of contact lenses is 'within the scope of optometry.' But this opinion had never been tested in court.

'Anyway, the problem didn't end there. It is common practice here for a seller of eyeglasses to grind the lenses prescribed by an optometrist or an ophthalmologist. Sellers of contact lenses seemed to be following the same pattern. But the fitting of contact lenses requires more than a prescription; that is, more than a determination of the strength the lenses should be. It involves measuring the curvature of the eye, and, as the head of the District Optometry Board put it, placing 'a foreign object in the eye.'

"Officials decided it was time to determine, once and for all, whether the intent, if not the letter, of the law made this practice illegal. The News assigned Reporter Clare Crawford to help the city find out.

"Mrs. Crawford was fitted for contact lenses at two optical companies, a process that took about a month, and on Wednesday, two opticians were arrested and charged with practicing optometry without a license. In one case, the optician arrived at his own prescription; in the other-a more subtle test of the law-the optician required a doctor's prescription, but measured the curvature of Mrs. Crawford's eyes himself.

"The cases are now headed for court.

Whatever the court decides, it seems clear that the law needs to be clarified. It should set forth precisely what professional training should be required of lens fitters at all stages of the contact lens process. Possible injury to the eye is at issue; the penalties should be harsh enough to stay the hands of the unqualified."

The Daily News reported that men with no educational or licensing requirements and subjected to no regulation or supervision are now fitting customers with contact lenses in the District of Columbia. Some of the work these laymen are performing is not only inadequate and unsanitary, but in at least one case, a woman lost the sight in one of her eyes.

Mrs. Crawford, the News reporter who assisted the police in the investigation, was fitted for contact lenses by a layman without having any prescription at all and without being sent to a doctor to get one. Needless to say, this is highly dangerous because, as Dr. McCrary pointed out, not everyone can wear contact lenses and it takes a vision specialist to determine who can and who cannot wear them.

There are flagrant abuses taking place every day in Washington. The files of the District court reflect the case of a woman who recovered a judgment against one of these quickie establishments for the loss of sight in one eye from contact lenses she had been sold. The educational qualifications of the contact lens fitters in that case is illustrative of the problem; one had a B.A. in music and the other had completed 1 year of dental school.

In another case, a young man who was a participant in the Job Corps program was standing outside a jewelry store. A man lured him inside and sold him a

pair of glasses for which he was charged $86. The boy was successful in getting a job at a chain grocery store, but he was not able to pay the $86 to the jewelry store. They tried to garnishee the young man's wages and the grocery store, which has a policy of dismissing employees whose wages are attached, fired him. A subsequent vision examination disclosed that the young man did not even need glasses.

I am sure that the complaint file of the District of Columbia Board of Optometry Examiners is replete with similar stories of fraud and deceit.

The existing law does not adequately protect the public from those operators who are bilking individuals of their money and, in the process, possibly doing serious damage to their eyes.

It is interesting to note that on October 8, 1946, the Corporation Counsel of the District of Columbia in a memorandum to the District of Columbia Commissioners referred to as "deplorable" "the silence of the act regulating the practice of optometry in the District of Columbia on the subject of contact lenses and on other subjects now generally covered by statute in forward-looking jurisdictions." Journalistic investigations of abuses in the vision-care field similar to that reported in the Washington Daily News have been reported in national magazines. An article, "Racket in Eyeglasses," appeared in Red Book, November 1952, and said in part:

"Featuring, for the most part, low prices and speedy service, these unethical practitioners attract the very patients who can least afford to tamper with their eyesight-young people just starting their careers, young marrieds just beginning to shoulder enormous responsibilities, and-this, perhaps, is the most serious of all—an alarming number of young children. In all I visited more than 50 eyecare

shops-those with the biggest signs, the biggest advertisements, those that seemed to be getting the bulk of the trade.

"The routine with small variations was the same a quickie examination leading inevitably to a pair of glasses. *** A complete eye examination on an initial visit requires an hour or more. Yet the longest examination received lasted 14 minutes and the rest averaged about 8 minutes ***. If [the optometrist] is a mere employee in a mass-production, eye care shop and has a profitminded boss urging him to rush the patients through, he cannot possibly do a competent job, even if he wants to."

Time magazine, February 8, 1960, said, and I quote in part:

'Get-rich-quick operators swarmed into the [contact lenses] field, advertising directly to eyeglass wearers through the lay press and classified telephone directories. *** In an uphill fight to crack down on these fringe operators, the Federal Trade Commission found most of [their] claims untrue."

Good Housekeeping, April 1959, said, and I quote in part:

"As a rule, cut-rate eyeglass dispensers have examiners on the premise. The examinations they give rarely take more than 15 minutes. Most ophthalmologists and optometrists say a complete eye examination requires at least 45 minutes."

An article in Science Digest, September 1960, said in part:

"One firm, for example, claims that it can fit [contact] lenses for $29.95 in one sitting with 'satisfaction guaranteed.' *** A third concern states about its contacts: 'We wear them up to 6 months without removal.'"

(I might say that contact lenses should be removed each night to give the eyes a rest.)

In the past decade dozens of articles have appeared, such as those highlighted here, which sound a warning to the public of the dangers of unscrupulous operators in the field of vision care.

The problems involved with unethical practices in this area are: (1) misleading advertising, (2) the lack of adequate time for thorough examinations, (3) the lack of quality materials, and (4) consideration of profit motive above consideration of the patient's best interests. The motivation of a corporation is profit-not to render the best service or vision care to the patient.

The materials used by these outlets are often factory rejects of such a low quality that no ethical professional person would think of prescribing them for a patient. This would be comparable to a physician prescribing contaminated or rejected drugs or medicines. These reject glasses sell for about $1 per pair and are sold for about $15.

Over-the-counter sale of readymade eyeglasses is a particularly pernicious practice which the proposed law would also outlaw. The use of these readymade eyeglasses may, by giving some temporary improvement in vision, mask the underlying causes of changes in vision, changes which might be symptomatic of eye conditions or bodily diseases which would be disclosed during an eye examination. Self-treatment though the use of readymade eyeglasses interposes delay that can make successful correction more difficult or even impossible.

We all read of the traffic toll, loss of lives, injuries, on many of the highways of this city. Over 85 percent of the decisions of a motorist are the result of what he sees or doesn't see. Our society has worked closely with the motor vehicle department in attempts to either bar from the highways motorists with serious visual defects or to provide them with the necessary corrective eyewear. Eveyone who rides in a taxicab, sooner or later if he looks at the driver's identification card, has seen stamped on some of them the slogan, "Must wear prescription glasses." This is beneficial, but let me point out that any taxi driver can go to any one of numerous stores which sell readymade eyewear and for $1 or less buy a pair of glasses which he selects; and neither the passenger of the cab or a police officer who stops the driver can tell whether those glasses were prescribed or purchased over the counter. Practically the only way to prevent this is to prohibit the sale of corrective eyewear without a prescription by either an optometrist or a physician.

As Dr. McCrary pointed out, most eyes are different optically from their mates, and readymade eyeglasses ignore this fact since they have two lenses of equal power. Because of the obvious abuses in the area of readymade glasses, the Federal Trade Commission in 1963 adopted regulations to govern the optical products industry. The FTC set forth rules relating to deception in general, false advertising, bait advertising, deceptive prices, and other matters. These regulations say this about these glazed goods:

"RULE 2-FALSE ADVERTISING OF NONPRESCRIPTION MAGNIFYING SPECTACLES. It is an unfair trade practice for any industry member to publish, or cause to be

published, any advertisement or sales presentation relating to nonprescription magnifying spectacles (sometimes referred to as readymade sectacles) which represent, directly or by implication, that the spectacles so offered will correct, or are capable of correcting, defects in vision of persons, unless it is clearly and conspicuously disclosed in the advertisement or sales presentation that the correction of defects in vision by such spectacles is limited to persons approximately 40 years of age and older who do not have astigmatism or diseases of the eye and who require only simple magnifying or reducing lenses; or to publish or cause to be published any advertisement or sales presentation which has the capacity and tendency or effect of deceiving purchasers or prospective purchasers in any other material respect."

The danger involved herein springs from the tendency on the part of many people to self-diagnose their problem and think to themselves "All I need is a pair of dime-store magnifying glasses." We feel that if a person insists on playing Russian roulette with his vision, he should at least realize the risks he is taking. The mere printing of a sign or ad "not for those folks under 40 or those with astigmatism or eye diseases" does very little to remedy the problem. Commonsense tells us that few dime-store salesmen will require proof of age before selling a cheap pair of glazed-goods lenses to a person. In fact, I purchased a pair of these glasses in a Washington store last week, and I was not asked my age.

Statistics tell us that over 90 percent of the total population has some amount of measurable astigmatism, which these glazed-goods lenses never could be made to correct.

Statistics also tell us that from 2 to 4 percent of the population has some form of eye disease, and that there is a much higher incidence percentagewise for those over 40, and this incidence increases in frequency with the aging process. How can a person tell whether he has an eye disease which may eventually visually cripple or blind him if he must depend entirely upon his own observations?

I don't understand how a person, regardless of age, would know whether he had astigmatism or disease of the eye. To determine the answers to those questions, optometrists spend 6 years in college. Among the types of practices prohibited by the FTC rules following a lengthy investigation of abuses are

"(a) Statements in advertising which represent or imply that a specified price for prescription eyeglasses or contact lenses includes the cost to the buyer of necessary eye examination and test by an ophthalmologist or optometrist for the purpose of determining his visual defects and prescribing suitable lenses for the relief or correction thereof, when such is not the case,

"(b) Statements in advertising which represent or imply that complete eyeglasses are purchasable for a specified price when an additional price is charged for a component part of the complete eyeglasses (such as frames thereof);

(c) Statements in advertising which represent or imply that a specified price is applicable to all types and kinds of eyeglasses or contact lenses when a higher price is charged for certain kinds of types (e.g., when the stated price has applicability to eyeglasses with single-vision lenses and a higher price is charged for eyeglasses with bifocal lenses);

"(d) Statements in advertising which represent or imply that contact lenses may be purchased at a specified price when an additional and undisclosed charge is made for processing and fitting services that are necessary and made evident after first use by the buyer and during the period required for his adjustment to the use of such lenses;

"(e) Statements in advertising which represent or imply that products may be purchased on credit for the same price that is applicable to cash sales; that no downpayment is required in the case of credit sales; that no finance charge or interest is required when products are sold on credit or an installment payment plan; or that a finance or interest charge in the case of sales on credit will not exceed a specified amount or rate; when any such statement is false or misleading; "(f) Statements in advertising which represent or imply that the price at which an industry product may be purchased from the seller by a consumer purchaser is the 'factory' or 'manufacturer's' price when such price is higher than the usual and customary price paid by wholesalers or others purchasing directly from the factory in the trade area or areas where the representation is made."

With all due respect to the FTC for the fine job it is doing, regulating the advertising of optometric services is not the answer. It should be prohibited completely.

I have before me a full-page advertisement placed in a Washington newspaper a few weeks ago by one of our local department stores from which I'd like to quote (exhibit No. 4):

"Eyesight Is Your Most Precious Gift. Give Your Eyes the Best of Care," is the boldface headline. "Find a Big Choice of Becoming Styles in Our Budget Eye-Frame Bar. $5. $7.50. $10. Let us show you how attractive glasses can be. *** Keep the Natural Beauty of Your Eyes With Contact Lenses. We specialize in contact lenses *** and that takes know-how that only our long experience can provide. Fitting contact lenses is a science in itself, and our technicians are experts. You're invited to come in for a consultation. *** There's no obligation, of course. Our price for contact lenses is $95. *** Eye Frame of the Month. Men's New Gotham Frames Are Light as a Letter That Takes a 5-Cent Stamp. New lightweight frames, equally handsome with tweeds and dinner clothes. With the new uni-fit bridge, hidden hinges, and frames that absorb extraordinary punishment. Black, brown, or gray. Modestly priced and you may charge them, of course.'

There are many, many more even more objectionable ads which, I am sure, members of the subcommittee have seen themselves. The question Congress should ask itself, it seems to me, as it weighs its responsibilities to protect the health, welfare, and safety of the people of Washington is, Can a person in need of vision care receive the caliber of care he deserves from these mercantile, priceconscious establishments?

Dr. McCrary said this mercantile atmosphere might be all right when buying furniture, but it is not all right when applied to the field of vision care. I would like to point out that we have an optical center in one of our Seventh Street furniture stores, and I understand that the management of that store is presently unhappy with their optometrist because he is not producing enough revenue for the store on the basis of the number of square feet his optical center occupies. With respect to similar establishments, I have some slides here which I would like to show members of the committee. Under the proposed bill, I might add, these abuses would be eliminated. [Demonstration.]

As we have pointed out, the failure to control advertising is one of the most serious defects in the present law.

In many advertisements, it is stated that readymade glasses will relieve fatigue and eyestrain, prevent squinting, and make it easier to see small print. There can be no assurance that these glasses will accomplish any of these things, and, in fact they very often will cause eyestrain, fatigue, and squinting and make reading more difficult. The sale of readymade glasses to an uninformed and gullible public is an evil which all professional and lay organizations in the eye health and vision care fields agree should be eliminated without delay.

The specious argument that these glasses cannot harm one's vision or that poor people will be deprived of reading glasses is simply not true. In fact, even aside from the vision problem, some of these glasses represent safety hazards. [Demonstration.]

It, unfortunately, is true that thousands of individuals experiencing vision problems will shop for help at the mercantile, unethical establishments about which we have been talking rather than seek proper vision care from a professional. Many of these people mistakenly feel they must resort to this action because of the costs involved. There is assistance available to financially disadvantaged persons who need vision care. As professional men and women, optometrists have great concern for persons in financial need, and we feel that it is incumbent upon us to provide vision care regardless of a person's ability to pay for our services.

The Optometric Society of the District of Columbia has had a program of care for the indigent for several years. Until 2 years ago, free eye examinations and necessary prescription glasses were made available to the poor through the offices of the individual members of the society, but since then this program has been transferred to the new Optometric Center of the National Capital, with local optometrists staffing the clinic as volunteers. The Optometric Center cooperates with some 35 different agencies, including the District of Columbia Public Health Department. The center, during the past 2 years it has been in operation, has cared for more than 400 patients. Not only does our optometric center have vision care programs for the indigent, but Lions Clubs, District of Columbia agencies, and other groups augment these services.

The price advertising of ophthalmic materials should be prohibited. It is commonly referred to as "bait advertising." There was a time here in the District when so-called "dental parlors" indulged in price advertising, but this

has disappeared as a result of congressional action. There are still one or two localities in the United States where physicians advertise blatantly to give physical examinations for a price. This is contrary to the ethics of the medical profession, but they can't eliminate it in those localities without legislation. Medicine's disciplinary powers are much greater than ours because they can bar unethical practitioners from access to hospitals, both for themselves and their patients. Our profession has no such power; and, therefore, it is necessary to vest the Commissioners of the District of Columbia, acting through the Board of Examiners of Optometry, to erforce the practices which would be prohibited by the passage of this legislation.

Another serious problem which the quickie examiner cannot be expected to recognize is that a child considered to be retarded may only be handicapped by a vision problem which deceptively gives the child the appearance of being backward. The subcommittee may recall one such case where a young man, once the true cause of his problem was discovered, not only was not retarded, but was, in fact, a genius.

An article in the March 1966 issue of Reader's Digest (which originally appeared in Parents Magazine) reflects that of the Nation's 6 million retarded, probably more than 1 million have been misdiagnosed. The article states: 'Among the first of these hidden handicaps to be distinguished were defects of the senses. It can be tricky enough to test the sight or hearing of a normal child. How do you do it when your patient cannot read, speak, understand instructions, or even think beyond the most primitive level? How do you even suspect such a problem? ***

"A team trained by the Child Development Clinic screened children in an institution for the retarded, including 4-year-old Leonard, who had been carefully examined by a physician before being labeled mentally defective. As the team's psychologist tried to test Leonard, he got no response. 'I don't think,' he said at last, that this child is seeing the test materials.'

"Examination by an eye specialist revealed that Leonard was so nearsighted that he could make out only vague shapes and shadows. Strong glasses opened up the world to him. Soon he was home again with his family, a child of normal intelligence with a normal life ahead ***.

"In a 2-year study, 800 'retarded' children were sent to the University of Oklahoma Child Study Center. *** Of the 800, almost half-373-were found to have normal or near-normal intelligence. And, once their real problems were treated, over 80 percent of this pseudoretarded group showed either a normal or superior IQ. * * *

"In one recent case, a clinic team suspected that a 22-month-old boy was being cut off from normal development by a severe sight problem. He was referred to a local eye specialist, who confirmed that the child was indeed handicapped by poor vision. 'Later,' he said, 'we'll want him to have glasses.'

"When it was explained that more than sight was at stake, the specialist maintained that it was ridiculous to put eyeglasses on a baby, but agreed to try. Three months later, the boy was showing every sign of normal mentality. 'Now,' says the eye doctor, 'whenever I see an infant with vision problems I ask myself if they might interfere with mental development.'

Can we expect patients with these types of problems to receive the care and attention they need from jewelry stores and furniture stores and other highpowered, sales-oriented, commercial establishments where the owners worry about how much income a square foot of space produces and how profits can be increased by handling eyeglass and contact lens "customers" as quickly as possible? These untrained, unlicensed, unprofessional vision purveyors are operating today and every day in the District of Columbia, taking advantage of a trusting public. We urge you and your colleagues in the Congress of the United States to pass H.R. 12937 and eradicate these abuses from the Nation's Capital and afford the people the protection they need and deserve.

Thank you, Mr. Chairman, for affording me the opportunity to present our views.

Mr. HARSHA. Doctor, apparently what you are telling us is that some of these commercial concerns employ an optometrist, and then set up a department and engage in a very active and substantial sales program to promote their product. Now does this occur in Maryland? Dr. HOFF. Yes, sir.

Mr. HARSHA. And does it occur in Virginia?