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Preventive vision care includes a thorough examination at the age of 3 to foresee future trouble. By that time it is possible to determine whether there is a tendency toward cross-eyedness, nearsightedness, or farsightedness, and whether the many visual skills that the child will need are beginning to develop as they should. Another benefit of that early examination is that it provides a record with which to compare later developments. With this accurate history, the optometrist can make a better evaluation of any symptoms that appear as the child grows older.
As he grows up, the child's vision may be “perfect”—according to the antiquated classical theory of 20/20 vision (visual acuity). Yet something is obviously wrong, and what possibly is wrong is that there is interference in visual perception. The child may not have learned skillful visual performance.
The optometrist must take into account the intricate and complex learned skills whereby the eyes do work together as a team-and perhaps he (the child) has developed distortions in various areas of performance. Visual training (orthoptics) can often restore his binocular skill and raise the level of his visual performance.
The Snellen chart and its emphasis on 20/20 sight will not bring out such problems. Lois Bing, whom I quoted earlier, makes this important point. She says, “In the field of vision screening in the schools, optometry has found that the multiprofessional approach, in which optometrists, ophthalmologists, school administrators, public health officials, teachers, and parents cooperate in the development of a program, provides the best hope of achieving a successful and effective and practical result. In practical operation, such an approach is being used with encouraging success in Euclid, Ohio, schools, where children are tested not only by Snellen chart for visual acuity at 20 feet, but by additional tests which reveal difficulties in using the eyes together with ease and efficiency for boardwork, deskwork, and reading."
When his eyes work together as a team, the child will learn faster, and retain more information. "Vision,” Dr. Arnold Gesell has aptly put it, “is the key to the child's whole individuality * * * To understand the child, we must know the nature of his vision."
Because the child can see small letters clearly at 20 feet and there are no obvious errors in the optical systems of either eye, the diagnosis is often that the child has healthy eyes and there is nothing wrong with his vision. The mistake here lies in the confusion between an eye problem and à visual problem. There are many children with 20/20 sight who have vision problems: They do not have vision for reading. For comfortable, easy seeing, the images must merge into one in the brain. If this does not happen, he may reverse letters or entire words, may see only one letter or one syllable of a word at a time, instead of seeing the entire word at one time. He may lose his place easily and have to follow his finger. He may see the chalkboard clearly, but focuses at a reading distance with difficulty.
When he has such vision difficulties, he is likely to be classed as a reading problem, or he may be considered lazy or disinterested. Teachers may reprimand him, parents castigate him, schoolmates tease him. And the child comes to feel that he is unjustly punished, and in time is likely to develop severe behavioral problems.
Repeating what I said earlier: The ideal time to start working for efficient vision is when the child is very young. Optometrists use a battery of developmental vision tests when working with a child only 16 weeks old. Modern optometry has a major role to play in aiding children in the development of adequate vision skills. Good vision skills developed early prevent such problems as I have just indicated. Such developmental investigation can chart the child's visual behavior and does, for example, uncover deviations from normal vision behavior—such as the child using only one eye, inadequate oculomotor patterns, poor form perception.
If the child does not evidence any visual difficulties, the time for the first important examination is at age 3 or just prior to his starting kindergarten. If any vision defect is uncovered at that point, the optometrist with the parents' cooperation can often lay out a training program to encourage normal, efficient vision development in the growing youngster.
As stated previously, modern optometry is based on the concept of functional vision, which takes into account not only the shape of the eyeball—the mechanistic-physical aspect of eye care-but the entire visual process, both physiological and psychological. It is important to know how well the child's
visual capabilities are geared for all of the normal demands made upon him, particularly the demand for sustained, near-point visual performance.
For it is precisely that near-point seeing task that is becoming increasingly important—both in the child's and the adult's life in today's civilization, and it is in this vital area of functional vision care that optometry has carved out its unique professional specialty and has made the greatest advances in recent years, providing the child—but also the adult-with the best possible vision for his major needs. Just seeing clearly is not enough. Each child—and each adult-must see comfortably and efficiently.
I have stressed the importance of early childhood vision care and vision development because it is a fact that a large number of those of us who are grown up today have been handicapped because we did not have vision care at an early age. Lack of proper training in vision usage has prevented many of us from entering professions which demand etxensive education—and the country as well as the individual suffers. Who knows how many scientists, engineers, educators, writers, and other professionals were lost to our Nation because of lack of vision care? What may have been regarded as laziness or lack of ambition during the school years of such people, might well have been the result of inadequate visual performance. The loss is great—to the individual, society, and Nation.
One of the chief responsibilities of the optometrist is to prepare a young person for sustained seeing activities—one of those activities being reading. In a good many cases, this can be a crucially important factor in a person's life. After all, those who want an education must be capable of the physical act of reading before they can become capable of understanding and absorbing what they are reading.
Vision problems are not only contributing causes to such educationally handicapped—they are also important aspects of the problem of the retarded child. It's only been in the past decade that much has been done for the brain-injured or severely retarded child. Optometry is proud to have had the opportunity to play an important part in the teamwork approach to the needs of such children. A number of studies reveal that many problems of retardation have at their base a vision problem.
I would like to leave with the committee a copy of the “Report to the 1960 White House Conference on Children and Youth,” which was presented by the American Optometric Association. I would like to call your attention to appendix B, page 28, which contains the paper entitled “Optometric Visual Care for the Brain-Injured Child," by Dr. G. N. Getman.
The retarded child presents a challenge to us, and so does another youngster with problems—the school dropout. The U.S. Department of Health, Education, and Welfare estimates that there will be a total of 7.5 million dropouts in the period 1962–70. This represents 16.3 percent of our total elementary and junior high school student body-approximately 46 million boys and girls.
A recent Labor Department study titled “Manpower Research" pointed out that “the educational attainment of the bulk of the Nation's adult population is below the high school graduation level. In 1960, 59 percent of the adults aged 25 or older had less than 4 years' high school education ***. In every State, at least 40 percent of the adult population is short of the 4-year high school mark.” What relation do these statistics bear to vision?
A survey of pupils in the Euclid (Ohio) public schools who did not complete high school indicates that these children had one deficiency in common: reading deficiency which expressed itself in poor or failing grades in reading in elementary school and in failing grades in English in secondary schools.
In other words, there is a considerable correlation between dropouts and reading deficiency which traces back to vision problems.
A comparative study of the incidence of reading disability in several clinical settings undertaken by Fabian, and quoted by him in a paper presented at one of the conferences of the American Orthopsychiatric Association, revealed the following: an incidence of 10 percent in a school sample; 33 percent in a child guidance clinic sample; 62 percent in a sample from a child placement agency ; 73 percent in the population of a psychiatric hospital's children's ward; and 83 percent in a sample of predelinquent and delinquent children.
And on this matter of delinquency let me quote another book, "Reaching Delinquents Through Reading,” by Melvin Roman. He says that approxi
mately 10 percent of the school population of America requires special aid because of retardation in reading. A survey conducted by the writer at the Manhattan Children's Court revealed that 84 percent of cases carried by the treatment clinic present the problem of reading retardation in conjunction with personality disorders and antisocial behavior.
Dropouts, delinquency, vision disorders. Five hundred and fifty-five thousand juvenile delinquent cases were tried in court in 1962. These offenders were in the 10 to 17 age group (representing 1.8 percent of all children of that group), this being the group in which the largest number of dropouts obviously occurs.
Now we already know that faulty vision or vision problems if not corrected can in time cause a youngster to be unsuccessful in school and unable to study effectively. Unless his family insists that he remain in school, or unless he has visual care which helps him solve his reading-and-seeing problem, he is a likely dropout candidate. And so, a vicious cycle may well result in adding another delinquent—a boy or girl who might have been saved with the aid of proper, professional visual care.
The growing lack of jobs for young people may then make it impossible for such a youngster to find a job. And if he does apply, his visual difficulties and limited education might make him unsuited for certain types of jobs.
We have thus lost a productive member of the American community. And the cause of that loss may well lie in the field of vision *** in our neglect to help that youngster when help might have made the difference between a useful and nonproductive life.
In American industry the results of lack of vision ability_even where there are no obvious physical defects—can be measured in millions of dollars and thousands of wasted man-hours.
Just as an example, let me use the illustration of one large printing company-R. R. Donnelley & Sons—which found that proofreaders who meet the minimum visual requirements are 37 percent more accurate than those who failed the minimum visual tests, have 7.9 points higher efficiency, and produce a net productive value of 12 cents per man-hour more than those failing to meet minimum requirements.
Another illustration: In a Washington, D. C., Federal Government office, a vision program, plus improvement in lighting, brought about an increase in worker efficiency, conservatively rated at 5.5 percent. Translated into cash value, it means that the 95 employees in that office, following the vision program and lighting improvements, created a payroll saving of $13,229. Using the same scale, if a business had 1,000 employees, it might save $139,250 over a period of a year. Good, efficient vision pays—in many ways.
And good, efficient vision is obviously a sound business investment—and a sound national investment. Let's remember that our 300,000 industrial plants employ about 16,651,000 people.
Now, let's look at what savings can be had in man-hours based on the figure I mentioned for the printing plant, which as the result of a vision care program found that having good vision produced 12 cents more per man-hour.
Translated into our national industrial plant with its 16.6 million employees, a vision care program would result in savings of about $4 billion annually.
In other words, the $4 billion saved would in effect be added onto the gross national product of $585 billion, instead of being lost to our gross national product, as indeed that $4 billion now is lost.
Well, how do we obtain these savings for industry and for the Nation ?
To service the 300,000 industrial plants, we would need about 4,800 optometrists in addition to those now practicing. That sounds like a large order—and at the present moment it is, when we only graduate about 500 students annually from our schools of optometry. But it's a very small number in terms of the real service they could render to industry and nation.
I did not pull that figure out of my hat or even my head. It is based on the fact that the optometrist's actual working time when you deduct such things as weekends, vacations, attendance at postgraduate educational meetings, etc.-amounts to about 250 days. Since there are 300,000 plants, and he needs about 4 days for each plant, that means that optometrists must spend 1,200,000 days a year to service those plants. If you divide the 1.2 million days by 250 days the average optometrist will work, the figure you come up with is 4,800 optometrists.
A number of optometrists work as consultants to industrial organizations. The first day they visit a plant, they obtain an overall idea of plant layout-in particular, they watch for potential dangers to sight and vision. The following days they spend looking over the shoulders of each worker. They watch everything—from his posture to the type of work he does; they measure the distance from his eyes to the instrument he uses—be it a lathe or a blueprint.
They evaluate the employees' sight requirements as they relate to the specific task each man has. In addition, they look for ways to prevent eye injuries and accidents that may result from faulty vision. They search for ways to increase production and eliminate waste caused by defective vision.
They cooperate with plant safety experts and perhaps with the medical staff to find and eliminate work and work processes which present eye hazards and to determine protective requirements for workers, including whatever protective eye devices may be needed. They advise foremen as to special and specific visual problems in the plant.
On the basis of their personal, in-the-plant observations, they make their recommendations to management which might include recommendations to control the quality, quantity, and direction of light; using paint which will improve lighting utilization; elimination of certain hazards to vision; wearing of certain types of protective goggles for some men in the plant; etc.
Here is both vision care and preventive vision care. Here is a job of major proportions that needs to be done. Yet we have not, at this moment, the manpower to do it.
H. W. Hofstetter reports in his book, “Industrial Vision,” that the total annual incidence of eye injuries alone is about 300,000. I would like this committee to have a copy of Dr. Hofstetter's book.
Anybody in the management field knows that manpower is the most expensive single factor in production costs today. Therefore, it is most important to use personnel at top efficiency. Vision is the key to man's brain, for 85 percent of all he learns comes to him through his eyes. His vision, therefore, is the human element that is the key to production.
Industrial managers are practical businessmen. And it is not difficult for them to establish the effects of a vision program on training time, labor turnover, sickness and absence costs, reduced spoilage, and accident expense. These factors, when eliminated or reduced, mean less production costs and an increase in profit margin.
There are many factors which influence the health level of any business. No claim is made that a vision program will cure, by itself, all the maladies of absenteeism, labor turnover, insurance costs, or the more complicated ailments relating to labor relations. However, a well-conceived continuous vision program properly integrated into personnel, safety, and medical activities of any industry has sufficient influence to validate the effort.
Research in industrial vision has developed a method of vision testing and analysis that will give industry a clear-cut statement of the dollars and cents value of good vision and good seeing, to bring about a realization of the importance of adequate visual attention of industrial employees. Results show that from 20 to 50 percent of the industrial employees need visual help for the jobs to which they are assigned.
The optometrist has a major role to play in industry, and in the future he will play that role in the best interests of individuals and business organizations.
There are about 90 million Americans who are of great concern to the optometrist. These are the Nation's drivers of private cars and commercial vehicles. We are constantly assailed by horrifying statistics concerning highway accidents and deaths. The optometrist cannot prevent all of them. But he can help to reduce them by making sure that all drivers have vision adequate for modern freeway driving.
Each year about 40,000 people are killed in auto accidents, hundreds of thousands more are involved in nonfatal but often serious accidents. There has been much discussion of the reckless youngster who speeds down streets and highways. A study made in California showed, however, that drivers involved in accidents with other cars were largely people over 65 years old. And the National Safety Council says that the fatality rate climbs rapidly for drivers over 70 who are involved in accidents. Our own motorists' vision and highway safety committee found that 80 percent of drivers 60 years and over have visual problems which make them risks on the highways.
Let's not forget in that connection that by 1975 nearly half the adult population of the United States will be over 65. This is, of course, not an indictment of our elderly drivers. But the fact remains that when you compare
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
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 re ent 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