He should know the professional organization facilities and sources of information accessible to him. His reference files and professional library should be kept up to date on related matters. He should be prepared and willing to serve on safety committees for PTA groups, civic clubs, and appropriate commissions. In short, he must ever be mindful of the fact that he is expected to be the best informed person in his community on vision as a factor in safety, and that being informed is not merely a matter of holding strong convictions and/or unsubstantiated opinions.

6. VISION STANDARDS FOR DRIVING

Perhaps the most vulnerable stand to take on vision standards is that they be fixed by arbitration. Granted that in any administrative program there must be fixed limits, the real success of this type of program requires the application of judicious considerations within a framework of limits. Such considerations involve highly professional evaluation of how effectively a person uses the visual skills with which he is blessed or which he can attain.

Within this concept, vision standards may be classified in terms of (a) desired and (b) minimum visual conditions. The desired visual test scores represent those that are normally attained by persons who suffer no visual impairment or handicaps. The minimum visual test scores represent those below which the person would be deemed to be unable to cope safely with the ordinary visual demands and conditions of driving. These may be established in part by statistical studies and in part by direct evaluation of the visual stimuli which serve as action criteria, landmarks, clues, and hazard indicators in driving.

Standards that have been recommended and/or adopted by many agencies tend to vary between these two limits and may be classified approximately as follows:

Desired standards.-20/20 or better in each eye, with normal binocular vision, no field restrictions, no muscular anomalies, and no color vision deficiencies. Minimum standards.-20/40 or better in one eye, absence of diplopia, and intact fields to at least 70° in each lateral direction from straight forward position.

More significant than the application of such standards, however, is the application of sound procedure in the licensing of drivers within these limits, since the great majority of drivers who do not seek professional attention score inside this range. The primary consideration to be made in such cases is that the driver shall maintain and employ the best vision attainable. This he should regard as his moral as well as his legal obligation.

In other words the driver who can attain 20/20 with the proper lense correction should not be permitted to drive without them just because he can see better than 20/40 unaided. Similarly a person, e.g., a hyperope, who obtains 20/20 both with and without his glasses should be obliged to wear his glasses for driving if they provide demonstrably greater accomodative and/or binocular efficiency.

7. PUBLIC EDUCATION

The unpardonable 30-year lag of adequate licensing standards behind the growing toll of highway accidents must be attributed to one major factorthe lack of public education. Reduction of the accident toll demands a cooperative effort that allows no room for exceptions. The individual caution exercised by 99 drivers carries little reward when 1 careless driver roams the highway. The license to drive must be regarded as a judiciously granted and earned privilege, not an inalienable right.

In his role as a citizen the optometrist must recognize that the latter concept is developed by public education, out of the resources of scientific study, political development and the legal interpretation of the constitutional rights of individuals. Not only because of his professional identity with one of the important aspects of driver qualification, but more especially because of his natural role as a community leader and opinion molder, the optometrist should participate in the complex undertaking of public education relative to the facts and concepts of driving safety. It is not enough to say that vision is important. The greater problem is that of making the public aware of the significance of driving safety and the means of accomplishing it.-The American Optometric Association, Inc., 4030 Chouteau Avenue, St. Louis, Mo.

36-202-64-5

Dr. EWALT. Thank you, Mr. Chairman. To begin with, about 30 million Americans every year seek vision care. Even more important is the fact that there are many millions, particularly schoolchildren, who need vision care and don't get it. Certainly the need for optometric vision care grows with the complexity of civilization in which we live and with the increase in educational demands for all kinds of activity. To read and to study in this age of science and technology is fundamental to achievement.

Optometry, with its unique concept of functional vision problems, in other words, in visual performance, is uniquely prepared to deal with these kinds of problems. The objective of the practicing optometrist is not only to be sure that the patient can see clearly, which we might think of as "squirrel hunting vision," but also that he is comfortable and that he is efficient in his seeing; in order that he can maintain efficient study, or laboratory activities, which are essentially near-point activities, over long periods of time.

Optometry is the Nation's first line of defense against blindness. When pathological conditions occur, optometrists refer these problems to medical specialists who are especially prepared and trained to deal with these problems.

The optometrist performs about 65 to 70 percent of the eyesight examinations in this country, does about 75 percent of the contact lens work, and about 80 percent of the work in orthoptics and visual training. So that somewhere around three-fourths of all who seek vision care in its broadest sense first turn to the optometrist. Optometrists, as commissioned members of the Medical Service Corps of the three services, render about 85 percent of the eyesight work that is done for the members of the Armed Forces.

You will find in the material that was presented to you a table showing the number of optometrists and the distribution of optometrists. This is exceedingly important as far as getting service to all of our people as conveniently and economically as possible.

The emphasis that optometry placed on meaningful seeing is a concept that is unique to optometry and is based on the unique education and training of optometrists. Meaningful vision is operating when the person has the best possible and most efficient vision for the tasks that he needs to perform, whether that person is a housewife or a student or a crane operator. These are considerations that come into the service of an optometrist.

A widely accepted biological fact is that anatomical completion or growth leads only to minimum performance. I mean by that, that track meets are not won by youngsters who have good legs and a good stout heart. Track meets are won by perfectly normal youngsters who have learned to walk and run and then are placed in the hands of a skillful track coach who enhances their performances.

The same thing is possible as far as vision is concerned. In the cross-eyed youngster, orthoptics and visual training procedures can correct many of the cases of cross-eyedness. In the matter of vision and child development, we have reached something that is at the very heart of our need in a number of problems as far as the country is concerned. Dr. Lois Bing, who was for many years chairman of our Committee on Visual Problems of Children and Youth, made a report to the White House Conference of 1960 which you will find as part

of the appendix of your material. She discusses there the visual problems of schoolchildren from the preschool level right through the college level. The thing that I think we need to realize is that recent development and understanding in the broad field of child development clearly indicates that visual problems begin very early in the child's life. For instance, Dr. Arnold Gesell, of the Clinic of Child Development at Yale University, says that vision is the key to the child's whole individuality. To understand the child, we must know the nature of his vision.

Further, in these studies-this study and in other studies-we find that visual problems can create performance problems as far as children are concerned and also create problem children thereby. A child who is unable to keep up with his work in school becomes a disinterested child. He is often wrongly accused of being lazy. If there are not the most stable sociological conditions around him, it is entirely possible he will become a delinquent or that he will become a school dropout.

We believe as a profession that preventive vision care is a matter of the utmost importance as far as the future of this country is concerned. Efficient, easy seeing where the images of the two eyes fuse together, where the eyes are coordinated in their motor activity, where we do not have a child that is skipping words or even whole lines or reversing words, who has a speed and span of perception as adequate to his needs in this reading situation, is a child that is very apt to achieve and get ahead in schoolwork.

Optometry has played a major role in aiding these children, particularly in the development of the adequate visual skills which are prerequisite to achievement in reading.

I want to stress the fact that modern optometry is based on this concept of functional vision and takes into account the entire seeing process, physiological and psychological. Just seeing clearly is not enough. Each child must see comfortably and efficiently in order to do his best in reading.

Of the many causes of reading retardation, and certainly we recognize that there are many, numbers of studies indicate that faulty vision performance, not lack of visual acuity, but faulty vision performance is the one most frequently found. In retarded children we find another unique opportunity for service because if the retarded child is to make the best possible use of his abilities, it is important that he perform effectively visually. Some studies show that these retarded children have functional vision problems which need to be straightened out.

And you will also find attached to the White House Conference report a paper by Getman on optometric visual care of the brain-injured child. Certainly we are concerned with the 72 million of school dropouts that are anticipated for the years 1960 through 1970. I have already indicated to you why we know that a certain number of these school dropouts result from inefficient vision, the lack of ability of the child to perform in school, particularly in the area of reading, and we have cited a number of studies to you in the paper which show the importance of this particular factor.

Optometrists are concerned with industrial problems. A number of optometrists serve as consultants to industry. They are develop

ing visual efficiency for productivity. We would estimate that if the 300,000 industrial plants in the country are to get the kind of help that a few plants are now getting, it would require at least 4,800 additional optometrists to do that one job alone. On the basis of estimates, it would look as though the saving to the Nation could be in the order of $4 billion if what we know today about visual efficiency, as it relates to industrial production, were applied to all plants as it is to certain individual plants.

I am sure that the members of the committee will agree that one of the things to which we need to give serious consideration is the matter of highway safety. When we think back to the visual demands or skills that were necessary to drive "old Dobbin" down a country road at about 5 miles an hour and compare them with the visual performance skills that are necessary to drive an automobile at 70 miles on our freeways, we realize they are two completely different things. Clearness of vision is only one of the visual factors needed. We must have a full field of vision. We must have good depth perception. We need adequate glare recovery. We have got to have adequate color vision and a number of other factors that enable the driver to perform the 90 percent of the judgments that he makes behind the wheel of a car visually.

And incidentally, as our population ages, we have an increasing need for vision service. Studies reveal that 80 percent of the drivers over 60 years of age have visual problems that can make them risks on the highway.

Now, all of the things that might be done, for this population of 191 million people must be performed by only 17,000 practicing optometrists, or one optometrist for every 11,279 persons, as your chairman has indicated. Now, this is a wholly inadequate ratio to do what ought

to be done.

I am leaving with you not only these books but the pamphlets that are appended here. They clearly point out the need for increasing the number of people that must be available to service all of the vision needs of the country.

Incidentally, in the war on poverty, we are talking about retraining older people. Certainly, from the viewpoint of an interested citizen, that would seem to be a very important thing to do. But, I wonder how successful we are going to be in retraining these people unless they have adequate visual performance. They are going to have to be able to not only see clearly but to see effectively in order to study and do that sort of thing. I suspect that if we are going to solve this problem of poverty, we are going to have to begin at the preschool level and prevent it by seeing that these people, these boys and girls coming up, are physically, visually, and mentally able to compete in the educational system. If we do, I am sure that ultimately we can stamp out the need for retraining the older citizen.

Optometry is interested and has made contributions to the care of the near-blind through special devices such as telescopic and microscopic lens systems. It is the philosophy of the profession that these boys and girls should be kept in a normal school environment as long as it is possible to keep them there, as long as they can compete, in order that they will not be set aside as special individuals unable to compete in the normal world when they get through.

So, let me conclude this way. Medical and dental students today have thousands of dollars of loan money available to them for every dollar that is available to an optometry student. We as a profession have to compete for the same group of people.

Yesterday, in the newspapers, there was a story telling about the fact that below the upper 20 percent in intelligence in our high school graduates there is a very large group of youngsters who don't have the opportunity to go to college at all for financial reasons. We, as a profession, would like to have some of these very bright but financially disabled young people that live in every State of this Union. Many of them would take the risk if they were sure that behind them was the opportunity to borrow money to complete their education. I feel very definitely, gentlemen, that a failure to amend this law will result in a reduction in the number of students who will study optometry in the years to come. Any handicap in recruitment means that ultimately there are going to be fewer optometrists to do all of the things I have indicated to you in a brief way. Optometrists are uniquely prepared to perform in the interest of the visual health and efficiency of the American people.

Thank you, Mr. Chairman.

Mr. ROGERS of Florida. Thank you very much, Dr. Ewalt.
Congressman Schenck?

Mr. SCHENCK. Yes. Thank you very much, Mr. Chairman.
First I would like to make an observation off the record.
(Discussion off the record.)

Mr. SCHENCK. Now, on the record, I would like to commend Dr. Chapman, Dr. Ewalt, and these other gentlemen for coming here and calling our attention to this very necessary amendment, it appears to me, to the Public Health Service Act.

I am wondering, Dr. Ewalt, if you have statistics showing that eye exercises, which I assume are a definite part of your profession, are really producing helpful results.

Dr. EWALT. Yes, sir. We can very well supply-I do not have them off the top of my head, but we can very easily do that. I would just like to point out the fact that the chairman of this committee in his earlier experience in the military dealt with one part of visual training, as I understand it, recognition-did you not? RecognitionMr. ROGERS of Florida. That was Congressman Roberts, actually,

who is the subcommittee chairman.

Dr. EWALT. I see.

Mr. ROGERS of Florida. That is correct. Roberts.

Dr. EWALT. And I was interested to see that the President's family has found it important to do this kind of thing, in the interests of the welfare of their own children. I saw a news story here this past week. But statistically we can give you the information.

Mr. SCHENCK. Well, that is fine, and I think it would be valuable to know that these exercises are helpful in a great many instances. In the instance of a member of the President's family, now becoming employed, it would appear that they are helping in the unemployment situation.

On the question of highway safety, in which I have been very deeply interested for a long time, and as very much of an amateur photographer, I know that certain types of filters added to the lens on the