vascular disease, all causing blindness if ill daignosed but which can probably be prevented by prompt and accurate diagnosis. Earlier in the statement you mention optometrists incorrectly diagnosing. Can you give us an example or two, tell us the difference between an optometrist and ophthalmologist? Dr. JAECKLE. The difference between an optometrist and ophthalmologist is like the difference between night and day. The ophthalmologist is concerned with everything pertaining to the eye and is responsible for that. Mr. ALGER. He is a physician? Dr. JAECKLE. He is a physician. After I completed optometry training to qualify to be an ophthalmologist, I spent several times as many years. A patient was referred to me by a very good friend, an optometrist, a man of the highest character, who stated that for 2 years he had been observing this man and now his loss of vision was such that his cataract should be removed. It was my unpleasant duty to advise the patient that his loss of vision was not due to his cataract and the cataract should not be removed. His loss of vision was due to changes in the eye due to high blood pressure and it had continued throughout the 2 years of observation. The permanent loss of vision caused by the high blood pressure had gone undiscovered and untreated. Mr. ALGER. In this case you have just given us, then, if this man had not been treated by an optometrist but instead had been to a physician, an ophthalmologist, this high blood pressure condition might easily have been prevented in the spirit of this bill? Dr. JAECKLE. The condition would inevitably have been discovered and could have been treated and the loss of vision could have been prevented, in all likelihood. Mr. ALGER. At least there would have been a chance to prevent it? Dr. JAECKLE. There would have been an excellent chance. Mr. ALGER. In this case, the vision was lost because there was not proper diagnosis and treatment for 2 years. Dr. JAECKLE. That is right, sir. No attempt had been made to treat the condition, of course. There was no knowledge that it existed. Mr. ALGER. You mean the optometrist did not know, as a physician would, what the trouble was behind the cataract? Dr. JAECKLE. That is right, sir. I would like to cite another case, sir. A patient came to me who had been examined by an optometrist, who advised her that she had a condition for which he could not help her and for which no one else could do anything for her. If anyone else could help her, he would have been glad to send her. He had seen in the eye-it was evident-a condition for which treatment is not as effective as it is for some other diseases. He prescribed very appropriate glasses for the patient but she was unsatisfied because her poor vision persisted. She sought further examination and quite unwittingly went to an ophthalmologist. She was found to have glaucoma. Her poor vision was due to the glaucoma. Because it was detected in time, she will probably have adequate vision for the rest of her life. If she had gone another 6 months or a year without treatment she certainly would have had very serious loss. She already had some permanent loss. A patient was sent by an optometrist, which is evidence of his good intent. For 6 months there had been changes in lenses with progressive loss of vision. The optometrist finally suspected glaucoma in one eye. The patient had suspected it months before and raised the question. The patient had advanced glaucoma not only in that eye but in the other eye, and there was permanent partial damage. A patient came to me who had been told by an optometrist over a period of several months, 6 months in fact, that he had cataracts which required no surgery. This was quite true. It happened to be true. But because he had been told he had cataracts and when his sight continued to get worse, he applied for admission to the veterans hospital for surgery for cataracts. When he arrived it was found that he was hopelessly blind. He was totally and permanently blind. His loss of vision over a period of 4 years, during which he did not have normal vision with glasses, was not due to cataract. It was due to glaucoma. Mr. ALGER. Dr. Jaeckle, you have made your point to me. If you have other cases, I am sure the chairman will permit the record to be kept open to permit you to add those if you would like to. There are only two or three on this committee who do not wear glasses and this member is about to. So I think we know something about ophthalmologists. The CHAIRMAN. Any further questions of Dr. Jaeckle? Dr. Jaeckle, we thank you again for coming to the committee. Dr. JAECKLE. Thank you, sir. (The following documents were submitted by Dr. Jaeckle for the record :) REPORT to The 1960 White House Conference on CHILDREN AND YOUTH from The American Optometric Association Committee on Visual Problems of Children and Youth THE IMPORTANCE OF VISION TO A CREATIVE LIFE IN FREEDOM AND DIGNITY P. N. DeVere, O.D., President Committee on Visual Problems of Children and Youth Lois B. Bing, O.D., Chairman Marguerite Eberl, O.D., Milwaukee, Wisconsin Daniel Woolf, O.D., New York, New York H. Ward Ewalt, Jr., O.D., Trustee Consultant, Pittsburgh, Pa. |