It is interesting to note that this B store ranked 19 during the month of October and promises even better things in the months to come. Port Huron, another B store, ranked 53.

"During these past months I have been commenting on the good performance of several of our stores, however, there are many other stores whose sales performance show the need for improvement. Let's pick them up! ***."

"The month of September was a good sales month. It saw the attainment of an alltime sales high which accounted for an increase of 25.5 percent over September of last year.

"A fine job, and all of you concessionaires are deserving of a word of commendation✶✶✶”

I ask you, gentlemen: Is it possible for a patient in need of vision care to receive the professional care and attention he needs in this type of crass, commercial, sales-oriented atmosphere?

When an interested third party-an individual or a corporation-interposes himself between the doctor and his patient-the professional man is not free to place the welfare of the patient above all else. If the optometrist's income depends on the volume of patients he sees in the day and on the number of lenses and frames which he "sells," the professional vision care of the patient must certainly suffer. Corporate practice does not allow this freedom of judgment.

I know of one individual who practices optometry under about 20 different names in 9 States in 200 offices. In fact, he has multiple optical outlets in the same city which compete with each other, each aiming their advertising campaign at different levels of the vision "market."

With respect to section 10(a) of the proposed bill, I would like to point out that the codes of ethics of medicine, dentistry, and optometry declare that advertising to the public is unethical. The practitioner can offer only his reputation, skill, training, ability, experience, and the trust and confidence of his patients. These are not matters to be offered via the usual means of advertising.

The argument is sometimes raised that the optometrist dispenses to his patient an article of personal property such as eyeglasses and it is claimed that, therefore, advertising should be permitted. A simple analogy refutes this argument. When the orthopedist furnishes his patient with the neck collar or the brace to support a limb or a back, these, too, are articles of personal property; but they may not ethically be advertised. When the dentist supplies his patient with dentures, bridgework or similar dental appliances, he, too, is furnishing articles of personal property; but these likewise do not fall in the category of being ethically advertised. Likewise, in optometry. Eyeglasses are not optometry per se; they are incidents of the practice of optometry, the results which may be indicated. The practice of optometry is primarily and basically the exercises of training, talent, discretion, and professional judgment involved in the examination of a person's eyes to determine whether anything is needed, and just what it shall be, for the purpose of correcting, improving, and making comfortable the vision of the patient.

When a package price is offered in advertisements, profit-oriented companies must turn over a high volume of patients and, therefore, are unable to give the professional, detailed personal attention which the patients require. There is a very definite danger in shortcut quickie eye examinations, especially those for contact lenses.

The poor, the uneducated, and the elderly are ready prey for these unethical charlatans who lure them with advertisements and seem to have no compunction in taking advantage of their gullibility to make a quick profit. Advertisements by these purveyors of vision goods are often misleading and serve as "bait" for those who feel they must look for a bargain. Too often it turns out to be a very costly bargain. Unfortunately, it is the poor, the uneducated, and the elderly who are most likely to choose someone to help them with their vision problems on the basis of advertising, low price, or the personality of some salesman. It is imperative that only well-trained, properly licensed professional vision specialists be called upon to help these people overcome their vision problems. Each patient, and indeed, each eye of each patient, is unique unto itself, presenting problems which require the total time, training, skill, and energy of a professionally trained, licensed and experienced optometrist or physician. The responsibility for such a delicate and complex procedure cannot be delegated to nonprofessionals who have, at best, only a superficial knowledge of the physiological, psychological, and anatomical principles involved.

To protect the public against unscrupulous persons, the proposed licensing law is urgently needed and essential to make certain that those prescribing eye care meet qualifications of training competence and character.

63-977 0-66- 3

CONTACT LENSES ARE A SPECIAL PROBLEM

It has long been the position of AOA that unlicensed, untrained laymen should not be permitted to fit contact lenses and instruct patients in their use, handling, and hygiene. It is imperative that only licensed optometrists or physicians prescribe and fit them. All persons cannot wear contact lenses and it takes a well-trained, competent vision specialist to know who should and should not wear them. Furthermore, in order to properly design a pair of contact lenses so that they will be visually correct, physiologically sound, psychologically acceptable, and physically useful, the professional person responsible must spend a great deal of time with the patient. Fitting a person for contact lenses is a complex, tedious process, requiring from 5 to 20 visits and return visits thereafter at least once a year.

The examination for contact lenses involves much more than that for spectacles. A number of different instruments must be used because contact lenses must be fitted to minute, exacting tolerances. As I have pointed out, no two eyes are alike. Not only do eyes differ from person to person, but it is exceptionally rare when a person's own two eyes are alike. The differences may be measurable only in thousandths part of an inch. Consequently, contact lenses must be made individually for each eye according to carefully worked out details of a complex prescription. Aside from the question of competence, a person who depends for his livelihood on the sale of merchandise is unlikely to have the time or inclination to give the patient the time and attention which is required to adequately instruct and supervise the contact lens patient.

Contact lenses should be prescribed and fitted only by licensed optometrists. No part of this practice should be delegated to the untrained and unlicensed so-called contact lens fitter. In all States and the District of Columbia, only optometrists and physicians are licensed to prescribe contact lenses. In actual practice, however, unlicensed, untrained, and unsupervised laymen are fitting contact lenses for a tremendous number of patients. This currently prevalent health hazard would be corrected by H.R. 12937.

Applicants for examination for optometry license must have at least 2 years of preoptometry training and 4 years in a school of optometry. They must have received complete training both didactic and practical, in physiological optics, geometric optics, ocular anatomy and pathology, general anatomy, diagnosis of ocular pathology, vision training, refraction, subnormal vision practice, contact lenses, ocular histopathology, physiology, psychology, general human anatomy, etc. Before being licensed they are required to pass rigid State board examinations covering all of the above subjects and must demonstrate their proficiency in refraction, vision training, visual field studies, subnormal vision, contact lens practice, and diagnosis of ocular pathology. Laymen who have not received this extensive type of training and background are simply not qualified to fit contact lenses.

An interesting point to illustrate this is that malpractice liability insurance rates for opticians (that is, laymen) are 50 percent higher than for optometrists, according to insurance specialists. I would like to quote from an article which was by Arthur Schwartz, a contact lens insurance specialist, entitled "Some Observations About Contact Lens Fitting by Technicians." Mr. Schwartz said, "There is an interesting relationship between the rates charged optometrists and those charged opticians for malpractice liability insurance. The optometrist bears a heavy professional responsibility-for which he is thoroughly trained, examined, and State-licensed-without supervision, or the need thereof. The optician, in theory, exercises no judgment. In theory, the optician has no function except to complete the work begun by the physician and to do so under the physician's personal supervision. Despite this great disparity in duties and, in consequence, exposure to acts or omissions which could lead to malpractice suits, the base rate charged optometrists is $10 per year. The base rate charged opticians who maintain "one-man" establishments grossing under $75,000 per year is $15-50 percent higher. That is, the National Bureau of Casualty and Surety Companies, which makes rates for most insurers, has found that its members' claim experience with opticians, despite the reduced exposure described, is much greater than among optometrists. This would indicate a higher frequency and severity of claims, claim reserves and claim payments among opticians."

Mr. Chairman, I am most appreciative of this opportunity to appear before this subcommittee to point out some of the evils which H. R. 12937 is designed to corWe earnestly request your approval of this vitally needed legislation.

rect.

At this point, and with the permission of the Chair, I would like to introduce the president of the Optometric Society of the District of Columbia, Dr. Henry J. Hoff.

Mr. DOWDY. Dr. Hoff.

STATEMENT OF HENRY J. HOFF, O.D., PRESIDENT, THE
OPTOMETRIC SOCIETY OF THE DISTRICT OF COLUMBIA

Dr. HOFF. Mr. Chairman and members of the subcommittee, my name is Henry J. Hoff, an optometrist with offices at 1212 I Street NW., Washington, D.C.

In regulating the practice of optometry in the District of Columbia, Congress is dealing with the vital interests of the public health and safety, and is entrusted with the responsibilities of protecting and enhancing the special gift of sight. The standards of conduct of 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 a profession by forcing its practitioners into a commercial rivalry which would increase the opportunities of the least scrupulous and penalize the most ethical.

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, 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. Mr. DowDY. It will be made part of the record.

(The material referred to follows:)

[From the Washington Daily News, Thursday, Feb. 17, 1966]

How OUR GIRL REPORTER ACTED AS A DECOY TO HELP DISTRICT OF COLUMBIA POLICE MAKE TWO ARRESTS

(By Clare Crawford)

Two District opticians were arrested yesterday and charged with practicing optometry without a license after selling contact lenses to a Washington Daily News reporter.

They are Anthony Sax, of the Imperial Optical Co. Inc., 1334 G Street NW., and Norman Fields, of Embassy Opticians, Inc., 1361 Connecticut Avenue NW. Their arrests ended a month-long investigation which consisted chiefly of my going through the long process of being fitted for contact lenses.

Mr. Sax, 33, of the Hampshire Motor Inn, Langley Park, and Port Chester, N. Y., and Mr. Fields, 42, of 1142 Loxford Terrace, Silver Spring, were released on personal bond by Judge Edward A. Beard of the Court of General Sessions. Hearings were set for March 16 for Mr. Fields and March 17 for Mr. Sax.

COMPLAINTS

Police Inspector Scott Moyer initiated the investigation at the request of the District Optometry Board, which licenses optometrists. Dr. Zachary N. Ephraim, president of the Board, said it has been receiving an increasing number of complaints from contact lens buyers. In the most extreme case reported, a woman lost the sight of one eye.

I worked with narcotics squad Sgts. John Panetta and Thomas Didone. The narcotics squad enforces the city's healing arts law, which forbids the practice

of medicine and related professions without a license. This includes optometry and ophthalmology.

In the District an ophthalmologist, who is a physician, is licensed by the Medical Board; an optometrist, who is a specialist in correcting but not treating the eyes, is licensed by the Optometry Board; but an optician, a grinder and seller of lenses, is not required to have a license.

FITTING

Mr. Sax fitted me for contact lenses after examining my eyes and my glasses himself. Mr. Fields sent me to an ophthalmologist for the eye examination and prescription. However, he personally measured the curve of my eye and inserted several pairs of lenses in my eyes.

*** to

The District optometry law states that it is "unlawful for any person represent himself as capable of examining the eyes of any person for the purpose of fitting glasses *** unless licensed."

The law, passed in 1924, does not mention contact lenses, which were not then in vogue. However, in 1946, the District Corporation Counsel wrote a legal opinion that "the fitting and adapting of contact lenses to the human eye are within the scope of optometry." Only a licensed optometrist or physician may legally fit contact lenses, the Counsel said.

In 1951 the District Commissioners took further note of contact lenses; they ruled that for a person to become licensed as an optometrist he must pass an examination in the theory and practice of contact lens fitting."

A violation of the District optometry law is a misdemeanor providing a fine of $500 for the first offense, and a fine of $1,000 and a year in jail for the second offense.

EXCESSIVE

The District Optometry Board said most complaints have been that lens buyers were charged $50 to $100 more than advertised prices and often found they were unable to wear the lenses.

"An unlicensed person should not be allowed to put a foreign object in the eye," Dr. Ephraim, president of the Board, said. "Luckily, the human eye is sensitive and people discard a pair of ill-fitting lenses. But we have complaints from people who got abrasions."

I became involved when a member of the Optometry Board told me of its concern over the apparent violations of the optometry law.

When he went on to say that police were having trouble finding a purchaser to help make a case, I offered to help. I am a contact lens wearer.

My editors readily agreed that I should meet with Detective Sergeant Panetta of the Narcotics Squad. His boss, Inspector Moyer, approved my participation and Assistant Corporation Counsel Clark King welcomed the assistance of the News.

"BE FAIR"

Sergeant Panetta explained to me, "We are interested in being fair. We don't want you to persuade someone to break the law. We want you to act just like another customer. If they fit you for the lenses, report to us."

On January 14, he sent me to the Imperial Optical Co. at 1334 G Street NW. "I am interested in finding out about contact lenses," I said to a young woman in a white uniform seated behind a glass window. "I'd like to know if I could wear them. Some friends of mine have them and have had trouble."

"The specialist isn't in," she said, "but you'll be able to wear our lenses. They are not like the round ones." She held up a scalloped lens.

EXAMINATION

She made an appointment for me and I returned on January 18. A man in a white coat led me back to a room where he examined my eyes. He used the instruments an optometrist or a physician uses to determine what strength lenses & patient needs.

He was Anthony Sax, who was charged yesterday with violating the optometry law. He is not a licensed doctor or licensed optometrist in the District.

He questioned me about my eyes and I told him I didn't think I had had any eye diseases or injuries and I had worn glasses since I was 11.

He took my glasses to another room and reappeared in 10 minutes to tell me that two pair of lenses-scalloped ones and "we throw in a pair of round ones"-would

cost me $155. The bill would be due in 3 days when the scalloped lenses would be ready. I gave him a $10 deposit.

REFUND?

He said, "All but a $15 fitting fee will be refunded if you are unable to wear them."

I returned for my lenses January 25 and gave him $100. I said I would like to pay the rest of the debt at the time of my 2-week checkup.

"Could you mail it in next week?" he asked.

I said I would.

He wrote on my receipt "balance to be paid on February 2" and told me to sign it.

I noticed the balance was $51.50 and not $45. It listed $2.50 for a lens case and $4 for cleaning and soaking solutions.

"How will I know if something goes wrong?" I asked as I put on my coat. "Oh, yes, I had these typed up for you," Mr. Sax said, handing me four mimeographed sheets of paper.

One of the instruction sheets listed "different normal sensations *** to recognize and not to become unduly concerned about them is a long step in the right direction."

SYMPTOMS

Among these symptoms was redness of the eye.

Dr. Charles E. Jaeckle, an ophthalmologist, said in a 1962 American Medical Association Journal article:

"Is anyone other than a physician qualified to determine whether the cause of the redness is the contact lens, some other foreign body or a disease? Both acute and chronic glaucomas have occurred in patients using contact lenses."

I returned to Imperial February 4 to complain quite honestly that I could not see well out of my left lens. Mr. Sax again tested my eyes and said I had more astigmatism in my left eye and it would take longer for the lens "to settle." He also said I had been inserting my lenses incorrectly.

I never had had this problem with my own lenses.

We discussed money again.

"I only have $20," I said. "Can I give you the rest at my next appointment?" "I don't know what the laboratory is going to say about this," he said. "They have written me already. I released the lenses to you and I am not supposed to unless they are paid for completely."

NO REFUND

I asked him again about the possibility of a refund in case the lenses didn't work out.

"I never have to refund money," he said. "We don't let them take the lenses out of the office if they can't wear them."

He then told me it was "necessary" for me to sign up for $30 insurance on the lenses for 3 years. "Everyone loses or damages a lens within 3 years and a new lens costs $42.50."

Yesterday I returned to Imperial Optical with Sergeants Panetta and Didone. They arrested Mr. Sax.

It took much longer to get contact lenses at Embassy Opticians.

I first called on January 15. I was calling most of the opticians who advertise contact lenses in the telephone book. All of them except Embassy told me I had to see an ophthalmologist to get a prescription and approval to wear the lenses. I was told by Embassy to come in anytime.

I did on January 17. Norman Fields talked to me for about 10 minutes. He was wearing a business suit.

He told me I had to get a prescription from a doctor and gave me the name of an ophthalmologist.

I went to the doctor. He seemed surprised at first that Embassy was selling contact lenses. "Do they have a (contact lens) laboratory there?" he asked. I said I didn't know. "Isn't it OK for me to get my lenses there?" I asked. "I have an optician here in my office," the doctor said.

"Should I get them from you?" I asked.