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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 xperiencing 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 enforce 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.
Dr. HOFF. Not any more in Virginia. They have passed a new optometry law in Virginia which does not permit the advertisement of professional ability or professional services.
Mr. HARSHA. If we should enact this legislation that you are supporting today, then you would still have the problem in Maryland.
Dr. Hoff. I believe that problem will be attacked in time, sir.
Dr. McCRARY. Mr. Chairman, with your permission I would like to present our next witness, Dr. Meridith W. Morgan, Jr., dean of the School of Optometry of the University of California.
Mr. WHITENER (presiding). All right, Doctor.
STATEMENT OF MEREDITH W. MORGAN, JR., O.D., PH.D., DEAN,
SCHOOL OF OPTOMETRY, UNIVERSITY OF CALIFORNIA
Dr. MORGAN. 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, 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. I would like to submit our page proof of our bulletin.
Mr. WHITENER. Without objection, it will be included in the record.
(The material referred to appears in the appendix on pp. 329-348.) Dr. MORGAN. The educational objectives of the school of optometry
First. 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.
Second. To provide him with the basis for an understanding of the place of optometry in, and its relation to, society.
Third. To prepare the student for intellectual, political, and cultural citizenship and leadership.
Fourth. 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 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 bioelectric, 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 the 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 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, and that he considers himself obligated to do so. 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, of the symptoms of any general disease as evidence 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 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. These persons telephoned the society office and were referred directly by the society to other practitioners for attention to their problems.
Throughout the United States a study made several years ago indicates that something in excess of 2 percent of optometric patients are referred to other practitioners for additional services. I wish