry which would increase the opportunities of the least scrupulous and penalize the most ethical.

Dr. McCrary discussed the problem of unlicensed, untrained laymen fitting contact lenses. Germane to this point I would like to call the subcommittee's attention to an article which appeared in the Washington Daily News on February 17, 1966, which was written by Mrs. Clare Crawford. Because of the importance of this article, I request permission to have it inserted in the record at this point.

Mr. Dowdy. It will be made part of the record. (The material referred to follows:)

[From the Washington Daily News, Thursday, Feb. 17, 1966]

How OUR GIRL REPORTER ACTED AS A DECOY TO HELP DISTRICT OF COLUMBIA POLICE MAKE TWO ARRESTS

(By Clare Crawford)

Two District opticians were arrested yesterday and charged with practicing optometry without a license after selling contact lenses to a Washington Daily News reporter.

They are Anthony Sax, of the Imperial Optical Co. Inc., 1334 G Street NW., and Norman Fields, of Embassy Opticians, Inc., 1361 Connecticut Avenue NW. Their arrests ended a month-long investigation which consisted chiefly of my going through the long process of being fitted for contact lenses.

Mr. Sax, 33, of the Hampshire Motor Inn, Langley Park, and Port Chester, N. Y., and Mr. Fields, 42, of 1142 Loxford Terrace, Silver Spring, were released on personal bond by Judge Edward A. Beard of the Court of General Sessions. Hearings were set for March 16 for Mr. Fields and March 17 for Mr. Sax.

COMPLAINTS

Police Inspector Scott Moyer initiated the investigation at the request of the District Optometry Board, which licenses optometrists. Dr. Zachary N. Ephraim, president of the Board, said it has been receiving an increasing number of complaints from contact lens buyers. In the most extreme case reported, a woman lost the sight of one eye.

I worked with narcotics squad Sgts. John Panetta and Thomas Didone. The narcotics squad enforces the city's healing arts law, which forbids the practice

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