you mention here in your testimony. You have located in my district the Knights of St. George Home in Wellsburg, W. Va. I was amazed at the arrangements there for the care of the aged and aging people. May I say to you that your charities are far in advance of anything the States have done, and the Federal Government has done in this field. You have evidenced your intention to take care of this problem within your church organization, and I want to commend you and congratulate you on what you are doing in the Knights of St. George Home in West Virginia. It is a revelation to me, and I think that if you are interested in trying to meet this problem on a national level like you are meeting it yourself in your church activities, you are to be commended.

Monsignor GALLAGHER. Thank you very much, sir.

Mr. BAILEY. May I inquire if there is anybody who faces an emergency of catching a plane or something, so that we could hear one more witness who happens to be in that category? Or shall we take about an hour for lunch and come back?

Is there anyone present here who wants to testify?

Dr. EXFORD. I do have to catch a plane in the early afternoon, sir. Mr. BAILEY. We will hear one more witness, then.

You may identify yourself to the reporter.

STATEMENT OF DONALD C. EXFORD, O.D., CHAIRMAN, COMMITTEE ON VISION CARE OF THE AGING, OF THE AMERICAN OPTOMETRIC ASSOCIATION

Dr. EXFORD. My name is Donald C. Exford, from Pittsfield, Mass. I am an optometrist, and my appearance before you is as chairman of the Committee on Vision Care of the Aging for the American Optometric Association.

Mr. BAILEY. You may proceed.

Dr. EXFORD. Mr. Chairman and members of this committee, my home is in Pittsfield, Mass., where I have practiced my profession for 24 years. I received my preoptometry education at Northeastern University and graduated from the Massachusetts College of Optometry. I am president of the New England Council of Optometrists, chairman of the Journal Committee of the New England Journal of Optometry, a member of the New England Gerontological Association, the national and international gerontological societies. I was a delegate to the White House Conference on Aging, January 1961, and am vice president of the Goodwill Industries of Pittsfield, Mass.

At the present time I am working on a project with the American Library Association, the Library of Congress, and the Massachusetts Library Association called Books for Tired Eyes. This consists of preparing a new list of books for the elderly in large type. This publication has gone through four editions, the last one being in 1951. It is both out of date and out of print, but we hope to have the fifth edition available shortly. The New York Public Library has recently published a small pamphlet listing some of these books, which is available.

Last week was known as National Library Week, which emphasizes the importance of reading. Recently Miss Eleanor Phinney, execu

tive secretary of Adult Services Division of the American Library Association, stated:

It seems to me that there is a fine opportunity here for optometrists, as specialists who can judge the proper format of books for those of limited vision, and for librarians who can judge the quality and suitability of titles for the list, to combine their efforts very profitably.

Mr. BAILEY. Will you permit the Chair to interrupt?

So as to convenience the other witnesses who are here, the committee will reassemble at 1:30 o'clock, which will give you time to get your lunch.

Dr. EXFORD. Thank you, sir.

There are other means to provide special editions, such as the microfilm Zerox process; the cost of duplicating a 200 page book by this method is approximately $7.

In the course of your hearings in various parts of the country, members of our profession have been privileged to appear before you and testify concerning some of the activities in which we are engaged in order to preserve and improve the vision of our older citizens.

Not having had an opportunity to hear these witnesses nor to read their testimony, there may be some repetition in what I have to say, but I am confident that you gentlemen will make allowance for this fact. I trust you will agree with me that it is impossible to overemphasize the importance of sight to our fellow men, and particularly to those who have entered what has been referred to as the "golden circle."

It was not long ago when the public regarded old age as a time when one should sit in a rocking chair in a quiet, darkened corner of a room and think of his past until the ebb tide of life ran out. But today things are different. People in their 70's and 80's remain physically and mentally active, thereby contributing to their own happiness as well as that of those around them. In order to do this, they are in a very large degree dependent upon good eyesight, proper illumination, and books specially prepared for their use. Practically everyone over 50 years of age has some sort of visual problem, and the age of many of them has moved back a decade.

Most of the legislation you are considering puts the dividing line at 65. Certainly at that point 100 percent of our fellow citizens are in need of vision care. Except where disease is involved, such as cataract and glaucoma, that care can be rendered best by optometrists. Members of our profession are trained to detect both of these diseases as well as many others which have symptoms that can be recognized during an eye examination. It is the duty and the function of optometrists to refer these cases to medical practitioners.

Last year there appeared in the November issue of the American Journal of Public Health an article entitled "Optometry's Role in Health Maintenance-A Study of Referrals" by Galen F. Kintner, O.D. The study was based on the patients' visits, which totaled 235,312. When this was projected for the entire profession, it showed the total patients referred to others for some type of health service totaled 818,360. Of these, 439,460 were referred to ophthalmologists, and 271,622 to general practitioners. A copy of this paper is submitted as an appendix to my statement. There is no question but that

optometry can truly be referred to as "the first line of defense" against glaucoma and cataract.

There are five or six times as many practicing optometrists as there are board certified practicing ophthalmologists. While it is true that both groups have a tendency to locate in the larger centers of population, there is no question but that optometrists are to be found in many, many smaller communities which never have had and probably never will have a board certified ophthalmologist practicing there.

Notwithstanding the fact that the services of members of our profession are more readily available to the public, when one considers the population who are over 65 years of age, one finds there are literally hundreds of thousands of them who, for one reason or another, are confined to their homes, and some are bedridden. Practically the only way to provide vision care for this substantial number of our older citizens is by means of a mobile unit equipped for a complete eye examination. Such projects have been proposed both by our Rhode Island optometrists and our New Jersey group, but as yet they have not, shall we say, been "put on the road." The passage of one of the bills now under consideration might well result in this service becoming a reality instead of a dream.

And I would like to submit for the record a proposed plan for a demonstration project for a Federal grant that has been dreamed up by Dr. Hayvis Woolf of Rhode Island.

Mr. BAILEY. There is nobody here to object, so we will accept it. (Proposed plan referred to follows:)

DEMONSTRATION PROJECT FOR FEDERAL GRANT

(By Dr. Hayvis Woolf)

PURPOSE OF PROJECT

To focus attention on vision care needs of the chronically ill and aged, and to aid in the planning of community programs for improving their visual well-being and constant future visual care.

To demonstrate the need of optometric facilities of a mobile nature, to serve the elderly population both physically incapacitated and bedridden, who cannot avail themselves of the services of an optometrist in his own office.

To show by research the prevalence and early detection by screening with use of the electronic tonometer to detect pathologic glaucoma.

HOW IT CAN BE ACCOMPLISHED

By the use of a self-propelled wheeled vehicle of large enough proportion to be outfitted completely with necessary diagnostic instruments for a complete examination of the eyes and all phases of visual care.

Included in this wheeled vehicle would be the necessary portable equipment for bedside examination of vision of the elderly and chronically ill patient. With a self-propelled mobile vehicle, ambulatory patients found to require optometric service can be serviced at their place of residence. The vehicle can be drawn up at the residence and the patient involved can be assisted into the vehicle where the necessary services required can be performed.

In the case of a housing development for the elderly, the vehicle can be placed at a sheltered point where ambulatory persons can enter and leave the diagnostic vehicle with ease and safety. Where many of the patients of a particular institution are bedbound, the portable equipment could be utilized for a bedside visual examination. A ramp could be provided for the mobile vehicle for wheelchair patients with accommodations in the vision testing room for such wheelchair visual examination service. All optometric diagnostic equipment and instruments should be of a light firm nature so that portability may be of prime consideration and duplication by other organizations following the project may be simplified.

OTHER INCLUSIONS FOR DIAGNOSTIC REASONS

Anisoconic instruments for the diagnosis of isoconia and subnormal vision devices to improve vision otherwise unobtainable, of a portable nature, to be used either in the wheeled vehicle or to be moved to the bedside or bedridden, chronically ill or aged person.

The wheeled vehicle can be made up of a self-propelled vehicle. A foot trailer could be used, partioned for the particular use of optometric services with one room as a waiting room and sitting area (while the vehicle is in motion), one room for vision testing, one room for orthoptics, visual skills, the electronic tonometer, contact lens fitting, and subnormal vision operations. The vehicle should be 10 feet wide to conform with the interstate laws for self-propelled vehicles.

Personnel needed to perform this research and demonstration project would consist of the following: Project coordinator (optometrist), project executive, project secretary-clerk, project professional assistant (social worker), project optometrists (five), rotating, project clerk recorder and historian, project custodian and driver of vehicle.

All homes for the elderly, both public and private, old-age homes, nursing and convalescent homes, domiciliary homes for aged and infirm and all district nursing offices, and offices of chronically ill, besides the information to be gained from usual social welfare sources, will be contacted by the social worker with assistance from project clerk, recorder, historian, to ascertain the number and location of chronically ill and aged people in the project area to be chosen. Personal contact will be made with all these people individually to determine the status of the need for optometric service. The needs of the individual will be determined and upon this basis will service by the unit be rendered.

Statistics will be compiled on the case record with the exclusion of names and addresses which will be kept separately. If the individual questioned does not wish to volunteer their name or want their name used, as well as address, their wishes shall be respected. All other data will be recorded.

Chronically ill or aged persons of all races and religious backgrounds will be included in the project on an impartial basis. Use of racial and religious background, sex, and age groups will be used for statistical purposes only.

Time required for a thorough investigation of above project involving approximately 5,000 urban, suburban, and farm dwellers would be approximately 2 years.

An explanation of how the project would proceed is as follows:

A 32 by 72-foot self-propelled vehicle would be purchased for approximately $7,000 with the necessary partitions required. The mobile vehicle would contain a sink for water and a refrigerator for cold storage and a small stove in case location does not afford ready access to eating places at meal times. The trailer will be further equipped with heat, air conditioning, and electrical connections sufficient to carry the heavy electrical load required by all the electrical connections. An auxiliary generator would have to be installed for use in areas where electrical connection is not available making the vehicle totally autonomous. Cost of this type of generator would be approximately $850. Gasoline, oil, and repairs for the vehicle should come from a contingency fund. This same fund should include moneys for stationary and supplies, office equipment, ophthalmic prosthetic devices, miscellaneous items, funds for conversion of equipment, maintenance of vehicle.

Bids and specifications would be requested for every necessary item in this project and the award of any contract will be on the meeting of the specifications to the lowest bidder in conformance with existing practices of the U.S. Government.

EFFECTS OF DEMONSTRATION PROJECT

One of the prime factors in this demonstration project should be to show the entire profession and other professions how essential services can be brought to the very doorstep of the millions of aged and chronically ill persons throughout our country. It is true that various screening, of a medical nature, is done by the use of mobile vehicles at the present time, but there are very few professions in the United States that furnish continuing service in the areas now being overlooked.

REBUILDING INSTRUMENTS

Instruments now used should be redone to lighten them so that they can be used, rotated, adjusted, and altered with a minimum of effort and the ease nec

essary for maximum operation in confined quarters. For example, the chinrest of the opthalmometer can be designed from aluminum eliminating the up-anddown adjustment, which can be compensated by a more easily adjusted traverse mechanism of the illuminated section itself. The base of the instrument could also be of lightweight case aluminum or a plastic material. The projector chart could be made with a stand of much lighter material that would be as durable as cast iron. The stand beside the chair can be made much lighter because of the reduced weight of the opthalmometer. If the stand is lighter, then the chair could be of a clinical variety for the purposes of demonstrating the layout of this type of self-propelled vehicle.

All instrument tables could be of lightweight construction with adjustable stools to vary the heights for proper adjustment and alining of instruments.

PORTABLE EQUIPMENT

For bedside vision examinations, an armpiece of equipment upon which to hang the refractor is necessary so that the bed may be straddled from one side (such as a bed table) and operation can be done from the other. The projector could be on a lightweight three-legged folding tripod stand as could be the projector screen. A headrest to attach to the bed could be arranged to assist bed patients and backrest. Such a headrest arrangement could be prepared for wheelchair patients also.

GLAUCOMA SCREENING

The electric tonometer screening would be conducted in conjunction with this project for the purposes of detecting glaucoma. Glaucoma, being a disease of the eye in which the internal pressure of the eyeball exceeds normal limits, would necessitate referral of cases that exceeds the norms for medical consultation and care. The prevalence of this disease is known but the screening of the multitudes is the only method of finding those afflicted with this disease in time to afford them remedial medical treatment.

The use of a self-propelled vehicle and portable bedside equipment would eliminate the use of ambulance transportability for bedridden patients thereby eliminating an expensive transportation problem.

PSYCHOLOGICAL BARRIERS TO SERVICE OUTSIDE USUAL OFFICE

The cost of optometric service to the chronically ill and aged has been a barrier, monetarily, in the minds of these patients; thereby keeping them from seeing properly. Reading and television are two sources that could while away the many long hours for those thusly afflicted as well as using vision to see rehabilitation projects that may be proposed. There are hundreds of our aged population that inhabit institutions that do not have facilities for vision testing. Those institutions that do provide this service are not now set up on a basis to service all the patients that require attention either due to lack of sufficient funds, lack of adequate equipment to do a professional examination or due to the lack of cooperation that exists under the present contractual arrangements between the professional vision specialist and the particular institution.

REVIEW OF FILM "VIGIL OF JENNY FAY"

Rarely do optometrists own portable optometric equipment and the cost of a home examination is high. Proper examination cannot be done without proper equipment.

Kansas City health and welfare organizations and churches supplied names of chronically ill and aged. Also lay and professional groups validating chronically ill and aged.

1. Administrator

2. Dentist

3. Dental assistant

4. Dental hygienist

5. Social worker

6. Secretary

7. Driver of car

Eligibility established by local dental board of 4,000 examined; 75 percent brought to clinic by car; 15 percent brought by ambulance to clinic; 10 percent treated at home.