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Mr. HARSHA. Well, would it be your opinion that this bill would prohibit such activities as you describe?

Mr. BABB. Yes, sir; and that is a very important phase of it.

I won't take any more of the committee's time on ads, but I do want to leave the Wichita Falls series here and the committee can judge for itself.

(The advertisement referred to follows:)

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Mr. BABB. I would also like to put into the record as the last example, a "confidential memorandum” from one of these commercial operators to his doctors. I won't read it all, but this is instructions to his doctor on how to examine the eyes of children, and all through it you will find where he encourages his doctors to use the ophthalmometer, or the ophthalmoscope because he says this is a very impressive instrument, and the whole tone of the memorandum is how to impress the parents, more than how to care for the vision of the children.

He also submits in here, and I will hand it up, he instructs the optometrist to fit children with prescriptions which are such that they will wear glasses all the time so that their patients will not think they do not need glasses.

(The "confidential memorandum” referred to follows:)

AUGUST 2, 1960. Confidential memorandum to: All optometrists. Subject: Review of procedure to be used on examining school and preschool

children. GENTLEMEN: Dr. N. Jay Rogers has requested that all optometrists be sent a copy of the memo of last summer with reference to examination of school and preschool children. Please review it carefully as you will be examining many children prior to the beginning of the school year. Sincerely,

W. ED ALLEN. (Copy of memo of July 1959) FELLOW DOCTORS OF OPTOMETRY: The following are the suggestions and recommenuations I offer. Please study them carefully and use them wherever possible.

1. Have parent in examination room. 2. Put child at ease by speaking in a friendly, soothing manner. Retain some illumination in room during examination, as child will be more at ease.

3. Get thorough case history. Attempt to get as much of case history from parent as possible.

4. Make thorough external examination including photopupillary and accomodative pupillary reflex; also "cover test” for any apparent muscular deviation. Do not invert eyelids. Just draw them back slightly and examine.

5. Make ophthalmoscopic examination. Explain to parent the condition and findings of the interior of the eye when you complete the internal examination. This is important.

6. Make examination with ophthalmometer if refracting room is equipped with one.

This is an impressive instrument. 7. Do not check unaided vision without phoropter in front of patient unless a vision deficiency is definitely indicated from case history or old Rx if worn (or old Rx record). You may have a child who definitely needs glasses but whose vision may not be impaired. The parent may get an erroneous impression if the child's vision is 20/20 unaided. You can always get unaided vision through the phoropter through plano. If you wish to demonstrate child's deficient vision to parent, it can always be done at end of examination.

8. Make static retinoscopic examination. Attempt to get as accurate findings as possible, especially the cylindrical power and axis. Be sure and record findings. If necessary, ask parent to assist in maintaining fixation.

9. Make dynamic retinoscopic examination. If a definite error of refraction is indicated by your retinoscopic findings, explain to parent what appears to be the eye condition of child. This will convince parent you are able to diagnose and ascertain the condition even before you have made any subjective vision tests. This is important. If parent is properly impressed with your knowledge and skill at this point, you will have achieved about 90 percent success already..

10. Make subjective examination. Limit subjective tests to the very minimum required to ascertain the desired Rx. Ask your question of the child in as clear and understandable a manner as possible, so that parent will never think the child is giving you the wrong answer. Use red-green test and flip-flop cross cylinders wherever possible; but keep subjective to a minimum, for the sake of proper impression of parent. Clock dial is not a good subjective test with children.

11. Make phoria tests wherever possible; far and near. 12. Test for amplitude of accommodation.

13. If there is a vision deficiency that can be demonstrated to parent, do so. If not, but if glasses are needed, simply forgo vision demonstration, and explain fully to parent why child needs glasses and how the lenses will correct the child's symptoms and trouble. Explain, also, how the child is to wear the glasses; whether to be worn constantly or just at certain times. It is generally best to prescribe a correction which the patient can wear as much as possible so that the parent will not feel that the child could probably get along without them since the child wears them so little of the time. Whenever possible it is generally best that the child be made to wear the new Rx constantly for the first 3 or 4 weeks in order to become accustomed to wearing glasses as well as adjusting to the new Rx. Of course, if glasses are for constant wear, the above would not be applicable.

14. A progress examination in 3 or 4 weeks should be recommended. Child should be brought back during the middle of the week to see if child is progressing properly with the new lenses. Parent should be told there is no charge for this progress examination, but that you just want to be sure child is getting along well and is adjusted to new lenses.

15. In any case where glasses are not indicated, it is as important to be sure of this as it is to be sure that glasses are indicated. Remember this: if you tell the parent glasses are not needed, but if in fact they are needed, should that child continue in school without glasses, you have done a grave injustice to the child and parents. If it is a borderline case, and you are uncertain, advise the parent that glasses are not indicated at this time, but your findings indicate the possibility of need of them in the future. Have the parent bring the child back in no more than 6 months for another examination. Be sure and tell the parent the importance of another examination.

CONCLUSION It is just as important that the parents have trust and confidence in you, as it is that your Rx be accurate.

This can be accomplished by the manner in which you make your examination and what you tell the parent.

When parents will refer their families and friends to you as a result of your satisfactorily examining and fitting their child, you can then claim and justly so, genuine optometric success frr yourself and optometry. I hope I have been helpful, even if only in small measure. Sincerely,

NATE ROGERS, O.D.,

Mr. BABB. Mr. Chairman, I apologize for taking so much of the committee's time. I know you have been patient in hearing me, and that you have a lot of witnesses, but we feel that these are good examples, once you open the door, of the things that this act is trying to stop. This is the type of consideration that the public in the District will get from those who try to commercialize this profession.

I thank you and with that I will be glad to answer any questions by any member of the committee.

Mr. Dowdy. Thank you, Mr. Babb. We appreciate your coming and presenting this testimony in this case. I am sure it will be quite helpful to the committee in its deliberations when it gets to the bill.

Mr. BABB. Thank you, Mr. Chairman.
Mr. Dowdy. Do you have any questions, Mr. Sisk?

Mr. Sisk. Mr. Chairman, I think we ought to commend Mr. Babb for a very excellent and very thorough statement here which I think brings out very ably some of the very things that we have had some experience with here in the District, particularly with this type of advertising which the witness mentioned, and I certainly want to commend him on making a very clear statement as to the problems involved and the basic objectives sought to be achieved here.

Mr. Dowdy. Thank you, Mr. Babb.
Mr. BABB. Thank you, Mr. Chairman.

Mr. Dowdy. Dr. Dryden, Dr. Albert, and Mr. Magee, you were here yesterday, and we are sorry to interrupt, but these people were from out of the District and from afar, and we did want to relieve them and allow them to testify so that they may leave.

Mr. MAGEE. We will be willing to step down any time, Mr. Chairman, if any other witness is in the same position—any time.

Mr. Dowdy. I am informed that Dr. Dryden had completed his statement, and Dr. Albert had not, and I didn't know whether he had one or not.

Mr. MAGEE. Dr. Albert has a statement, and I have a statement also, Mr. Chairman, which I would like to give, just a brief one. STATEMENT OF DAN G. ALBERT, M.D., PRESIDENT, SECTION ON

OPHTHALMOLOGY OF THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA

Dr. ALBERT. Mr. Chairman, members of the committee, ladies and gentlemen, I am Dan G. Albert. I have practiced ophthalmology in the Greater Washington area for the past 12 years. În 1938 I was graduated from the Ohio State University School of Optometry, receiving a B.S. degree. I practiced optometry in the State of New York for the next 4 years. During this time it became increasingly obvious to me that I was not satisfied with the limited training I had had to render eye care that I felt the public should receive. Following a 4-year tour of duty in the armed services, I entered Syracuse University College of Medicine and received an M.D. degree from that university in 1950. Following a year of internship, I took a 3-year residency program at the old Episcopal Eye, Ear, Nose, and Throat Hospital here in Washington, D.C., and started the private practice of pediatric ophthalmology with Frank D. Costenbader, here in Washington. În 1955 and 1956 I took the special examination in ophthalmology and am now board certified. It appears to me that

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