in the District of Columbia; Mr. Frank Jones, who is president of the Washington, D.C., guild, even though he practices in Silver Spring; and to my left is Mr. Charles White, who is chairman of the Virginia Board of Opticians; and to my right, Mr. Joseph Stoutenburg, who is special counsel for the guild." The Guild of Prescription Opticians is a national nonprofit membership corporation representing skilled and ethical dispensing opticians throughout the United States, including the District of Columbia. The Guild of Prescription Opticians of Washington, D.C., is our affiliated organization in the District of Columbia. So far as this bill is concerned, we understand that Congress will be sitting as the legislature for the District of Columbia. Normally, therefore, our national organization would have a secondary interest. However, since a national association has admitted to be a coproponent of this bill, we can only assume that the proponents want to use this bill if enacted to establish a national pattern. We have asked for this opportunity in order to make known that both our organizations are opposed to H.R. 12937 and its companion bills. While there are literally dozens of passages in this bill which make it objectionable, there are three reasons why this bill should not be allowed to pass. They are: 1. This bill will substantially change the traditional patterns of visual care in this city; 2. This bill will put out of business many opticians in the District of Columbia; and 3. This bill will work to the detriment of the public. Permit me to comment on these three objections. The first being, the proposed bill is designed to change to upset, in fact-the traditional pattern of eye care. What is this traditional pattern of eye care? The oldest practitioner in the field is the optician, for whoever made the first pair of eyeglasses was, in reality, the first optician. By 1483 opticianry was developed sufficiently to warrant the formation. of a Guild of Master Spectacle Makers in Nuremberg. Initially, the optician helped those in need of visual correction by a trial and error method. He simply let his customer try on different. pairs of glasses. This process was carried on first by spectacle peddlers, who dragged their carts through the streets, and later in the optician's shop. In the middle of the 19th century scientific means of testing vision were developed. As this vision testing-or refraction-was developed, opticians naturally took an interest in these new methods and learned how to test eyes. Physicians, who had played a leading role in the development of refraction, were also testing eyes. As the medical men took more of an interest in sight testing, one group of opticians continued to do their own sight testing. The other group chose to make and fit glasses prescribed by the physician. The two groups of opticians were known respectively as refracting opticians and dispensing opticians. Around the turn of the century, the refracting opticians, that is, those who chose to continue testing eyes, took the name of optometrist in the United States. Those who chose to continue making glasses for physicians and to let the physicians do the testing became knownand are known today as dispensing opticians. 60-677-6614 The optician, in the tradition of his forebears, continues to provide optical services, exclusive of sight testing, to the public-primarily upon the authorization of the physician. Because of this relationship between dispensing opticians and physicians for more than a century, it is not surprising that opticians and ophthalmologists are opposed to this bill. Today, therefore, there are two types of practitioners providing optical services in this city, the optician and the optometrist with the unique difference between the two of them being that optometrists test sight and prescribe opticians do not. I might add, as an aside, that Franklin and Co., Inc., a member of our organization, has been functioning as opticians without interruption in this city for 111 years-years before the scientific development of sight testing and 50 years before the use of the term optometrist. We had in our audience yesterday, I don't know whether he is here today or not, the grandson of the founder of that business, and the present owner and manager of it. The third practitioner serving the needs of the public's vision is the ophthalmologist or oculist. He is a physician, a doctor of medicine, who specializes in the care of the eye and all its related structures. He is the only person legally and professionally qualified to diagnose and treat all eye disorders. He uses eye drops, eye ointments, and other medications, if necessary, in the examination and, treatment of the eye. He prescribes whatever eye treatment is necessary, including eyeglasses, contact lenses, optical aids for the partially sighted, and eye exercises. Traditionally, and most especially in the District of Columbia, the ophthalmologist does not provide the eyeglasses and other optical aids which he prescribes, but relies upon the services of the dispensing optician. What will this proposed legislation do to this traditional pattern of eve care? First, it will move the optometrist, by legislative action, to the level of professionalism. Second, it will make the traditional functions of dispensing opticians part of the practice of optometry. Third, it extends the practice of optometry into the field of medicine and ophthalmology by allowing optometrists through legislative action to diagnose departures from the normal. Our second reason is that this proposed bill will put opticians out of business. It is true that the bill purports to give certain exemptions to persons who fill prescriptions-spelled out in section 9(c)-but the definition of optometry creates a virtual monopoly of optical services when it includes the use or furnishing of lenses, prisms, or frames *** the fitting or adaptation of contact lenses. The dispensing optician has traditionally dispensed lenses, prisms, and contact lenses upon the prescription of a physician or optometristand has provided frames, frame repair, and lens duplication service without the necessity for a prescription. By the inclusion of these services in the definition of the practice of optometry, the services of a dispensing optician are defined as the practice of optometry. Though section 9(c) gives an exemption, that exemption is so confining that it will put out of business many optical stores in the District of Columbia. This bill would require the optician to have a written prescription in order to make lenses. In other words, I carry in my pocket a copy of my physician or my prescription for my eyeglasses. It is not signed by the physician, it is an exact copy. And if I need emergency repair, I cannot get that repair on the basis of the actual prescription I have written in my pocket. It requires a written prescription to duplicate lenses from existing lenses, a written prescription to repair broken frames, a written prescription to sell sunglasses, a written prescription to put old lenses in a new frame. All these are services traditionally rendered for the benefit of the public by dispensing opticians. Mr. HARSHA. May I interrupt? Mr. MILLER. Yes, sir. Mr. HARSHA. Aren't you required to have a written prescription to make lenses? Mr. MILLER. I am not familiar with the practice in the District of Columbia, but in some areas this may be done by telephone, rather than by a prescription, so presumably a physician or an optometrist could give the prescription over the telephone. Mr. HARSHA. How is it done here in the District? Mr. MILLER. I will have to ask one of the District opticians, Mr. Teunis. Mr. TEUNIS. We can in the District, as one of your constituents, as we have done on many occasions for Members of this House, If you have an emergency and break a lens, if you have a large enough piece intact, we can take a reading from the lens and we would duplicate it without a prescription. If the lens cannot be duplicated, we will immediately try to contact by telephone or telegraph that person's eye doctor or optometrist, whoever is needed to prescribe. Either that, or they have a copy of the prescription, otherwise we have to get an examination. Does that answer your question? Mr. HARSHA. Yes, thank you. Mr. SISK. Thank you. Mr. MILLER. Not only must the prescription be written, the prescription must be signed by a physician or an optometrist licensed in the District of Columbia. By prohibiting opticians from performing such services without a written prescription, the proposed legislation forces patients of ophthalmologists to go to optometrists-which is contrary to the interests of the public, the ophthalmologists, and the opticians. This proposed legislation prohibits the optician from doing the mechanical and technical work in dispensing contact lenses to patients who have had a complete medical eye examination for contact lenses and who hold a prescription for contact lenses. The optician performs this function only on the written prescription of an opthalmologist or an optometrist and has done so traditionally. Now, our time is much too short to go into the optician's role in the fitting of contact lenses, but I ask the chairman's permission to submit at this time a statement for the record which outlines the optician's original contributions to this field and describes the role which opticians play in dispensing contact lenses upon prescription. Mr. SISK. That will be made a part of the record. (The pamphlet on "The Optician and Contact Lenses" follows:) THE OPTICIAN AND CONTACT LENSES (A Statement by the Guild of Prescription Opticians of America, Inc.) I. INTRODUCTION In recent years throughout the United States, a far-reaching controversy has developed concerning the proper function of the dispensing optician in the contact lens dispensing field. Various agruments have been advanced on all sides of the controversy, primarily by those persons who are intimately involved therein: ophthalmologists, optometrists and opticians. It is the purpose and objective of the following discussion of this problem to reach a sound conclusion, based on all relevant factors, as to the legal and proper scope of the optician's responsibility in this area. II. DISCUSSION A. Contact lens fitting in historical perspective The concept of what is now known as a contact lens is by no means a new one. The idea from which contact lenses subsequently developed originated in the early 19th century. Early experimentation is said to date back to the era of Leonardo da Vinci (1452-1519). The position of the dispensing optician in the early years of contact lenses cannot be clearly defined, as there was no distinction made in those years between an optician and what is now known as an optometrist. While early refraction and eye care was performed by physicians, opticians played an important role in optical dispensing and in the development of equipment relating to eye care. One writer has suggested with respect to a popular instrument, the keratometer, that if the keratometer's use were to be restricted, “* * * historically it should be restricted to astronomers, opticians, physicists, and physicians." Dr. Arthur H. Keeney, "Scientific Tools and Proprietary Prerogatives" 52 American Journal of Ophthalmology 277 (August 1961). Thus is illustrated the importance of the optician in optical history. In the 19th century, eyeglasses were generally sold by opticians, either according to a physician's prescription or as selected by the wearer. Prior to the turn of the century, some opticians began to engage in refraction and adopted the name "refracting opticians." Those refraining from this practice became known as "dispensing opticians." The "refracting optician" became legally and commonly identified as "optometrist" between 1901 and 1925. It can be seen from the above that the distinction between an optometrist and an optician developed not from any legislation or legal basis but rather from custom. Optometry evolved out of opticianry when certain opticians began engaging in refracting. Only after this evolution did legislation begin to appear authorizing optometrists to measure the powers of vision and to adapt lenses for the aid thereof. The immense popularity and public acceptance of contact lenses is of relatively recent date, as is the controversy over the optician's function in contact lens dispensing. Historically in the contact lens field, the roles played by the physician, optometrist, and optician in this field followed those in the general eye care field. Opticians pioneered in contact lens dispensing in the early 1930's. When contact lenses became developed for general use by the public, opticians assumed as a matter of course the function of designing contact lenses upon written prescription and delivering them to the customer. Similarly, the physician and the optometrist assumed the same functions with respect to contact lenses as they performed with respect to regular eyeglasses. This situation, and the division of functions between physicians, optometrists, and opticians, exists generally today except where modified by statute. In the contact lens field even as in the area of regular eye care, the optician has played a tremendously important role historically. Indeed, many of the early contact lens pioneers and persons most responsible for the development of contact lenses were engaged primarily in optical dispensing. It is noteworthy to set forth a few of the accomplishments of opticianry in the contact lens field. Some of the original contributions of opticians in this area are as follows: (1) Development of a molding technique for taking impressions of the eyes; (2) Discovery of the fluorescein and blue light method for checking contact lenses; (3) Production of the first all-plastic contact lens; (4) Design of fluid less scleral contact lenses; (5) Development of scientific design methods and techniques of insertion and removal; (6) Production and patenting of corneal lenses; (7) Devising of slide-rule procedures for calculating contact lens powers; (10) Use of keratometer in measuring the cornea of the eye; (11) Publication of numerous textbooks concerning contact lenses. The above contributions, and many others not listed, demonstrate the fact that opticianry has played a crucial part in the development of modern contact lens technology. This role of the optician in the contact lens field, and the contributions of opticianry in this area, are of continuing importance today. B. The contact lens process and the optician's function (1) Mechanics of contact lens dispensing.—We do not attempt here to discuss in detail the technical matters and procedures involved in contact lens dispensing, but rather the general procedures and basic decisions involved in such dispensing. An understanding of these basic mechanics is essential to defining the proper function of the optician in contact lens dispensing. The overall process of contact lens fitting can be separated into three fairly distinct phases. The first phase encompasses general and special medical history and diagnostic examination. In this phase, decisions must be made as to whether or not the person needs a visual aid of any sort and then whether or not contact lenses should be applied to correct the visual defect. This latter decision must be based in large part on a diagnosis of the capability of the cornea to adapt physiologically to contact lenses. If the decision is in the affirmative, then the refractive prescription is obtained. The second phase of the contact lens process involves the actual designing of the lens from the prescription and delivery to the customer. During this phase, the physical characteristics, primarily curvature, of the appropriate lens are finally determined. The primary instrument utilized in this process is the keratometer, sometimes called ophthalmometer. This is primarily a measuring tool used to check the curvature of the contact lens. În the hands of an optician, the keratometer is a purely nonrefractive instrument used for measuring contact lenses. In addition to the keratometer, another instrument commonly used by opticians in contact lens dispensing is the slit lamp. The slit lamp is used to study the fit of the contact lenses; it determines the accuracy of the design of the lenses. Other mechanical and technical tests of the lens are also conducted. After these tests, complete information is at hand concerning the radius, size, power, and other details of the lenses. From this information the lenses are fabricated. Upon inspection after fabrication and design, the lenses are delivered to the wearer, who is instructed on the proper wearing and care of the lenses. The third phase of this process involves the followup medical examination and evaluation of the effect of the lens on the eye. This should generally be a continuing process, since periodic examinations are needed to diagnose possible latedeveloping complications. (2) The optician's function in contact lens dispensing.-The three phases of contact lens dispensing described above are basically those which are followed today. This first phase, which involves medical examination and prescription, obviously cannot be performed by an optician. In fact, many physicians seem to be of the opinion that examination for contact lenses should not be performed even by an optometrist, because of the potential pathological consequences of contact lens wearing. In spite of this contention, no statute or reported decision has forbidden an optometrist from prescribing contact lenses. The third phase described above is also properly the function of the physician, since it involves continuing medical examination of the physical effect of the lenses on the patient's eyes. Opticians are presently engaged in carrying out the second phase of the abovedescribed contact lens process. The duties performed by the optician in this phase are set forth below. First of all, a dispensing optician will design and deliver contact lenses only upon a written prescription of an ophthalmologist which specifies that the customer's eyes are suitable for contact lenses. Without this specification, contact lenses will not be dispensed by the optician. When the patient first arrives at the optician's office, the optician endeavors to impart to the customer any mechanical information which the customer may desire concerning contact |