obligated and are legally required to refer patients needing medical or surgical attention.

The ophthalmologists, on the other hand, give their primary attention to the treatment of diseases of the eye and surgery, although they also may legally prescribe lenses and frames, and is interested in the enhancement of visual performance as well.

The optician, on the other hand, is primarily a mechanic, and the amount of training varies tremendously among the 50 States. I am not familiar with the way it is here. They are not licensed in the District of Columbia, so that anyone may call himself an optician who wishes to. So that we have two licensed groups and an unlicensed group in general, although the opticians are licensed to some extent.

For instance, in my own State of California, opticians are licensed, but they may receive a license by the simple process of having three physicians sign their petition to the medical board of examiners, and they take no examination and need not present any evidence that they are certified in any way.

Mr. HORTON. How can department stores provide this advertising and provide this service under the existing law in the District of Columbia?

Dr. MORGAN. I would have to defer that to one of the people who is more familiar with the present District law than I am. I have read the new act, but I am not familiar with the old act.

Mr. HORTON. In your judgment, will the new act prohibit that? Dr. MORGAN. Yes, sir. I should say my experience would be temporarily.

Mr. HORTON. Would you explain that?

Dr. MORGAN. Well, we have in California, for instance, a restriction against price advertising. It is in the California Optics Act. This worked very well for a while, until some clever attorney found out that one way around this was to insert an ad "Call us up and find out what our low one price is." I mean no price was mentioned. And so it was necessary to amend the Optometry Act to make this also illegal, and this was done recently.

Mr. HORTON. In other words, that is not in the bill that is proposed here?

Dr. MORGAN. I am not an attorney, so I would not be in a position to know.

Mr. HORTON. From your practical experience in California, would the provisions of this act be sufficient to cover that type of advertising by department stores and the like.

Dr. MORGAN. Well, this act, I think, is more extensive than our present Optometry Act in California, in that it prohibits any advertising, not only price advertising. The Californía act merely prevents advertising.

Mr. HORTON. Thank you.

Dr. MORGAN. Preprofessional courses that are concerned with developing optometrists' competence to make professional judgments with respect to contact lenses, orthoptics, presence of ocular pathology, et cetera, are: biology, chemistry, physics, math, and psychology.

To understand how corneal tissue is affected by contact lenses, one must understand the metabolism of the cornea. Such understanding begins with biology and chemistry.

To understand how miniscule changes in curvature of the ocular surface of the contact lens affect the relationship between lens and cornea, one must begin with physics and mathematics.

To assist patients in proper adaptation to contact lenses, one must understand human behavior, the formal study of which begins with psychology in preoptometry.

It is my opinion that optometry has not only earned its place in contact lens placing, but that place is preeminent because the profession has met the needs for education and for research and has developed the most significant literature in the contact lens field.

I might add parenthetically that one of my own faculty members. Robert Mandel, has recently published a book I think that most authorities would consider the authoritative textbook on contact lens practice.

Some of the previous witnesses have emphasized the evils of optometric practices in commercial establishments. I think the members of the subcommittee will be interested in some of the classified ads which have appeared during the past few months in the Optometric Weekly trying to lure our graduates into these mercantile companies. I have here several of the ads, and they are marked. (The material referred to follows:)

EXHIBIT No. 2

[From the Optometric Weekly, 5 North Wabash Avenue, Chicago, Ill.]

Indiana optometrist wanted for Indianapolis area. $25,000 for man with qualifications. Address B-333 Optometric Weekly.

Optometrist Wanted: Ohio licensed or M.D. for qualified refractionist. Excellent opportunity, refracting only. $12,000 to $15,000 per year. Replies confidential. Address B-373 Optometric Weekly.

INDIANA O.D.-Exceptional opportunity to make $19,500 per year refracting only Indianapolis area. Replies confidential. Address Box B-89 Optometric

Weekly.

Dr. MORGAN. From the salaries offered, one can well imagine the fantastic profits that must be made from selling eyeglasses and contact lenses. I would like to quote from some of these advertise

ments.

Wanted: Indiana licensed optometrist for association in growing optometric practice. Diversified functions. Beginning salary $15,000 plus profitsharing. Other fringe benefits. ***

Wanted: Indiana optometrist. Earn $20,000 in optometric practice. Refracting, general duties, and management. ***

Wanted: Arizona optometrist. Earn $35,000-plus first year. Refract only. ***

Michigan optometrist wanted for Muskegon, Mich. Salary $15,000 per year plus vacation and other benefits. Refracting only. Contact lens experience important.

***

Indiana optometrist wanted for Indianapolis area; $25,000 for man with qualifications. * * *

Optometrist wanted: Ohio licensed or M.D. for qualified refractionist. Excellent opportunity, refracting only. Salary $12,000 to $15,000 per year. * * * Wanted: Alabama licensed optometrist. Start $15,000 with paid vacation. * * *

Indiana, O.D. Exceptional opportunity to make $19,500 per year refracting only. ***

Wanted: Texas-licensed optometrist. Work only 48 weeks each year; 51⁄2 days. Two weeks off in December and 2 weeks off in May. Earn $11,500 minimum to start with potential of more than $12,000. *** Moving expenses paid. * * *

And they go on and on and on. It is very difficult to convince a graduating student to go into professional practice and expect not to equal these incomes.

Because vision is one of man's greatest gifts, it should be protected with the utmost care. Good sense dictates that only a competent, ethical, well-trained professional should be entrusted with a gift as precious as vision.

I sincerely hope that Congress will approve this legislation. It has been a privilege and a pleasure to appear before this distinguished subcommittee and I thank you for the opportunity.

(The complete statement of Dr. Morgan follows:)

STATEMENT OF MEREDITH W. MORGAN, M.A., O.D., Ph. D., DEAN, SCHOOL OF OPTOMETRY, UNIVERSITY OF CALIFORNIA

Mr. Chairman and members of the subcommittee, my name is Meredith Morgan and I reside at 11 Silver Leaf Court, Lafayette, Calif. I obtained my degree in optometry in 1934 from the University of California, Berkeley. In 1936 I returned to the University as a graduate student in physiology and received an M.A. in 1939 and a Ph. D. in 1941. Since 1942 I have been a member of the faculty of the School of Optometry at Berkeley and for the past 5 years I have served as dean of the School of Optometry of the University of California.

It should be clearly understood that the opinions I express are my own and do not necessarily represent the opinion of the university, the American Optometric Association, or any other group or individual. My claim on your attention and my reason for being here is that I hope I know something about optometry after serving as an optometric educator for nearly 25 years.

The field of optometry, as presently constituted, has been determined by its historical heritage; by the laws regulating and defining it; by court decisions interpreting these laws; by custom, practice, and public opinion; and by what has been and what is being taught in its schools and colleges. Since these are all changing factors, not everyone looking at the evidence presented will come to the same conclusion as to the real field of optometry. The interpretation which I will present represents, I believe, the opinion of the vast majority of optometrists, all of the schools and colleges of optometry, and the Council on Optometric Education, the officially recognized accrediting body in optometry.

Technically, optometry is the clinical application of the physiological optics, the science of vision. It deals with all phases of the optics, physiology and psychology of vision. It is particularly, but not exclusively, concerned with the detection, measurement, and correction of optical defects, physiological malfunctions, and psychological perceptions which detract from efficient visual performance. Optometry is dedicated primarily to the enhancement of vision. Therefore it is also concerned with the preservation of vision and thus accepts the responsibility for the intelligent referral of individuals with ocular or systemic diseases, and patients in need of corrective surgery. Today optometry considers itself to be one of the health care professions based on the biophysical sciences.

At the present time optometric education is in a transition stage from a 5- to a 6-year program of collegiate education. All but 2 of the 10 schools of optometry are operating on a 6-year program and, soon, all schools will be on such a program. The programs of the various schools vary in details but the general academic plans are similar. Since I am best acquainted with the program at my own school, which will hopefully prepare some of the future optometrists for the District of Columbia, I will use our program as a model (exhibit No. 1). The educational objectives of the School of Optometry are

(1) To provide the student with the necessary professional training and education so that he may successfully engage in the practice of optometry and that he be sufficiently competent to deserve the trust of his patients and the esteem of his professional colleagues.

(2) To provide him with the basis for an understanding of the place of optometry in, and its relation to, society.

(3) To prepare the student for intellectual, political, and cultural citizenship and leadership.

(4) To instill in the student a respect and desire for knowledge and truth which will continue through his lifetime.

In order to achieve these objectives our curriculum has been divided into two categories: preprofessional education and professional education.

The preprofessional curriculum may be completed at any accredited collegiate institution and consists of a minimum of 90 quarter hours in the same kinds of courses usually taken by premed and predental students. The following subject areas must be included: general chemistry, organic chemistry, analytical geometry and calculus, English bacteriology, general physics, psychology, and physiology or biology. Theoretically a college student should be able to complete such a program in 2 years, but the usual student takes 3 years.

The professional program requires 4 years of intensive work and is designed to meet all of the stated educational objectives. The first year consists largely of advanced work in the basic sciences and includes courses in general human anatomy, ocular anatomy, geometrical and physical optics as advanced physics courses, general and mammalian physiology, the optics of the eye, and mechanical optics. In addition, a course in biometric statistics is required.

The second and third years add the clinical and optometric sciences to the advanced basic sciences. For example: In the first year the student studies anatomy and physiology including a course on cellular mechanisms underlying biolectric, secretory, and contractile phenomena in living organisms. In the second year he studies the vegetative functions of the eye including such topics as the physiology of the cornea and lids; formation and function of lacrimal fluid; metabolism and circulation in the eye; physiology and biochemistry of the lens; iris and pupil; accommodation; and the characteristics of drugs producing miosis, mydriasis, cycloplegia, accommodative spasm, and anesthesia of ocular surfaces. Then after the study of normal function, it is natural to study abnormal function in an Introduction to Pathology. This includes a study of basic pathological processes in human development, senescence and disease and a correlated survey of disturbed function in disorders of visceral systems, including disturbances of electrolyte and fluid balance and of metabolism. Other similar examples in optics, refraction, and the analysis of clinical data could be given but I do not wish to make this presentation too long.

The fourth and final year is almost entirely clinical. It is during this year that the student applies all he has learned by helping patients obtain the most efficient vision possible.

In addition to the basic sciences, the advanced sciences, and the clinical sciences, we are this year adding work designed to give the student an appreciation of social and community structures, the community agencies, health care problems, and modern society. We believe that the various health care professions such as optometry must be better prepared to serve in a modern, complex, coordinated society in which most forms of health care will include the practitioner, the patient, and third parties such as agencies of government.

The present-day optometric education is designed to prepare an optometrist to differentiate the normal from the abnormal; to measure all of the functions of the eye; to use lenses, prisms, visual training, orthoptics, and pleoptics; and to intelligently refer patients with nonoptometric problems.

I wish to emphasize that the optometrist is qualified to recognize the presence of disease by virtue of his training. He is deeply concerned with the detection of any condition which may require referral of the patient. He gives a careful, detailed examination to detect the presence of eye disease, or the symptoms of any general disease as evidenced in the eyes.

First he inspects the exterior of the eyes and lids and may measure the pressure within the eyeball. Where the examination or the history indicates the need, he investigates the field of vision. Then by means of the ophthalmoscope, an instrument which shines a bright light into the interior of the eye, he is enabled to examine the optic nerve head and determine whether it presents a normal appearance. Do the blood vessels appear normal, or are they constricted, tortuous or otherwise abnormal? Have there been hemorrhages? Is there any sign of inflammation? In short, is there any evidence of pathology?

It is the legal and moral responsibility that the examining optometrist be qualified to recognize pathology of the eye. Optometrists, of course, do not treat diseases of the eye, but the optometrists graduating from our schools of optometry throughout the Nation have been well trained to recognize these diseases so they can refer the patients so afflicted to medical specialists. Many

persons do not know they have an eye disease until the condition is discovered during a routine eye examination. Since 75 percent of the optical devices are prescribed by optometrists, much eye disease would go undetected if the optometrist were not trained to recognize it.

Not only do individual optometrists make referrals to other professions, but records of the Optometric Society for the District of Columbia show that from July 1, 1964, to January 1, 1966, some 214 persons were referred to ophthalmologists or hospitals for emergencies or other medical eye problems. I make this point solely to indicate that optometrists are cognizant of the fact that there are optometric eye problems and there are medical eye problems. It is and always has been our policy to deal objectively and fairly with the patient's problem and to handle it in the patient's best interest. It is imperative therefore that optometrists have a knowledge of anatomy and physiology, vision, refraction, visual anomalies and their correction. They must have the ability to conduct an adequate visual examination and analysis of visual needs. They must understand the fundamental laws of light, leases and prisms and their application to vision. They must study the relationship of psychology to the visual process and to the care of their patients. In addition they must have the mechanical ability to fit and adjust the optical device to the eye for maximum comfort and best vision. To qualify for his license, the optometrist should be required to pass a rigid comprehensive clinical and written examination or in other manner specified in the law to prove his proficiency in these areas.

Contact lenses comprise a specialty requiring special training.

Preprofessional courses that are concerned with developing optometrists' competence to make professional judgments with respect to contact lenses, orthoptics, presence of ocular pathology, etc., are biology, chemistry, physics, math, and psychology.

To understand how corneal tissue is affected by contact lenses, one must understand the metabolism of the cornea. Such understanding begins with biology and chemistry.

To understand how miniscule changes in curvature of the ocular surface of the contact lens affect the relationships between lens and cornea, one must begin with physics and mathematics.

To assist patients in proper adaptation to contact lenses, one must understand human behavior, the formal study of which begins with psychology in preoptometry.

It is my opinion that this education better prepares students of optometry to evaluate contact lenses with respect to an adequate fit than is a practitioner in any other field. Optometric schools at Indiana University, Ohio State University, as well as the University of California, have pioneered in studies of the effect of contact lenses upon such physiological functions as metabolism, temperature, carbon dioxide buildup, and corneal curvature change. Optometry students also gain routine experience in fitting contact lenses in their final (clinical) year of study. Each is responsible for from 6 to 30 patients which he handles under direct supervision, and each is further exposed to additional demonstration patients. In addition the students in each school learn to fabricate and modify contact lenses. The faculty personnel responsible for this area of instruction have generally demonstrated competence by doing research and writing.

The National Board of Examiners in Optometry as well as each State board requires that each successful applicant demonstrate proficiency in contact lens fitting. Optometrists who graduated before the increased attention to formal instruction in contact lenses have flocked to postgraduate courses in basic procedures as well as advanced courses to gain increased competence in fitting and in understanding basic principles of contact lenses. The American Academy of Optometry, the American Optometric Association and virtually all of the State optometric associations have held numerous postgraduate educational sessions and seminars to give basic and practical instruction to optometric practitioners. Optometry has not only earned its place in contact lens practice, but that place is preeminent because the profession has met the needs for education and for research and has developed the most significant literature in the contact lens field.

I am presenting the committee with this, "Encyclopedia of Contact Lens Practice.' A cursory glance at its contents should convince anyone that contact lens procedures are too complex and important to entrust to anyone other than those who are schooled and qualified by examination for service in this field.

Some of the previous witnesses have emphasized the evils of optometric practice in commercial establishments. I think members of the subcommittee will be