camera will permit making photographs through fog, haze, and so on. I am wondering if there is any advantage to a similar type of filter such as the yellow lens or some other color in helping high way drivers to see through fog or whether or not that cuts down vision and is therefore wrong.

Dr. EWALT. There is a committee on night visibility that is working on those kinds of problems. The approach has been made through different colored lights at intersections, and so forth, in handling the fog situation, and in using different colors in the pavement of the highway itself. And all kinds of filters are being experimented with on the basis which you have suggested and the work is not yet completed.

Mr. SCHENCK. Such as clip-on glasses, you mean.

Dr. EWALT. That is right. Numbers of things. A great deal of work is being done in the field.

Mr. SCHENCK. Well, our committee has been very deeply interested in this entire matter of highway traffic safety as well as health matters, and I have often wondered whether or not these filters actually cut down vision or whether they help vision.

Dr. EWALT. Well, I think we ought to say for the record that most of the filters developed cut down vision and are not to be recommended. The only reason I said most is because they are still experimenting with certain types of lenses but we do not have the final answer. The School of Optometry at Indiana University is doing a great deal of work in this field.

Mr. SCHENCK. Thank you very much, and thank you for your testimony.

Dr. CHAPMAN. I want to make a suggestion, and it might not be practical, but I suspect that many of the questions which some members of the committee have are going to be rather thoroughly amplified in subsequent statements we make, and I wonder if we could make those in brevity and then have each of you record your questions and record the whole group because we have several experts, Congressman Schenck, in what you just mentioned, here in the room and could later give you a more definite answer.

Mr. ROGERS of Florida. The committee would be glad to do that, and thank you very much, Dr. Ewalt, for your testimony.

STATEMENT OF DR. GORDON HEATH, O.D., PRESIDENT, ASSOCIATION OF SCHOOLS AND COLLEGES OF OPTOMETRY

Mr. ROGERS of Florida. Dr. Heath, president of the Association of Schools and Colleges of Optometry. The committee will be glad to hear you now, Dr. Heath.

Dr. HEATH. Thank you, Mr. Chairman and members of the committee.

I do not wish to presume on the valuable time of this committee. I have submitted a more complete statement. I would like here just to summarize a few of the most important points of that.

Mr. ROGERS of Florida. That will be fine. Without objection, your full statement will be made a part of the record at this point.

(Dr. Heath's statement in full follows:)

STATEMENT OF GORDON HEATH, O.D.

Mr. Chairman and members of the committee, I am Dr. Gordon G. Heath, professor of optometry, of the division of optometry, and chairman of the graduate school committee for physiological optics, at Indiana University.

I am presently serving as president of the Association of Schools and Colleges of Optometry, an organization composed of all the optometric educational institutions of the United States and Canada. It is on behalf of the 10 accredited U.S. schools of optometry that I submit this statement in support of H.R. 8546 to provide Federal loans for optometry students. I am appending a table of the accredited schools and colleges of optometry in the United States, their deans, and year organized to this statement, and would like you to have these copies of each school's catalog which I have brought with me.

The number of our institutions is small, but their collective responsibility to the public and to the profession is large, indeed. The Nation relies on these 10 schools to provide the professional education and training of the practitioners who will provide over 70 percent of the vision care received by the American people. To meet this important obligation the schools have continuously advanced their educational programs to provide solid backgrounds in the basic sciences pertinent to optometry, and to incorporate the many recent developments in the field of vision care. I want to outline some of the facts about optometric education, about optometry students, and about optometry schools and some of the problems confronting them which have a direct bearing on their accomplishment of this mission. These facts, I believe, will demonstrate the importance of this proposed legislation.

Today's optometrist is very well trained. Tomorrow's will be even better trained. A major change is now taking place in optometric education. Recent advances in the field of optometry have been so numerous and extensive that the regulation 5 years of college level training has been stretched to its limit in order to incorporate these advances. Four of the ten schools have already added an additional year, and others will follow their example.

To become a licensed optometrist today it is necessary to pass a rigorous State board examination in the State or States where one wishes to practice. Such examinations are open only to graduates of the 10 schools of optometry, which currently are accredited by the American Optometric Association's Council on Optometric Education, the official accrediting agency recognized by the National Commission on Accrediting.

Graduation from one of these schools requires a minimum of at least 5 years study beyond high school. This includes 2 years of preoptometric education which may be taken at any accredited junior college or university, followed by at least 3 or, in some cases, 4 years of professional study in an optometry school. The 4 years of preoptometric education must include mathematics, physics, chemistry, and biology, plus English, history, and other liberal arts courses.

Over half of the students now enrolled in optometry schools had completed more than 2 years of college, and nearly one-third had earned bachelor's degrees before entering optometry school. The specific courses in the 3- or 4-year optometric program vary among the optometric institutions, but the general study program is very similar in all schools. Subjects typically include geometric, physical, physiological, mechanical, and opththalmic optics; general and ocular anatomy; general and ocular physiology; general and ocular pathology; physiology; bacteriology; theoretical and clinical optometry; orthoptics; and visual training, and industrial and occupational vision. It requires careful preparation and planinng for a student to complete the program in 5 years.

One of the schools, Pennsylvania State College of Optometry, has since 1955 required completion of a 6-year program (2 years preoptometry, 4 years professional study) for graduation. Another, Ohio State University, has just this year adopted a similar requirement. Two other schools offer an optional sixth year. and it is expected that they and the remaining 5-year schools will soon adopt a mandatory 6-year program. As a result of modern vision research and advances in optometric techniques, too much information had to be crammed into a 3-year curriculum, imposing an unfair and unreasonable burden on students and faculty alike.

A study, now being conducted by the Association of Schools and Colleges of Optometry, of the actual number of hours of instruction at each institution re

veals that some of the schools actually provide more hours of instruction in a 3-year professional program than would be required in a normal 4-year college program. An average load for a full-time student at most colleges and universities is 15 credit hours per semester. In optometry schools the load has, in some cases, reached or even exceeded the classtime equivalent of 21 credit hours per semester.

So, a change to a 4-year course will add relatively little to the content of the curriculum, but it will redistribute its subject matter into courses of more appropriate and reasonable lengths and weight.

It costs an average of $2,200 per year to train an optometry student. This figure is not markedly different from what it takes to educate a student in any discipline requiring laboratory instruction. If it is less than the instructional cost in some fields, the reason lies in forced economies and restricted funds, especially among the schools not affiliated with State universities. Lower per student instructional cost does not, in general, signify greater efficiency in providing comparable training. Instead, it usually indicates lower salary scales for faculty and staff, larger classes, less laboratory equipment, and less construction and maintenance of facilities.

As costs rise and enrollments grow, it becomes imperative that optometry schools receive State and Federal support to aid in the necessary construction, extension, and rehabilitation of facilities if the schools are to continue to provide adequate training for the Nation's total supply of future optometric practitioners.

Now, what does it cost to train an optometry student?

Before giving you actual figures, let me point out that since we have fewer schools in the optometric field than there are in dentistry or medicine, chances are that many optometry students will have a nonresident status, which in itself results in higher tuition fees. In addition, the optometry student will have higher travel costs, since he must come to the school from a greater distance than most medical or dental students who live in closer proximity to the schools of their choice. These two factors, greater nonresidency, greater travel distances, must be kept in mind as we compare tuition fees between a particular school of optometry and a school of dentistry. For example, at the Ohio State School of Optometry as many as 25 percent of optometry students are out-ofStaters.

Let's look at some comparative figures. As an example, I have chosen the optometry, medical, and dental schools at Ohio State University. Ohio State's School of Optometry is just starting on an expanded program, a 4-year instead of a 3-year program.

1964-55 OPTOMETRY

$486

981

80

120

480

105

950

DENTISTRY

755

1, 250

100

415

1, 208

90 810

MEDICINE

Books and equipment (excluding cost of microscope, which runs between

$400 and $600).

Room and board_

690

1, 140

150

1,000

I want to add that as far as the discrepancy in costs of room and board is concerned, I have used the most up-to-date figure from the optometry school at Ohio State; presumably the figure for dental students' room and board, which comes from a booklet published by the American Association of Dental Schools, Chicago, is now comparable.

In addition, most optometry students find it necessary to also attend a summer semester, thus adding $162 and $327, respectively, to their total tuition costs. And I have not even added the additional costs which they incur: For example, they must buy their own meals during part of the weekend, and there is the matter of incidental fees amounting to another $30.

Tuition fees in the various schools range from $840 to $1,280 per year, the average being $1,050. This excludes State universities that offer lower fees for in-State residents. Thus, students pay approximately half the cost of their education. The remaining cost must be met from the income of the public optometry clinic which each school maintains as part of its training program and investments from alumnae fund-raising drives. The State university schools, of course, receive tax support and also receive a portion of the license fees which each registered optometrist in his State must pay annually.

In addition to his tuition fees, each student must purchase certain instruments and tools, at a total average cost of about $300, as well as books and academic supplies. The remaining costs of room, board, clothing, laundering, transportation, and incidentals vary widely according to individual taste and resources. With the extremely heavy course loads now required in the optometric schools, students frequently find it impossible to hold a part-time job to help defray their expenses while attending school. Those who do work, often find that their grades suffer accordingly, a fact which usually precludes any posisbility of winning a scholarship.

Scholarships are available at all schools of optometry. But they are very limited in number, and modest in amount, usually between $50 and $400 per year each. They are variously provided by these schools themselves, by State optometric associations, and their woman's auxiliaries, and by alumnae organizations. A very few come from other sources.

Many students rely on summer employment and family funds to see them through. If these income sources prove inadequate, they must obtain student loans. Some of the schools have small student loan funds which have been supplied by alumnae or by srevice organizations. These will accommodate only a small fraction of the need, and they are generally reserved for emergency purposes only.

Although the National Defense Education Act student loan program has been helpful to some optometry students, it has been inadequate at most schools. Dr. Chester H. Pheiffer, dean of our school of optometry at the University of Houston, testifying last year before this committee, pointed out that the National Defense Education Act gives first choice to students in education, languages, and the like. National Defense Education Act loans at State universities are usually gone before optometry students receive consideration.

Then, too, the National Defense Education Act loan program was designed primarily for undergraduate college students, particularly those planning to go into the teaching profession. As in the study of medicine, dentistry, and osteopathy, the high cost of an optometric education requires a higher loan ceiling than is available to students under the National Defense Education Act. The National Defense Education Act program forgives up to 50 percent of loans for teaching in elementary and secondary schools. There is no similar forgiveness for health professions whereas there is such forgiveness under the Health Profession's Educational Assistance Act for doctors who set up practice in areas critically short of health personnel.

The Health Profession's Educational Assistance Act is also operated by the individual schools of the health professions. Exclusion of optometry from the Health Profession's Educational Assistance Act therefore constitutes an undesirable disadvantage in optometry's recruitment program.

The need for training additional optometry students is acute. For the Nation now faces a serious shortage of professional optometrists. There are about 21,000 licenses issued to optometrists in the United States. On the basis of the average practice span of 30 years, 700 new licenses per year would be required just to maintain that total number. However not all of those licensed are actually practicing full time, and the figure also includes optomists licensed in more than one State. The actual number of working optometrists is about 17,000.

It has long been held that an average ratio of 1 optometrist per 7,000 population is needed to provide even minimum adequate vision care. The current national average is 1 per 11,250 population.

Even with careful redistribution, geographically, of optometrists to provide uniform coverage, there still exists a great need for additional optometrists. A total of about 30,000 optometrists is needed to provide the minimum adequate vision care for a nation of nearly 200 million people.

As longevity increases, raising the average age of the population, the need for optometric services also increases markedly. So the estimate of the need for 30,000 optometrists is assuredly a conservative one. To meet this need the optometry schools must graduate at least 1,000 new optometrists each year. To do this their facilities must be expanded. Enrollments in optometry schools increased sharply for several years following World War II, but even these large increases did not meet all needs created by low enrollments during the war. Enrollments declined again during the mid-1950's as veterans completed their studies, reaching a low point in 1958 when only 368 new students were admitted in the 10 schools. Since then, new enrollments have increased as follows:

Applications for admission at all of the schools have increased each year since 1958. And it is expected that the current year will see several of the schools forced to reject otherwise qualified applicants because of space or facility limitations. Career inquiries directed to the American Optometric Association in the first 4 months of 1964 show an increase of 23 percent over the number of inquiries for the same period in 1963. Similar experiences are reported at all of the schools. The stated total capacity of the 10 schools of optometry is less than 2,000 students. With the adoption of the 4-year professional curriculum, the capacity of the schools will be only about one-half the capacity needed to provide the minimum requirement of 1,000 graduates per

year.

I have mentioned so far only the needs of more American trained optometrists to take care of the vision care of our population and the education of future optometrists. But today we have obligations, as Americans, that go far beyond our own needs, that transcend national borders, and reach from one end of the world to the other.

For many years, American optometric schools have acted as a magnet on foreign students, men and women from every continent. Right now, for example, Indiana University's School of Optometry has students from the Philippines, India, Britain, Canada, France, and Australia. In the recent past that school included students from Ghana, Kenya, and Thailand. At the School of Optometry of the University of California, there are currently a number of students from Iran, Holland, Japan, and India.

Some students from abroad who come to study here take undergraduate training in optometry; others take training leading to a doctorate. But there are few optometry schools in existence outside the United States. For example, throughout most of the Far East and the Near East, optometry does not exist as a profession. There are probably less than 100 fully qualified optometrists in those areas. Only in a few countries, including the United Kingdom, Colombia, the Philippines, Japan, Canada, and Australia, can it be said that the profession of optometry, in our sense of that term, exists.

The need for vision care both in quantity and quality around the world is urgent. Potential optometrists from many countries will increasingly turn to the United States for their education. For practical as well as humanitarian reasons we must do our best to provide education in optometry for those students. This is an additional reason why our profession needs to expand in trained manpower, so that we can provide education for our own people and those who come to us from other lands.

Incidentally, some of those students, once they have graduated from an American school, elect to stay and practice optometry in this country. Naturally, in view of our shortage of trained manpower we are delighted to have them stay, although we feel a little guilty about keeping them from their own people who also desperately need their services.

However, we would feel no guilt about Cuban refugee optometrists who elect to study and then practice here. Currently, with the help of the Department of