AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company

EDITORIAL STAFF DERRICK VAIL, Editor-in-Chief

700 North Michigan Avenue, Chicago 11 FRANCIS HEED ADLER, Consulting Editor

313 South 17th Street, Philadelphia 3 ALAN C. WOODS, Consulting Editor

Johns Hopkins Hospital, Baltimore S BERNARD BECKER

640 South Kingshighway, Saint Louis 10 WTT.LTAM L. BENEDICT

15 Second Street, S.W., Rochester, Minnesota FREDERICK C. CORDES

384 Post Street, San Francisco 8 SIR STEWART DUKE-ELDER

63 Harley Street, London, W.l EDWIN B. DUNPHY

243 Charles Street, Boston 14 F. HERBERT HAESSLER

12 Apple Tree Lane, Alamo, California PARKER HEATH

Sullivan Harbor, Maine S. RODMAN IRVINE

9730 Wilshire Boulevard, Beverly Hills, California

BERTHA A. KLIEN 950 East 59th Street, Chicago 37

JAMES E. LEBENSOHN 4010 West Madison Street, Chicago 24

DONALD J. LYLE 411 Oak Street, Cincinnati 19

WILLIAM A. MANN 251 East Chicago Avenue, Chicago 11

A. EDWARD MAUMENEE Johns Hopkins Hospital, Baltimore 5

P. ROBB MCDONALD Lankenau Medical Building, Philadelphia 31

FRANK W. NEWELL 950 East 59th Street, Chicago 37

JOHN V. V. NICHOLLS 1414 Drummond Street, Montreal

ALGERNON B. REESE 73 East 71st Street, New York 21

PHILLIPS THYGESON University of California Medical Center,

San Francisco 22 KATHERINE FERGUSON CHALKLEY, Manuscript Editor

Lake Geneva, Wisconsin Directors: WILLIAM L. BENEDICT, President; FREDERICK C. CORDES, Vice-President; WILLIAM A.

MANN, Secretary and Treasurer; ALGERNON B. REESE, DERRICK VAIL, ALAN C. WOODS. Address original papers, other scientific communications including correspondence, also books for

review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins.

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N A T I O N A L M E D I C A L F O U N D A T I O N F O R

E Y E C A R E *

F I F T H A N N U A L REPORT OF T H E PRESIDENT

Five years have passed since that day in October, 1956, when some 600 of us met in this hotel and wrote our names on slips of paper, thus signifying our intention to be­come charter members of a new ophthalmo-

logical organization. Out of this was born the National Medical Foundation for Eye Care.

The original membership of 600 has now grown to more than 2,500. Nearly four mil­lion pieces of literature have gone out to the

* Text of address prepared by Ralph O. Ryche-ner, M.D., president of the National Medical Foun­dation for Eye Care and presented at an open meeting of the Foundation at the Palmer House, Chicago, October 8, 1961.

995

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people of this country over the Foundation's signature.

The Foundation, its publications and other activities have been mentioned and quoted throughout the country and far beyond in press, magazines, television and radio. The central office handles each year thousands of letters and calls from all over the world on all aspects of eye care.

Working on this project from day to day, I have often been overwhelmed and some­times frustrated, at the tremendous variety of challenges, problems and concerns which have come to this Foundation.

On the other hand, it sometimes comes as a surprise to me, reviewing the five-year span since we were organized, to realize the tremendous progress we have made and the enormous amount of work we have accom­plished. I feel that all of us who have had some part in organizing, working for or supporting this Foundation may well take pride in what it has done in its first five years.

Right at the start, it seems to me that this report should mention a milestone in oph­thalmology's efforts to clarify the relation­ship of medicine to optometry. I refer to the adoption by the American Medical Associa­tion of the report of its Subcommittee to Study the Relation of Medicine to Optome­try.

This report provides a solid basis, hereto­fore lacking, for ophthalmology in formulat­ing its own policies. And this new base, from which we can operate with secure con­fidence, is founded in the body of American medicine, enunciated by the American Medi­cal Association. It clearly states the position of medicine on the subject of eye care. As most of us will recognize, this is a statement that has been needed, not only by ophthal­mology but by American medicine for the past 25 years.

Let me emphasize that this is an A.M.A. action, and not a product of the National Medical Foundation for Eye Care. But I may say that this report would probably

never have been drafted, much less adopted, without an active, determined National Med­ical Foundation for Eye Care which had probed and expounded the informational ba­sis on which this report rests. I would like to express on behalf of the Foundation, and I am sure for all ophthalmologists, our thanks to three members of the A.M.A. Sub­committee which prepared this report, who are also devoted members of the Founda­tion: Drs. Harold F. Falls, Chairman of the Executive Committee of the Foundation, Charles E. Jaeckle, Secretary-Treasurer of the Foundation, and Barnet R. Sakler, our Vice-President.

A summary of the report itself has been presented in the August News Bulletin of the Foundation, and a complete version of the report, together with an editorial on the subject, will appear in an early issue of J.A.M.A.

I urge you to pick up a copy, read it and study it yourself and then get some extra copies for your medical colleagues, your lo­cal newspapers, legislators and any others who need to be informed about the meaning of medical eye care and the difference be­tween such care and other services offered in the eye field.

During the past year the Foundation com­pleted a project which has long needed do­ing ; an expose of the widely circulated opto-metrically sponsored pamphlet titled, "What Medical Authorities Say About Drops." This unfortunate bit of propaganda should long ago have been repudiated and dis­avowed by optometry itself. It served no useful purpose except to raise unfounded questions in the minds of patients as to the use of cycloplegics in eye examinations. It contributed nothing to the public welfare ex­cept confusion.

The Foundation investigated this pamph­let. We discovered that the so-called "medi­cal authorities" quoted in this publication had very little claim indeed to being medical authorities. We discovered that these per­sons had, in some instances, been completely

EDITORIALS 997

misquoted, and in other instances their in­tended meanings had been distorted by being lifted out of context or otherwise edited. In short, this pamphlet is a tissue of false­hoods. We believe we have exposed it thor­oughly and we ask that you continue with the exposure, so that its unfortunate effects can be thoroughly obliterated. You have re­ceived copies of this report and more copies are available at the Foundation's exhibit here.

It should not be necessary for me to point out the uses to which this report can be put. Not only does it serve to clarify the confu­sion about the use of drops, but also to indi­cate the purposeful source of some of this confusion. The response of the medical and public press to this material proves it to be timely and of general interest.

While we are on the subject of publica­tions, may I call your attention to several new pieces published by the Foundation, in­cluding our attractive little booklet for glau­coma patients titled, "Living With Glau­coma" and our extremely popular pamphlet on the eye care of children titled, "Eye Cues for Eye Care." Please notice, also, the new format of all of our Foundation publications for the public. They have been brightened up and made more lively and eye-catching. We hope this investment will be returned to us in greater readership and more effective service to the public.

I think it is scarcely necessary to remark upon our outstanding News Bulletin, which has been enthusiastically received by oph­thalmologists and also by the medical press generally.

The 1961 survey of state legislation af­fecting eye care appearing in a recent News Bulletin was most valuable to many of us involved in state legislative problems.

This year the Foundation has conferred its First Annual Helmholtz Award on Mr. John Kord Lagemann, author of an article titled, "The Facts About Your Eyes," which appeared in Redbook Magazine in May, 1960. Mr. Lagemann's article was adjudged

by our distinguished Advisory Board as the best article on any aspect of eye disease and eye care published in a popular magazine during the preceding 12-month period. We believe this annual award will prove a useful stimulus toward better writing in the field of eye care for the people.

Our committees are hard at work on sev­eral projects. The School Eye Health Com­mittee has been very active. Among other things, it prepared the pamphlet, "Eye Cues for Eye Care," and it is working on other projects to help parents, teachers, school phy­sicians, nurses and supervisors.

The Contact Lens Committee now has in hand the results of a nationwide survey made by the Foundation to determine just how ophthalmologists are handling the ex­amination, prescription, fitting, and after care of contact lens patients, and the results of the various procedures used.

The Committee on the American Registry of Ophthalmic Technicians is now hard at work upon data collected by the Foundation from ophthalmologists throughout the coun­try. This material indicates the pattern of employment and use of ophthalmic techni­cians by ophthalmologists: how many of them there are, what functions they perform, and so forth. The raw data has been proc­essed by computers and is now being inter­preted by our Committee. The results of this type of Foundation committee work and re­search will, undoubtedly, have a profound, far-reaching effect upon the practice of oph­thalmology in the future. We are gathering, organizing, analyzing and interpreting in­formation for the first time which will, when complete, accurately indicate national pat­terns of practice, trends in the modern evo­lution of ophthalmology, as well as our strengths and weaknesses. Most important of all, it will indicate what needs to be done and how to go about doing it most effec­tively.

In this connection, I would like to call your particular attention to the extremely valuable and informative paper on the "Op-

998 EDITORIALS

portunities and Problems Confronting Oph­thalmology in the Sixties," which was pre­sented by Dr. Frank W. Newell of Chicago at the special conference of ophthalmologists held in New York City on June 26th. This paper was extensively reviewed in our News Bulletin for September and it deserves a careful reading and re-reading by every one of us.

Perhaps you will forgive my enthusiasm, but I would like to express the opinion that if the Foundation had done nothing more than initiate its several surveys and studies in the areas of ophthalmological practice al­ready mentioned, its existence would have been more than justified. We are now begin­ning to establish for the first time a factual picture of just what is going on in the prac­tice of ophthalmology in America. Hereto­fore we have had to rely on individual sub­jective impressions to a very large extent, The value of such studies in better inform­ing our policies in the future could scarcely be exaggerated.

As the Foundation continues to earn re­spect and recognition as an effective voice for American ophthalmology, it will be able to present the views of ophthalmology with greater impact.

In New York City last June some of your Foundation officers met with representatives of the National Society for the Prevention of Blindness, the better to co-ordinate our respective activities. Basically we are trying to eliminate confusion and misunderstand­ing in presenting the story of medical eye care to the people, to obviate overlapping or duplication of effort, and to achieve for the work of both organizations maximum effec­tiveness.

I am delighted to report that the represen­tatives of the National Society for the Pre­vention of Blindness were most receptive and responsive to the ideas which we pro­posed and the suggestions we offered. I can assure you the Society welcomes the views of the practicing ophthalmologist, and on your behalf the Foundation welcomes the

opportunity to co-operate with the Society. This exchange of views has been placed on a continuing basis and your officers are meeting with the representatives of the So­ciety again this week to discuss other mat­ters of mutual interest.

We have been active with other organi­zations in our field. By the action of the Foundation ophthalmology was officially represented by the chairman of our School Health Committee at the National Confer­ence on School Health jointly sponsored by A.M.A. and the American Education Asso­ciation. We were officially represented, too, at both of the recent White House confer­ences, namely, on ageing, and on children and youth. The Foundation's representatives were the only spokesmen for ophthalmology at these three conferences. We are to be rep­resented on a committee organized by the American Medical Association to develop a plan for emergency medical indemnification of persons having special sensitivities or chronic conditions, such as glaucoma and di­abetes. We are also an active member of the National Committee for Research in Oph­thalmology and Blindness.

The Foundation has for several years been recognized by the American Medical Association as an authoritative source of in­formation and advice in the socio-economic and public information areas of eye care.

In connection with our expose of "What Medical Authorities Say About Drops" it may be useful to call your attention to the apparently developing confusion in optome-try, evident in a recent inconsistency of policy and attitude toward the use of drugs in diagnosis and treatment of eye conditions.

While optometry, on the one hand, at­tempts to convey the impression that drops are not necessary to an examination of the eye (which, of course, is the burden of their misleading pamphlet), on the other hand they seek to force through legislation, most notably and recently in Pennsylvania, which would have enabled them to use medication. The question confronting optometry today

EDITORIALS 999

seems to be: to use drops or not to use drops ?

This confusion and contention within op-tometry over the use of medication is but a manifestation of a deep, basic and bitter schism over the fundamental issue: Will op­tometrists stick to the practice of refraction, or will they attempt to become eye physi­cians by legal fiat?

From personal knowledge we can testify that this question is producing serious and growing contention in the optometric ranks. Many optometrists are determined to remain within the bounds of their competent train­ing. Some of these are increasingly annoyed at the determination of some of the more aggressive leaders to convert optometry into medicine by legislation and high-powered lobbying, such as they attempted, unsuccess­fully, this year. It is interesting to note that the Pennsylvania expansionists were repri­manded by the national body for their abor­tive putsch into the practice of medicine, but one can scarcely avoid noting that tfiere was no repudiation of the effort while it was in progress.

In years past, when the Foundation was in its early infancy, I usually found it nec­essary to devote some major part of my an­nual report to a fervent appeal for more members—just to provide us with the mini­mum funds with which to carry on. Today —although we need every cent we can get from our loyal members merely to carry on our basic programs—nevertheless, I would prefer to base this appeal for universal membership of American ophthalmology on the need of the Foundation to complete its internal organization and to become a truly representative and authoritative voice for our profession. As the members of our Board of Trustees declared in our current News Bulletin, in their special message to the members of the Foundation, this Foun­dation: "cannot represent you—its policies cannot truly reflect your wishes and judg­ment—unless you are part of the Founda­tion. The present membership of the Foun­

dation is representative of our profession as a whole. But if you are not a member, you deprive yourself of a national channel for expression of your views.

"If you are not a member of the Founda­tion, isn't it high time to join? If you are a member, isn't it high time to see to it that all your colleagues put their shoulders to the wheel ?

"We believe the time has come for every ophthalmologist to contribute his share of support and to add his voice to this increas­ingly articulate and respected voice of Amer­ican ophthalmology.

"The time for action is NOW." Ralph O. Rychener.

A DECLARATION O F MEDICAL PRINCIPLE

When "refracting opticians" first became licensed as optometrists, they made no pre­tense to any functions (beyond the opti­cian's traditional role of providing and fit­ting spectacles) other than determining, without the use of drugs, the manner in which an eye focused light and what lenses would compensate for the refractive error to produce a focused image in that eye. By defi­nition the "practice of optometry" as a li­censed occupation* included the use of any means other than the use of drugs to accom­plish this specific purpose. These functions were then also performed, and continue to be performed by physicians providing medi­cal care for all conditions of the visual sys­tem—physicians who not only use drugs when appropriate in refraction but whose concern has encompassed and whose respon­sibility extends to every aspect of the pa­tient's welfare relative to vision and the eye.

From the beginning the optometrist was distinguished from the physician by a lim­ited authority and responsibility in refrac-

* Contrast the use of the word "optometry" as a medical term, originated a quarter century earlier: the measurement of the refraction of the eye.