2. Thorough vision examinations for accident repeaters.

3. More extensive use of licensed vision specialists as consultants to licensing examiners, traffic courts and other government agencies dealing with highway safety.

4. Adoption of minimum vision standards in the following skills:

(a) Acuity in the better eye;

(b) Glare resistance:

(c) Adaptation to low illumination;

(d) Distance judgment;

(f) Breadth of field of view;

(f) Color vision.

5. Dissemination of more information on the fact that drivers lack necessary visual skills without knowing it; and that almost all shortcomings can be corrected with proper vision care. Voluntary screening, voluntary correction and voluntary caution can bring immediate results that compulsory laws may never achieve.

For more details on the survey referred to and the joint program now underway, any of the following major participants may be consulted:

Motorists' Vision and Highway Safety Committee, American Optometric Association, 4030 Chouteau Avenue, St. Louis, Mo.

Safety Division, the Woman's Auxiliary to the American Optometric Association, 4013 Byers Avenue, Fort Worth, Tex.

Women's Division, Automotive Safety Foundation, 200 Ring Building, Washington, D.C.

Mrs. O. G. Rushing, Safety Chairman, National Home Demonstration Council, Shawnee, Okla.

AMERICAN OPTOMETRIC ASSOCIATION

Committee on Motorists' Vision and Highway Safety:

P. N. DeVere, O.D., Trustee Consultant

Wendell E. Bryan, O.D., Denver, Colo., Chairman
William E. Hervey, O.D., Los Angeles, Calif.

Everett L. Porter, O.D., Belfast, Maine.

THE OPTOMETRIST AND SAFE DRIVING

INTRODUCTION

Without a doubt the practicing optometrist is the most frequently consulted professional man on matters of eligiiblity for driving. This places on the optometrist a great responsibility for the effectiveness of driver licensing programs in the combating of danger on the highway—public enemy No. 1 in its toll of fatalities, injuries, and physical damage.

The following outline is intended as a guide to the optometrist in his daily encounters with this terrible national problem. The information, opinions, and recommendations incorporated in this outline are endorsed by the American Optometric Association Committee on Motorists' Vision and Highway Safety as representing the best and most consistent views of leading researchers and recognized authorities.

1. ADVICE TO THE PATIENT WHO DRIVES

The optometrist should discuss willingly and frankly the driving problems of the patient in terms of:

(a) Glare, or difficulty in seeing under conditions of bright, stray, or rapidly changing illumination.

(b) Poor vision in dim light.

(c) Poor central acuity, or failure to discriminate signals, road signs, and small hazards.

(d) Poor peripheral vision, or failure to detect the existence of hazards originating peripheral to the point of regard.

(e) Poor color vision, or failure to interpret correctly signals and signs employing color schemes.

(f) Diplopia, resulting in misjudgment of direction of approach of objects in the field of vision.

(g) Lack of ability to judge distance and depth accurately.

(h) Difficulty in adapting to changes in fixation distances.
(i) Inability to recognize briefly seen objects quickly and easily.

2. THE PHILOSOPHY OF DRIVER LICENSING TESTS

It should be emphasized and reemphasized that it is not the basic purpose of license tests to eliminate drivers, but rather that the tests are intended to enforce the maintenance of the best possible driving skill and attitude on the part of each driver. Very few persons are unable to qualify under even the highest existing licensing standards. The great majority of disqualifications are due to negligence and unwillingness to take the steps to comply.

3. THE RELATIONSHIP OF VISION TO SAFE DRIVING

Vision bears a relationship to safe driving analogous to that of good brakes, adequate road markings, good highway design, and knowledge of the rules of the road. None of these factors assures safety or good driving. But, they are prime factors which make good driving possible. The driver with superior vision and superior equipment who exploits these advantages is a greater hazard on the highway than the less fortunate driver who recognizes and respects both his own limitations and those of fellow motorists. Such complexities in the relationship of good vision to safe driving have made conventional statistical analyses relatively meaningless.

4. SERVICE TO DRIVER EXAMINING PERSONNEL

Perhaps the greatest single problem that licensing agencies face is that of maintaining good rapport with wary and belligerent applicants. Such persons often exaggerate unfortunate errors and misjudgments that may creep into the routine licensing procedures and thereby undermine the objectives of the total licensing programs. The optometrist is in the best position to minimize this problem by:

(a) Getting acquainted with the driver licensing personnel in his community, discussing such problems as they arise, and making his consultatory services available.

(b) Becoming personally familiar with the visual licensing procedures and requirements of his State.

(c) Enlisting the cooperation of his fellow optometrists in the development of a helpful attitude toward the driver licensing personnel.

(d) Encouraging the establishment and maintenance of uniform testing conditions not only in licensing stations but also in optometric offices consulted by examinees.

(e) Preparing his patients for the driver tests, letting them know what to expect, and explaining to them the problems of reliability of vision test scores. He should not tell a patient that he will pass or fail; rather, he should simply tell the patient how he can expect to do if his visual responses at the licensing center are the same as in the optometrist's office. Discrepancies between the license examiner's findings and the optometrist's findings should be resolved by retesting and consultation, not by presumptive discrediting of the procedures employed.

(f) Giving due credit to the licensing personnel for excellence of work and their conscientious administrative efforts. In particular the optometrist must respect the professional responsibility of the licensing personnel to make the decision to grant or deny a license to drive. The optometrist's contribution is that of implementing its validity and effectivity.

5. PROFESSIONAL RESPONSIBILITIES FOR SAFE DRIVING

In his professional capacity the optometrist must assume the same type of responsibility toward safe driving as a cooperative objective as is normally shared, for example, by the highway engineer, the automobile designer, the traffic control agencies and driver education personnel. In this role he should be studiously familiar with research studies and authoritative evaluations of vision as a factor in driving. He should be prepared to give reliable information and advice to legislative, judicial, and regulatory agencies responsible for establishing laws, standards, and procedures involving vision in driving.

He should know the professional organization facilities and sources of information accessible to him. His reference files and professional library should be kept up to date on related matters. He should be prepared and willing to serve on safety committees for PTA groups, civic clubs, and appropriate commissions. In short, he must ever be mindful of the fact that he is expected to be the best informed person in his community on vision as a factor in safety, and that being informed is not merely a matter of holding strong convictions and/or unsubstantiated opinions.

6. VISION STANDARDS FOR DRIVING

Perhaps the most vulnerable stand to take on vision standards is that they be fixed by arbitration. Granted that in any administrative program there must be fixed limits, the real success of this type of program requires the application of judicious considerations within a framework of limits. Such considerations involve highly professional evaluation of how effectively a person uses the visual skills with which he is blessed or which he can attain.

Within this concept, vision standards may be classified in terms of (a) desired and (b) minimum visual conditions. The desired visual test scores represent those that are normally attained by persons who suffer no visual impairment or handicaps. The minimum visual test scores represent those below which the person would be deemed to be unable to cope safely with the ordinary visual demands and conditions of driving. These may be established in part by statistical studies and in part by direct evaluation of the visual stimuli which serve as action criteria, landmarks, clues, and hazard indicators in driving.

Standards that have been recommended and/or adopted by many agencies tend to vary between these two limits and may be classified approximately as follows:

Desired standards.—20/20 or better in each eye, with normal binocular vision, no field restrictions, no muscular anomalies, and no color vision deficiencies. Minimum standards.—20/40 or better in one eye, absence of diplopia, and intact fields to at least 70° in each lateral direction from straight forward position.

More significant than the application of such standards, however, is the application of sound procedure in the licensing of drivers within these limits, since the great majority of drivers who do not seek professional attention score inside this range. The primary consideration to be made in such cases is that the driver shall maintain and employ the best vision attainable. he should regard as his moral as well as his legal obligation.

This

In other words the driver who can attain 20/20 with the proper lense correction should not be permitted to drive without them just because he can see better than 20/40 unaided. Similarly a person, e.g., a hyperope, who obtains 20/20 both with and without his glasses should be obliged to wear his glasses for driving if they provide demonstrably greater accomodative and/or binocular efficiency.

7. PUBLIC EDUCATION

The unpardonable 30-year lag of adequate licensing standards behind the growing toll of highway accidents must be attributed to one major factorthe lack of public education. Reduction of the accident toll demands a cooperative effort that allows no room for exceptions. The individual caution exercised by 99 drivers carries little reward when 1 careless driver roams the highway. The license to drive must be regarded as a judiciously granted and earned privilege, not an inalienable right.

In his role as a citizen the optometrist must recognize that the latter concept is developed by public education, out of the resources of scientific study, political development and the legal interpretation of the constitutional rights of individuals. Not only because of his professional identity with one of the important aspects of driver qualification, but more especially because of his natural role as a community leader and opinion molder, the optometrist should participate in the complex undertaking of public education relative to the facts and concepts of driving safety. It is not enough to say that vision is important. The greater problem is that of making the public aware of the significance of driving safety and the means of accomplishing it.-The American Optometric Association, Inc., 4030 Chouteau Avenue, St. Louis, Mo.

36-202-64-5

Dr. EWALT. Thank you, Mr. Chairman. To begin with, about 30 million Americans every year seek vision care. Even more important is the fact that there are many millions, particularly schoolchildren, who need vision care and don't get it. Certainly the need for optometric vision care grows with the complexity of civilization in which we live and with the increase in educational demands for all kinds of activity. To read and to study in this age of science and technology is fundamental to achievement.

Optometry, with its unique concept of functional vision problems, in other words, in visual performance, is uniquely prepared to deal with these kinds of problems. The objective of the practicing optometrist is not only to be sure that the patient can see clearly, which we might think of as "squirrel hunting vision," but also that he is comfortable and that he is efficient in his seeing; in order that he can maintain efficient study, or laboratory activities, which are essentially near-point activities, over long periods of time.

Optometry is the Nation's first line of defense against blindness. When pathological conditions occur, optometrists refer these problems to medical specialists who are especially prepared and trained to deal with these problems.

The optometrist performs about 65 to 70 percent of the eyesight examinations in this country, does about 75 percent of the contact lens work, and about 80 percent of the work in orthoptics and visual training. So that somewhere around three-fourths of all who seek vision care in its broadest sense first turn to the optometrist. Optometrists, as commissioned members of the Medical Service Corps of the three services, render about 85 percent of the eyesight work that is done for the members of the Armed Forces.

You will find in the material that was presented to you a table showing the number of optometrists and the distribution of optometrists. This is exceedingly important as far as getting service to all of our people as conveniently and economically as possible.

The emphasis that optometry placed on meaningful seeing is a concept that is unique to optometry and is based on the unique education and training of optometrists. Meaningful vision is operating when the person has the best possible and most efficient vision for the tasks that he needs to perform, whether that person is a housewife or a student or a crane operator. These are considerations that come into the service of an optometrist.

A widely accepted biological fact is that anatomical completion or growth leads only to minimum performance. I mean by that, that track meets are not won by youngsters who have good legs and a good stout heart. Track meets are won by perfectly normal youngsters who have learned to walk and run and then are placed in the hands of a skillful track coach who enhances their performances.

The same thing is possible as far as vision is concerned. In the cross-eyed youngster, orthoptics and visual training procedures can correct many of the cases of cross-eyedness. In the matter of vision and child development, we have reached something that is at the very heart of our need in a number of problems as far as the country is concerned. Dr. Lois Bing, who was for many years chairman of our Committee on Visual Problems of Children and Youth, made a report to the White House Conference of 1960 which you will find as part

of the appendix of your material. She discusses there the visual problems of schoolchildren from the preschool level right through the college level. The thing that I think we need to realize is that recent development and understanding in the broad field of child development clearly indicates that visual problems begin very early in the child's life. For instance, Dr. Arnold Gesell, of the Clinic of Child Development at Yale University, says that vision is the key to the child's whole individuality. To understand the child, we must know the nature of his vision.

Further, in these studies-this study and in other studies-we find that visual problems can create performance problems as far as children are concerned and also create problem children thereby. A child who is unable to keep up with his work in school becomes a disinterested child. He is often wrongly accused of being lazy. If there are not the most stable sociological conditions around him, it is entirely possible he will become a delinquent or that he will become a school dropout.

We believe as a profession that preventive vision care is a matter of the utmost importance as far as the future of this country is concerned. Efficient, easy seeing where the images of the two eyes fuse together, where the eyes are coordinated in their motor activity, where we do not have a child that is skipping words or even whole lines or reversing words, who has a speed and span of perception as adequate to his needs in this reading situation, is a child that is very apt to achieve and get ahead in schoolwork.

Optometry has played a major role in aiding these children, particularly in the development of the adequate visual skills which are prerequisite to achievement in reading.

I want to stress the fact that modern optometry is based on this concept of functional vision and takes into account the entire seeing process, physiological and psychological. Just seeing clearly is not enough. Each child must see comfortably and efficiently in order to do his best in reading.

Of the many causes of reading retardation, and certainly we recognize that there are many, numbers of studies indicate that faulty vision performance, not lack of visual acuity, but faulty vision performance is the one most frequently found. In retarded children we find another unique opportunity for service because if the retarded child is to make the best possible use of his abilities, it is important that he perform effectively visually. Some studies show that these retarded children have functional vision problems which need to be straightened out.

And you will also find attached to the White House Conference report a paper by Getman on optometric visual care of the brain-injured child. Certainly we are concerned with the 72 million of school dropouts that are anticipated for the years 1960 through 1970. I have already indicated to you why we know that a certain number of these school dropouts result from inefficient vision, the lack of ability of the child to perform in school, particularly in the area of reading, and we have cited a number of studies to you in the paper which show the importance of this particular factor.

Optometrists are concerned with industrial problems. A number of optometrists serve as consultants to industry. They are develop