Volume 1,Number 2 Spring, 1975

Action: noEflgetal Opportunit^y or Reverse Discrimination? ;. *,• • <* ,.fe_..tV JOE: A Reflective Medium Focusing On

I Optometrihe Journal of Optometric Education (JOE) cSoun Educationd interesting? Then join the growing ranks of. is the new quarterly publication of the professionals who are subscribing to JOE. A Association of Schools and Colleges of subscription to JOE is not only a show of support Optometry. Representing the optometric for professional education, but a way of furthering education segment of the profession, this your own education now that you are out of attractive magazine focuses on a wide range of school. topics on significant aspects of your profession. Highly praised for its visual appeal and innovative design, JOE aims at keeping the optometric Send to: Journal of Optometric Education 1730 M Street, N.W. Suite 411 I profession —students, faculty, academic Washington, D.C. 20036 administrators and practitioners—up-to-date on a I myriad of important topics like the growing costs 4 issues/year - $10.00 of educating an optometry student today, the Foreign subscription - $15.00 I development of the Optometry Colleges Make checks payable to ASCO Admission Test (OCAT); the impact of affirmative I action guidelines on optometry schools; the Name relationship between PSRO s and continuing I education, and optometry's expanding role in the Address I Veterans Administration. In ad.diti,on..to4l-^.y - professional I features, si Zip I Private Practice. I Institution I Other .1 JOURNAL OF OPTON\ETRIC Volume 1, Number 2 EDUOfTION Spring, 1975 Official Publication of the Association of Schools & Colleges of Optometry

54 Can Early Diagnosis Aid in Treatment? By Francis A. Young The concept of preventive maintenance is applied to primary health care delivery.

58 Veterans' Administration: We Train Health Professionals By Kenneth J. Meyers Opportunities for training optometrists within the vast patient-care facilities of the VA are discussed.

64 Affirmative Action: Walking the Tightrope Between Equal Opportunity and Reverse Discrimination By Sheila Doctors Ms. Doctors clarifys the confusion surrounding the affirmative action order.

70 The Ohio State Tradition: Innovation and Professional Excellence By Frederick W. Hebbard A profile of OSU's College of Optometry.

74 Tomorrow's Challenge By William ft Baldwin The author describes developing trends in optometric education and how they will affect the future scope of optometric practice.

80 Teaching Health Care: Under One Roof In an interview, Dr. Thomas W. Mou discusses his views on optometric education in an integrated setting.

84 Parent Guidance: An Integral Part of Vision Therapy By J. Floyd Williams The importance of educating parents about their role in their child's vision therapy is discussed.

DEPARTMENTS

52 Editorial by Norman E. Wallis 53 Authors 63 Books by Frank A. Brazelton 83 Letters 88 Classifieds page 74

Front cover idea by Roger Kranz, drawn by Annie Lundslord.

The JOURNAL OF OPTOMETRIC EDUCATION is published by the Association of Schools and Colleges of Optometry. (ASCO). Manag­ ing Editor: Louis A. Ebersold. Associate Editor: Barbara J. Harrelson. Art Director: Roger Kranz. Contributing Editor: Sheila Doctors. Editorial Assistant: Cindy J. Simms. Business and editorial offices are located at 1730 M Street, N.W., Suite 411, Washington, D.C. 20036. Subscriptions: JOE is published quarterly and distributed at no charge to dues-paying members of ASCO. Individual subscriptions are available at $10.00 per year, $15.00 per year to foreign subscribers. Postage paid for a non-profit, tax-exempt organization at Washington, D.C. Copyright® 1975 by The Association of Schools and Colleges of Optometry. Advertising rates are available upon request.

51 V,ook, i

Although many accept the fact with mixed emotions, it is increasingly ap­ parent that optometry's development is signifi­ cantly affected by many influences outside of the profession. Not too long ago, it seems, our professional leaders could decide upon a particular course of action and then proceed to implement it. It is not quite that simple anymore. Op­ tometry, like all health professions, is being increasingly influenced by state and federal laws as well as changing concepts of health care delivery ... As educators and health professionals, we must be concerned about these ex­ ternal influences. If we keep our heads in the sand and refuse to recognize what's happening in the "real world," we will not meet our responsibilities to the stu­ dents—or to society. Unless^students are aware of these influences while they are stu­ dents, they will not be responsive as practitioners ... This issue of the JOURNAL con­ siders several aspects of outside influence which can make us look at our educational programs in a new light: Francis Young, a researcher in vision and close friend of the profession for many years, presents some ideas about early detection of health problems that have significance for the future scope of optometric practice and, therefore, for op­ tometric education ... ASCO President William Baldwin, with acknowledge exper­ tise in futuristic planning, takes a long look at current directions in optometric education and reports some specific recommendations regarding the education of tomorrow's op­ tometrists ... Thomas Mou, a physician/educator/administrator with responsibility for all professional health sciences education at the largest university in the world, gives a candid, optomistic and personal view of the current trends in optometric educa­ tion—as influenced by other disciplines ... Kenneth Myers, the first Director of Op­ tometry of the Veterans Administration, describes opportunities for optometric educational affiliations to be developed with the largest independent federal agency ... Floyd Williams, a young faculty member working in another area that holds great potential for the future of the profession, writes about the counseling of parents of children that optometrists examine and treat ... Sheila Doctors, of the National Office editorial staff, discusses affirmative action in equal employment opportunity as another external influence that can shape the future of the profession ... As educators, students and practitioners, we have a responsibility to understand these outside influences. Only by understanding them more completely can we determine to work with needed changes for the ultimate benefit of the public. With increasing knowledge of the forces affecting op­ tometric education will come greater capability for service and professional development.

by Norman E.\^llis Chairman, Editorial Council . 41JTHORS

Coming out with a new magazine such as the ministration's Department of Medicine and Surg­ 1 Journal of Optometric Education (JOE) is never an ery. Dr. Myers, with an O.D. from Massachusetts easy task, so when the first issue appeared last College of Optometry, became interested in winter, many people were surprised and elated to physiological optics and psychophysics while a see it happen. The happiest people were those con­ doctoral candidate in nuclear physics. He holds ^ • ~ >• nected with JOE, the writers, the editorial council B.S.E.E. and B.Sc. degrees from the University of and especially the editors. As you can see from Akron, as well as M.Sc. and Ph.D. (biophysics) some of the letters on page 83, our readers were degrees from Ohio State University. In addition, he also very pleased with the first issue. has taught at the OSU College of Optometry, MCO and was recently named adjunct assistant profes­ gA But once the jubilation died down, we went back «h to work on our second issue, which after much sor at the Pennsylvania College of Optometry. time and hard work, is now in your hands. We are Sheila Doctors, a native of New York City, at­ very pleased with it and hope you will be too. We tended Brooklyn College, City University of New n frl will be happy to hear your views and comments on York where she earned a B.A. degree in English. I I .UK li "l null*; this issue. Ms. Doctors taught high school English in New Before we began on the first issue, one of our York for several years before coming to Washing­ greatest fears was not having enough copy for a ton, D.C. She has written professionally for the past full-fledged scholarly journal. Luckily our fears four years on health and education topics—first, were not founded, for we have received many good for the federal government, then, for a private, articles and papers, making our editing difficult. As non-profit drug abuse research organization, and you can see, we have had contributions from nine most recently, as editor of the "ASCO Educator," different ASCO member institutions (including six the monthly membership newsletter. deans or presidents), one federal agency, one Frederick Hebbard assumed the leadership of research center, as well as articles written by our the Ohio State University School of Optometry in own staff in Washington. 1966 and was named dean when the College of Op­ While we have been pleased with contributions tometry status was designated in 1968. Well- so far, we are anxious to receive more articles from known by his colleagues as a serious scholar and more of you. We are looking for articles of all able administrator, Dr. Hebbard was formerly types, from research papers to human interest sto­ president of the NBEO, 1964-74. Dr. Hebbard ries. Thus far, JOE articles have ranged from the earned both his O.D. and Ph.D. (physiological op­ general to the specific, traditional to futuristic, pre­ tics) degrees at the University of California School dictable to the revealing—allof which emphasize of Optometry, Berkeley. He is a member of the the idea that JOE is a forum for an exchange of AOA and a fellow of the American Academy of ideas and opinions relevant to all facets of op­ Optometry. tometric education. We hope that you will send us William Baldwin, the outgoing ASCO president, something soon. has distinguished himself as an articulate spokes­ And now to introduce those that have con­ man for optometric education concerns. His pro­ tributed to this issue. Working with us since last fessional activities include participation in the Fall has been Roger Kranz, a young, professional New England Board of Higher Education, as well graphic arts consultant who has designed JOE and as leadership positions in the AOA, American Op­ helped make it an original and innovative journal. tometric Foundation and the Optometric Research Roger is from Washington, DC and has been in­ Institute, Inc. He has been president of the Massa­ volved in publications for five years, sandwiching chusetts College of Optometry since 1969, previ­ in a B.A. in journalism at Rutgers College and a ously having served as dean of Pacific University's M.A. in Communications at American Uniersity. College of Optometry for six years. Working with Roger to make JOE interesting to J. Floyd Williams joined the faculty of his alma look at as well as to read have been two Washing- mater, University of Houston's College of Optome­ tonian freelance artists, Chuck Steacy and Annie try, in 1971, after receiving his O.D. degree. He Lundsford. became Chief of HCO's Vision Therapy Services a year later and was named assistant professor of op­ Francis Young, a researcher studying the * -** ,4 development of myopia in primates, teaches psy­ tometry in 1973. He is currently engaged in study chology at Washington State University in Pull­ towards an advanced degree, as well as clinical man, Washington. Although Dr. Young is not an research. With the support of an Optometric Ex­ optometrist (Ph.D., psychology, Ohio State U.), he tension Program Foundation Grant, Dr. Williams has been a fellow of the American Academy of will be devoting all his time this summer to the Optometry for 27 years and last year served as a study of clinical vision development profiles of visiting professor of ophthalmology at the Univer­ disabled learners. J. Floyd Williams sity of Oregon's medical school in Portland. Again, we hope you enjoy this issue of JOE and Kenneth Myers was appointed last July as the we look forward to hearing from you about it. first Director of Optometry of the Veteran's Ad­ The Editors

53 feastV^g* V.^ ••:*^te

by Francis A. Young minimum expenditure of time and the operation of the car to detect energy. when it is not as it should be, even The operation of this adage de­ though he may not know what is The old adage, "a stitch in time pends upon early detection of the wrong or why it is wrong. saves nine," applies equally well to difficulty or irregularity. This task In the case of the human body, the tailor, the automobile relies on, to a great extent, the the owner of the body again must mechanic, or the human mechanic capabilities of the perceptive per­ be in a position to make a judgment (health care practitioner). In each son—one who knows the subject as to when the operation of the case, the early detection of a well and is able to detect ir­ body is not as it should be and to difficulty—whether it be a loose regularities at the outset. seek assistance when he detects thread, an engine knock, or high In the case of the automobile, it is this malfunction. Unfortunately, in blood pressure—combined with essential that the person in closest the case of high blood pressure, he the application of appropriate contact with the automobile be in a may not be able to detect the mal­ treatment will go a long way toward position to notice the new sound function until the symptoms are keeping the coat, the car, and the which did not exist before and to severe enough to cause serious human in good condition, at a respond to this new sound by seek­ problems. o ing a diagnosis of the nature and If early maintenance is not ap­ 2 Dr. Young is director of the Primate cause of this sound. Thus, the plied in either of these instances, Research Center, Washington State owner of the car must have a suffi­ the lack of correction will add to University (Pullman, Wash.). cient awareness of the nature of the stress of other parts of the 54 mechanism and can result in Health care in its entirety from the Americans are dying each year of a further malfunction. As has been viewpoint of providers and con­ virulent new malady called "Doc- stressed many times, early diag­ sumers alike is the sum total of care toritis" which is caused by the in­ nosis of human illness or malfunc­ rendered by all disciplines. It com­ ability to get hold of a doctor when prises more than diagnosis treat­ you need one; (b) a study by the tion greatly improves the chance of ment and rehabilitation associated adequate treatment being carried with acute and chronic illness; it in­ United States Senate indicates out. Late detection permits cludes health education, health that America should have 600,000 widespread distribution of the maintenance, prevention and early doctors, while we have fewer than damaging agent —especially in case finding. It involves giving the half that many at the present time: cases of cancer—and will make it public a voice in the design and (c) since more and more doctors virtually impossible to bring about operation of health systems and the are refusing to make house calls or any type of cure. Additional allocation of health forces to meet to work at night and on weekends, benefits from early detection and changing demands. Any such health hospital emergency rooms are care is not the province of any one proper treatment of illness would being overrun with non-emergency profession, nor does it lend itself to cases. ("We've simply become a appear to be fewer days lost from delivery through a rigid professional illness, more effective treatment of hierarchy.1 substitute for the family doctor," illness, and less time and money says the head of emergency ser­ required for treatment. vice at New York's Roosevelt Hos­ Early detection and early diag­ As Dr. Egeberg points out, pital); (d) in some communities a nosis are certainly not new to medicine is still operating on the doctor is not available at any time. health practitioners. However, the "come and get it" basis. Thus, it is (The Wall Street Journal reports concepts of preventive medicine essential that the patient make the patients in some localities must plead with up to half a dozen doc­ and treating "the whole person' original diagnosis himself: that he tors before they can find one will­ (promoting general well-being in­ somehow doesn't feel as well as he ing to treat them, while the gover­ stead of treating only specific com­ should feel, or that something hurts nor of. Texas states that fifteen plaints) represent some innovation in his head, or that he has a pain in his shoulder, or that any number of counties in western Texas have no in established forms of health care doctor at all), and finally, (e) a study delivery. The following observation changes have occurred which sug­ gest to him that he should see a by the Brookings Institute indi­ by Dr. Roger O. Egeberg and LeRoy cates that by 1975, due to the pres­ A. Pesch (chairman and co-chair­ physician. The ability of a patient to make this preliminary diagnosis sure of Medicare, Medicaid and man of the HEW Secretary's Com­ the population explosion, Ameri­ will greatly depend upon his level mittee to Study the Extended Roles cans will require one billion doctor of intelligence and experience as for Nurses) emphasizes this fact: visits. There simply will not be well as education available to the enough medical manpower to meet It has been said that biomedical individual. Clearly, an individual this need. science has advanced further in the who has been given a course in last three decades than in all prior health education will be more history. Certainly providers of health services now have access to aware of the nature of some of his The changes which have occur­ knowledge, skills and resources symptoms than will an individual red in medicine in recent years sufficient to deal effectively with who has had no such educational make it almost impossible in many problems that not many years ago opportunity. Since relatively few in­ locations to obtain medical treat­ defied solution. While the effect of dividuals in our present society are ment. This is particularly true with this progress can be measured in im­ sophisticated enough to carry out a the decrease in the number of proved health, it is also reflected in meaningful interpretation of general practitioners and the in­ increasing complexity in the whatever is causing their organization and delivery of health adequate increase in the number of services. And equally important, symptoms, the concept of early internists. An editorial by Ladd progress in biomedical technology detection of illness is unlikely to be Hamilton in an Idaho newspaper, has not been matched by a necess­ applied effectively in our society. the Lewiston Morning Tribune3, ary change in the underlying philoso­ complains that "The average phy of the provision of health care. Access to Medical Care American has less access to good Our system is still largely operating But even if the person is capable medical care at reasonable cost on the hippocratic principle that the than the average European. The doctor or nurse must wait until the of deciding that something is patient seeks help before they set wrong and has some concept as to reason is that the best doctor in the about to minister to his needs. what might be wrong, he is likely to world can't do the patient much Despite some limited efforts to the have considerable difficulty in good if the patient can't get in to contrary, the health care system still finding a physician who is willing to see him." operates on a "come and get it" work with him in attempting to car­ The maldistribution of health ser­ basis. Yet some of the greatest ad­ ry out a more accurate diagnosis vices in many parts of this country vances in the health field, especially and to institute a program of treat­ is a scandal. One writer pointed out in the areas of disease prevention ment. recently there are more physicians^ and health maintenance, depend upon the health care delivery system Moneysworth, a Consumer's in one building in the affluent loop- Newsletter, recently sent out an section of Chicago than in several reaching out to those people who do 2 not see the need or lack the oppor­ ad for its Home Medical Advisor square miles of the same city's tunity to "come and get it." which is intended to provide some black ghetto. Health services in the basis for diagnosing illness. Their United States are good, but they And further, they comment: ad reported that: (a) over 20,000 are uneven, the pattern being 55 ;\* . VT-V/JA ., • ••".-.'-.Si k • ••••?] Wm ' -:Vi 11ri* ... .>i . s .*to , • W5

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Detection of hypertension is taught to practicing optometrists in continuing education courses like this one at Southern College of Optometry.

determined by the distribution of approximately 25%) are general fluence and status as incentives personal wealth. practitioners, and another 149 (or toward specialization. Most stu­ 15%) are specialists in internal dents who enter medical schools Specialization Trend medicine. If these two groups are are motivated by one or more of the If one compares the membership lumped together, then 40% of the above. Therefore, they cannot be of the American Medical Associ­ physicians in Portland, Oregon expected to desire to enter general ation in 1950 with the population of would be deliverers of primary practice or to establish a practice the United States in that year, one health care. in a small community. finds that there was one member By contrast, in 1950, approx­ The tendency of physicians to physician for every 1,098 persons. imately 60% of the members of the congregate in large cities is fairly Assuming that the same proportion American Medical Association obvious when one compares Port­ of M.D.'s are members of the Ameri­ were in general practice or internal land, Oregon with 375,000 people can Medical Association in 1970 medicine. Thus, the ratio of primary and one physician to every 386 as in 1950 (this may be questiona­ health care personnel to popula­ persons; Spokane, Washington ble since the AMA appears to be tion was 1 to 1829 in 1950, and with 168,654 persons and one losing membership), one finds that dropped to 1 to 2280 in 1970. physician to every 429 persons; there is one member physician in In spite of monies provided to in­ Pullman, Washington with 20,384 1970 for every 912 persons. Thus, crease the number of general prac­ persons and one physician to every it would appear that there is an in­ titioners trained, the medical 1,073 persons; Moscow, Idaho with crease in the ratio of physicians to schools are turning out more and 13,731 people and one physician persons in the United States. more specialists and fewer general to every 1,373 persons, and Moses However, this relationship is practitioners. From the medical Lake, Washington with 10,164 peo­ misleading. For example, in 1972, student's point of view, there is lit­ ple and, at last indication, no physi­ there were 973 physicians listed in tle but social service to reinforce cians at all. the Yellow Pages of the Portland, becoming a general practitioner With a situation such as this fac­ Oregon telephone directory. Of and much more in the way of in­ ing American medicine, and no ap­ these 973 physicians, only 241 (or come, pleasant working hours, in­ parent hope of remedying the 56 situation for at least a decade, a care delivery plans focus on the many more persons could be tre­ significant move toward a nation­ physician as the primary provider ated more effectively with the num­ wide health plan will presumably of health services, with other prac­ ber of M.D.'s currently available. overload the present medical care titioners included in some varia­ Since these practitioners are not system. Many people may find it tions. However, the current supply trained as M.D.'s, they would not be impossible to obtain the type of of general practitioner M.D.s is able to make the final diagnosis or medical care to which they are ac­ presumably insufficient to meet the carry out the treatment, but they customed and it may become even demands for primary care under a could help the individual patient more difficult for some to obtain national health program. Obviously, determine whether he needs treat­ any medical care at all. some alternatives must be found to ment and what type of treatment he meet growing national health needs. With a proper system of Federal Health Planning needs. referrals to medical practitioners, The direction of thinking at the these health care providers could present time with respect to na­ Emphasis on Early Diagnosis help direct the patient to the proper tional health care plans under con­ One solution is to emphasize the specialist. sideration by Congress seems to diagnostic skills and early detec­ The use of such preliminary have polarized in two directions. tion practices for which many screening techniques will un­ One faction supports the develop­ health professionals, besides doubtedly result in a number of ment of the health maintenance physicians, receive training. Den­ false referrals, although the num­ organizations (HMO's) such as the tists, optometrists, podiatrists, ber of false referrals should ac­ Kaiser-Permanente Foundation or public health nurses and others tually be less than would be the the Group Health Organization in receive much the same early case if the individual referred him­ Seattle, Washington. The HMO health sciences training that physi­ self to a specialist. Since these re­ agrees to provide comprehensive cians do. In addition, these health ferrals would probably bypass the health care to all members in a care providers are all experienced general practitioners (who are in household unit under one umbrella, in patient care. If certain early diag­ particularly short supply and high for a fixed monthly payment. nostic procedures were stressed demand), it is unlikely that these more in clinical aspects of these Under the HMO system, the prac­ false referrals would result in any health professionals' education, serious disruption of the present titioner becomes a partner or then more of them could function health care delivery system. shareholder in the organization more effectively as providers of pri­ and receives a salary plus divi­ By improvement of training and mary health care, as their training better cooperation between the dends or a bonus from the and licensure allows. Such organization. He works on a regular medical profession and the other measures could significantly health care professions, the diag­ schedule in conjunction with a reduce the magnitude of health number of other colleagues and nostic ability of all primary care care delivery problems that must providers could be improved and members of supporting and related be met. professions to deliver a large the number of false referrals amount of health care supposedly decreased. With the addition of more effectively to a large number Optometrists and other health course work and demonstration at of people. (The Seattle Group practitioners could offer expanded the student level, it is likely that all Health presently has over 150,000 services if they were taught to of these health professional groups persons enrolled in this type of pro­ recognize common diagnostic could achieve a satisfactory level of knowledge which would provide gram.) signs which accompany the more common and prevalent diseases. the type of screening discussed. The other approach favored by They would thus serve a screening This background could be most federal lawmakers is to increase function and locate persons who effectively imparted by basic the efficiency of the solo practi­ show signs of a variety of diseases science personnel and by clinical tioner through development of sup­ which may not, as yet, manifest instructors in an integrated health- porting personnel, as well as in­ themselves to the patient. Such science-oriented setting. For those crease utilization of diagnostic screening would assist the pa­ health care providers currently in tools and treatment equipment. tient's entry into the health care practice it might be possible to develop a series of short courses Frequently the individual physician delivery system at a point and a which could be provided as a pro­ may join with a group of other place which would provide effec­ gram of continuing education to health care professionals to form a tive and prompt preventive service. improve their ability to carry out clinic, thus reducing the cost of For example, dentists and their these screening operations. diagnostic equipment and support­ assistants, in many parts of the ing personnel by sharing expenses. country, are routinely taking blood In this situation, however, each pressure measurements on their The educational implications of provider still works on a fee-for- patients to assist in the detection this approach to providing primary service basis, with no attempt to of high blood pressure, a disease health care must be addressed by utilize the general prepayment condition which does not readily optometric educators, as well as concept of the HMO. The patient, of manifest itself to the person in­ their colleagues in the other health course, may subscribe to any num­ volved. If the development of a professions. It would seem that no ber of health insurance plans to variety of disease conditions could drastic revision of curriculum help pay for medical expenses. be prevented by early diagnosis would be needed if necessary at- Both of these proposed health through the use of common signs, Continued on page 90 57 Veterans' Administration: We Train Health Professionals

By Kenneth J. Myers produced 14 million visits to VA design and fitting of ocular-max- ambulatory or outpatient clinics illofacial cosmetic and prosthetic The Veterans Administration, the (plus 2 million visits to private devices. practitioners for fee-for-service in- largest independent U.S. agency, As another example of the VA's operates, as part of its over-all off ice treatments) last year. Outpa­ tient dental examinations were diversity, several speciality centers responsibility for our country's are staffed and equipped for the veterans, the world's largest hospi­ given to 227,000 veterans and 248,000 dental cases were com­ treatment and care of spinal cord tal/clinic system. To provide health injury patients where a system of care to eligible veterans the VA's pleted. At the same time nursing home care was provided for an ever limb and orthotic shops is ad­ Department of Medicine and Sur­ ministered by a Prosthetic and gery (DM&S) administers and increasing number of World War II veterans (65 years of age or older) Sensory Aids Program that is a staffs a system of 172 Hospitals, long recognized world leader in 206 Outpatient Treatment Clinics, with 18,137 being cared for in the 87 VA nursing homes while 19,922 devising and fitting artificial limbs, 87 Nursing Home Care Units, 18 braces, adaptive equipment and Domicilliaries, 8 Cosmetic Restora­ veterans were quartered at the 18 VA domiciliaries across the nation. sensory aids. Table I lists other tion Centers, 3 Blind Rehabilitation special medical services and the Centers (plus 5 smaller psychiatric Finally, over 25 million prescrip­ tions were filled and dispensed number of operating units in each blind centers) and many other service. special programs and centers. To during this same year. do all this, the VA utilizes the ser­ The Department of Medicine and In short, each modern VA hospi­ vices of over 180,000 employees, Surgery now maintains within this tal is composed of many special approximately 60,000 of whom are immense hospital/clinic system medical services and supporting physicians, dentists, nurses, phar­ more than 1,200 other special units which makes the entire macists, optometrists, podiatrists, medical clinics, programs, and system of 172 hospitals and 206 residents, interns, students, or centers. For example, veterans with outpatient clinics so diverse as to members of supporting allied impaired, or no sight, are cared for stagger one's imagination. It has health care professions. Last year at the 3 Blind Rehabilitation Cen­ thus long been clear to all the com­ a budget of $14 billion was re­ ters (BRC's) in San Francisco, missions that have studied the VA quired (Fiscal Year 1974) to oper­ Chicago, and West Haven, that medical system over the years that ate the agency from which some together train over 400 "blind" the VA has, does, and will continue $3.5 billion was appropriated to veterans each year, while a net­ to play a large role in shaping support this hospital/clinic system. work of vision impairment centers American modes of health care and In the same period, the system is under development. A screening the training of its health care prac­ treated and discharged well over 1 network of 72 visiting and in-hospi­ titioners. million in-hospital patients. tal Vision Impairment Services America now has over 29 million (VIS) Teams first identify, work VA Teaching Affiliations living veterans of its armed forces with, counsel and, when needed, By the same argument this arti­ or 13% of the general population. In refer the visually impaired to these cle will show that an intimate and addition to the over 1 million in- BRCs. Each year these VIS teams wholesome relation has long ex­ hospital patients treated and dis­ invite those blinded or sight-im­ isted between the VA hospitals/ charged, the veteran population paired veterans in their respective clinics and our country's medical areas who are eligible for care to and allied health schools. This Dr. Myers is Director of Optometry in visit their hospital for an interview relationship, if only by its size, has the Department of Medicine and Sur­ and counseling. The VA also main­ done much to shape the present gery at the Veteran's Administration, tains special restoration centers education programs at these Washington, D.C. staffed by artists skilled in the schools. Both the VA hospitals and 58 the schools have greatly benefited section (3) since 1972 but to date formed at these newly affiliated from these teaching affiliations, only one school has so applied. hospitals through the efforts of and most allied and/or supporting These highly competitive grants General Bradley's key official, Dr. health profession schools, except run on a continuing year-to-year Paul Magnuson, produced a siza­ optometry's, have long taken part basis, can be renewed, and are ble and sudden quantum jump in in these training affiliations. given directly to the school. The patient care quality (in keeping Recent legislation has continued deadline for the next cycle of ap­ with Dr. Magnuson's motto, "health to spell out the VA's importance as plications is September 1, 1975, care second to none"). The VA's a training facility of this country's with approved programs to be acti­ Department of Medicine and Sur­ health professionals. For example, vated on January 1, 1976. (In the gery is now currently affiliated with the recent Public Law 92-541, The first round 70 of the more than 200 92 medical schools, 57 dental Veterans Administration Medical applications were approved.) schools, 314 nursing schools, 45 School Assistance and Health These PL 92-541 funds can be schools of pharmacy and over 850 Manpower Training Act of 1972, used to hire faculty, build clinics or other allied professional or sup­ established new programs of (1) purchase equipment to be used porting health schools. grants to state-supported institu­ either on the VA's or on the In contrast, presently only the tions to assist them in establishing school's property to provide im­ University of Alabama and the up to eight new medical schools; proved training and patient care.* University of California at Berkeley (2) grants to existing affiliated In addition, the VA's Department medical schools to assist them in Schools of Optometry are so affili­ of Academic Affairs has long ated with a VA hospital. The type expanding and improving their directly funded a wide range of un­ capacity for educating medical stu­ and quality of each of these various dergraduate and graduate training training programs at the affiliated dents; and (3) grants to nonprofit programs (see Table II). These universities, colleges and other in­ hospitals (over half of the 172 VA funds provide for intern-resident hospitals are affiliated) are deter­ stitutions affiliated with or to stipends, consultant/preceptor become affiliated with the VA to mined and controlled by each hos­ fees and, in some cases, clinic pital's Dean's Committee. assist them in expanding and im­ equipment and related remodeling proving their facilities for training when required for educational pur­ professional or technical allied poses at a VA hospital. *Dr. Richard Hopping, President of The health personnel while, at the same These teaching affiliation pro­ Southern California College of Op­ time, enhancing care of the VA's tometry and the current ASCO adviso­ grams began on a large scale after patients. ry representative to the VA Director of 1946 when General Omar Bradley Optometry, has recently been named a The optometry schools have assumed administration of the member of this PL 92-541 biannual been eligible to apply for this direct agency. The resulting academic review committee and will serve for a VA Central Office funding under Deans' Committees that were three-year period.

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Schools of optometry and the Veteran's Administration are both exploring improved methods of instruction. V.A. affiliation with the schools could provide learning experiences with opthalmologists and other V.A. health personnel.

59 These training affiliations were mologists) now provide the eye established and made possible health care in the VA. These total only after all VA physicians, den­ Table I 356 (but less than 100 on a FTE tists and nurses were removed Units basis) but do not include the pro­ from the control of the Civil Service Specialized Medical Services Operating fessors of ophthalmology who visit 6/30/73 Commission via an Act of Con­ Total Units 1.224 their residents and provide precep- gress. A separate pay, leave, retire­ Alcohol Treatment Units 65 torship and assistance. Full-time ment, and rights of employment Blind Clinics 3 residents were paid an average (continuing education, attendance Blind Rehabilitation Centers 3 salary of $13,307 per year in 1973 Cardiac Catherteization Labs 65 at medical seminars, etc.) category Day Hospitals 37 ($11,000 for interns) or a total of was created for these physicians, Day Treatment Centers 48 $1,898,287, while the 33 full-time dentists and nurses in Title 38 of Drug Dependence Treatment Units 44 VA staff ophthalmologists Electron Microscopy Units 41 the U.S. Code; the set of laws and Epilepsy Centers 5 averaged $33,521 (a total of regulations governing the Veterans Hemodialysis Units 46 $1,106,192). A total of $3,004,480 Administration. Both the school Home Dialysis 47 was thus paid to full-time oph­ Satellite (Self) Dialysis 25 affiliations and Title 38 changes Hospital Based Home Care 16 thalmological residents and staff (allowing these three health pro­ Hospitals with Intensive/Coronary while a comparable amount was fessionals to be hired, evaluated Care Beds 125 paid to visiting attending/consul­ Mental Hygiene Clinics 83 and fired by fellow professionals Nuclear Medicine 110 tant and fee-for-service oph­ rather than by bureaucrats) ele­ Open Heart Surgery Centers 30 thalmologists (estimated to be over Prosthetic Treatment Centers 19 vated the then smaller hospital Pulmonary Function Laboratories 138 $3 million) or a total resulting sal­ system (92) to its presently recog­ Renal Transplant Centers 16 ary budget of about $6 million dol­ nized position of high quality Reference Laboratories (Special) 7 lars. At the same time just under$2 Respiratory Care Centers 117 health care; a quality of health care Speech Pathology Units 87 million was spent that year among the best to be found any­ Spinal Cord Injury Centers 15 purchasing eyeglasses and con­ where in the world. But this im­ Stereotactic Brain Surgery Centers 5 tact lenses (excluding the low vi­ Specialized Diagnostic & pressive improvement was only Treatment Units 4 sion or special optical aids issued), possible once the teaching affilia­ Supervoltage Therapy Units 23 so that a grand total of approx­ tions and Title 38 changes oc­ imately $8 million for salaries and curred, for only then could the VA tion. This Vision Impairment Com­ materials resulted. utilize the finest and most recent mittee was created and has been medical methods, recruit and retain supported by the Assistant Chief well qualified staff and, at the same In contrast to this ophthalmologi­ Medical Director for Professional time, help to train future doctors, cal program of 188 residents, 85 Services, Dr. Lyndon E. Lee, Jr. In dentists and nurses. staff and 90 consulting/attending addition, the VA's ophthalmological and numbers of fee-for-service advisory committee has endorsed ophthalmologists, only 8 full-time, Ophthalmology and Optometry the concept of expanding the pre­ 13 part-time and under 40 attend­ In The VA sent emphasis on eye health care ing/consulting optometrists were In the eye health care, as in other to the more comprehensive con­ employed. The 8 full-time op­ hospital health services, the VA cept of eye/vision care via inter­ tometrists' salaries averaged has extensive speciality teaching disciplinary team delivery. The $16,016 (full-time with at least 15 internships and residencies. This ophthalmologists believe this team years of service) and, combined year 188 residents underwent should consist of ophthalmology, with the part-time optometrists' training in ophthalmology at the VA optometry, impaired sight re­ salaries, totaled only $300,000 for via 141 full-time residency posi­ habilitation experts, and peri- all optometric services rendered. tions while a large full and part- patologists, for it is becoming clear time core of medical school faculty to all concerned with eye/vision The ophthalmology/optometry and VA staff contributed to both care within the VA that only such a ratios for numbers employed, full- their training and patient care. The truly interprofessional team can time salaries and total salary faculty, of course, acted as the pre­ best provide, in all areas, the high budgets were thus: 356/60 (about ceptors of the residents but they quality care that ever increasing 1 00/1 7 on a FTE basis), also contributed to maintaining the numbers of eligible patients right­ $33,521/$16,01 6 and $6 high standards of eye health care fully expect to receive. At the same million/$0.3 million. Compared to now provided within the VA by con­ time the Chief Medical Director, Dr. optometrists, there were six times ducting related research. John Chase, has approved estab­ as many ophthalmologists in the lishing a VICTORS system.* V.A. and they were paid twice the The VA's newly formed Central As mentioned, there are pre­ optometrists's salary. (There are, Office Vision Impariment Commit­ sently 188 residents in oph­ remember, 3 optometry officers tee (with representatives from thalmology rotating through 141 and 3 opticians for each Ophthalmology, Optometry and residencies and 2 internships ophthalmology officer in the Armed Blind Rehabilitation) has just (first, second or third year). Addi­ Forces Medical Corps while there recommended that similar training tionally, 33 full-time and 52 part- are 2 optometrists per affiliations be strengthened or es­ time VA staff ophthalmologists and tablished with the schools and col­ 90 attending/consulting oph­ 'Vision Impairment Centers To Op­ leges of optometry and the gradu­ thalmologists (plus numbers of fee- timise Remaining Sight. The first 3 pilot ate programs of blind rehabilita- for-service private ophthal­ stations are scheduled for FY 1977.

60 ophthalmologist in the general pri­ past before audiology developed The ocular disease/injury rate in vate practice population.) as a separate V.A. field service. The the veteran population is now more While both full-time VA audiologist is able to screen, ex­ than twice that of the general ophthalmologists and optometrists amine and provide non-medical/ population (VA's population is average 54 years of age and have surgical, ear/hearing care. There skewed to the age 55), and while an average of 17 years of service, are now 87 audiology/speech there are 20,800 optometrists and the ophthalmologist is GS-15 pathology clinics in the VA system 9,980 ophthalmologists licensed in (under Title 38) while the op­ (over 90 full-time audiologists) that the U.S. and 10,000 opticians (a tometrist is GS-11 (under Civil Ser­ include examinations by audi­ few states require registration of vice). The obsolete Civil Service ologists and speech pathologists, opticians but only 4% of all opti­ Commission ratings for optometry who offer diagnostic and prog­ cians receive any formal training presently go no higher than GS-11, nostic information and referral to whatsoever), the VA, which draws a rating exceeded by many other otolaryngology as well as ther­ on a good part of 13% of this na­ professionals or non-professionals apeutic treatment to maximize tion's population, employs about with comparable or even fewer communicative abilities. (In all but 1.0% of the country's ophthal­ years of training. The ratings ob­ 8 or 9 of these hospitals, audiology mologists, less than 0.08% of the viously need revision. These rat­ reports to the Chief of Staff as a country's optometrists and even ings fail to reflect recent changes separate Service.) Last year fewer opticians (full-time in optometric education and will 299,837 patients were examined in equivalents). negate attempts to recruit and re­ these clinics. This concentration on eye health tain young, well-trained optometry The otolaryngologists are in a care and only on limited aspects of doctors. much better position than their vision care has not been due to in- Both professions, but especially ophthalmological colleagues since sensitivity on ophthalmology's optometry, are not now being they have many more professionals part; it has resulted because they recruited into the VA at a rate suffi­ to provide the non-medical/surgi­ are, so to speak, about the only cient to replace those retiring, and cal parts of ear/hearing care that ones trying to move this particular no young, full-time staff (in either most ENT patients need. On the football in the Va. (They are also, profession) are now on duty. Today other hand, the eye surgeons must quite rightly, more interested in it is impossible, as mentioned, to provide a great many of the re­ medical or surgical care than in op­ recruit or retain young optometrists quired optometric services. tometric care.) It should also be due to this low Civil Service rating since the career high salary now possible is less than one-half that of the average private practitioner 1976 YY Budget with similar years of practice. This lack of staff optometrists as Appropriation Requirements—S16.424,284,000 well as optometric training affilia­ tions has, quite frankly, sometimes Distribution by Major Program handicapped delivery of com­ AMOUNT prehensive eye/vision care to eligi­ (In Millions of Dollars) ble veterans because our VA ophthalmologists have had, in the General Operating Expenses S 453.0 2.7% main, to bear the entire weight of Benefit Programs 11,723.9 71.4% providing all types of eye/vision Medical Programs 3.843.5 23.4% care. They have had no choice but Construction Programs 403.9 2.5% to provide, on their own, many of TOTAL. VA $16,424.3 100° the non-medical/surgical services needed for complete eye/vision The President's budget submitted to Congress February 4. 1975 includes care and thereby have been forced S16.424.264.000 for the Veterans Administration under existing legislation. The to establish priorities among these; VA's share of the total Federal budget will be 4.5 percent. sometimes slighting or delaying Average employment for 1976 is expected to increase by 9,218 to a total of services such as contact lenses, 205,766—the highest since 1947. Average employment of 181.511 for the special aids for limited vision, ward Department of Medicine and Surgery will be the sixth consecutive year of record screenings,-routine yearly eye ex­ high employment. In 10 years—1967 through 1978—appropriations for veterans' benefits and aminations, certification of the services will have increased over S9.9 billion, or 155 percent. Average employ­ blind and other services the ment has increased 48.541, of which 44,092 has been for the Department of modern optometrist provides. In Medicine and Surgery. some hospitals ophthalmologists The "Medical Programs" Budget will provide: have had to resort to delegating • Inpatient hospital, nursing home, or domiciliary care for 1.246,531. includ­ non-medical/surgical work to tech­ ing 1.138.480 in VA hospitals. nicians who sometimes have but a • Veteran outpatient medical care totaling 14.743,000 visits. month or two of training. • Dependent medical care totaling an average daily level of 450 hospital pa­ tients and an annual level of 1,485,000 outpatient visits for the dependents of Ophthalmology is presently in a 100 percent service-connected disabled veterans and veterans who have died of position similar to that in which a service-connected disability. otolaryngology found itself in the 61 clear that our VA ophthalmologists have not always been used as effi­ NUMBER OF TRAINEES IN DM&S ciently as possible because they generally must see 100 presenting patients to locate the 5 to 10 ac­ Estimate tually requiring their specialized FY 1972 FY 1973 FY 1974 FY 75 of Nation's 76 Total 1974 medical treatment. They have been forced to practice primary care, op­ Medical House tometry, ophthalmology and even, Staff 11.774 13.638 14.097 15.100 25 sometimes, opticianry. Dental House VA ophthalmologists have thus Staff 327 413 469 500 14 Medical'Dental been pressured by these circum­ Students 12.020 13.758 13.153 13.400 29 stances to practice at less than Nursing Students 18.292 21.870 24.995 25.000 10 their highest or most appropriate Optometry Students - 10 20 — 0.6 training levels. These men have Psychology Interns 1.412 1.344 1.652 1.600 18 never failed, however, to provide Social Worker excellent ophthalmological eye Interns 991 1.121 1.310 1.300 12 care once patients reached them, Other Associated and their efforts are to be admired. Health Profes­ It is also clear, however, that some sions 10.786 12.723 15.041 15.300 asymptomatic patients needing Administrative Trainees 595 661 729 800 - care are not seen. Ophthalmol­ ogists are overdue for help; they 56.197 65.538 71.466 73.000 need both professional optometric colleagues to help them run with The Veterans Administration is the largest single Ir.nner o! health profes­ sionals. All of the above trainees, except medical dental, nursing and optometry the football and opticians to pro­ undergraduate students (rows 3-51 receive stipends or salaries from the VA. vide blocking for them both. (House staff refers to interns and residents while the remaining rows 6-9 refer to It is apparent than that optome­ graduate trainees.) For comparison, optometry's 1 2 schools now collectively try, via staff or teaching affiliations enroll about 3.400 students but less than 20 of these (and no optometry resi­ (the backbone of the ophthal­ dents) received training at a VA hospital in FY 1974 (UAB) mological effort) is poorly utilized within the VA. While some optome­ try schools have, in fact, ap­ proached local VA hospitals in the past with plans for teaching affilia­ Table II tions only to be turned down for lack of space, money, or in isolated NUMBERS OF RESIDENTS AND TYPES AND NUMBERS OF cases, resistance on the part of INTERNS IN TRAINING VA STAFF ENGAGED IN RESEARCH ophthalmology, the situation is AT VA HOSPITALS AND CLINICS changing and these efforts should be renewed. Specialty or Subspecialty 1972 Staff Physicians 2,21 7 Consultants 629 Total One solution optometry schools Attending Physicians 160 can offer to the VA's goal of improv­ Allergy 6 Interns and Residents 248 ing its patients' eye/vision care Anesthesiology 155 Dentists 114 program is to work with the hospi­ Cardiology 65 Research fellows 97 tals in setting up optometric Colon and Rectal Surgery 1 Ph.D.'s 893 teaching and residency programs. Dermatology 109 Doctors of The VA and the medical schools Gastroenterology 84 veterinary medicine 18 General Surgery 888 have, as we have seen, long recog­ Other scientific Internal Medicine 1,824 nized the value of these affiliations personnel 521 Neurology 177 Without VA and over 25% of all medical/surgi­ Neurosurgery 84 compensation 798 cal residents trained in this country Ophthalmology 1 77* receive training each year at VA Orthopedic Surgery 228 Total 5,695 hospitals. Everyone benefits from Otolaryngology 133 these teaching affiliations since Pathology 229 the hospital receives excellent, low Physical Medicine 66 cost, and experienced staff support Plastic Surgery 53 via the preceptors and their young Psychiatry 365 vigorous residents and interns Pulmonary Diseases 63 Radiology 430 while the schools, on their part, Thoracic Surgery 49 receive financial support and Urology 180 diverse training and patient ex­ posures for their students. Several •188 IN 1974. medical schools have, in fact, Continued on page 86

62 Book reviews, abstracts and comments are solicited on any publications or learning resource materials related to optometric education. Book reviews ^OOKS should include complete publication information.

question of how professional attitudes are that time assembled nearly 300 educators, by Frank A. Brazelton formed, are just a few of the issues which computer programmers, administrators, perplex all of us. and others working in or intrigued by the Teaching and Learning The author's approach is logical and possibilities of Computer Assisted Test in Medical School practical and the exposition so clear that Construction (CATC). George E. Miller, Editor one is tempted to regard their conclusions This book summarizes the principles Harvard University Press, 1961. and suggestions as self-evident. Whether and mechanics of CATC. The concept is the discussion concerns evaluating diag­ based on the nature and purposes of test­ The old aphorism which says "Those nostic skill or how to use a blackboard, ing itself. Every instructor is faced with who can, do; those who can't, teach," sources of student anxiety, or conducting the problem of designing and constructing reflects a viewpoint as American as seminars, it reflects the consensus of ex­ tests which are valid, reliable and dis­ plastic wrap. We are a nation of doers and perienced educators who have melded criminate between good and poor lear­ our species is Homo Faber rather than their own perceptions with the wealth of ners. Ultimately these characteristics are Homo Sapiens. The glories of our civiliza­ research and information now available. statistical in nature. Each question or item tion are found on highways and in The health professions educator who in a test has certain traits such as kitchens rather than classrooms and li­ wants to do a more effective job could difficulty level and discrimination power braries. scarcely find a better guide. which distinguish it as adequate or not for There may be no place in which this at­ its purpose. The determination of these titude is maintained more tenaciously traits is called item analysis. The poten­ than in teaching institutions for the heal­ tial value of CATC is its capacity to help ing arts. Although the apprentice method the instructor select and maintain good as a model for health professions educa­ Computer Assisted items in sufficient numbers to generate tion has passed into history, its legacy re­ Test Construction powerful measurement instruments mains, especially in clinical teaching. Im­ Gerald Lippey, Editor readily and easily. plicit in that method was the assumption Educational Technology Publication The process begins with the teacher that the experienced clinician or 1974, ($11.95). who, alone, can write the questions perti­ researcher is automatically endowed with nent to his course of instruction. These the capacity to transmit his skills, Not too many years ago, the magic let­ must be in objective format. They are knowledge, and behavior to the fledgling ters in educational technology were CAI- then translated and stored in the com­ practitioner. This short, provocative and Computer Assisted Instruction. A com­ puter as -an item bank. They can be very readable book confronts that attitude bination of operant conditioning, televi­ retrieved at will and, in more sophisti­ with evidence which does not so much sion or typewriter terminals, and cated installations, test copies will ac­ contradict as reassess it in the light of our electronic "brain" was projected to tually be printed by the computer. Once present knowledge of how learning oc­ revolutionize teaching and learning. Un­ administered, the test results are scored curs. Its premises are that teaching itself told hours and dollars, mostly Uncle by the computer, a complete item analysis is a professional discipline and that teach­ Sam's, were siphoned into this new is done, and the results go back to the in­ ing skills are no more innate than patient panacea. The vistas sketched by its structor. Once the performance charac­ care skills. prophets were bold and broad with many teristics of the items have been deter­ The text is organized around what of the details left vague. Alas, it was some mined, an almost infinite number of might be called the five fundamental of those very details which proved so parallel forms of a given test can be con­ variables of the educational process: the refractory in practice that the revolution structed and the instructor can generate characteristics of the learner, the function stumbled to a halt. Many educators reluc­ short tests for teaching purposes, as well of the teacher, the role of learning objec­ tantly concluded that the "I told you so" as longer tests for evaluation, at will. tives, the types and uses of teaching camp had won again and that, perhaps, "a These methods have been used exten­ methods, and the problem of evaluation. simple bench, Mark Hopkins on one end sively in some colleges and universities This short synopsis does the authors and I on the other," still epitomized teach­ where banks of up to 10,000 items in some disservice for its rather abstract ing. Overambitious, oversold, and physics, biology and psychology have nature tends to hide the many concrete bemused by the computer mystique, CAI been generated. Most courses of instruc­ examples they cite which illuminate their promised more than it could deliver and, tion of one semester would require a bank thesis. The medical connotation should in the process, alienated many in the of 1,000-1,500 items. Though this may not disturb the potential reader. One is educational community. seem a formidable number, it probably struck by the parallels rather than the However the role of the computer in does not exceed what most optometric in­ differences between- medical and op­ teaching may turn out, it seems apparent structors who have taught for 4 or 5 years tometric education. Little imagination is that its ultimate function will more likely have already written. Since many parallel required to transpose the illustrative inci­ be to assist rather than displace the questions can be constructed based on a dents to an optometric educational set­ classroom teacher. Some recent develop­ single concept, the expansion of an item ting. Indeed the problems in health pro­ ments point the way to this kind of pool in any given area is not as difficult as fessions education seem generic. The utilization. In January, 1972, a conference might be thought. relevance gap between basic science and sponsored by IBM brought together a It is probably premature to expect that clinical instruction, the objective assess­ small group of educators who, working CATC will find wide acceptance or use in ment of clinical performance, and the independently, had begun to apply com­ optometric education at this stage, but its puters to constructing tests. At that time potential should not be overlooked. For Frank A. Brazelton, O.D. is Director, Op­ only 20 such programs were in operation. those who wish to lift the veil and see tometric Center of Fullerton, Southern By November, 1974, that number had in­ what our future may have in store, this California College of Optometry. creased tenfold. A second conference at book is highly recommended. 63 Affirmative Action: Malking the tightrope between Equal Opportunity and Reverse Discrimination

by Sheila Doctors employment opportunity provi­ To some, this constitutes a per­ sions stretching back to the Tru­ verse self-contradiction. Namely, American colleges and univer­ man Administration, Executive that the government, in seeking to sities have been walking an admin­ Order 11246 embodies two distinct end discrimination, is in fact man­ istrative tightrope ever since Presi­ (and according to some, contradic­ dating and authorizing measures dent Lyndon Johnson signed Ex­ tory) concepts: nondiscrimination inherently discriminatory. The ecutive Order 11 246 back in 1965. and affirmative action. It prohibits seeming contradiction has pro­ Known popularly as the "affirma­ federal contractors and sub­ duced some of the most tive action" order, the directive has contractors, including institutions troublesome questions regarding produced more than its share of of higher learning, from dis­ affirmative action. These questions confusion, debate, and division in criminating against any employee have been raised not only by critics higher education—as well as an or applicant for employment. This of affirmative action, but also by abiding misconception of what applies to every person, not only to well-intentioned administrators affirmative action really means. All members of minority groups. No who sincerely wish to comply with of the optometric institutions are person may be denied employment the order but are too confounded to federal contractors, and therefore or related benefits because of race, know how. How can they increase share in the affirmative action color, religion, sex, or national the ranks of women and minority obligation. origin. faculty members without dis­ A decade after its signing, the criminating against white male ap­ controversial order is still being ex­ At the same time, the Executive plicants? Some say they can't. plained anew by the HEW Office for Order requires affirmative action to Civil Rights (OCR), the agency overcome "underutilization" of charged with enforcing the affirma­ women and minorities. Affirmative According to Peter E. Holmes, tive action order. The mere mention action obligates the contracting in­ Director of the HEW Office for Civil of affirmative action today can trig­ stitution to do more than ensure Rights (OCR) there is no contradic­ ger a host of emotional and/or employment neutrality with regard tion; affirmative action does not re­ ideological reactions. This article to race, color, religion, sex, and na­ quire so-called "reverse dis­ hopes to add a helpful perspective tional origin. In exchange for tax­ crimination." Holmes describes & to the issue by confronting some of payers' dollars, the college or affirmative action as a commitment. | the popular misconceptions sur- university must make additional The underlying assumption of | rounding affirmative action and at- efforts to recruit, employ, and pro­ affirmative action, says Holmes is I tempting to clarify them. mote qualified members of groups "that qualified women and minority £ A successor to several equal formerly excluded—even in the ab­ applicants for faculty positions ex­ c sence of evidence of previous dis­ ist and that, as federal contractors, 1 Sheila Doctors is the editor of the crimination by that particular col­ universities must give them equal 1 monthly "ASCO Educator." lege or university. opportunity to compete for those 64 positions by eliminating practices discretion appears to have inter­ which have excluded them in the fered with equal opportunity, past." however, the Guidelines require Holmes recently circulated a rigorous re-examination and ?>.1 greatly publicized memo to this elimination of the discriminating effect among the leaders of 2,400 effects. colleges and universities. That In recruiting, for example, the memo, which reaffirms the schools' university must carefully examine right to hire the best qualified its recruitment policies. Where a faculty and staff, has been called a much lower representation of re-interpretation and even a rever­ women or minorities appears in the sal of the affirmative action order. applicant pool than is available in However, according to Holmes, it the work force, the university con­ merely clarifies what has long been tractor must try to locate and en­ the position of the OCR courage qualified women and According to HEW's Higher minority candidates. Universities -"J Education Guidelines, published must recruit women and minority faculty members "as actively as in 1972 to aid in the enforcement of 2 Executive Order 11 246, "nothing in they have recruited white males." the Executive Order requires that a Affirmative action may not re­ university contractor eliminate or quire reverse discrimination, but it dilute standards which are neces­ is not hard to see that anyone sary to the successful performance responsible for implementing of the institution's educational and affirmative action has to do some research functions."1 It was never pretty fancy stepping to balance on the intent of the affirmative action what is a very fine line indeed. concept to require that a university Most optometry school faculties looked like this a few employ or promote unqualified per- years ago, but affirmative action is changing that. The sons, according to Holmes. Optometric Applicant Pool Furthermore, it is a violation of the Some help for optometry schools Executive Order for a prospective may be found in the recently applicant pool would consist of the employer to state that only mem­ published report from the School of active optometric practitioners. Optometry, University of Alabama With the cooperation of Mr. bers of a particular minority group 3 or sex will be considered, or even in Birmingham (UAB). While strug­ Douglas Redmond of the Op­ gling to evolve its own affirmative tometric Manpower Resources preferred for a position, or that the 4 available slot is an "affirmative ac­ action program, UAB developed a Project. (funded under an HEW tion position." description of the optometric appli­ grant), a summary table of the age, It is ironic, therefore, that critics cant pool. UAB assumed that, at sex, and racial backgrounds of the of affirmative action often point to least insofar as the clinical op­ active optometrists in the United the proliferation of recruitment ad­ tometric faculty is concerned, the States was prepared. vertisements which state racial or sexual preferences as proof that affirmative action requires reverse discrimination. Such advertise­ Age ments may indeed result from ill- laoie i advised affirmative action efforts, Optometrists Availability Data Under 30 1,694 8.8% Sex 30-39 3,084 16.0% but they are certainly not in com­ 40-49 5.283 27.4% pliance with actual affirmative ac­ 19.269 active optometrists 100% 50-59 6,236 32.4% tion requirements. 18.859 male optometrists 97.9% 60-69 2.177 11.3% 410 female optometrists 2.1% 70- 795 4.1% Affirmative Action Recruitment 19,269 total optometrists 19,269 100% What is required is that each school construct and adopt its own Racial standardized employment and 19.269 active optometrists 100% recruitment procedures. It must ar­ 18.655 white optometrists 96.8% ticulate in writing (and make 105 black optometrists 0.5% available upon request) detailed 287 Japanese and Chinese optometrists 1.5% standards and criteria for appoint­ 9 Other Asian optometrists 0.05% ment, retention, and promotion. 13 Indian-Eskimo optometrists 0.07% 20 Other 0.10% Otherwise, arbitrary and/or dis­ 38 Mexican-American 0.2% criminatory employment decisions 1 Puerto-Rican would be more likely. Of course, a 10 Other Latins 0.05% certain range of discretion is in­ 131 Not reported 0.07'.- evitable and therefore permissible Courtesy Optometric Manpower Resources Project 1973 under the Guidelines. When such 66 Academy. A geographical listing of the female membership is shown in Table III. An additional recruitment tech Table II nique strongly recommended by UAB is the publication of advertise­ Alabama 1 ments for faculty in the national op­ Arkansas 1 tometric press. This is documenta­ Florida 2 tion of the intent to open the search Georgia 8 to all interested parties. It does not Illinois 18 Indiana 2 mean that a particular candidate Kentucky 3 must be selected. It merely means Louisiana 3 that a search has been conducted Maryland 1 to determine who is available and Massachusetts 1 what the individual's qualifications Michigan 7 Minnesota 1 are. The schools and colleges Mississippi 1 would remain free to determine New Jersey 4 who is the best qualified candidate. New York 4 Of course, as UAB points out, the N. Carolina 8 school should be prepared to de­ Ohio 4 Oklahoma 2 fend its reasons for selecting a par­ Penn. 4 ticular applicant over all the others. S. Carolina 2 Tennessee 1 Texas 6 Goals and Quotas Virginia 8 Washington 1 Controversy about the affirma­ tive action commitment first Bcrkclc) optometry school, which once had no women, now has four women on its faculty. erupted in 1972 when Professor Total 91 Paul Seabury, University of Califor­ nia at Berkeley, published a Table I shows that the minority scathing attack on the regulations. Courtesy School of Optometry, and female applicant pools total About the same time, the New York University of Al abama in Bir- 1,024, assuming no overlap. That, Times ran an editiorial sym­ mingham. 1 974. of course, is an erroneous assump­ pathetic to Prof. Seabury's point of tion. According to UAB, the total of view, charging that a resort to these two pools is-less than 1,000, quotas was the "unmistakable sug­ or approximately 5% of the active gestion in HEW's approach." optometrists. Although the OCR has traditionally In an attempt to confirm some of condemned illegal hiring quotas, these statistics, UAB obtained a critics say there is no real Table III membership roster of the National difference between quotas and the Optometric Association. The goals required by the Higher geographical distribution of the Education Guidelines. NOA members is shown in Table II. Alabama 2 Dramatizing what he believes to California 10 be a distinction without a District of Columbi a 1 These figures show that the Na­ difference, Dr. Seabury conceived Florida 1 tional Optometric Association has the following labels: the quoal, a Illinois 3 a membership that includes almost slow-moving quota-goal; and the Indiana 6 gofa, a faster-moving quota- Kentucky 1 87% of the active black op­ Maine 1 tometrists in the nation. goal. Massachusetts 4 UAB also made a compilation of Is HEW playing a semantics Michigan 1 the members of the American game? The affirmative action New York 3 Academy of Optometry. UAB felt Guidelines assert, "While goals North Carolina 2 Ohio 4 that these individuals, by their are required, quotas are neither re­ Pennsylvania 2 membership in the Academy, quired nor permitted by the Execu­ Tennessee 1 showed above-average interest in tive Order." According to Mr. Texas 3 the scientific endeavors of the op­ Holmes, this is not semantics. In­ Virginia 1 tometric community, and should be stitutions may have tended to Wisconsin 1 above-average candidates for focus too narrowly on the numbers Total 47 academic careers. A total of 47 aspect of affirmative action, he (2.66% of total U.S Membership) members of the Academy were believes. He acknowledges that women. Of these 47 women, 26 affirmative action is result- were already affiliated with a col­ oriented, but says that the develop­ Courtesy School of Optometry. University of Alabama in Bir­ lege or university, either full or ment of goals and timetables is but mingham 1974. part-time. That is approximately one integral part of an acceptable 55% of all female members of the affirmative action plan.5

67 Even if the university falls short I would request you kindly 10 of its goals, that does not define more precisely what you necessarily constitute non-com­ mean by the term "black." Am I pliance. If the university generally right in supposing that you are follows its affirmative action pro­ seeking information regarding gram, it is likely to be found in com­ American faculty of African des­ cent? Or do you wish West In­ pliance with both the spirit and the dian and African faculty mem­ letter of the Executive Order. Ac­ bers to be included—or dark cording to Holmes, the process is skinned faculty from other coun­ crucial: tries?7 If the institution gathers and pro­ Even for those who do not enjoy perly evaluates all relevant data, poking holes in affirmative action, it carries out a thorough utilization is not always easy to know who is analysis, secures accurate infor­ or who is not a minority applicant mation on availability, and sets in under the meaning of the Depart­ motion an internally well-under­ ment of Health, Education, and stood recruitment program effec­ Welfare. tively designed to reach qualified women and minority candidates, Another troublesome term is this total process should lead to "underutilization"—a key word in successful affirmative action in the Guidelines, but unfortunately hiring policy. There is no intrinsic fraught with ambiguity. Under­ magic to figures.6 utilization is loosely defined in the regulations as "having fewer There are other misconceptions women or minorities in a particular about affirmative action whose job than would reasonably be ex­ origins lie in the ambiguity of a pected by their availability." The word. Especially problematical are affirmative action order requires "minority" and "underutilization." that a school identify and try to The word "minority" does not ac­ overcome such underutilization. tually appear in either the Execu­ Critics have seized upon this tive Order or the Civil Rights Act of idea as proof that HEW is far more 1964, although it is used and interested in placing women and defined, in HEW's Higher Educa­ minorities in faculty positions than tion Guidelines. It is not surprising it is in preserving the quality of therefore that some have balked at higher education. However it is im­ their obligation to apply a standard portant to understand that what is so arbitrarily-derived. meant is not the availability, of The Guidelines state: women and minorities within the "Minorities are defined by the total population, or even within the Department of Labor as Negroes, total labor force. What is meant is Spanish-surnamed, American In­ the availability of qualified women dians, and Orientals." What of and minorities. Underutilization of other minorities reportedly under- these qualified individuals is the represented in higher education? real concern of HEW, and it is for Appalachian-Americans, Irish, them that affirmative action is re­ Greek, Italian and Slavic-Ameri­ quired. cans have all been suggested for inclusion as "underutilized Compliance, Sanctions minorities." Furthermore, there re­ and Academic Freedom mains the overwhelming problem Perhaps the most recurrent of ethnic measurement. Consider theme found in articles opposed to the harsh realities of attempting to affirmative action is the notion of collect statistical data on faculty the heavy hand of government. For members' minority group affilia­ there is no question that Uncle tions, as defined by the Department Sam can impose some serious of Labor or otherwise. Ethnic penalties on colleges and univer­ classification can become very sities which do not comply with the sticky business, as many univer­ sities have already discovered. affirmative action order. All univer­ sities subject to the Executive Dr. George Roche, President of Order (i.e., universities which are Michigan's Hillsdale College and holders of federal contracts) must author of The Balancing Act, a develop and implement an affirma­ book staunchly opposed to affirm­ tive action plan. Drafting such a ative action, used the following plan requires institutions to con­ tongue-in-cheek example: tinually update personnel data 68 such as race, sex, and job education community with every classification. An administrative opportunity to meet its obliga­ procedure must be set up to organ­ tions.8 ize and monitor the plan and to continue carrying out the required As of April 14, 1975, 501 com­ auditing and reporting obligations. plaint cases filed under the Execu­ Institutions which fail to comply tive Order are still pending. Only with these admittedly expensive 280 cases have been resolved and burdensome requirements be­ since the Order was signed. As of come subject to the following OCR April 3, 1975, OCR reports that it sanctions and penalties, all of has requested and received only which are authorized by the Execu­ 170 affirmative act/on plans. tive Order: Another 115 affirmative action 1. Publication of the name of the plans have been voluntarily sub­ non-complying contractor. mitted to OCR for review. The total 2. Cancellation, termination, and number of affirmative action plans suspension of contracts or por­ accepted to date: only 33. tions of contracts. 3. Debarment from future con­ It is likely that the affirmative ac­ tracts or extensions or modifica­ tion obligation will continue to be tions of existing contracts. something of an administrative In addition, the Director of the Of- headache to the higher education fice of Federal Contract Com­ community and to HEW for some pliance may, in some cases, time to come. Hopefully, however, it recommend to the Department of will become less of a problem as Justice or to the Equal Employment more people come to understand Opportunity Commission (EEOC) what the program requires and that judicial proceedings, including what it does not require. The mis­ criminal proceedings, be com­ conceptions which have plagued menced. affirmative action efforts for a Concern has arisen particularly decade will hopefully give way to over the government's authority to more widespread understanding of postpone a contract award. Under what the commitment actually en­ existing procedures, the OCR tails. Then, we are more likely to routinely investigates the affirma­ see the advancement of equal op­ tive action plan of any university portunity without compromising which has pending a contract the quality of higher education. JOE award application for $1 million or more. In addition to these routine pre-award reviews, OCR engages in several other kinds of com­ pliance reviews, including com­ References plaint investigations. Whereas the EEOC investigates individual com­ 1. U.S. Department of Health, Educa­ plaints of discrimination, OCR in­ tion, and Welfare. Higher Education Guidelines, Executive Order 11246, vestigates class or group com­ plaints and allegations of general (1972), p. 4. institutional patterns of discrimina­ 2. Ibid., p. 5. 3. Peters, Henry B. "A Report on the tion. Affirmative Action Program of the For staunch defenders of School of Optometry, University of academic freedom, no doubt these Alabama in Birmingham." Submitted to ASCO Board of Directors, March, can be hard pills to swallow. 1975. However, it should be remembered 4. Optometric Manpower Resources that there are practical and legal Project. Douglas Redmond, Director. constraints to the authority of the 1730 M Street, N.W., Suite 206, Wash­ OCR. Says Mr. Holmes: ington, D.C. 20036 Far from applying sanctions, 5. Holmes, Peter E. "Affirmative Ac­ penalties, and threats in such a tion: Myth and Reality," (prepared for manner as to constitute what delivery at Annual Meeting of the some might regard as an abuse American Political Science Associ­ ation, New Orleans, September, 1973), of power, the comparatively few p. 17. cases in which the Office for Civil Rights has prompted the delay of 6. Ibid. contract awards is evidence 7. Roche, George. The Balancing enough of our continuing en­ Act LaSalle, Illinois: Open Court deavor to provide the higher Publishing Co., 1974, p. 39. 8. op. cit. Holmes, p. 10. 69 By Frederick W. Hebbard and dental schools into the Ohio basis in his home near the OSU State University structure as the campus, as well as lecturing at »r»radition and innovation—these Colleges of Medicine and Dentistry. various state and national meet­ *two words both describe The These changes were inspired by ings of optometrists for several Ohio State University College of the 1910 recommendations of the years. It was Dr. Sheard's aspira­ Optometry. The traditional ties be­ historic Abraham Flexner Commis­ tions, along with the encourage­ tween the optometry school and sion on Medical Education. That ment and assistance of many other the state university go back to study is well-known for its conclu­ dedicated men, which made the 1914, when, under the leadership sion that medical schools, a ma­ Ohio State University College of of Dr. Charles Sheard, an optometry jority of which were then proprie­ Optometry a reality. curriculum was established in the tary, should associate with univer­ Among those men who should be Department of Physics. That move, sities and build on solid education mentioned for their role in early in itself, was an innovation since, at in the basic sciences related to development of the optometric pro­ that time, all but one of the existing health. gram at OSU are: Dr. Emil Arnold, f optometry programs were proprie­ an Ann Arbor (Michigan) op- I tary or part-time courses of in­ tometrist; Dr. John C. Eberhardt, % struction. Formative Leadership the Dayton practitioner credited J The decision to develop the op­ Dr. Charles Sheard, the "Father with independently coining the ^ tometry curriculum as a separate of Optometry at OSU," was a word "optometrist" and encourag- £ academic discipline occurred physicist whose major study was _ .2 simultaneously with the merging of physiological optics. He had been Dr. Hebbard is Dean of the OSU Col- 1 the private Starling-Ohio medical practicing optometry on a part-time lege of Optometry. I 70 ing its wide-spread usage (Dr. one-half week for one semester in leadership which has continued in Eberhardt is also a past president the office of an optometrist. many ways. of the Ohio Optometric Association Almost simultaneously with the Professor Sheard continued to and the American Optometric As­ start of the two-year certificate head the program until 1919, when sociation), and Dr. P.C. Harris, of course, Dr. Sheard submitted, in he accepted a position with the Columbus, who later became first September, 1914, to the University American Optical Company as president of the Ohio State Board a proposal for a four-year degree head of its scientific bureau and of Examiners in Optometry. course to replace it. This recom­ editor of its American Journal of mendation was approved in May Physiological Optics. His interest It should be noted in the context 1915, by the Committee on Instruc­ in optometric education research of this early development that in tion, and subsequently approved continued throughout his life, and 1914, only thirty-three states had by the Board of Trustees in time for he personally contributed a sub­ passed laws recognizing the pro­ the opening of the new academic stantial sum to the Sheard Founda­ fession of optometry. Some state year in September, 1915. tion for Research in Vision. (The laws required no education to Foundation was set up in 1944 by a practice, mandating only that the A Major Milestone number of his admirers in order to optometrist pass a state board ex­ Looking back, we realize that the provide an endowment to assist vi­ amination, while others—among establishment of the four-year pro­ sion research at Ohio State.) them New York, Iowa, Delaware, In­ fessional degree program was a diana, and Michigan —required at major milestone in optometric his­ Dr. Sheard served in the 1940's least two years of high school, plus tory, for it was the first four-year de­ as a member and chairman of the three years of study in an op­ gree program to train optometrists AOA Council on Optometric Edu­ tometrist's office or graduation offered anywhere, and it was at a cation, and actively promoted a from a school of optometry. Ohio major university. It set a pattern for five-year curriculum to lead to the had yet to pass an optometry law professional doctorate. He con­ and did not do so until 1919. tinued to work for the advancement of optometric education, assisting Two Hundred Dollars in the efforts of The Ohio State Per Student "Ohio State has University to establish the first In August, 1914, Dr. Sheard sub­ been a pioneer in mandatory six-year professional mitted a proposal to The Ohio State program to lead to the Doctor of University recommending a two- deveioping com­ Optometry degree at a major state year certificate program in optome­ puter-assisted in­ university. He died in 1963, only a try. One month earlier he had struction in opto­ few days before the Ohio State received the unanimous vote of the University Faculty Council ap­ Ohio Optometric Association au­ metry." proved the six-year program. thorizing him to submit the pro­ posal and pledging $2,000 to be "At least ten state Developing Graduate and given to the University by Septem­ optometrist as­ Research Programs ber 1. (In addition, the proposal The year 1935 marked another provided for equipment necessary sociations have had major milestone in optometric edu­ to educate ten students.) On Au­ Ohio State gradu­ cation at Ohio State. In the 1930's, gust 4, the university trustees ap­ ates as presidents." enrollment in optometry increased proved the proposal and named Dr. considerably, and during that Sheard director of the courses. A decade there were 192 graduates, month later, twelve students "... the first four- compared with 78 previously. registered. The $2,000 contribution year degree pro­ However, the University adminis­ seems small by today's standards, tration felt that optometry had not but it represented over 20% of the gram to train opto­ made adequate academic prog­ $9,150 in gifts for all purposes metrists ... at a ma­ ress, and was not making a suffi­ made to The Ohio State University jor university." cient contribution to research. Dr. in 1914! Glenn A. Fry, a Ph.D. psychologist The two-year optometry cur­ from Duke University, was named riculum requiring two years of high ','... leadership in to head the program and charged school education for admission in­ optometric educa­ with improving it academically. Dr. cluded first-year courses in mathe­ Fry, working with Professor matics, physics, anatomy, physiol­ tion and research Alpheus W. Smith, Chairman of the ogy, English, theoretical optics, implies initiative in Department of Physics, lost no time practical optics, and theoretical the pursuit of ex­ in establishing a graduate program and practical optometry. The leading to the M.S. and Ph.D. courses during the second year cellence." degrees in physiological optics, the were theoretical optics, physi­ first to be associated with an op­ ological optics, practical optics, tometry program. The output of this theoretical optometry, ocular graduate program helped to meet pathology, and optometric practice, the pressing need for qualified in which the students spent at least faculty, not only at Ohio State but 71 also at other schools and colleges of optometry—a need which is not fully met even today. In 1937, the University gave its vote of confidence by establishing the School of Optometry within the College of Arts and Sciences. In 1939, following the original goal of leadership in optometric educa­ tion, the curriculum was extended to five years, with one year of pre- optometry and four years in the School of Optometry. In 1946, this was changed to two years of preop- tometry and three years in the School of Optometry.

Expansion of Facilities With the increased enrollments from the return of veterans, classes were expanded to sixty to help meet the demands for optometrists. The clinics and laboratories were still located largely in Mendenhall Physics Laboratory, as they had been since 1914, and the need for a building for optometry became so critical that Ohio optometrists took effective action. A fund drive from optometrists and friends of optom­ etry raised over $108,000 which was supplemented with a $200,- 000 appropriation from the Ohio Legislature. A committee of University admin­ istrators and optometrists was formed to determine the location of the new building. Some optome­ trists felt that a site in the educa­ tion complex of the campus should be selected, while others felt that the evolving role of optometry would move the profession more and more in the direction of a full- fledged health profession. This viewpoint won out, and a site was selected adjacent to the out-pa­ tient clinic of the College of Medi­ cine which is near the College of Medicine and the College of Den­ tistry. With the completion of the Op­ tometry Building in June, 1951, the School of Optometry in effect became the first optometry pro­ gram to become a part of an aca­ demic health center. The influence of Dr. Sheard, who had close ties with both optometry and ophthalmology, as well as the close working relationships of Dr. Fry and Dr. Arthur Culler, then chairman of the Department of Ophthalmology, helped to influence this decision. 72 Dr. Culler, along with Dr. Fry, Dr. Carel C. Koch, and others, became part of an Interprofessional Com­ mittee on Eye Care, which tried to establish logical and harmonious working relationships between op­ I tometry, ophthalmology and opti- cianry. The positive influence of Dr. Culler was lost when in the mid & 1950's he suffered an untimely stroke. The School of Optometry con­ r tinued to occupy space in Men- denhall Laboratory when, in 1957, the Ohio Legislature appropriated $600,000 to build phase two of the i*. Optometry Building, which was completed in 1960. At this time Ohio State had the most modern and complete optometry facilities anywhere in the world. However, since then, optometric education everywhere in the United States has moved forward at such an amazing pace that now these facilities are among the least ade­ quate of any school or college of optometry in the country. However, these inadequacies will at least in part be relieved in the near future since the old medical out-patient clinic adjacent to the Optometry Building is now being extensively remodeled at a cost of roughly $1.5 million for the College of Optome­ try. The College of Medicine clinics have recently occupied a new $13 million building.

New Academic Status In 1966, Dr. Glenn A. Fry was given the special rank of Regents Professor—one of only a handful in the University—which enabled him to devote his full attention to research and graduate teaching. Dr. Frederick W. Hebbard, a mem­ ber of the faculty since 1957 and Associate Director of the School of r Optometry since 1962, was named "S3 Director. One of the major ac­ complishments during his first year was the creation of the College of Optometry, which gave it equivalent academic status with the College of Medicine, College of Dentistry, and College of Veterinary Medicine. Ohio State is the only university where these four major health professions are to be found on one campus. Although Ohio State graduates •:;»! comprise only five percent of U.S. optometrists, they have accepted & Continued on page 90

73 Tomorrow's Challenge by William R. Baldwin

he written language of the Chinese uses two which will provide total, comprehensive health care T characters to symbolize the word CHALLENGE: with emphasis on quality and prevention and that we one, the character for "danger," and the other, denot­ should proclaim this. However, as we proclaim, we ing "opportunity." At no time in its history has op­ must see things as they are and establish the full tometry fulfilled this double meaning of challenge as credentials that qualify us even by the strictest mea­ it does today. The forces of change are converging sures of preparedness. This we are not doing well. towards totally new concepts and systems of health We extol diversity in our educational programs, fail­ care. Most of these forces are operating outside of ing to modify the meaning to include only diversity of and independently from optometric planning and method. influence. Single National Purpose We must adapt on the basis of projections of One of the major conclusions of a preliminary the world as it is most likely to become. Not only study of our profession by an outside agency, in do we need to adapt to the changes in concept 1963, warned that optometry must organize and delivery as they become clear, but we the premises on which visual care is ren­ should also influence them. Never have we dered according to theories and facts that had a greater opportunity to establish for achieve general acceptance within the ourselves roles which will provide the profession. It seems clear that optometry most effective use of optometric ser should have strong national uniformity vices to the largest number of people in its educational programs when This is true, in part, because estab issues of the nature and quality of lished roles are not considered as „ optometric education and training sacrosanct as they have been in JK. are considered. We should have a the past. single national purpose concern­ Even though the tide of op ing the roles that optometrists portunity is at its crest, op should fill in future delivery tometry is in danger of being systems. We are not likely to cut off from the mainstream . have significant influence of future health care, or of / on what these roles should being thrust into future L be unless we have systems as sub-professionals. Some of the danger uniformity of education and unless we speak loudly, results from uncertain answers to reasonable ques­ lucidly and with one voice. tions that are now being asked and for which Consensus should not come without debate. It answers will soon be established—by others. These cannot come without thorough study of alternatives, include: What is the nature and quality of optometric planning and leadership. We have the structure of education? What is the optometrist educated and leadership in optometry. But we are not moving with trained to do for patients? (Not, what is he licensedto sufficient momentum towards a well-planned or a do?) What is presently the nature and quality of op­ well-organized consensus. Optometric leadership tometric practice? and, What is the most effective must develop the will to confront the pressing issues use of optometrists in future health care delivery of the day. Certainly the capacity is sufficient and the systems considering present and potential training? responsibility clear. What is needed is: first, produc­ My view is that neither we nor our antagonists will tive discussion to lay out specific premises upon be able to determine by persuasion how these ques­ which we operate; then, objectives toward which we tions are answered. If the answers are not to our lik­ organize and move as one force. ing, it may be because we have not achieved the There have been many professional conferences quality and scope of education and practice that we focusing on these issues. One of these , AOA-spon- convince ourselves we have earned, rather than sored Airlie House Conference of January, 1969, because we have influential enemies. produced 78 resolutions, each of which received I believe that we are just as prepared as other unanimous or near unanimous support of the op­ health professions to meet the demands of a program tometric leaders present. Collectively, these provide 74 a comprehensive blueprint for action. But their in­ improve visual acuity. Further, it is assumed, though fluence on new directions for the profession has manpower studies are woefully lacking, that there been limited. are not enough ophthalmologists to render this ser­ Many ideas and recommendations have come from vice and those which they are additionally qualified other conferences, but they have not yet been dis­ to render. Therefore, if the service is included (or, tilled into a logical, feasible, acceptable and com­ more likely, when it is included), optometry will par­ prehensive action program. Perhaps one of our prob­ ticipate. Another assumption indicating that optome­ lems in finding solutions which we can work toward try will participate in the future delivery system is in unison is that we have been looking at the parts, that since optometric education is supported by not as essential elements serving major objectives, federal funds, optometric participation in a federally- but in isolation. Small plans developed now and sponsored health care plan can be forecast. again cannot be set easily on course nor are they These assumptions suggest some of the major likely to have significant impact on our future. We dangers which optometry faces as its role is being must develop without delay the master plan for op­ considered. If the scope of optometric competence is tometry's future. misinterpreted and judged to be limited to refraction, Potential Obstacles to Action our role will be very limited and participation possi­ Four deterrents to action may continue to delay us: bly delayed because eyeglasses are not considered 1. Indecision because of the notion that leaders to be one of the higher priorities under national cannot lead but must wait for all constituencies health services. (The provision of eyeglasses to per­ to become informed; sons who suffer no other health problems represents 2. Belief that the time for change is not ripe a substantial expense; thus, the possibility exists because we are developing rapproachement that this service would be excluded from the pro­ with the leadership in medicine; gram, at least initially). In this respect, we will proba­ 3. Fear that we cannot achieve our goals; bly be dealt with in the same way as dentistry in its 4. Assumption that things are not really happening provision of dentures. Dentists are recognized to out there and optometry's niche is already es­ have other competences and to render valuable pre­ tablished and secure. ventive as well as restorative health services not re­ Just as inaction is a major danger, so is failure to lated to commodities or appliances. They will, understand changes which will shape our future. therefore, likely be included in any national health Already, state laws have given way to national legis­ program. If our capabilities were understood as well, lation in shaping the future of optometry. Principal our participation would be as likely. examples are the various national laws creating If and when eyeglasses are included in the na­ federal support for health professions education. tional health services program, and if the misconcep­ Current issues that receive widely varied interpreta­ tion concerning optometry's limited scope of compe­ tion among state legislative bodies must ultimately tency prevails, we could be assigned a sub-profes­ be made uniform through the U.S. Congress and the sional role as refractionists and possibly dispen­ U.S. Public Health Service if optometry is to serve sers—the latter along with dispensing opticians. with maximum effectiveness in future national health Even if we can convince the appropriate authorities care programs. Among these issues are the scope of that we are competent to discover ocular disease or optometric practice, the modes of optometric prac­ systemic disease affecting the eye or vision, our tice, licensure and continuing examination of profes­ duties might be expanded but our role might not sional competence, the role of ancillary personnel in change. vision care and interprofessional cooperation in the While optometry now participates in all federal care of patients. health care educational programs created by Con­ Elements of a national design for health care are gress, there is continuous and increasing pressure to already apparent. Emphasis will be on PREVENTION, make a case for greater needs and higher priority of QUALITY and COMPREHENSIVENESS OF CARE. funds for medical education. Medicine and dentistry, National planners are already actively concerned in the view of public planners, are considered to have with determining manpower needs, proper distribu­ established the fact that they suffer from severe tion of services, use of ancillary personnel, methods manpower shortages. The other professions (except for early detection, methods for evaluating efficiency nursing) have not convinced that manpower shor­ and quality and determining costs. The next major tages exist. The restricted role which optometry is thrusts will be towards evaluating the quality of generally conceived to be prepared to fill thus places education and training, determining the role of the us in double jeopardy in the consideration of our role various professions, and establishing delivery in any new national health plan. Not only is refraction systems. a relatively low-priority service, but, if optometrists The strongest assurance that optometry will be in­ are limited only to providing this service, fewer op­ cluded eventually in the national health care plan tometrists will be needed. lies in the fact that we represent a presence in the Need to Mobilize and Educate health care field of approximately 20,000 individuals Our basic weakness is that we have failed to trained to render needed services. To date, these enlighten the national health care planners concern­ services have not been specifically defined by the ing the education of optometrists and the appropriate national health care planners, but the notion consis­ scope of optometric practice. Our 'educational pro­ tently emerges that optometrists merely measure the grams do, in fact, vary in purpose and in quality—and refractive state of the eye and provide spectacles to the scope of those optometric practices that are most visible is often limited to refraction and the dispens­ Dr. Baldwin, President of the Massachusetts College of ing of spectacles. Unfortunately, this may also be Optometry, ends a distinguished two-year term as ASCO true of all too many of the less visible practices. As president in June, 1975. we strive to acquaint the decision-makers in HEW 75 with what the best in optometric education should be such commitments now may well condemn us to and what this adequately prepares optometrists to retrenchment rather than restructuring even as the do in the case of patients, we must also mobilize na­ opportunity for change is at the crest. While there is tionally to educate and to practice in the manner that now no coherent plan, nationally-instituted systems we preach. for planning are being reorganized in response to the Planning for optometric education cannot wait for deep national sense of need for new ways. We must optometry's master plan to emerge. Estimates must make known our commitment to meeting national be made now concerning future optometric roles needs. which today's students will'fill. ASCO's current plan­ Defining Professional Objectives ning is premised on the axiom that the nature of the The primary mission of optometry schools is to education of health professionals determines the create professionals who will practice optometry— nature and scope of their practice. Growing dis­ which may be defined as the application of enchantment with existing ways of education, knowledge and professional insight in the service of analysis of problems and educational reform are patients who present visual symptoms or who seek cyclical events as well as a continuing undercurrent information concerning vision. In addition, the prac­ in each health profession. It is by such evolution that tice of optometry should involve activities not professions change. directly associated with vision care but which serve to maintain and improve the general health of pa­ tients and to promote community health. To design the future of optometric practice, one must be guided by present and potential educational resources and by present and future needs. No plan "The new role of the optometrist... should can be implemented unless current optometric be to bring all of the knowledge educational resources can be restructured and ex­ of visual science ... to bear on panded to prepare optometrists for selected patterns of practice. Efficient implementationof the design the improvement of human potential." proposed herein requires (1) that the quality of enter­ ing students be maintained or improved, (2) that op­ tometric educational institutions coordinate certain optometric teaching with units of academic health centers, (3) that substantial new funds be invested in the education of optometrists, and (4) that certain ex­ Optometric education is in the midst of perhaps isting traditional attitudes concerning the role of op­ the most significant soul searching in its history—or tometrists be overcome. These are formidable tasks, future. Causes and contributing factors to this but I believe the social value of achieving competent development are both internal and external. Optome­ practitioners who fulfill the proposed role is worth try was born of a combination of technological the major concerted effort which will be required. achievement in lens making, growing demand occa­ The new role of the optometrist, broadly stated, sioned by educational and industrial progress, and should be to bring all of the knowledge of visual by failure of existing social groups to apply new science that is applicable to bear on human prob­ knowledge to meet new demands. Early progress in lems and on the improvement of human potential. optometric education has been within this frame­ The education and training of optometrists does work. But now, new opportunities for professional not and is not contemplated to include the treatment services exist because new knowledge of vision per­ of intraocular disease by chemotherapy or surgery; mits more extensive and refined evaluation of visual therefore, the differential diagnosis and medical function and the identification and solution of more treatment of these conditions is outside the realm of human problems associated with vision. The time optometric practice. span of optometric education and the range of study of visual science and related subjects has expanded. However, because the optometrist is a first-contact Larger numbers of highly-qualified students are professional who primarily attracts patients who seeking to become optometrists. Substantial new have visual symptoms,it is considered important that resources have been infused into the education of he be competent in the early diagnosis of the pres­ optometrists. ence of ocular disease and systemic diseases dis­ External social changes also add to opportunities playing ocular symptoms and that he make compe­ for change. A new national mood pervades the tent judgments concerning referral of such patients. analysis of health care and planning for its future. No It is also considered that all first-contact profes­ longer are the best interests of consumers to be sub­ sional should be trained and oriented to screen for merged by an aura of mystery created by providers to general health problems which have high incidence, serve their self interests. Demands of quality, scope, low early visibility to the person afflicted, high pre- accessibility, early discovery and preventive treat­ ventability when detected early, and for which effec­ ment have a new urgency and new authority. In such tive early detection methods are available. a climate, critical self-analysis and attempts to dis­ The general optometrist's responsibility to patients cover new ways are a mandate to the profession. then can be divided into four major categories: The urgency of committing optometric education to A. To diagnose, treat and counsel concerning vi­ new designs, higher standards and greater sion problems of high prevalence; challenges is perhaps at its peak. Failure to make B. To recognize and refer unusual vision prob- 76 lems to optometrists with specialized educa­ almost 1500 optometric graduates a year through tion and experience; 1990 in order to assure a ratio of one optometrist per C. To screen for certain high incidence general nine thousand population (1:9,000) at that time. health problems While this falls far short of the AOA-adopted goal of D. To diagnose health conditions which portray one per seven thousand (1:7,000), even this objec­ visual and ocular clues, signs and symptoms, tive will be very difficult, if not impossible, to achieve. but which are treated effectively by other Approximately 1500 optometrists per year will be health practitioners—and consequently make leaving practice in the mid-1980's due to death or appropriate referrals, providing follow-up care retirement. This results from the fact that during the and management when advisable. period 1949 to 1954, the yearly number of graduates Three conclusions derived from the above are that from all U.S. optometry schools was the greatest in (a) the optometrist will function as general practi­ our history. If we achieve this almost impossible goal tioner of vision care, (b) that close cooperation with and begin, as early as 1980, to produce 1500 op­ other health practitioners is essential, and (c) that tometric graduates per year, the ratio of optometrists certain optometric specialties must be developed to to population in 1990 will be approximately the same deal with special problems which, while not seen as that which existed in 1960 (1:9,108), and less often in general practice, are sufficiently frequent, than existed in 1950 (1:8,506). Even under the best complex and treatable to justify the special educa­ tion competency and instrumentation necessary to their most effective care. A Major Change Proposed A major change in scope of practice projected is the responsibility to screen for certain general health "Current projections indicate the need problems. Such action naturally raises questions for twenty-five schools of optometry about licensure and whether or not current laws in the United States by 1981—each would need to be changed to legitimize the proposed expansion of optometric practices. In arriving at with an average class size of sixty students." answers to these inevitable questions, it should be kept in mind that the boundaries of professional practices are determined by education and training. Professional and regulatory agencies—as well as laws—are most often concerned with keeping the ac­ tivities of a profession within its boundaries. circumstances then, optometric manpower is Optometric regulatory laws and procedures should unlikely to show anything like the kind of growth be clearly and simply dedicated to making certain necessary to meet future needs. that optometrists do only what they are educated to Other important factors in estimates of future man­ do. However, they have a purpose equally important; power needs include increased demand for vision they should ensure that, within the limitations im­ and health care services which would result from posed by education and training, the profession federal commitment to make comprehensive health should have maximum freedom. Given this condi­ care available to all citizens and from expanded tion—freedom to engage in all of the activities for functions of optometrists resulting from new which educated and trained—optometrists should be knowledge and new technology and from anticipated held fully accountable for the interests of individual expanded roles as primary health care practitioners. patients and of the public they serve within the boun­ How can we best solve this serious problem? All dary of activity set by their education and training. but a very few of the existing twelve schools of op­ Viewed in this perspective, no massive restructur­ tometry have expanded enrollment so that they are ing of state licensure procedures should be re­ now beyond optimum size based on available quired—but more definitive instruments for measur­ resources. Even so, the number of graduates pro­ ing the accomplishment of professionally-adopted jected for 1978 is approximately 980. objectives may be needed. This represents no obsta­ If we consider bringing existing schools to op­ cle in my mind —indeed, expanded definitions and timum size based on the needs of the constituencies clarifications of licensed procedures would seem to which they serve and upon their resources, the follow naturally, just as expanded practice modes average number of students per school would be will evolve as a matter of course from the implemen­ somewhat less than it is now. Planning for meeting tation of proposed educational models. the goal of fifteen hundred graduates per year by The proposed design for implementing innovations 1985 is being carried out by the Council of Institu­ into the optometric education system which will pro­ tional Affairs of ASCO. Current projections indicate duce the type of optometric practitioner previously the need for twenty five schools of optometry in the described, incorporates guidelines for development United States by 1981 each with an average class of new schools, along with adoption of a national cur­ size of sixty students. riculum model. There are two overriding reasons why there should be twice as many schools as exist now rather than New Schools twice as many students in each school. First, we The need for more optometric manpower is clear. must recognize that in the predictable future op­ Based on the Optometric Manpower Profile tometric education can only be financed adequately developed by AOA, we must maintain a level of if it is partially supported by funds through state leg- 77 .i «« M g * '•"Br -ii *"«••• •.! M'» *• .r—»-'•*.•'. -run-. *n ulTMinw-h ... -MI m .!'• •*•*! •wi"w->'t^*>- JJJ-1 •*-«<"-mm-Mjm..nrt

islatures. Presently only six of the twelve optometry of others; and they need to contribute their influence schools are affiliated with public state supported to planning for optimization of health planning and universities. Two additional schools, Southern Col­ improvement of professional services in all areas of lege and Pennsylvania College, receive funds ap­ the country. propriated by state legislatures. Southern College We believe that it is important that this substantial from contracts with fifteen states which partially number of new schools needed to keep our man­ support the educational costs of their own residents, power supply from dwindling should be created ac­ and Pennsylvania College from a direct appropria­ cording to criteria based on national planning. The tion from its own state legislature. When distributed Council of Institutional Affairs has developed such a on a pro-rata basis among the total student popula­ plan. We hope optometry will mobilize to implement tion in schools however, these funds are far from this plan just as soon as possible. ASCO has also sufficient to provide adequate operating budget developed guidelines indicating criteria which assistance, let alone capital funds. Therefore, to gain should be considered in the development of new state funds in amounts necessary to support op- schools of optometry. These include the need to tometric education nationally, private optometry locate in a comprehensive academic health center schools must become public, and those states with environment, the guarantee of state financial sup­ substantial needs for optometrists must develop new port, availability of patient populations of sufficient schools. Theoretically, optometry schools could exist size and variation, and interdisciplinary relationships adequately in private universities if these institutions in teaching research and patient care. were sufficiently endowed, or if they receive suffi­ A Curriculum Model cient financing from other sources to maintain ade­ For General Practice quate programs. However, no existing private op­ tometry school has such resources, nor is it likely The Council on Academic Affairs of ASCO has that private universities meeting these criteria can been at wrok for eighteen months to develop a cur­ be encouraged to develop new high cost programs riculum model which is appropriate to our best esti­ such as optometry. mate of the future role of optometry. They have deter­ mined that this curriculum must be designed in terms of what the general practice of optometry is to be. As Secondly, optometry schools need to be well dis­ in other fields of health science, the general practi­ tributed geographically to help serve continuing tioner should be concerned with all problems in his education needs and other important professional field which have high prevalence, which do not re­ missions. They need to be affiliated with major quire rarely used and expensive instrumentaion and academic health center education programs in order diagnosis and treatment, nor extensive special | to provide comprehensive health delivery models education in the development of competence. The a and educational efficiencies inherent within these general optometrist is a primary health care practi- ^ environments; they need to exist in universities tioner; because he represents a point of entry into 5 which have strong health care and basic visual health care he should have competence to identify § science research resources so that they can con­ health problems which can be ameliorated by other | tribute to and draw from related research capacities health professionals. 1 78 We identify then two major areas of professional The ten categories above represent the ten major responsibility. One derives from the fact that optome­ study units which have been circumscribed as try is that profession which applies knowledge of necessary elements in the preparation of optometric visual science to human problems and human poten­ graduates of the future. The Council on Academic tial. This knowledge is applied to the diagnosis and Affairs is now working on the next step—defining treatment of conditions which are categorized under content in each subject area. Every educational topic the following divisions of primary optometric care: and activity must be measured in terms of its impor­ 1. Refractive and accommodative conditions tance and relevance to one of these units of study. 2. Problems of motility and binocularity Whether academic divisions are based on divisions 3. Sensory and integrative vision problems of basic health sciences, visual sciences, and patient 4. Conditions of visual environments care, or, whether attempts are made to organize 5. Involvement of vision in other behaviors academic units around the circumscribed subject areas in the final development of a model curriculum One major responsibility of optometric education is is less important than are the criteria of priority and to provide unique training, education and experience relevance to the behavioral goals of mastery of which lead to understanding in dealing with the knowledge and competence in its application to above conditions. No health profession, other than human needs. optometry, will possess this combination of compe­ Optometric Residencies and tencies. No other health profession will develop ex­ Optometric Specialties tensive insights into any one of them. Two conditions are necessary to assure compe­ If patients came to optometrists only because all tence in treating given conditions—knowledge and possibilities of health problems, other than op­ experience. If knowledge—beyond that made part of tometric problems, had been ruled out, their respon­ the general optometric curriculum —and ex­ sibilities to patients would be limited to those above. perience—beyond that available from general pa­ Rather, optometrists are very likely to continue to tient populations—is required, some optometrists function as first contact health professionals; should be educated and trained to deal with such therefore, the second major portion of their profes­ problems. The latter is probably a more persuasive sional responsibility derives from the fact that they reason for developing specialties in optometry. are primary health professionals as well as op­ ASCO formed a special committee to study re­ tometrists. quirements for residencies in optometry. The Com­ mittee recommends that it is appropriate to establish Patients can therefore expect that optometrists will general residencies of varying periods of time. These recognize non-optometric health problems which should be employed primarily to give optometrists in­ they might not themselves discover but which re­ tensive training in specific procedures such as con­ quire attention from other health professionals. Com­ tact lenses or visual training. They should also be munities in which optometrists work also have the developed to provide intensive experience with right to expect that they will provide leadership in special population groups such as mentally retarded health planning, health education, and health admin­ or elderly. General residencies should not lead to istration. Knowledge necessary to fulfill these pro­ certification or special designation. fessional responsibilities is classified under the The Committee also determined that three types of following divisions of other professional respon­ residency programs should be established which sibilities: could lead to special certification. The criteria on 1. Ocular Health Assessment which these three specialty areas are based are: 2. General Health Assessment 1. Any specialty area should include a body of 3. Health Counseling scientific knowledge applicable to patient care 4. Health Education which needs to be more extensively covered 5. Health Administration than it is in the O.D. curriculum. In each of these areas optometrists will cooperate 2. Conditions treated must be rare enough so as with other health professionals in serving the best in­ not to provide consistent experience for general terest of patients and other publics. Treatable ocular optometric practitioners, but frequent enough to disease will require consultation with require the full time efforts of practitioners ophthalmologists. Discovery of other health prob­ operating within appropriate patient population lems will lead us to make certain that patients are areas and seeing patients almost exclusively directed to other appropriate practitioners. Our upon optometric referrals. knowledge of genetics, nutrition, and other scientific 3. Conditions delegated to an optometric concepts affecting patients' health and welfare will specialist should be deferentially diagnosable often permit us to provide valuable counsel to pa­ (as opposed to tentative or presumptive) and tients. We have responsibilities not only to patients appropriate treatment methods must be availa­ but to local and larger communities to provide ble. leadership which will help prevent vision impairment, 4. While education and clinical training must be promote public awareness to good vision and more extensive than that available to students general health practices, and to participate in com­ in genera) optometric educational programs, munity activities and events which support good they must be available within the academic en­ health practices. The administration of health care vironment of optometry. represents an area of knowledge which each health profession has responsibilities to develop. Continued on page 89 79 Teaching Health Care: Under One Roof

The following is an informal con­ versation with Thomas W. Mou M.D., the Provost for the Health Sciences of the State University of New York (SUNY). As health pro­ vost of that large educational com­ plex, Dr. Mou, along with his col­ leagues, has coordinating and staff responsibility for four medical schools, two dental schools, a Pharmacy college and a college of optometry as well as a school of podiatric medicine, a college of veterinary medicine, some forty schools of nursing and many allied health programs. The JOURNAL OF OP- TOMETRIC EDUCATION invited Dr. Mou's comments after hearing his presentation at the December 1974 meeting of the American Academy of Optometry in Miami Beach. At that time, he discussed among several items of interest to the profession, the ASCO guide­ lines for the development of new schools of optometry which were adopted in September. 1974 80 What impact will the proposed respiratory therapy technicians, to In my view, there is great need to national health insurance have on name a few. provide good settings for integr­ professional health sciences ated educational opportunities in education, in your estimation? However, in the future, a much the health professions. There is the Let me briefly talk about the greater proportion of the health hope that if we educate the profes­ health sciences professions over­ care provided, including op- sions together, they will then even­ all and their changing approaches tometric services, will be delivered tually work together. At present, to education and patient care. in an ambulatory, out-patient set­ this tends to be true more in the Those of us who are involved in ting, presumably financed by a theoretical than the practical, but a health sciences education must be comprehensive national insurance portion of this problem may reside mindful of these evolving changes. plan. in present faculty, administrator For example, we all know of the Our educational process will and practitioner attitudes rather hospital-based strengths of need to further orient all health than student attitudes. We need to medicine and nursing. Dentistry, care professionals, including create settings in which the health pharmacy and podiatric medicine physicians and nurses, to function professions faculties and students also have hospital roles. In recent efficiently in an ambulatory setting. can learn together, work together years, the allied health professions The dentist, the pharmacist, the op­ and develop respect for each other. have assumed a larger role in our tometrist and the podiatrist, as well This is one reason / am fully sup­ hospitals —the medical tech­ as the public health nurse and portive of the concept of academic nologists, physiotherapists, oc­ others, have had more experience health sciences centers—where a cupational therapists, and in the ambulatory setting. wide range of health sciences educational activities are con­ ducted in a university setting.

ASGO Guidelines For Of the several health profes­ sions, medicine and nursing proba­ bly have the greatest integrative New Schools of Optometry responsibility. Optometry deals This statement is prepared to present the conditions the Association with one organ system, dentistry of Schools and Colleges of Optometry holds important to the develop­ with another, podiatry with another. ment of new schools. Pharmacy has a defined and ex­ panding role in the health 1. Under appropriate conditions, the most advantageous location for sciences. But medicine, as it has a new school or college of optometry is in the academic health become amazingly complex, has center of a state university. lost some of its ability to integrate 2. Optometry should have separate status as a professional school or for good patient care. With college, administratively on the same level as medicine and den­ specialization, medical specialties tistry, within the health center. limited to specific organ systems 3. There should be strong central administrative support for the have occurred. This development focuses on the great need for in­ school or college of optometry and commitment to interdisciplinary tegrated education. development and interaction. If students are to fulfill their roles 4. There should be shared basic health science programs for stu­ to the maximum of their dents of the health professions where appropriate. capabilities, they must understand 5. There should be the opportunity for development of optometric and communicate effectively with clinical services in the various patient care facilities of the center. their colleagues in all health pro­ 6. There should be the opportunity to develop interdisciplinary fessions so that patient care—the research programs of mutual interest. principal goal of the health educa­ 7. There should be a commitment to graduate and continuing educa­ tion process—will be the most effi­ tion for the further development of practicing optometrists and cient possible. We must have a bet­ future educators. ter perception of what other mem­ bers of the health professions team 8. The size of the entering class of professional students should be can do and we must integrate the approximately 60 students. strengths of all if we are to survive 9. The school should be located in a community of at least 200,000 the demands that national health population to provde an adequate clinical base for the program. insurance will place upon us. 10. The school should, where possible, be a regional resource for the development of optometric manpower and vision care referral ser­ The concept of integrated health, vice. professional education which 11. There should be a commitment of both adequate capital funds and you describe has been gaining operating support to provide for the orderly development of a pro­ support in the past decade. As gram of excellence in optometric education. you are well aware, optometric 12. There should be an established faculty-student ratio of not less education has made great strides than one faculty member per five students. in the recent past as well. The new schools guidelines (printed 81 here) adopted by ASCO, and sub­ ged stool" of teaching, research an independent and cooperating sequently by the AOA's Council and patient care. health care profession. on Optometric Education, repre­ Item #3. The sharing of basic Third, the purpose of an increase sents not only an endorsement of science instruction with the other in the biomedical base of op­ integrated education, but also a health sciences is important and tometric education is to better pre­ blueprint for the future education timely—and an appropriate vehicle pare the optometrist to perform his of optometrists. Would you give for accomplishing a learning as­ functions, including appropriate us your reaction to the policy sociation among students. referral of patients to statement? Item #4. They will then learn of ophthalmologists and other health the capabilities of their colleagues professionals. in the other disciplines, the Fourth, that the optimal educa­ I have several points to make benefits of which have already tional environment for a school of about the guidelines, but first, a been emphasized. optometry is within an academic brief statement about my associ­ health center. ation with optometric education, Item # 5. The sharing of clinical past and present. I have been in­ experience is also very important The fifth has to do with phar­ volved, of course, in the develop­ in providing the optometry student maceutical agents. "Any utilization ment of the SUNY College of Op­ with an insight into the respon­ of pharmaceutical agents by op­ tometry. About the same time as sibilities and capabilities of the tometrists is for the purpose of im­ the establishment of that op­ other health professions. In turn, proving recognition of conditions tometric program (1971, 72) I students and faculty in other health requiring referral for appropriate became more active in the Associ­ professions will learn of the op­ medical or other health services. It ation for Academic Health Centers tometry students' capabilities. is not for treatment of any health (AAHC),* serving as chairman of Item # 6. The concept of inter­ problem. Utilization of diagnostic the Liaison Committee on Optome­ disciplinary research programs is, agents assumes the local legal try. Through that committee, I have in my view, one of the most impor­ authorization and'professional had the pleasure of working with tant areas to which optometry must liability for their use." many distinguished optometry and address itself. Graduate programs Sixth, the committee proposed ophthalmology educators —too in the field of physiological optics, that it is in the best interests of the numerous to mention individually, for example, should withstand the public and both professions for but every one helpful and con­ same rigorous review as a program ophthalmologists and optometrists cerned about the important issues. in the department of biochemistry to train technical assistants under As you know, the AAHC Liaison or anatomy or microbiology. mutually acceptable guidelines for Committee on Optometry prepared Items 7, 8. The setting for op­ their supervision and control. some working concepts about the tometry must certainly be in a ma­ The seventh states that in­ relationship between jor urban area and there must be creased participation by each pro­ ophthalmology and optometry. continuing education for the prac­ fession would enchance the These were drafted a little more ticing optometrist, just as there educational programs of both than a year ago, and I will address should be continuing education in ophthalmology and optometry. them also, since they have much every other health profession. And finally, statement eight relevance to your question. There are other statements on recommends that there should be The ASCO guidelines on new education by the optometry college quality assurance of appropriate schools and colleges of optometry, deans that will need further con­ referrals established by participa­ viewed in entirety, represent a sig­ sideration. These are issues of a tion of ophthalmology and optome­ nificant "working paper" in a com­ separate school, a specific class try in a review mechanism to iden­ plex policy-making process. More size, a regional resource, and a tify needs and to implement pro­ specifically: specific faculty/student ratio. The grams for continuing education. concepts expressed in those state­ Taken together, the' ASCO and Item #1 should enable some ments will need further discussion. the AAHC statements represent universities and academic health Now, let me compare the deans' two very important steps forward. centers to accept the concept that concepts with those of the Liaison They appear to me to be rational optometric education should be in Committee of the AAHC. At least and logical developments for the a university setting as a full partici­ five of the committee's "working future of optometric education. pant in the academic environment. paper" observations appear to Therefore, I commend both of these Item #2. would then allow op­ complement the statements of the developments as significant, not tometry to have its own "three-leg- ASCO deans, and the remaining only to optometric education, but, three are compatible. This I find in turn, to the practice of optometry. very encouraging. *The AAHC, located in Washington, First, the professions of optome­ In what ways can optometry — D.C., is composed of presidents, vice- try and ophthalmology are both pri­ both educators and practi­ presidents and provosts of academic mary entry points into the field of tioners—facilitate the necessary centers. For AAHC purposes, an changes to ensure full participa­ academic health center consists of at eye and vision care. Second, the professions of op­ tion in the integrated health pro­ least a medical school, a teaching hos­ fessional team approach to pital, and one other major health tometry and ophthalmology recog­ science school, such as dentistry, nize and subscribe to the concept health care delivery? nursing, pharmacy or optometry. that each has the right to exist as Continued on page 83 82 HealthCare- BETTERS Continued from page 82 Let me answer that by first point­ I am indeed grateful to receive a copy I am impressed! What a fantastic ing out some other important of your new periodical, Journal of Op­ beginning. Your Journal is not only a developments. Members of your tometric Education. Optometric beautifully conceived, excellently laid profession are already involved education is of vital concern to me. It out publication but a prestigious addi­ with various regional higher educa­ is most essential that we in Congress tion to the literature of the profession. tion bodies in developing new continue our fight through legislation The heads are attractive; your use of schools according to the ASCO- for adequate funding of these profes­ color in good taste; and your illustra­ adopted guidelines, as well as at­ sions. tions truly professional. The image tempting to generate more state Thank you for writing. Please con­ portrayed by Optometric Education support for existing optometry tinue to keep in touch with me about can only be enhanced by the new schools. For example, the Southern optometric education legislation. Journal of Optometric Education. Regional Education Board (SREB), Edward W. Brooke Milton J. Eger, O.D. after a major study of optometric U.S. Senator Editor, Journal American Optometric education in fourteen southern Massachusetts Association states, has recommended the Secretary Weinberger has asked me to development of a limited number of Just a note to let you know that I read thank you for your letter of February new optometric schools, regionally the first edition of the Journal of Op­ located, and that they conform to 25 with which you enclosed a copy of tometric Education. I find your new the guidelines adopted by ASCO the first issue of the Journal of Op­ venture both interesting and informa­ and the AAHC. tometric Education. We are most im­ tive. I am certain that it will be valua­ Similarly, the New England Board pressed with this first issue and look ble to the members of the profession. of Higher Education is examining forward to the contributions which Thomas M. Rowland, Jr. its responsibilities and the role of the Journal will make in the future to President the six New England states in pro­ optometric education. Philadelphia College of viding for optometric education. Thomas D. Hatch Osteopathic Medicine In addition, the State of Virginia Director has appointed a special committee Division of Associated to study the need for optometric Health Professions, HEW Thank you very much for sending me education in that area. It has been a copy of the first issue of your new my pleasure to be involved in the Thank you for sending me a copy of Journal of Optometric Education. The three studies, to a varying degree, Volume 1, Number 1 of the Journal of Journal is a lively document contain­ as have Drs. Peters and Baldwin, of Optometric Education. I would like to ing articles of much interest and I am the Alabama and Massachusetts add my compliments to the many I'm very pleased to learn particularly optometry schools, respectively. certain you have already received on about the Pennsylvania College of It seems then that this is an in­ your excellent publication. Optometry. teresting time for optometry. There All best wishes for your continued Please accept my congratulations for is ferment, excitement and action success. this outstanding effort and best wishes that is healthy. Mrs. Mildred Yarrington for continued success. Your profession has excellent Executive Secretary Darrell Holmes educational leaders, superb The Auxiliary to the President organizational leaders and effec­ American Optometric Association East Stroudsburg tive accrediting groups. I urge you State College (Pa.) to support their wise decisions Many thanks for sending the first copy while overruling any self-serving or of the Journal of Optometric Educa­ "turf-protecting" attitudes. Keep tion. Please give my congratulations your professional relations strong, to Dr. Baldwin, President, and also to both within and outside of optome­ the Board of Directors, Editorial try. Make sure your educational in­ Council, and Advisory Committee on stitutions maintain and improve the this notable educational advance. quality of programs that now exist I have read the papers and special and strive to ensure that op­ features with very considerable in­ tometric institutions are in the terest and I shall look forward to the "right places" for their future roles. next edition. There is a need for Academic acceptability, greater educational liaison in optome­ research accomplishment and try on a world-wide basis and I multi-professional health care pro­ welcome your project. grams can be achieved by intellec­ G.V. Ball tual rigor and objective evaluation Professor and Head of Department V of competence by all professions. Department of Ophthalmic Optics This is the course you appear to be University of Aston Today! following. Birmingham, England

83 Parent Guidance: An Integral Part of Vision Therapy

By J. Floyd Williams Parent Guidance Clinic is to pro­ sion Therapy Clinic, at maximum vide additional unique training op­ utilization, can provide therapy op­ The Parent Guidance Clinic of portunities for optometry students. portunities for only 200 Vision the University of Houston's College At present, the student's ability and Development patients per year. The of Optometry (HCO) was recently opportunities to counsel patients Parent Guidance Clinic fills an im­ re-designed and re-programmed to and parents relative to vision portant gap, insuring a reasonable involve both optometric faculty and therapy and vision development amount of continuity in patient students to make it an integral part activities are limited. The Parent care. The program specifically pro­ of the vision therapy services and Guidance Clinic provides an ex­ vides home therapy routines optometric training opportunities cellent opportunity for students to parents may utilize to develop and offered by the Optometry Clinic. gain this much needed experience. enhance visual and visuo-motor Group therapy procedures were Previously, students had few op­ perceptual abilities, as well as as­ instituted which may make vision portunities to develop and practice sociated perceptual motor skills therapy service more economical group therapy techniques. Now, prerequisite to effective learning. for both the practitioner and optometry students direct and More generally, the program pre­ parents. In addition, the interaction supervise groups of patients and sents selected topics of a public of parents, children, and student their parents in therapy routines. information nature for the parents. clinicians in an informal clinical With this kind of experience, stu­ Student Requirements setting has built student confi­ dents gain confidence in directing Training opportunities for both dence to advise and guide both parents and patients in home third and fourth year optometry parent and teacher groups once in therapy practice, and develop com­ students are available. Each Op­ practice. It had been this lack of munication skills so necessary for tometry III student clinician is re­ confidence, plus high costs, which a well-educated professional. quired to work in the Parent Gui­ had limited students' utlization of Program evaluation, an important dance Clinic for a single month vision therapy procedures which aspect of any clinical program, is during one semester. During each had been developed. The revised accomplished concurrently with student's tenure, he/she is ex­ program has been well-received by the collection of clinical research pected to participate in eight parents in Houston and surround­ data. Vision Development Evalua­ parent/patient therapy sessions (1 ing communities. tions provide extensive pre- 1/2 hours each) and three or four What follows is a detailed therapy diagnostic workups. Post- parent seminar sessions (1 1/2 description of the program, includ­ therapy evaluations are routinely hours each). Each student pro­ ing: (1) goals of program, (2) stu­ scheduled to analyze the impact of vides close direction and supervi­ dent requirements, (3) faculty the program on our patients. sion of patients as therapy routines commitment, (4) clinical pro­ As a by-product of all clinical are administered. cedures and (5) program content. teaching programs, community Optometry IV student clinicians Goals of Program services are made available. In may elect additional experience in The primary function of the HCO HCO's case, the Parent Guidance Parent Guidance as an area of con­ Clinic provides important support centration for one semester. The Dr. Williams is Assistant Professor of to our Vision Development Evalua­ Optometry IV students supply Optometry at the University of tion Clinic. Each year approx­ close support for the Optometry III Houston, College of Optometry. The author wishes to acknowledge the imately 500 Vision Development students, plus assistance in the contributions of the following in re­ Evaluations are performed by stu­ direction of the parent seminars. designing the HCO Parent Guidance dents. Remedial procedures are In the future, the use of op­ Clinic: Drs. Morris Berman, Dennis Levi recommended for approximately tometric assistants in the Parent and Steve Virgilio. 80% of these patients. HCO's Vi­ Guidance Clinic will be a desirable 84 educational experience for both clinical space is available. A fee of which are directed by optometry the assistants and the optometry $20.00 per family is charged in ad­ students. interns. vance, refunds are allowed only In general, the parent seminar Faculty Commitment with significant advance notice of sessions are used to develop and One faculty member (1/4 FTE) cancellation. Daily therapy pro­ discuss a wide variety of topics— directs the program and when tocols are kept for each patient, the most important being the practical, this clinical duty is ro­ plotting the type of therapy and definition of the problem and asso- tated on a semester basis. Faculty time spent in each activity. Rather ciated behaviors — sue has advise all students of the program than administering a variety of etiology, remediation, and optome­ outline and assign each student therapy activities to each patient, try's philosophical and clinical ap­ specific reference material to be specific therapy programs (based proach to the problems of learning presented to the parents. The key on the original vision development disabilities. JGE element of the program is "learning diagnosis) are designed by the stu­ by doing". This has been true for dents for each patient to increase parents in the past, and is the rule the program's effectiveness. REFERENCES for students now and in the future. Program Content Resources for the HCO Parent Faculty give guidance to all stu­ The program provides both Guidance Clinic program are: A Motor Perceptual Developmental dents on group therapy procedures specific and general information Handbook of Activities; Belgau, Frank and are available for parent con­ for the parents. Specifically, the A. sultation. To improve the effective­ parents are instructed in the ad­ Motoric Aids to Perceptual Training; ness of the program, individual ministration and supervision of Chaney & Kephart therapy protocols are prepared for home therapy routines designed Steps to Achievement For the Slow each patient by the student clini­ to remediate, develop, and Learner; Ebersole, Kephart, Ebersole cian based on the original Vision enhance the visual, visuomotor, Pictures and Patterns; Frostig, Development Analysis, at the perceptual, and associated per­ Marianne direction of the faculty. ceptual-motor abilities which are How to Develop Your Child's In­ Clinical Procedures prerequisite to efficient, effective telligence; Getman, C. N. Developing Learning Readiness; Get­ Only patients referred by the Vi­ learning. To accomplish these man, Kane, Walgren, McKee sion Development Evaluation goals, there are several well- The Slow Learner In The Classroom; Clinic are accepted for the Parent designed programs which may be Kephart, N. C. Guidance program, although called upon, or the Vision Therapy Training That Makes Sense; Kirshner educators and interested parents faculty modifies programs pre­ Strictly For Parents; Golick, Margaret may observe and participate as sently utilized in school programs Developmental Learning Materials 85 within ophthalmology this does not, within the VA can hope to establish \A Training- I feel, represent a majority view and an optometry program that will is often based (as is part of op­ work with ophthalmology as a Continued from page 62 tometry's fear of ophthalmology) on fellow team member unless there is started out as wings or floors of ex­ misunderstood intentions or non­ effective outside support and effort isting VA hospitals. professional considerations. on the part of academic optometry It appears to the author that most Personal Comments and ophthalmology. past failures to develop eye/vision Let me conclude by speaking The optometry schools will, I care teams can be attributed to personally. In the 10 months since hope, continue on their part to both an intra-VA ignorance of Mr. Richard L Roudebush, the Ad­ strengthen their clinical faculty modern optometry and to optome­ ministrator of Veterans Affairs, ap­ and training programs and begin to try's ignorance of the VA. Too often pointed me to the new VA position, actively meet with their local VA an optometry school has, when ap­ Director of Optometry (created by hospitals. They must, at the start, proaching a VA hospital, failed to Public Law 93-82), I have visited work with the Hospital Director, his first meet and work with the over 25 of our VA hospitals and Chief of Staff, and the Chief of ophthalmology department and have found their administration Ophthalmology and his residents other hospital staff, and it would and ophthalmology staffs to have a to properly identify those areas of then appear to ophthalmology staff sincere, concerned interest in ex­ eye/vision care they can provide. that optometry was "trying to pull a panding the comprehensiveness of They must answer the question fast one" or to practice medicine. their hospital's eye/vision care and "What can optometry do for the As a result, ophthalmology Deans the role optometry can play as VA" before asking "What can the didn't always know optometry's ac­ fellow professional team members. VA do for our teaching programs". tual interest is the same as theirs, Hospital Chiefs of Staff and Chiefs My motive is to promote more i.e., the teaching of, and training in, of Ophthalmology Services are comprehensive eye/vision care their profession as defined by law becoming familiar with the well-es­ while yours, as educators, is to or that optometry staff could act to tablished use of optometry as a pri­ train doctors of optometry. These both relieve them of non-medical/ mary provider of initial and non- two goals can, should, and will surgical services but also to in­ medical/surgical, eye/vision care dovetail perfectly but your schools crease ophthalmology's desired in the Armed Forces (550 optome­ must now take part of the lead by surgical/medical caseload. In fair­ try officers, 500 technicians and informing both themselves and the ness, these past negative reactions 180 ophthalmology officers), and VA about each other. The interest may have been due to this failure to they see the validity of an ap­ is there on the VA's part and the realistically inform local hospital propriately modified form of this ball is in your backfield; I hope you staffs, Deans' Committees and system (with teaching affiliations) will run with it. ophthalmology departments as to I don't say this lightly for I am what modern optometry can now for their VA hospitals. These pro­ often asked if an optometrist is an do in assuming the non-medical/ grams could, for example, corres­ optician, or if it takes formal educa­ surgical components of complete pond to protocols now working well tion to be an optometrist, or if op­ eye/vision care and the students' between other overlapping medical tometry involves anything other desire to practice only optometry. and non-medical professions such as audiology/otolaryngology, and than "refraction". Many VA pro­ While there may still exist iso­ psychology/psychiatry. gram directors are surprised to lated opposition by some groups But no man or advisory group learn at least two years of college

VA-Educational Institution Affiliations VA Hospital Personnel Serving as VA Faculty in Medical Schools and VA Hos- Other Academic Institutions Educational Institutions Schools pitals VA VA Other VA Medical Schools 92 104 Academic Title Total Physicians Dentists Categories Dental Schools 57 50 Total 4,076 3,078 247 751 34 Nursing Schools 314 1 23 Professor 402 363 5 Clinical Professor 92 73 9 10 Schools of Associate Professor 618 533 21 64 Pharmacy 45 45 Associate Clinical University Psychology Professor 187 147 19 21 957 40 163 Programs at Assistant Professor 1,160 Assistant Clinical Doctorate Level 89 126 Professor 412 333 40 39 Schools of Graduate Instructor 513 321 26 166 Social Work 80 137 Clinical Instructor 266 197 28 41 All Other Allied Health Adjunct Titles 70 10 15 45 Other Titles 356 144 44 168 Professions and Occupations Programs... 687 159 Table III

86 and four years of professional ing to other educators and not the school study are required for the professional administrators now O.D. degree or that your schools making the key decisions in third now devote 85% of their effort party health care plans. towards teaching the detection (not definitive diagnosis) of ocular/ Visitors to my office are often adnexa, disease/injury or that op­ surprised when I explain op- tometrists perform eye health tometric examinations are useful screening/evaluations and other even if eyeglasses were never dis­ supplementary physiological test­ pensed since such examinations ing. will detect those patients actually requiring medical/surgical or other I fear your spokesmen may have care, so that cost effectiveness often spent part of their time talk- alone argues for establishing VA optometric teaching affiliations and staff positions. In addition, the VA has the legal obligation, given by Congress, to take part in the Health Staff training of all health professionals and your schools, of course, train the next largest independent V.A. Occupational Approximate health profession after physicians, Listingt number on staff* dentists and nurses. Nurse and Nurse Anesthetist 19.500 Thus, I ask for your help and ad­ This initial action must come from Physician 8,650 vice in the coming years. Investi­ you and the hospital before we in Therapist: Occupa­ gate with your local VA eye clinic Central Office can help for we in tional and Physical 2,925 staff how to best set up teaching the Department of Medicine and Social Worker 2.150 affiliations. Their funding can come Surgery only act in a professional Psychologist 1,250 from the hospital's budget, from advisory and policy planning Dental Assistant capacity for the hospitals. We can­ or Technician 1,190 P.L. 92-541 grants, or our Central Pharmacist Office Division of Academic Affairs not, and do not, direct day-to-day 925 field operations. Dietitian 925 that now supports the other train­ Dentist 750 ing programs. I would be happy to You must "sell" your program to arrange your meeting the appropri­ the hospital's Deans' Committee tSelected numbers of staff specialists ate officials in the field or here in for once they support your affilia­ from the more than 335 different V.A. Washington. tion proposal it will proceed with a Occupational listings. There are only I encourage your school's staff to. minimum of trouble. 16 full time equivalent staff op­ talk with the Hospital Director of tometrists. Lastly, I suggest your schools your nearest VA hospital and to liberalize their clinic rotations for 'excludes intermittent employees, in­ work with him and his staff to find fourth year students (so they can terns, residents or consultants practical proposals that directly be off campus a quarter at a time) benefit the care of our patients. and investigate residency pro­ grams. Many hospitals will now welcome your students and help Birmingham VA Optometry Service arrange for their preceptors hip, but they are often 100 miles or more from your school. So, while the VA Patients examined 473 will offer your students diverse pa­ Patients in need of new prescription 335 (70.8%) tient populations with higher dis­ Patients provided glasses 242 (51.2%) ease/injury rates and unusual in­ Patients referred to other services 91 (19.2%) Blind patients previously unidentified as blind terprofessional specialty settings, 10 (2.1%) your schools must be flexible to our These statistics were gathered after the first few months that the University of needs so that we can together Alabama's School of Optometry began providing optometry services at the Bir­ demonstrate the value of team eye/ mingham VA Hospital in January, 1973. vision care. Note first that high percentages of patients required significantly updated I ask for your help, advice and prescriptions and that the referral rate to other health services was well over five times the national rate. (Many of the detected conditions that produced referrals encouragement. Let us now join would have remained undetected without these optometric examinations since forces with our ophthalmology col­ the veterans were initially seeking care for different conditions.) leagues and other concerned prac­ Finally, 2.1 per cent of these veterans were found to have become legally blind titioners to provide more complete but were unidentified as such and were not, therefore, receiving the rehabilitation and efficient eye/vision care. An or other benefits for which they were eligible. This percentage contrasts with ever greater number of our coun­ other VA hospital studies which found about 1 per cent previously unidentified as try's veterans are, and have been, blind. waiting. Let's get on with the job. J6E

87 and Colleges of Optometry (ASCO). f erred to in the text, with all references Manuscripts are accepted for review with listed on a separate page at the end of the the understanding that they are to be manuscript. published exclusively in JOE, unless Tables or charts should be typed on a other arrangements have been made in separate page, numbered, titled and cited Notice to advance. in the text. Tables should be numbered Preparation of manuscripts: Submit consecutively and tailored to fit within original manuscripts and two copies to: column width or page width. Line and Contributing halftone illustrations should be of high Editorial Council, JOE quality for satisfactory reproduction and 1730 M Street, N.W., Suite 411 should be submitted in duplicate if possi­ Washington, D.C. 20036 ble. Illustrations must be numbered and Authors cited in the text. Please do not bend, fold Manuscripts should be written in the or use paper clips on photographs. third person and typed double-spaced on Special charges to the author may be 8%" x 11" paper, with one-inch margins made whenever special composition costs on all edges. No length requirements ex­ exceed standard costs. ist, with the content of each paper deter­ Proofing and Editing: The author mining length. It is noted, however, that should proof his copy both for content the average length for most full-fledged and mechanics. Manuscripts should be professional papers runs 3000 words, or well-edited by the author before being approximately fifteen double-spaced submitted to JOE. The JOE editorial staff typewritten pages. reserves the right to edit manuscripts to fit References and Illustrations: Use the articles within space available and to en­ JOE style for references, keying the sure conciseness, clarity and stylistic con­ references to the text in numerical order. sistency. Authors will be notified upon For journal references, give the author's receipt of manuscripts and advised of any name, article title, journal name (or stan­ proposed significant editorial changes The Journal of Optometric Education dard abbreviation), volume number, first prior to publication. (]OE) publishes scholarly papers, descrip­ page of article and complete date. For Identification and Reprints: Authors tive and timely reports, continuing infor­ books, give the author's name, book title, must be identified by academic rank and mation and findings in the field of op­ location and name of publisher, and year institution, with brief biographical notes tometric and professional heatlh educa­ of publication. Exact page numbers are re­ included on a separate page. Reprints of tion, as well as news of the member in­ quired for direct quotations from books. all articles are available, but must be re­ stitutions of the Association of Schools Limit references to those specifically re- quested prior to printing. CLASSIFIEDS Advertisements of employment oppor­ desirable. Rank and salary are com­ tometry, 3241 S. Michigan Avenue, tunities will be published at no charge to mensurate with qualifications and ex­ Chicago, 111. 60616. ASCO member institutions. perience. Apply with curriculum vitae An equal opportunity to: Dr. Jack W. Bennett, Dean, College affirmative action employer Pacific University College of Op­ of Optometry, Ferris State College, Big Rapids, Michigan 49307. tometry announces the addition of Southern California College of Op­ teaching and research faculty positions An equal opportunity affirmative action employer tometry announces the following for academic year 75-76. Persons seek­ positions: (l.) Department of Clinics- ing employment should send a letter of Full-time instructor for general clini­ application along with a current cur­ Illinois College of Optometry, op­ cal service with expertise in pathology riculum vitae to: Dr. Willard B. tometry's oldest and largest institution, detection and/or non-routi'ne examina­ Bleything, Pacific University College with an enrollment of 540, seeks an tion procedures. (2.) Department of of Optometry, Forest Grove, Oregon academic dean. Responsibilities in­ Optometry—Part-time lecturers in In­ 97116. clude working with faculty and divi­ dustrial Vision, Vocational Vision, An equal opportunity sion chairmen, providing leadership in Legal aspects of Optometry, Com­ affirmative action employer curriculum development and in in­ munity (Public) Health, Special novative instructional program plan­ Education. (3.) Administration- The College of Optometry at Ferris ning, as well as shaping and Director of Continuing Education, State College has positions available strengthening an already excellent Assistant Director of Development, for faculty members to teach courses faculty. Coordination and expansion of Director (and instructor) of Op­ in the first professional year of the academic programs including research tometric Technician's Program. newly developing program and to aid both within the school and with area Appropriate degrees and experience in planning and developing upper- institutions is another important part required. "Applications for Employ­ level courses in the optometric cur­ of this challenging opportunity. ment" forms may be obtained by con­ riculum. Salary commensurate with tacting the Dean, Southern California Applicants should have an O.D. qualifications. Send applications, College of Optometry, 2001 Associated degree or a Ph.D. degree in an ap­ nominations and resumes to: Dr. E.R. Road, Fullerton, California 92631. propriate discipline. Experience in Tennant, Chairman, Dean's Search An equal opportunity teaching and curriculum planning is Committee, Illinois College of Op- affirmative action employer

88 quired to pursue continuing education. Therefore a need exists to present, in discrete units, selected Challenge- subject areas designed to bring new competence Continued from page 79 and diagnostic and treatment skills to optometrists 5. The number of specialty areas should be as few now in practice. as possible but must provide for comprehensive New technology and new knowledge in visual coverage when summed with general practice. science permit more useful services to optometric This special committee has proposed three resi­ patients. In addition, all optometry schools are pre­ dency programs which could lead to specialty cer­ sently emphasizing the role of the practicing op­ tification. In order to be implemented, these must be tometrist as a primary or first contact health profes­ approved by ASCO and other appropriate optometric sional who should develop and maintain competence bodies. Each of these programs should have to discover common general health problems. prescribed standards of length, content, and compe­ Additional needs for continuing education include tency levels. They are: effective use of technicians and new instrumentation 1. Pediatric Optometry—Specialty functions in­ to improve manpower efficiency ratios, and continu­ clude assessment of infants vision, diagnosis ing education to help optometrists understand na­ and treatment of unusual binocular vision and tional social developments in health care and to motility problems, and vision problems associ­ assume leadership roles in health education. ASCO ated with development and learning. is developing plans for working cooperatively with 2. Rehabilitative Optometry —This specialty other entities in optometry who have special interest would include diagnosis and treatment of vision in continuing education, to seek financial support for and ocular problems that are residual to dis­ developing such a national program. ease, trauma, and degenerative processes in­ Ancillary Personnel cluding unusual vision and ocular problems as­ ASCO recognizes the need to develop two-year op­ sociated with aging. tometric technician training programs when this can 3. Environmental Optometry —This specialty be done under appropriate circumstances. It is felt would not be oriented to the care of individual that such programs should develop in environments patients but it would include determining stan­ where optometry students and technicians can be dards for visual performance; assessing the trained together. Our organization is collaborating effect of environmental and visual performance with Technical Education and Research Centers, in ocular safety and the prescription of environ­ Cambridge, Massachusetts, to evaluate models of mental changes; assessment of the effect of work for optometric technicians and to design the visual environment on safety and the prescrip­ most effective education and training to prepare tion of changes in environment to promote them to serve in these roles. safety; and the prescription of adaptations of Research visual performance to specific environments. Research activities in optometry schools are far Counseling, training, and application of specific below the level needed. We recognize the critical appliances would be carried out on an in­ need for significant increase in emphasis on dividual basis. research and accept it as a responsibility. If we are to Post Graduate and meet this responsibility, substantial new financial Graduate Education resources must be added to optometry schools. ASCO is developing plans to encourage optometric Action Needed Now graduates to enroll in post graduate courses in other The last part of this paper is essentially a report of disciplines which have direct relevance to the im­ those ASCO activities which are directly related to provement of vision care. These include programs in helping prepare the profession to fulfill the oppor­ public health administration, social services, com­ tunities and meet the obligations of a future that has munity medicine, and health economics. not been designed. We believe they cover the range Schools of optometry are encouraged to develop of primary missions of optometry schools and col­ sound graduate programs in physiological optics as leges in the United States. Broadly stated, these mis­ soon as they can develop necessary resources. This sions are to develop and disseminate knowledge of is crucial to alleviate current problems resulting from visual science and its application to the solution of a paucity of research in optometry and a shortage of human problems. Whatever form our future takes will optometric educators. Optometric graduates should result largely from how well we serve these missions. also be encouraged to enroll in graduate programs in The role of optometry in the future health care biological and social sciences, and engineering delivery system(s) can be predicted only if we act which have a reputation for excellence and which vigorously now. Many details of the general plan are provide a focus on vision science. yet to be determined—we must influence. If optome­ Continuing Education try's capacities are to become clear in the minds of More than any other health profession, optometry decision makers, we must inform. Finally, optometry has taken steps to assure that practitioners are re­ must get its educational and practicing houses in quired continuously to upgrade their diagnostic and order so that its image will represent both a good and treatment skills. What is needed now is the delivery accurate reflection of its being. JGE system to insure that organized programs of continu­ ing education courses of high quality regularly are Ed Note: This paper was adapted from Dr. Baldwin's report made available on a national basis. Optometrists are to the ADA'S conference on the Future of Optometry in attitudinally prepared, and, in large numbers, re­ Tucson, Ariz., January, 1975.

89 the largest number of patients at OSU Profile- any school in 1973-1974. Detection- With the expansion of clinical Continued from page 73 Continued from page 57 facilities, a major step forward will the responsibility of leadership in titudinal and conceptual changes take place in contact lens instruc­ optometric activities at virtually all occur. Hopefully, expanding the levels. At least ten state optometric tion and research, where Ohio focus in treatment areas and creat­ associations have had Ohio State State is already a leader. The old ing additional learning experiences graduates as presidents: from out-patient clinic, which will be­ in integrated health sciences set­ California and Arizona in the west, come the East Wing of the Optome­ tings would automatically result to New York and Pennsylvania in try Building, will largely be devoted from such changes. Appropriate the east; from Michigan and to various clinical specialties in ad­ educational interaction between Wisconsin in the north, to Florida dition to contact lenses, including the medical profession and the and Alabama in the south. Dr. H. vision training and orthoptics, low other health sciences professions Ward Ewalt served as AOA presi­ vision, aniseikonia, and evaluation could produce the desired ap­ dent in 1962-1963, and Dr. Henry of ocular pathology. proach to effective and com­ W. Hofstetter served in 1968-1969. Classroom and clinical instruc­ prehensive delivery of health care. Facilities are important, but with­ tion is supplemented with space- As Donald G. Bates, M.D., con­ out an outstanding faculty they age systems. Ohio State has been a cluded in a paper discussing could not be effective. Today, the pioneer in developing computer- medicine's role in comprehensive College of Optometry has a dedi­ assisted instruction in optometry. care: cated faculty of international The College of Optometry Instruc­ Considerable thought should be reputation, including fourteen with tional Media Center is widely given to the possibility of com­ the Ph.D. degree. Faculty number acknowledged to be one of the prehensive community services to almost sixty in physiological optics most effective in optometric educa­ which a person may turn for many and optometry alone, not to men­ tion. It produces teaching materials kinds of assistance. The ameliora­ tion those teaching courses in utilizing television, movies, slides, tion of biological disorders should other departments within other col­ graphics, and audio tapes, as well be among them, not on top of them. Any design for comprehensiveness leges of the University. Over half as other specialized materials for should carefully examine priorities, are part-time faculty with highly the Self-Teaching Laboratory, the alignment of personnel, and their successful practices, who serve as which will shortly be expanded. respective roles.4 a mainstay of the excellent clinical Major progress has been made in faculty. incorporating instructional media In summary, optometrists and into both the classroom and the other non-M.D. primary care pro­ Distinctions and Innovations clinic. viders can be trained to recognize Although Ohio State is widely In 1975, the OSU College of Op­ and look for common disease signs known for its outstanding aca­ tometry looks back on sixty-one in those patients who come to them demic and research programs in years of optometric progress, eager for their special services. These optometry and physiological op­ for continued growth and improve­ professionals should be equipped tics, very few optometrists other ment, and still dedicated to the to recommend the entry of these than Ohioans and Ohio State alum-1 principle set forth in 1914 by Dr. patients into the health care ni are aware that it also has one of Sheard and his associates: leader­ system at an effective level which the outstanding optometric clinical ship in optometric education and would provide early treatment and programs in the country. Columbus research implies initiative in the possible prevention of more is a population center with over 1 pursuit of excellence. Within that serious diseases. In this way it million, and optometry students tradition, the OSU College of Op­ should be possible to reduce the receive a wide variety of clinical tometry—faculty, students, gradu­ number of people who wait until it experiences on a large number of ates and administration—will con­ is too late to receive adequate patients. Data of the AOA Council tinue to strive to meet the profes­ medical treatment. JGE on Education indicated, for exam­ sional educational challenges of ple, that OSU students each saw the future. JGE References 1. Egeberg, R.O. and Pesch, LA. Pre­ ventive Medicine: A New Biomedical Journal (Editorial). Journal of the American Medical Association, 1972. 220:9, 1237-1238. Oqly a miqute... 2. Kuhne, P. Moneysworth Home Medi­ cal Advisor. New York: Moneysworth, 1972. (Also Ad for Moneysworth Home It only takes a minute to fill out the subscription blank found Medical Advisor) on the inside front cover. Please complete it now to assure 3. Hamilton, L. Doctors Where Doctors Are Needed. Lewiston Morning Tri­ continued receipt of the Journal. The next JOE will be the first bune. Idaho, 1972, June, p.4. issue sent out on a subscription-only basis. Don't miss it — 4. Bates, D.G. Medicine's Role in Com­ subscribe today! prehensive Care. Perspectives in Biology and Medicine, 1972, 15:3, 317-324. ASSOCIATION of SCHOOLS and COLLEGES of OPTOMETRY

The Association of Schools and Colleges of Optometry (ASCO) represents the twelve fully-accredited professional programs of optometric education in the United States. ASCO is a non-profit, tax-exempt professional educational association with national headquarters in Washington, D.C.

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President, Vice-President,,^s^ i Secretary-Treasurer, William R. Baldwin, O.D., Ph.D. Norman E. Wallis, O.D., Ph.D. Jerald W. Strickland, O.D., Ph.D. President, Massachusetts President, Pennsylvania Director, Pennsylvania College College of Optometry College of Optometry of Optometry's Division of Professional Studies

Dr. Norman E. Wallis, President Editorial Council, Pennsylvania College of Journal of Optometric Education Board Optometry 1260 W. Godfrey Norman E. Wallis, O.D., Ph.D., Chairman JPWUidelphia, Pa. 19141 Pennsylvania College of Optometry

Dr. Spurgeon B. Eure, President Chester H. Pheiffer, O.D., Ph.D. Southern College of Optometry University of Houston's College of Optometry Directors 1245 Madison Avenue Memphis, Tennessee 38104 Irvin M. Borish, O.D., LL.D. Division of Optometry Dr. Alden N. Haffner, Dean Dr. Alfred A. Rosenbloom Indiana University President State University of New York Illinois College of Optometry College of Optometry 3241 S. Michigan Avenue 122 East 25th Street Frank Brazelton, O.D. Chicago, Illinois 60616 New York, N.Y. 10010 Southern California College of Optometry

Dr. Gordon G. Heath, Director Dr. Fredrick W. Hebbard, Dean Vonne Porter, Ph.D. Indiana University Ohio State University Southern College of Optometry Division of Optometry College of Optometry Bloomington, Ind. 47401 338 W. 10th Avenue Columbus, Ohio 43210 Members of the Technical Advisory Dr. Richard L. Hopping, Committee to the Editorial Councih President Dr. Henry B. Peters, Dean University of Alabama Southern California College of H. Carl Grebe, M.A. Optometry School of Optometry Pennsylvania College of Optometry 2001 Associated Road 1919 Seventh Avenue, South Fullerton, Calif. 92631 Birmingham, Ala. 35233 Penelope Kegel Flom, Ph.D. Dr. William Baldwin, President Dr. Monroe J. Hirsch, Dean School of Optometry Massachusetts College of University of California University of California, Berkeley Optometry School of Optometry 424 Beacon Street 101 Optometry Bldg. John Levene, O.D., D.Phil. (Oxon.) Boston, Mass. 02115 Berkeley, Calif. 94720 Division of Optometry Indiana University Dr. Willard Bleything, Acting Dr. Chester H. Pheiffer, Dean Dean University of Houston Pacific University College of Optometry Harold Gibson, M.A. College of Optometry 3801 Cullen Blvd. School of Optometry Forest Grove, Ore. 97116 Houston, Texas 77004 University of California, Berkeley

91 ov o Tenure: 99 The «« Sticky Stuff of Academia An ASCO National Office news feature examines the basis of tenure, considering both legal and administrative challenges... ASCO Re-examines the Curriculum A report by the Council on Academia Affairs sets the pace for future thinking on the optometry curriculum... Pacific University in Profile Optometry in a small, private school setting is featured in the profile of Pacific University... Plus Much More Our next issue will also include several more articles of vital interest to op­ tometrists, plus book reviews, Association news, classified ads and editorial com- , ment.

Be sure to subscribe to JOE so you won't miss any of it!

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ASSOCIATION OF SCHOOLS AND COLLEGES OF OPTOMETRY Non-Profit Org. 1730 M Street, N.W., Suite 411 U.S. POSTAGE PAID Washington, DC 20036 at Wash., D.C. Permit No. 46070