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lishments 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 financial disadvantaged persons who need vision care.
As professional men and women, optometrists have great concern for people 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 those services. The Optometric Center of the National Capital, with local optometrists staffing the clinic, is voluntary, cooperates with 35 different agencies, including the District of Columbia Public Health Department.
Another serious problem which the quickie examiner cannot be expected to recognize is that a child considered to be retarded might only be handicapped by a vision problem, which gives a child the appearance of being awkward.' An article in the March 1966 issue of Reader's Digest reflects that of the Nation's 6 million retarded, probably more than 1 million have been misdiagnosed. A number are retarded by vision problems. They are not mentally retarded.
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 high-powered, 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 opportunities to present our views.
(The complete statement of Henry J. Hoff, 0.D., follows:) STATEMENT OF HENRY J. HOFF, 0.D., PRESIDENT, THE OPTOMETRIC SOCIETY OF
THE DISTRICT OF COLUMBIA Mr. Chairman and members of the subcommittee, my name is Henry J. Hoff. I am engaged in the practice of optometry in the District of Columbia and am currently serving my second term as president of the Optometric Society of the District of Columbia, which supports passage of the District of Columbia Optometry Act. I graduated from the School of Optometry of Columbia University and have been admitted to practice by passing the State board examinations in New York, New Jersey, Maryland, and the District of Columbia. I have been a member of the American Optometric Association since 1932. My military service was in the Navy. I enlisted in 1942, was commissioned an ensign in 1946 and was a lieutenant junior grade in the Naval Reserve when I retired from the service,
On behalf of my fellow optometrists in Washington, I want to express our gratitude to this subcommittee for considering this extremely important legislation for the protection of the public. In support of this statement I would like to quote a brief paragraph from a lecture delivered by Ward Halstead, Ph. D., member of the faculty of the University of Chicago. The lecture was delivered during the annual Reading Conference of the University of Rhode Island last July:
"Clear and efficient vision is one of the highest functions of the human brain. Part of what we, in psychology, have in the past attributed to the individual differences in native endowment of intelligence is probably due to the distortions of the outer world impressed upon the brain, and hence on the mind, through
neglect of vision or improper correction of visual problems. It is probably no accident that the English language uses the term 'I see' to mean 'I understand.' Let us all make certain * * * that the eye, as the great window of the mind, is properly cared for at all professional levels.'
The present law which regulates the practice of optometry in the District of Columbia was enacted in 1924. It remains unchanged after more than 40 years while optometry laws in all of the States have been revised and updated to keep pace with the changing requirements and needs of the people, as well as the growth of the profession. As a result, our District of Columbia licensing law is hopelessly antiquated.
In regulating the practice of optometry in the District of Columbia, Congress is dealing with the vital interests of public health and safety and with a profession which is entrusted with the responsibility for protecting and enhancing the precious gift of sight. The standards of conduct for 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 the profession by forcing its practitioners into a commercial rivalry which would increase the opportunities of the least scrupulous and penalize the most ethical.
At this point, I would like to quote from S. Howard Bartley of the Department of Psychology of Michigan State College who defines a professional as follows:
“A group of persons recognized and protected by law and public opinion as the only ones qualified to serve the public in certain specified ways, because of (1) the seriousness of the services to the public, (2) the adequacy of the training and education received by the members of the group, and (3) the group's guarantee to safeguard the public by certain standards of licensure and a body of ethics.
“From this, it may be seen, that six basic factors are involved in a profession, namely: (1) definition of the service area; (2) the implied uniqueness of the services within the area; (3) the seriousness to the public of the area covered by the service; (4) the need for special preparation by those rendering the services; (5) recognition, regard, and protection of the group by the public through its laws; and (6) the protection of the public by the group through its acceptance of responsibility.”
As professionals, members of the American Optometric Association are bound by its policy to make no profit on material supplied in connection with their services. They are instructed to pass on to their patients their exact laboratory and material costs and charge only for their time, knowledge, and skill.
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, entitled How Our Girl Reporter Acted as a Decoy To Help District of Columbia Police Make Two Arrests,” 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. [Exhibit 1. I would also like to offer clippings of stories on the same matter which appeared in the Washington Star on February 16 and the Washington Post on February 17. (Exhibits 2 and 3.] It will be noted that in one of these articles a spokesman for the optometric board is quoted as saying that hundreds of similar complaints have been filed in the past 2 years, but complainants had never agreed to appear in court before.
On February 18, 1966, the Washington Daily News published an editorial which read as follows:
"THOSE CONTACT LENSES “There has been growing official concern here, shared by the Washington Daily News, that the District's optometry law does not adequately guard the public in the delicate area of contact-lens fitting.
"Evidence had been mounting in recent months that many lens buyers were not getting the kind of professional service and care that these lenses seem to require.
"In response to numerous complaints, the District Optometry Board, the Corporation Counsel's Office, and District police jointly undertook an investigation.
*First, they had a look at the law-and they were dismayed. The optometry law had been enacted in 1924, when contact lenses were ali but unheard of. It stated that only a licensed optometrist, or an ophthalmologist, a physician, could examine the eyes for eyeglasses. It didn't mention contact lenses. In 1946, the Corporation Counsel, noting this fact, had written an opinoin that the fitting
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 ready made 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 he obviou , 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 astigmatis.n, 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,
“(6) 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;
“(s) 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.