physiologic, and pathologic subjects which underlie all studies of special systems and without which instruction in special systems would be incomprehensible and without value." [Italic supplied.] In January of this year, Mary C. Mulvey, administrator of the Rhode Island State Division on Aging, wrote a paper entitled "Optometry's Significant Role in the Total Approach to the Challenge of Aging." Dr. Mulvey received her B.A. degree from the University of Maine, her M.A. from Brown University, and Ed. D. from Harvard University. We submit the following quotations from this paper: "The optometrist might be considered the key practioner of the health disciplines for his primary responsibility for advising the patient to seek further treatment in accordance with his possible needs and/or refer him to a practitioner in another discipline. "I am quite knowledgeable of your excellent work and achievements and am deeply impressed with the dedication to work of the Committee on Vision Care of the Aging of the American Optometric Association." We respectfully submit that during the 12 years that have elapsed since the Doughton amendment was incorporated into title X of the social security law, the optometric profession has rendered a needed service which should be continued and expanded under the terms of H.R. 10032, Public Welfare Amendments of 1962. EXHIBIT 1 NATIONAL BOARD OF EXAMINERS IN OPTOMETRY TOPICAL OUTLINE1 Anatomy of the eye (pt. 1, sec. III) 1. The bones of the orbit and accessory nasal sinuses.-Orbital foramina and structures transmitted. 2. Fibreous tunic.-Cornea: General description, minute anatomy, physiology. nerve and blood supply, function; limbus; sclera; canal of sclemn, pectinate ligament, scleral spur. 3. Vascular tunic.-Choroid; ciliary body; iris; general description, minute anatomy, nerve and blood supply function. 4. Neural tunic.-Retina: General description, location, histological structure, blood supply, function. 5. Anterior and posterior chambers.-Aqueous formation, circulation and drainage. 6. The lens.-General description, location, histological structure, function physiology of the lens; zonule of Zinn. 7. Vitreous humor. 8. The appendages of the eye.-Eyelids: General description, location, histological structure, blood and nerve supply, function, medial, lateral; eyebrows: Conjunctiva: Histology and gross anatomy, glands, blood and nerve supply caruncle, plica semi lunaris; lacrimol apparatus. 9. The extrinsic muscles.—Origin, insertion, primary action, secondary action, nerve and blood supply, reciprocal innervation, synergistic and antagonistic actions, yoke muscles, detection of impaired muscle actions; levator palpebrae superioris, tenon's capsule, check ligaments, orbital fat. 10. Cranial nerves, II, III, IV, V, VI, VII nerves.—Nucleus of origin, course, components, consequences of its impairment, ciliary ganglion. 11. Automatic nervous system.-Path of the light reflex, near reflex, ArgyllRobertson pupil. 12. Visual pathway, minute anatomy, fiber distribution. 13. Vessels of the eye. 14. Development of the eye.-Organogeny of the nervous system, differentiation of the component parts of the eyeball. 1 The topical outlines provided by the national board are intended merely as a guide, not as a rigorous plan of examination. The individual topics and subtopics serve only to suggest the general coverage and possible areas of emphasis in each examination. In the design of the examination, attempts are made to word the questions, and to allow sufficient choice of questions to be answered, so as to compensate for differences in curriculum emphasis and recognized differences in doctrines prevailing in the different schools and colleges. Theory and methods of optometry (pt. II, sec. II) 1. Refractive status.-Hyperopa, myopia, astigmatism; causes, classification, prevalence, hereditary influences, eye changes, etc. 2. Functional status.-Accommodation, convergence, anisometropia, aniseikonia, presbyopia; norms, relationships, classifications, prevalence, etc.; test procedures and significance. 3. Examination procedures.-History, external ocular, ophthalmoscopy, field charting. Norms, significance, relation to systemic, occupational and aging influences. Specific techniques and instrumentation. Ophthalmometry, retinoscopy, static and dynamic, subjective routines, phorometry. Techniques and instrumentation; evaluation, significance, and comparisons. Analysis and prescription. Specific case applications, comparisons; isolated procedures and significance; problems of prescription, such as prism problems, etc.; lenses and multifocal selection. Strabismus, orthoptics, visual training. Training procedures; diagnostic and differentiating techniques and implications. (a) Paralytics from functional cases. (b) Correctable functional indications from noncorrectable indications, etc. Fitting of contact lenses. Aids to subnormal vision. Occupational and industrial vision problems. Diseases of the eye (pt. II, sec. IV) 1. The eyelids.-Congenital defects; diseases of the lid margin; diseases of the glands of the lid; diseases of the skin of the lid; diseases of the cilia of the lid; tumors of the lid ; injuries of the eyelid. 2. The orbit. Congenital anomalies, displacement of the eyeball, periostitis, celluitis, thrombosis of the cavernous sinus, ocular manifestations of accessory sinus diseases. 3. The lacrimal apparatus.-Diseases of the lacrimal gland and ducts. 4. The conjunctive.-Pinguecula, concretions, subconjunctival hemorrhage, chemosis, dry catarrh, anomalies of circulation. Types of conjunctivitis: Catarrhal, purulent, membranous, inclusion, trachoma, phlyctenular, vernal, allergic, angular; symblepharon, pterygium; differential diagnoses; tumors; injuries of conjunctiva. 5. The cornea.-Congenital anomalies; degenerative processes-arcus senilis, dystrophies, keratoconus, etc. Inflammation of the cornea-ulcers, superficial keratitis, deep keratitis; foreign bodies on cornea; wounds of the cornea. 6. The sclera.-Pigmentation; ectasia and staphyloma. Inflammations: Scleritis, episcleritis; injuries. 7. The iris, ciliary body, and pupil.-Congenital anomalies; reactions of iris and ciliary body. Inflamations of iris and ciliary body; types of endogenous uveitis; diagnosis of specific types of iridocyclitis; tumors; sympathetic ophthalmia; disturbances in pupillary reaction. 8. The choroid and vitreous body.-Congenital anomalies of the choroid; degenerations of the choroid; inflammations of the choroid; tumors and injuries; fluidity, opacities, muscle volitantes, hemorrhages, abscess, foreign bodies in vitreous. 9. The lens. Congenital anomalies. Cataract: Symptoms, types, differential diagnoses, secondary involvements; dislocation of the lens. 10. Glaucoma.-Intraocular pressure. Types of glaucoma: Primary, secondary, open-angle glaucoma, congenital; visual field changes; differential diagnoses. 11. The retina.-Congenital anomalies, injury, inflammations, circulatory disturbances, degenerations, detachment of the retina; tumors; retroletal fibroplasi. 12. The optic nerve.-Inflammatory changes, hyperemia, papilledema, toxic amblyopias, optic atrophy, tumors of nerve and sheaths, injuries, visual field defects. 13. Ocular manifestations of general disease.-Syphilis, tuberculosis, rheumatism, nephritis, diabetes, arteriosclerosis, cardiac affections, diseases of metabolism, chronic intoxications, infective diseases, diseases of the central nervous system, head injuries. 14. Disturbances of ocular motility.-Paralysis of ocular movements—supramuscular paralysis, of individual ocular muscles, paralysis of the III nerve: The ophthalmoplegias. 15. Ocular therapeutics.-Local anesthetics, antiseptics, mydriatics, cyclopligies, miotics, staining agents, eyewashes, use of ACTH. Mr. KING. I would now like to place in the record a letter and statement from Dr. George I. Deane, Jr., Director of the Department of Public Affairs, California Optometric Association. CALIFORNIA OPTOMETRIC ASSOCIATION, Hon. CECIL R. KING, House Office Building, Washington, D.C. DEAR CONGRESSMAN KING: It is the understanding of the California Optometric Association that H.R. 10032, a bill introduced on February 1 by Congressman Mills, of Arkansas, which among other provisions would add a new title to the social security law to be known as title XVI, "Grants to States To Aid for the Aged, Blind, or Disabled, and for Medical Assistance for the Aged." As introduced it provides that for a State plan to be approved it must "(12) provide that: In determining whether an individual is blind, there shall be an examination by a physician skilled in the diseases of the eye or by an optometrist, whichever the individual may select." It is our further understanding that a representative for the National Medical Foundation for Eye Care recently appeared before your committee requesting the elimination of the words "or by an optometrist, whichever the individual may select." He also asked that the existing law as it pertains to certification of the blind entitled to benefits under title X be amended so as to eliminate the utilization of optometrists and expressly require a certification be made by a physician skilled in diseases of the eye. We understand that oral testimony has been completed but the record will remain open until February 23 for the inclusion of any written statements which may be submitted. Therefore, on behalf of the California Optometric Association, I would deeply appreciate your kindness in requesting the inclusion of this letter and its enclosures as written statements for the record of the committee. During February of 1958, the then director of the Department of Social Welfare, State of California, George K. Wyman, prepared a statement entitled “Use of the Services of Optometrists." A copy of this statement is attached. While president of the California Optometric Asociation, I wrote a letter dated November 2, 1959, to John M. Wedemeyer, who was and is the current director of the California Department of Social Welfare; a copy of this letter is enclosed. At the close of the calendar year 1961, the records of the State department of social welfare show that there were 303 optometrists serving as authorized examiners rendering professional service under the State aid to the blind program. This is an increase of 36 over the previous year. During the year 1961, 848 applicants were examined by optometrists. The proponents of the amendment to delete optometric participation from this program have stated that as a consequence to the present inclusion of optometrists in the program the States have commonly, having accepted the optometrist's report, nevertheless found it necessary to call for an examination by an eye physician. The official records of the Department of Social Welfare, State of California, will show that this is a gross misrepresentation inasmuch as only 1 percent of the reports submitted by optometrists were considered by the State ophthalmologists who reviews all reports of optometrists and physicians and surgeons, to be in need of further clarification, requesting further information from the examining optometrist or requiring an additional examination of the applicant. Thus we can say that it is rare indeed that the department has found it necessary to call for an additional examination. We believe that the record of optometry is proof of its importance and contribution to the program and urge the defeat of any amendments that would remove the services satisfactorily rendered during the past 11 years by members of the optometric profession in California and, of course, other States. Sincerely yours, GEORGE L. DEANE, JR., O.D., Director, Department of Public Affairs, California Optometric Association. USE OF THE SERVICES OF OPTOMETRISTS George K. Wyman, director, State department of social welfare It has been about 61⁄2 years since the law became effective which authorized the State department of social welfare and county welfare departments in California to use the services of optometrists in determining degree of blindness in connection with eligibility for aid to the blind. Each applicant for aid to the blind must have an eye examination by either an optometrist or an ophthalmologist and, if found eligible for assistance, a second eye examination is secured 1 year later from a different examiner. When two eye examination reports are in conflict, i.e., one indicating eligibility and the other ineligibility as to degree of blindness, a confirming examination is required by a third examiner to resolve the conflict. The department makes a continuous study of all such conflicting examinations to evaluate the quality of the eye examination reports involved. At present there are 226 optometric examiners serving the aid to blind program in the State, and 456 medical examiners. During the calendar year of 1958 a total of 1,188 reports of eye examination were completed by optometrists. The use of the services of optometrists has continued to contribute to the smooth functioning administration of the aid to blind program in California. This is particularly true for the less populous communities where there is a scarcity of examiners. The availability of optometric examiners has meant that the State could take action as to eligibility for aid to the blind without the cost to the county of transporting the applicant or recipient to a neighboring or distant community to secure the required eye examination; and, of course, without the resultant inconvenience to the client. Also, the availability of optometric examiners in the larger communities of the State has appreciably shortened the waiting period for eye examinations between the date of request and the date of appointment. Throughout the past year the members of the department's advisory committee of optometrists have continued to carefully process all applications from those applying to be optometric examiners, as well as the status of those who move their offices. The quality and degree of service of the optometric examiners has been outstanding, as well as the department's relationships with the examiners. This happly result attests to the soundness of the advisory committee's work over the years-especially in devising the application and examination forms; in establishing and conscientiously maintaining high standards for examiners; and in assuming major responsibility for relationships with individual examiners and with the profession of optometry. As a result of these efforts of the members of the department's advisory committee of optometrists and the wholehearted cooperation of the profession, California's use of the services of optometrists in the social welfare programs for the blind has been highly successful. The department is very appreciative of the work of its advisory committee-Dr. Goeffrey Davis, of Sacramento, chairman; Dr. Kenneth E. Lady, of Santa Monica, vice chairman; Dr. Lester A. Fourness, of San Francisco; Dr. Clifford E. Miller, of San Diego; and Dr. Roy M. Swain, of Ukiah. JOHN M. WEDEMEYER, Director, State Department of Social Welfare, NOVEMBER 2, 1959. DEAR MR. WEDEMEYER: It is my understanding that in the near future, there will be a review of the standards for eligibility to serve as optometric examiners for the aid to the needy blind program. As president of the California Optometric Association, I would like to formally state that this association is most desirous of having your department maintain very high standards for those optometrists who serve as examiners. As you undoubtedly know, previously the department has used the AOA group rules of practice as a criteria. It matters not what the rules are called, however, the standards they uphold are the important thing. In your letter to me of March 24, 1959, you stated-"Our advisory committee of optometrists, composed for the most part of past presidents of your association, have done such a splendid job for us that we honestly do not have any suggestions as to how the services of optometrists throughout the State could be improved insofar as our department is concerned.." I most sincerely believe that this statement attests to the soundness of the advisory committee's work over the years, especially in devising the application and examination forms; and establishing and conscientiously maintaining high standards for examiners; and assuming major responsibility for relationships with individual examiners and with the profession of optometry. The program in California has been a shining light throughout the United States and I am sure that we both desire this to continue to be the outstanding program. Sincerely yours, GEORGE I. DEANE, Jr., O.D., President, California Optometric Association. The CHAIRMAN. Mr. James A. Evans in behalf of the National League of Senior Citizens. STATEMENT OF JAMES A. EVANS, LEGISLATIVE ASSISTANT OF THE NATIONAL LEAGUE OF SENIOR CITIZENS Mr. EVANS. Mr. Chairman, members of the committee, my name is James A. Evans, with headquarters at 1031 South Grand Avenue, Los Angeles 15, Calif. I am the legislative assistant to George McLain, president of the National League of Senior Citizens, and chairman of the California Institute of Social Welfare. Both are nonprofit corporations concerned with the problems of recipients of public assistance and social security. In this capacity, Mr. McLain has for 20 years been engaged daily in the field of the administration of the public assistance section of the Social Security Act. We have not had the opportunity to study H.R. 10032 entitled "The Public Welfare Amendments of 1962," introduced in behalf of the administration. A copy of the letter dated February 1, 1962, to Hon. John W. McCormack, Speaker of the House of Representatives, from Abraham Ribicoff, Secretary of the Department of Health, Education, and Welfare, deals mainly with the aid to needy children program, and not with the aged, the blind, and the totally disabled-except in the matter of reducing the residence requirements from 5 to 1 year, to which we heartily endorse. NO FEDERAL PROTECTION For 25 years, because of lack of Federal protection for the aged, the blind, and totally disabled on public assistance, the States have individually imposed all of the vicious provisions of the Elizabethian Poor Laws, outmoded years ago in Great Britain. This lack of Federal laws has caused a hodgepodge of 50 different States with 50 different public assistance programs, no two alike. Pauper's oaths, shame lists, unreasonable residence requirements, lien laws, deduction for home ownership, discrimination because of sex, strict limitation of real and personal property, responsible relatives laws, overzealous welfare workers, costly duplication of administration, and recipients prohibited from retaining even the smallest of earnings. We recommend that the following be included as amendments to H.R. 10032: THE AGED, THE BLIND, AND TOTALLY DISABLED (1) The elimination of the ceiling on Federal matching funds to the States, so as to encourage the States to grant a realistic and decent standard of living for their needy. And may I remind this committee that the meager $1 per month increase granted by Congress for those on public asistance in the higher per capita income States will soon expire; |