It has been a privilege to travel throughout this country as president of my association and visit with not only my own colleagues but other interested parties in the health care field. At the same time I have visited all of the schools and colleges of optometry in the United States. From these trips and from these experiences I have seen the very acute need for additional services and additional personnel in the optometric field.

There has been a vivid awareness of the extreme manpower shortage which exists in this particular realm of the health care field and the need for more optometric practitioners. Additionally, I can report the necessity for my profession to be responsible for the solution of this problem. We are most grateful to be here today for the privilege of explaining our position, documenting it for this committee and seeking the help, guidance, and direction from our Federal Government in meeting this need which our country faces and about which we are deeply concerned.

I would like to point out that there are numerous departments and committees within the American Optometric Association structure which are dedicated to serving the public welfare of this Nation, and I would like to mention certain of these at this time.

Under the department of public health optometry is our vision care for the aging committee, and the committee on aeronautics and space. There are committees on motorists vision and highway safety and research. The committee on social and health care trends has been particularly active in providing vision care for the indigent of this Nation. There are other committees known as the committee on occupational vision, visual problems of children and youth, vision aid to the partially blind and the committee on contact lenses.

I point out these facts now, in this brief summary, to indicate the keen interest that my profession has in the area of public health need. Our interests go far beyond that which the individual practitioner does in his respective office to his own individual patient. We are indeed cognizant of the fact that this responsibility of optometry in the public health field is becoming even greater each passing day. In meeting this responsibility we find it is very difficult to honestly compete with the other health care professions, particularly since student loan facilities were made available to medicine, dentistry, and to osteopathy in the original bill. The competition is keen for the minds of the young men and women of this Nation, and we desperately need the help and assistance that can be given through the provisions of this act to aid us in securing for our profession and for the Nation qualified students.

I was going to make reference to the very fine legislation which my own State adopted for optometry back some years ago. Congressman Fuqua has referred to this measure in his introduction and so I shall not go into it in greater detail. It has been a tremendous help to our State in providing the type of optometric care and vision care that is needed in many areas, and it has been a far-reaching move on the part of the Florida Legislature to provide this help for its citizens.

Today, accompanying me are some of the very outstanding people of optometry throughout this Nation. I am going to introduce them at this time, Congressman Rogers, in a group. They will appear in turn without further introduction.

The first will be Dr. H. Ward Ewalt, who is the immediate past. president of the American Optometric Association. Following Dr. Ewalt we will hear from Dr. Gordon Heath of the faculty of the Division of Optometry at Indiana University. He is president of the Association of Schools & Colleges of Optometry.

Following Dr. Heath will be Dr. Nelson Waldman, chairman of our committee on vocational guidance whose primary function is to recruit students for our schools and colleges of optometry throughout the country. Dr. Waldman is from Houston, Tex.

Our final speaker will be Dr. Don Springer from Alabama, president of the American Academy of Optometry. Dr. Springer will describe the financial problems of the young optometric graduate who enters practice. Dr. Frank Kitchell of the American Optometric Foundation who was unable to be present this morning has presented a statement to this committee which will be incorporated as part of the record.

I have additionally brought along another of the fine leaders of optometry, Dr. Nelson Abrahamsen, Sr., of Cleveland, Ohio, who is chairman of the Council on Optometric Education. This agency is responsible for the accrediting of our schools and colleges. He is here in case any of the committee would care to ask a particular question in the field which he represents.

I do thank you, Congressman Rogers, for the privilege of making this summary statement and presenting these gentlemen on behalf of optometry.

Mr. ROGERS of Florida. Thank you for your statement and for your being here to give your testimony to the committee. Are there any questions? Mr. Pickle?

Mr. PICKLE. I don't have a question now except I want to welcome the doctor here. I had occasion to visit with him right at the first of the session, and we had some pictures made, and I got to know him personally then and some of the people he worked with. I was glad to hear his statement and glad he is here.

Mr. ROGERS of Florida. Mr. Schenck?

Mr. SCHENCK. No, thank you.

Mr. NELSEN. No questions, thank you.

Mr. ROGERS of Florida. Thank you very much, Doctor.

STATEMENT OF DR. H. WARD EWALT, JR., O.D., IMMEDIATE PAST PRESIDENT, AMERICAN OPTOMETRIC ASSOCIATION

Mr. ROGERS of Florida. We will be glad now to hear from Dr. Ewalt, immediate past president of the American Optometric Association. Dr. Ewalt, it is a pleasure to have you here with us this morning.

Dr. EWALT. Thank you. I am glad to be here. I want first to assure the members of the committee I am not selling books. However, some of the things that I would like to present to the committee are of such a nature that I thought some of our fundamental scientific information ought to be available to the staff of the committee in order that they can look into the matter to whatever extent suited their interests and purposes.

I, too, would like to summarize the statement that has been prepared as the formal statement for the committee.

Mr. ROGERS of Florida. Without objection that will be permissible, and your formal statement will be made a part of the record at this point.

(Dr. Ewalt's statement in full along with additional literature follows:)

STATEMENT OF H. WARD EWALT, JR., O.D.

Mr. Chairman and members of the committee, I am Dr. H. Ward Ewalt, immediate past president of the American Optometric Association and a practicing optometrist in Pittsburgh, Pa. I am optometric consultant to the Surgeon General of the U.S. Army, a fellow of the American Academy of Optometry and the American Association for the Advancement of Science. I am also a member of the National Education Association and the International Reading Association.

It is indeed a privilege for me to appear before you today in support of H.R. 8546 and to answer some of your questions about the importance of optometry and the vision care provided our Nation.

Optometry is the profession specifically licensed in all the 50 States and the District of Columbia to care for vision, just as dentistry is the profession specifically licensed for dental care. Every year more than 30 million Americans obtain vision care; and the chances are 3-to-1 that you or a member of your immediate family will have a professional vision examination within the next 12 months.

The informed American-particularly you who are our representatives in Congress should have available all the basic facts about vision and optometric care. In very brief fashion today I will attempt to inform you on such questions as-why is the need for vision care growing?-what is the education of the optometrist?-what is optometry's unique service?

The need for vision care grows as modern civilization becomes more complex. Nature made man's eyes for distant seeing-for stalking game or for looking off to the horizon. Today, in an age of science and technology, most critical seeing tasks are within arm's length. Everyone must read and study more than was true for any previous generation. Technical jobs require more accurate near-point vision.

About a hundred years ago, instruments for measuring vision were developed. Some opticians, who ground and sold lenses, began using these instruments, and soon they became known as "refracting opticians" or "examining opticians." In 1898 these specialists organized what has become the American Optometric Association, and the development of optometry as the vision-care profession had begun.

The background of optometry is comparable to the evolution of other health professions. There was a time when teeth were pulled by blacksmiths, because the blacksmith's tongs served this purpose better than anything else readily available. The barber-surgeon was once common, because only the barber had the sharp instruments best suited to bloodletting, boil-lancing, and similar "operations."

Just as the other health professions have evolved so, too, the optometrist of 1898 bears only an ancestral resemblance to the modern professional practitioner. Many sciences have contributed to a better understanding of vision and its improvement. Not only is the examination of vision and the prescription of glasses a highly developed science and art, but the optometrist has pioneered and added many innovations-visual training, contact lenses, special aids for the partially blind, and other types of specialized lenses-to solve problems for which there were formerly no solutions.

Modern optometry performs a unique and distinct vision service. It is based on the concept of functional vision in contrast to the traditional concept of the eye as a static optical instrument. This means that the optometrist's objective is to enable the patient to see clearly, comfortably, and efficiently for each specific task, regardless of demand or distance. He concerns himself with visual development in the growing child and the prevention, as well as correction, of vision problems.

Competence in optometry is gained by formal education as well as by example, precept, demonstration, and extensive clinical experience under com

petent teachers at institutions of higher learning and by continuous programs of postgraduate education.

With its education in physiological, psychological, mechanical, physical, and geometric optics, in addition to a broad foundation in other sciences such as physiology, anatomy, and pathology, optometry provides its practitioners with a complete and thoroughly rounded preparation for the vision care of mankind. This fundamental training with emphasis on psychophysiology of vision, underlies modern optometry's concept and practice of functional vision

care.

The treatment of pathological conditions and eye surgery is acknowledged by optometry to be in the field of medicine. However, for the protection of the public, about one-fourth of the optometrist's education is devoted to study of the body, eye diseases, and symptoms of other diseases revealed in the eyes. Thus the optometrist is well trained in the detection of ocular signs of pathology so that he can refer patients for whatever other professional care they may require from other practitioners and specialists.

Because the optometrist performs 65 to 70 percent of the refracting work in this country, 75 percent of the work in contact lenses, and 80 percent of the work in orthoptics and visual training-and thus first sees approximately threefourths of all patients seeking vision care, the optometric profession is our country's first line of defense against blindness.

Dr. Galen F. Kintner, in an article in the American Journal of Public Health, which I am appending to this statement, put it this way: "The visual system is a generous window to a number of the patient's health problems. While the optometrist's area of service includes refraction and coordination problems (with lenses, orthoptics, subnormal visual aids and the like), his field of investigation includes much more in determining the state of health of the patient and his visual system. Conditions requiring medical or surgical treatment of the eyes are referred to an ophthalmologist. In general, referrals can be divided into two groups: the desirable but elective, and the more formal or specific referrals. Even though the public is becoming more sophisticated in its self-diagnosis, and hence its choice of health specialists, the fact is that a great number of people with vague symptoms first come to the optometrist." As consultant to the Surgeon General of the Army, I have intimate knowledge that in our armed services optometrists take care of the vision requirements of 85 percent of our fighting men. The following table illustrates the number and distribution of the optometrists and ophthalmologists in the Armed Forces. Ophthalmologists are the eye physicians and surgeons to whom optometrists refer most of their patients who are found to have pathological or other conditions requiring medical treatment.

Optometrists in the M.S.C.:

Army: 184 (authorized ratio of 1 to 7,500 soldiers, but most training centers have approximately 1 to 5,000).1

Navy: 59 (no set ratio).

Air Force: 162 (no set ratio).

Ophthalmologists in the M.S.C.:
Army: 71 (16 board certified).
Navy: 67 (23 board certified).

Air Force: 45 (9 board certified, 30 eligible, and 2 with 1 year training ophthalmology).

Relative distribution of optometrists and medical eye specialists, who are in civilian practice across our country, is shown in a table I am appending to this statement for the record.

Optometry has become the profession that it is because it provides a complete vision care service. As noted, there is need in our modern complex civilization for functional vision care, principally for near-point seeing tasks. It is this need which optometry fills and which accounts for the development of optometry as an independent coordinate profession, separate from medicine.

Since its early beginnings, optometry has placed emphasis on meaningful seeing. No one has "perfect vision" for all purposes-a woman at her housework, a man operating a crane, a child reading a primer in school-each of these persons should have the best possible and most efficient vision for the task to be done and it is on this that the optometrist concentrates.

1 The ratio figures do not include military dependents.

Optometry discovered many years ago that a person could read a Snellen letter chart at 20 feet and still have vision problems that make adequate achievement impossible. A person may be able to see perfectly well at 20 feet and lack good binocular (two-eyed) coordination at near, thereby finding reading difficult or impossible.

A person with good sight can see the chart at 20 feet and still have vision difficulties; so let me make clear now the difference between sight and vision. Sight is acuity-the ability to see forms; vision is the ability to give meaning to those forms.

Vision is a learned skill, not something solely dependent on the shape of the eye as tradition held for many generations. Skills that are learned can be taught. This is the basis of scientific visual training in which optometry has pioneered. Anatomical completion or growth leads only to minimum performance. Visual training results in the enhancement of visual performance skills. Visual training (orthoptics) has long been recognized as an effective method of correcting some types of squint or strabismus (crossed eyes). The child who has difficulty in making the two eyes work together may turn one out of the way and use only the other. Visual training, or orthoptics, can in many instances restore the binocular skill. When the eye straightens, the child sees with both eyes.

Just as visual training may restore the skill in the crosseyed, it may also restore binocularity where the lack of it is not so obvious. There are many children, and adults as well, who suspend vision in one eye, without turning it out of the way. Intermittently, or continuously, they have only one-eyed vision. Just as visual training may restore the skill in the crosseyed, it may also restore binocular efficiency where the lack of it is not so obvious.

By the use of visual training, in combination with lenses or without lenses, optometrists solve not only these problems, but many others as well. Through visual training one can learn to see several words at once, instead of only a few letters or syllables, and to perceive more quickly, all of which is of great value in reading. It can teach accuracy and speed in seeing.

As the very able chairman of the subcommittee, Congressman Roberts, knows from his special wartime training in the field of "recognition" at Purdue University, visual training was found to be the only successful method of training airmen to quickly distinguish enemy from friendly aircraft during World War II. As practiced by optometrists today, visual training has many uses, particularly for those schoolchildren who for some reason have failed to develop necessary vision skills.

The concept of vision as a learned skill is probably best described by Dr. Arnold Gesell in "Vision-Its Development in Infant and Child," a copy of which I am leaving with the committee in case you should desire further information on this subject.

A proper vision examination takes into account all areas of visual performance. It must ask and answer such questions as: Can the patient focus and point his eyes together as a team? How accurate is his vision when he looks from one object to another? Can he sustain his visual performance comfortably and efficiently and over a protracted period of time when he is reading? What is his speed of visual perception? Does he have a full field of vision? And so on.

Vision problems are not the same eye problems. Classically, eye problems are focus problems and are commonly known as farsightedness, nearsightedness, and astigmatism.

Low visual performance is a major contributor to reading problems. Helen G. Robinson in "Clinical Studies in Reading, Part II," Educational Monograph No. 77, University of Chicago Press, says, "The only visual test that consistently differentiated high achievers from low achievers were tests involving measures of binocular ability."

Dr. Lois B. Bing, then chairman of the American Optometric Association's Committee on Visual Problems of Children and Youth, in the committee's report to the 1960 White House Conference on Children and Youth, said, "Vision problems at the college level require far more concern than has been given them up to this time. As college populations have expanded, and as the number of students taking advanced work has increased, more and more students are finding they cannot adjust satisfactorily to the reading demands made upon them.