Mr. DANIELS. Mr. Ast, I am happy to have you here and I wish to commend you for the thoughts you have expressed here, and particularly to commend you for the work of your organization in handling such a wide area and sphere of all of the problems of our citizens.

I think we should give due consideration to the problems of our people before they reach their older age.

Counsel, do you wish to ask any questions?

Mr. ELLSWORTH. No; I don't have any.

Mr. DANIELS. We have no further questions. Thank you, Mr. Ast. Mr. AST. Thank you for having me.

Mr. DANIELS. Next we have Mr. Alphonse Miele of 609 Bloomfield Ave., Bloomfield, N.J. There is no response.

The next witness will be Dr. Andrew Fischer, medical director of New Jersey Optometric Association.

Dr. Fischer, do you have a prepared statement?

TESTIMONY OF DR. ANDREW FISCHER, O.D., ADMINISTRATIVE DIRECTOR, NEW JERSEY OPTOMETRIC ASSOCIATION

Dr. FISCHER. Yes, I do.

Mr. DANIELS. Do you have copies for the committee?

Dr. FISCHER. I have. May I suggest a correction? I am not medical director, I am administrative director of the New Jersey Optometric Association, I am not a physician. I am an optometrist.

Mr. DANIELS. The record will be so corrected.

Dr. FISCHER. I would like to thank the committee for the opportunity afforded our organization to present our views to this group, and before going into the prepared statement I would like to make a few observations, if I may.

Mr. DANIELS. You may.

Dr. FISCHER. First of all, the New Jersey Optometric Association has operated with a rule, the rule being "What is good for the public is good for us." We have observed this very carefully down through the years.

I would like to note too that we have been on record in favor of all progressive, social legislation ever since and including the introduction of the Murray-Wagner-Dingell bills in the Truman administration. We have approved the Forand bill. We are in favor of the present King-Anderson bill.

I would also like to point out that in his comments Mr. Jacobson spoke of doctors. Now, there are other doctors besides medical doctors. We are doctors of optometry and I think it would serve some purpose if the terminology used in these situations were mutually exclusive. There are doctors of medicine, doctors of optometry, doctors of dentistry, or when you are speaking of medical doctors, we could call them physicians because in talking of doctors, as he did, we being doctors feel somewhat lumped in on that and it does not represent our viewpoint.

Mr. DANIELS. You are making it very clear in the record. [laughter]. Dr. FISCHER. If I may I will go to my statement. I have a copy of my own and I have a statement from a Dr. Woolf of Rhode Island, which I would like to read when I conclude with my statement.

My name is Andrew F. Fischer. I am an optometrist licensed to practice in the State of New Jersey. I am now and for the past 16 years have served as administrative director of the New Jersey Optometric Association. Our association, like other State optometric associations, is affiliated with the national organization known as the American Optometric Association.

It is my understanding that your committe is particularly interested in knowing whether the present programs in the State and surrounding territory are providing adequate vision care for the aged, whether this care is readily available, generally utilized, and if not, what might be done to improve the situation. Also that you are concerned with the desirability of having an independent Federal agency to supervise the governmental programs for our older citizens, or whether the supervision should remain in the Department of Health, Education, and Welfare. In this event there would be some expansion of the Department's present duties and an advancement in the standing of this particular activity by putting it in charge of an assistant secretary of the Department for the aging.

While I can see that there are advantages and disadvantages in each of the two methods of organization, in my opinion the principal roadblock to providing the best possible vision care for the aging is due to the position of the American Medical Association and its handmaidens, the National Medical Foundation for Eye Care and the National Society for the Prevention of Blindness. For years the American Medical Association has had in force a resolution declaring it to be unethical for members of the medical profession to teach in our schools and colleges of optometry, to address our gatherings or to confer with optometrists on a professional basis. To be sure, this edict has been violated but there is every indication that the American Medical Association intends to be more strict in its enforcement. Only a few weeks ago, when the House Ways and Means Committee was considering the Public Welfare Amendments of 1962 (H.R. 10032 and H.R. 10606), these three groups requested the committee to amend the bill as it relates to new title XVI so as to prevent optometrists from certifying as to blindness and to amend title X of the existing law to the same effect.

When the Social Security Administration, as an independent agency of the Federal Government, was administering the aid to the blind program, their original regulations required that the certification of blindness should be made by a physician skilled in the diseases of the eye. The result of these regulations was that in many jurisdictions not only were optometrists barred from participating in the aid to the blind program, but also from all other vision programs which were financed in whole or in part by Federal funds.

This situation was corrected by the social security amendments of 1950 which required that in order for a State to share in Federal funds, the certification of blindness should be made by a physician skilled in the diseases of the eye or by an optometrist, whichever the beneficiary might select. The State welfare department was not bound by the certification regardless of whether it was made by an ophthalmologist or an optometrist, but the results of this legislation have been beneficial to all parties concerned. One of the outstanding benefits has been the saving of time and expense incurred in trans

porting the indigent blind from their home to the certifying ophthalmologist. There are many more optometrists than there are ophthalmologists. On the whole they are located in the smaller communities and their services are more readily available. We in New Jersey have under consideration organizing a mobile eye clinic which will enable us to transport professional optometric care to older citizens whether they are residing in groups or with their own families.

Over and above this, the work of optometrists in providing optical aids for the partially sighted has been almost miraculous. Studies indicate that approximately 75 percent of those individuals whose vision is so impaired as to have them declared legally blind have some degree of visual perception. Of this group nearly 70 percent, by the use of optical aids such as telescopic lenses, contact lenses, etc., coupled with visual training, have experienced an improvement in their visual acuity sufficient to enable them to become more independent, self-reliant, and in many cases economically self-sufficient.

Our national organization has a committee on vision aid to the partially blind, and also a committee on vision aid of the aging. To some it might appear there would be a good deal of duplication in the work of these two committees, but I would call your attention to the fact that practically 100 percent of our aged population have visual problems even though they may not be partially blind and that among the partially blind there are many who are under the age which is generally accepted as that dividing our elder citizens from the younger generations.

No doubt it has already been called to your attention that in order to secure an original license to practice optometry in any one of the 50 States or the District of Columbia, an optometrist must be a graduate of an accredited school of optometry. All of these schools require a minimum of 5 years of study at the college level. Some require a 6th year for the O.D. degree. The curriculum of these schools includes not only subjects having a direct relation to vision care but also comes in anatomy, physiology, pathology, etc., with the result that the average optometry student devotes about one-fourth of his time to a broad study of the human body, with particular emphasis on diseases of the eye and symptoms of other diseases which can be detected in the course of an eye examination. The members of our profession do not attempt to treat diseases of the eye or to perform eye surgery, but refer their patients in need of such care to members of the medical profession.

We in New Jersey feel particularly fortunate that the House Committee on Education and Labor has on it four members of the New Jersey delegation. Our New Jersey optometry law is regarded in many quarters as one of the best optometry laws in the United States. Only recently I had occasion to secure a certified copy of the law to be sent to a foreign country for their guidance in providing legislation. A week ago today, in offering amendments to include optometry in S. 1072, a bill to provide grants for construction of medical, dental, osteopathy, and public health teaching facilities and scholarship grants for those professions, Senator Williams of New Jersey said:

Mr. President, few Americans go through life without at some time requiring professional vision care. Every year more than 30 million Americans obtain vision care, and millions more who need such care neglect, or are unable to seek

it. As the average age of our population continues to rise, more and more Americans are living beyond the age at which unaided vision serves their needs. With our expanding school population, correction of vision defects and preventive vision care become increasingly important if we are to make sure our children have the opportunity to develop and utilize their total capabilities and talents. We shall never know, for example, how many unfortunate children have been handicapped in learning reading skills because of an undetected vision problem, and consequently how many potential scientists and other badly needed professional people have been lost to our society.

During the 1950's the ratio of our population wearing spectacles increased more than 10 percent, and today two out of three adults are receiving professional eye care services. As our need for advanced scientific and technical skills increases, and our population becomes more mechanized, not only will the demand for professional vision care rise, but vision requirements will also become more exacting.

The companion bill to S. 1072 is H.R. 4999. As reported out of the House Committee on Interstate and Foreign Commerce, it was amended to include schools and colleges of optometry in the grants for construction. A student loan fund was substituted for the scholarship grants but, unfortunately, optometric students were not included in this section of the bill. It is not my purpose to discuss the merits of that legislation at this time but I merely call it to your attention for the purpose of reinforcing what I have previously tried to state, namely, that vision care for the aging is a necessity, that optometric participation is essential and that our profession stands ready and willing to cooperate with ophthalmology on a professional basis whenever the opportunity offers.

However, it is only when Congress tells medicine that they must cooperate that we find them willing to do so. The outstanding examples of this are: the passage in 1947 of the Medical Service Corps law, as a result of which we now have commissioned optometrists in the Army, Navy, and Air Force holding ranks from second lieutenant to colonel, or their equivalent in the Navy; the 1950 amendments to the social security law referred to above in more detail; the passage by the 86th Congress of the law which made available the services of optometrists to veterans entitled to outpatient vision care; a the language of the Kerr-Mills bill which made it optional for the States to include in their program eyeglasses and optometric services.

In view of the testimony you have received from other members of the optometric profession and the brief presentation I have made, I trust that any legislation enacted as a result of these hearings, will make certain that the services of an optometrist are made available to those individuals who desire to utilize them.

Mr. DANIELS. Mr. Fischer, how many optometrists do we have in the State of New Jersey?

Dr. FISCHER. There are approximately 700.

Mr. DANIELS. Do all other States have laws pertaining to optometry?

Dr. FISCHER. Yes, every one of the States.

Mr. DANIELS. Do all of the States require them to be licensed? Dr. FISCHER. Yes.

Mr. DANIELS. And, therefore, optometrists as a professional group are recognized in each of the 50 States of the Union?

Dr. FISCHER. They are.

Mr. DANIELS. With respect to the 11 bills that I have mentioned at the outset of this hearing that this committee is studying, do you

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have any specific recommendation as to whether or not an agency should be set up with respect to the problems of the aged and aging on a local, State, or Federal level?

Dr. FISCHER. Well, I think we can say that we believe that a Federal agency separate and apart should be established as the first step, and we believe that from that will derive the advantages which we think the aged require without the conflict, the interagency conflicts that are now hampering some of the programs that might materialize. Mr. DANIELS. Is it your thought that by reason of the lack of action on the part of localities and State governments, that the Federal Government should give it the impetus necessary to get this program on the road, so to speak?

Dr. FISCHER. Very definitely.

Mr. ELLSWORTH. We had testimony at one of the hearings from one of the deans of the college of optometry regarding the problem of glaucoma and indicating that the optometrists were in many small towns where there was no ophthalmologist and no method of detecting glaucoma through the usual medical manner, but that they had developed the electronic device for measuring glaucoma and could thus make it more readily available to the aged people.

I wonder if there is any comment you have on this, or if anything is being done in this area?

Dr. FISCHER. Well, the electronometer is a device that was designed at the Ohio State University School of Optometry. I am sorry-it was at the University of California School of Optometry that this device was first designed and it is now being produced, and the opinion has been given that it is the most effective way of determining glaucoma in its early stages.

Now, glaucoma is a condition which is very, very difficult to determine and generally by most present methods by the time glaucoma is established it is pretty late in the day for that eye.

It has lost considerable vision which can never be regained.

In the other statement which I have there is a reference made to the use of this equipment in a mobile unit, and glaucoma, of course, has a much higher incidence among the aged than among the younger portions of the population, and therefore a good method of detecting glaucoma as early as possible is very important to the saving of eyesight of the older people.

Mr. ELLSWORTH. Is it a faster method?

Dr. FISCHER. It is not only faster, it is considered much more positive.

Mr. ELLSWORTH. Apparently this is something practical. In other demonstration projects provided for in the Fogarty, and I think two or three of the other bills; is this something that might be practical to experiment with in communities of this size?

Dr. FISCHER. I would say, Mr. Ellsworth, it is past the experimental stage. I think it is in the stage now where it could be used very affirmatively in dealing with the aged.

Mr. ELLSWORTH. The Kerr-Mills bill is not in effect in New Jersey, as I understand it.

Dr. FISCHER. Not at the present time.

Mr. ELLSWORTH. There is legislation pending?

Dr. FISCHER. There is legislation pending to authorize it.