involvement in motor vehicle accidents according to age groups, the rate for the older driver is 45 per 100,000 population, while it is only 25 for people of age 25.

Obviously, more attention must be given to vision care for this group, but not for this group alone. When you remember that about half of our population needs some visual attention, it is obvious that a large group-a group larger than older drivers-among the driving population is in need of such attention. It should be realized, however, that a great many States have a "grandfather clause" once an individual obtains a driver's license, he can go on driving a car indefinitely without any further examination.

Studies indicate that 90 percent of all driving decisions are based on the ability to see, yet probably about half of today's drivers fall below acceptable vision standards. Yet 40 percent of today's drivers are over 40 years old, when vision defects become more pronounced.

A few States have compulsory driver reexamination. Most do not. As long ago as 1941, New Jersey began a program of reexamination of all drivers over 65 years old who had been in a reportable accident, no matter how minor. As a result, several thousands had their licenses revoked. North Carolina reexamines all drivers-totaling more than half a million-every 4 years. In Illinois, Delaware, Maine, and New Hampshire there is a requirement for the periodic reexamination of senior citizen drivers.

Good vision as far as driving is concerned is not just a question of having 20/20 sight. Driving demands vision that is clear, complete, and quick, each of which is a separate skill of the eye. Good peripheral vision is important-how much you can see on each side without turning your head or eyes. So is depth perception-your ability to judge distances and direction. And night visionyour ability to see under low illumination and your adaptability to darkness. Glare resistance is also important-your ability to see against headlights or sunlight and the rapidity with which you can recover from being blinded by glare.

Good driving vision, then, means many things, all of them important to safe driving.

Optometrists work with many of the State motor vehicle administrations. Quite a few work on a voluntary basis with driver training courses in the Nation's schools. But again, we must come back to the lack of sufficient manpower in this profession.

A population of 191 million people is served by approximately 17,000 practicing optometrists. In other words, the rate is 1 optometrist to every 11,279 persons. Even though not every American needs vision care today, this is still an alarming ratio. Plainly speaking, it means that the optometrist simply cannot do all the jobs that need to be done.

Despite such lack of manpower, the optometrists of the Nation have contributed their services to making the highways safer, and are anxious to do more. The American Optometric Association's Committee on Motorists' Vision and Highway Safety has worked closely with numerous organizations, bringing to their programs the necessary professional and technical knowledge of our most precious sense-vision.

"Optometry," in the words of the past chairman of AOA's Committee on Motorists' Vision, Robert C. Sneller, "occupies a unique position in the field of highway safety and can make a substantial contribution to the fund of knowledge necessary to many remedial programs. Almost all actions and decisions of a driver are dependent upon what he sees. Thus, almost all factors relating to movement and control of the motor vehicle are at least in part within the scope of optometry. The optometrist, as a professional man and responsible citizen, is anxious to lend his efforts to the further reduction of fatalities, injuries, and loss of property due to auto accidents." I would like to leave with this committee a copy of Dr. Sneller's book, titled "Vision and Driving."

I am also leaving with the committee a pamphlet entitled "The Optometrist and Safe Driving," which spells out the role of the optometrist in this area.

On the highway, in the school, in industry, and the office the optometrist's help is needed-and critically needed. And there are yet other areas of our national community where his services would be a personal as well as an economic advantage to many of our citizens. As part of the war on poverty, a good many men will have to be retrained, and this is a big job. For the individual to be retrained, it will not be an easy thing. It will become very much harder for a man without good, efficient vision. And a good many of these men will be in middle

and upper age brackets. The visual part of the entire retraining program will be of great importance.

Since the Department of Health, Education, and Welfare will be principally concerned with this campaign, optometrists should be on the Department's staff to evaluate programs and plans, to supervise the carrying out of plans-all in the interest of vision care.

Optometry occupies a unique position in the health care field. It renders visual care in the physical sense through the measurement of the refractive powers of the eye, and the visual training to develop a high level of visual performance skills for accurate perception of objects in space. But it also gives advice regarding environmental factors which may affect visual efficiency. This is certainly true in office and industrial work which the optometrist undertakes.

Optometrists also work with the near blind, including near-blind children. Time was when educators believed that students with limited vision would damage their eyes further if they used them for classroom work. Today it is realized that some children, at least, who have limited vision, should be working in the classroom for all or part of their educational process. This is the result largely of the renewed interest in exact refractions and in the use of low vision optical aids.

There is a recognition today that not all who are classified as legally blind are in effect completely unable to see. The optometrist has developed many effective aids for the partially blind, and it is no longer uncommon for the legally blind persons, some of whom are on blind pensions, to have their vision restored sufficiently to read or watch television. Optometrists have led the way in improving telescopic spectacles. They are a boon to children—and to the aging whose number is rapidly growing.

The new philosophy here is to keep the partially seeing child in a normal school environment as much as possible. Thus, he can lead a normal school life. He can learn and play with his normally seeing classmates and not feel set apart from them. Thus, he is better prepared for life than if he had been kept apart from the "normal" child of his own age, and learns at an early age how to live with his handicap and how to make the most of his total abilities in a normal environment.

Such an approach to the problem of the child with limited vision was possible only when the idea that one had to conserve the child's vision was recognized as being faulty. The fact is, that properly supervised and guided, a partially seeing child does not wear out his limited vision. Rather, he enhances and develops it, and thereby his own role in life as well.

Optometry believes in dynamic progress, and not in just making the best of what is available. Thus, to improve a partially seeing child's vision, it can give him specialized vision aids-including telescopic and microscopic types of eyeglasses which often enable him to read even the smallest type. But again, this is not enough. The optometric profession has evolved a program and a concept of low-vision rehabilitation which, in the main, makes these points: that the child or adult patient utilize rather than "conserve" his vision; that he shun the sheltered life and instead take an active part in it and in the edu cation he needs for life.

In such ways does the optometrist help to raise the visual efficiency of America. But more, much more, needs to be done; and to do it we need more optometrists.

This means that more students and prospective students of optometry should receive the financial assistance that will enable them to obtain or continue their education. Medical and dental students have available thousands of loan dollars for every loan dollar available to optometry students.

Under these circumstances it would seem self-evident that optometry students be accorded the same privilege of borrowing and paying interest on student loans as the medical, dental, and osteopathic students. If you vote favorably on these amendments, and I urge you gentlemen to do so, the money you will be lending these students will be a pittance compared to that now being provided to the other health professions.

Failure to act favorably will result in a reduction of the number of students who will study optometry in the years to come; it will mean a reduction in the number of qualified optometrists when the country needs more, many more, to perform the vital services which only optometry can perform. It will mean that the profession would have to abandon some of the areas it is investigating and developing, or at least greatly reduce some of its work in those areas.

It is almost certain that untrained laymen will occupy the void created by the shortage of professional specialists and, gentlemen, that is not the way to improve the Nation's vision.

On the other hand, passage of this bill will go a long way toward insuring a continued flow of able, well-trained optometrists into vision care and into the necessary research connected with vision care. Your support will be appreciated not only by us, the Nation's optometrists, but by the American people as à whole, and in particular by that vast segment of our population which is or will be served by optometry.

Thank you very much for your patience. I shall be happy to answer any questions that any member of this committee may wish to ask.

APPENDIX

Licensed optometrists and certified ophthalmologists related to the population of the United States of America

Sources: Blue Book of Optometrists, 1958; Red Book of Eye, Ear, Nose, and Throat Specialists, 1959 Directory of Medical Specialists, 1957; Bureau of the Census, Statistical Abstracts, 1958.

VISION AND SCHOOL ACHIEVEMENT

IMPORTANCE OF VISION

More than 80 percent of all school tasks are based on vision.

Vision is the key to a child's whole development, according to the Gesell Institute of Child Development. Not only school achievement but personality, posture, and adjustment to life are closely integrated with vision development. Many retarded readers have neglected vision problems.

Four out of ten grade school children in the United States are visually handicapped for adequate school achievement.

ELEMENTS OF GOOD SCHOOL VISION

Near vision-ability to focus and see clearly and comfortably with both eyes and each eye separately at a distance of about 15 inches. This is the distance at which most school desk work is done.

Distant vision-the same as above for a distance of 20 feet or more. This is necessary to see the chalkboard, to enjoy motion pictures and television, and to engage in sports.

Binocular coordination-ability to make the two eyes work together. This is necessary for art work, handicrafts, and play activities, as well as to read efficiently.

Adequate field of vision-ability to see to both sides and up and down while focusing on a small target. This saves unnecessary eye and head movements and is essential for participation in sports and for personal safety.

These and many other requirements for adequate vision must be considered in a complete vision analysis, especially for the schoolchild. Because most school tasks are performed within arm's length, it is not enough to determine whether a child can read the Snellen chart at 20 feet or to prescribe corrective lenses to bring them up to that ability. How well a child's visual capabilities are geared for all of the normal demands made upon him, particularly the need for sustained, nearpoint vision performance, must also be determined.

VISION EXAMINATION

Modern optometry is based on the concept of functional vision. This takes into account not only the shape of the eyeball, but also the entire vision process, both physiological and psychological.

Any complete vision examination for a child cannot be done hurriedly. It often takes an hour for all of the necessary tests and sometimes more than one visit.

A case history is an essential part of a child's vision examination. It should include symptoms observed by parents and teachers, general health history, developmental history, and the child's attitude toward school and play activities. There should be a thorough examination for eye disease.

Both the examination and correction provided should pertain to actual use of

CORRECTION

For refractive errors (such as nearsightedness, farsightedness and astigmatism) either conventional glasses or contact lenses (for the older child) are usually prescribed. Lenses may also be prescribed to enable the child to function with greater ease and efficiency.

Visual training or orthoptics is the answer to many problems of muscle imbalance, where the two eyes do not work together as they should. It is often the means by which strabismus (crossed eyes) may be corrected. Sometimes a child may be trained to improve the vision of a lazy eye (amblyopia).

The vision specialist's advice should be followed on how to use the eyes, on when to wear glasses (for reading, play, all schoolwork, etc.), and on proper light and proper posture when doing close work. All of these are important in correcting vision problems.

With the aid of modern science all but a few children can have their vision brought up to par. Few health problems respond so completely to proper professional care.

VISION SCREENING

The American Optometric Association recommends a complete, professional visual examination before a child enters kindergarten, and annual checkups thereafter to provide maximum preventive care and early correction. However, the achievement of this ideal for every child is not yet within the foreseeable future.

In the meantime, many schools and parent-teacher groups render a valuable service to the vision conservation of the schoolchild by conducting preventive education and vision screening programs.

While even the best school vision screening programs fail to detect all children who are in need of professional care and sometimes refer those whose vision is adequate, the value of such programs is unquestionable. Every school should offer the best screening program possible within the limits of available

resources.

The limitations of the Snellen chart at 20 feet as a sole criterion for vision screening are now well known. Numerous other tests have been developed and are readily available for school use of help determine which children need professional care.

An important part of any screening program is the observant parent or teacher who watches for symptoms of vision problems particularly while the child is reading.

SYMPTOMS TO WATCH FOR

Losing place while reading.

Avoiding close work.

Body rigidity while looking at distant objects.
Holding reading material closer than normal.

Excessive head movements.

Poor sitting posture and position, or facial distortions while reading such as frowning, excessive blinking, scowling, or squinting.

Tilting head to one side.

Tending to rub eyes.

Thrusting head forward.
Headache.

Tension during close work.

Little or no voluntary reading at home.

In general, any child in the lower third of the class should have a complete eye examination, particularly if he seems to have ability to achieve at a higher level. Any child who is not working up to within reasonable limits of his own capacity should also have a complete vision examination.

HOMEWORK CORNER

The schoolchild should have a suitable place for homework-a corner, if not a room, that is his or her own.

Such a place should be evenly lighted, without glare and without large dark areas. If possible, the room should be painted in light pastel colors that reflect rather than absorb light. It should be comfortable and attractive. It should be a place the child likes.

Chair and table should be of the right size for proper posture.

Small children should have reading matter of large type the smaller the child, the larger the type.

Children below the third grade should not concentrate for more than 15 or 20 minutes on close work without looking up to relax their eye muscles and whole bodies.

NOTE. This pamphlet, prepared by the American Optometric Association, St. Louis, Mo., is published in the interest of furthering the visual welfare of the American people; 12,000 licensed professional optometrists, members of the American Optometric Association, serve the vision needs of 60 million Americans.