This paper discusses the history of optometry in the Department of Veterans Affairs (VA), starting from minimum involvement and developing into an extensive level of activity benefiting both the profession of optometry and the VA. The author also recounts experiences which led him to a career in optometric education and work in VA optometry.

This article profiles the careers of the Ohio State University College of Optometry’s most prominent mid-century women graduates: Dr. Lois Black Bing (1909-2009) and Dr. Ruth P. Morris (1920-2011). The author highlights Drs. Morris’ and Bing’s contributions to the profession, including Dr. Bing’s leadership role in bringing together the fields of education, psychology and optometry to advance children’s vision., and Dr. Morris’ business model as a family practice serving the vision care needs of patients in all stages of their lives, and her role as a mentor for optometry students at the OSU.

The American Optometric Foundation (AOF), an affiliate of the American Academy of Optometry and now called the American Academy of Optometry Foundation (AAOF), has a proud history of financially supporting graduate optometric education since 1947. This article reviews its mission, history, governance and success in establishing the requisite academic foundation for an ever-evolving independent health care profession.

Purpose: A few reports have indicated corneal hysteresis (CH) is influenced by different anti-glaucoma medications. This retrospective study was created to determine if CH is affected by the use of 2 commonly prescribed compounds to lower the intraocular pressure (TOP). Overview and Methodology: The objective was attained by reviewing patient records of selected veteran patients at a busy outpatient clinic. Patients were divided into 3 groups: (a) primary open angle glaucoma/ocular hypertension (POAG/OHTN) patients taking only prostaglandin analogs (PAs); (b) POAG/OHTN patients using only beta blockers (BBs), and a (c) control group of non POAG/OHTN patients. Ocular Response Analyzer (ORA) measurements were taken before and after initial treatment to determine relationship between intraocular pressure and CH values respectively. Results: All patients using PAs showed lower TOP values and an increase in CH values thirty days after treatment as measured by the Ocular Response Analyzer. The ratio was calculated to be a 5 mm Hg IOP decrease to every I mm Hg of CH increase in this population. The other 2 groups showed reduced IOP in the beta-blocker group with a slight elevation of CH. In contrast no IOP or CH change was seen in the control group. Conclusion: Treatment of these patients with topical PAs lower the IOP while concurrently increasing the CH values. This was also noted in the BB group to a lesser extent, and absent in the control group.

PURPOSE:Several reports have revealed a difference in various populations regarding the variability of intraocular pressure (IOP) and corneal hysteresis (CH). This retrospective study was created to determine a profile for U.S. Veterans in a large outpatient clinical setting. OVERVIEW AND METHODOLOGY: The objective was to evaluate a random cohort of patient records in this clinical setting to determine the mean and standard deviation (SD) of the following parameters: Goldmann-correlated IOP (IOPg), CH, waveform score, and central corneal thickness from the Reichert Ocular Response Analyzer.RESULTS:All patient records were reviewed by Veteran Health Affairs Eye clinical staff which resulted in data collected on 538 eyes. The mean IOP of this cohort for IOPg was 17.39 (SD 10.08). The mean for CH was calculated at 9.61 (SD 3.04) with a waveform score mean of 5.66 (SD 2.18) and central corneal thickness for 207 eyes was a mean of 545.09 (SD 51.09) nm.CONCLUSION:From the results, IOPg appears to be significantly higher and CH significantly lower than other populations reported in the literature. This information provides an accurate baseline for the evaluation of the U.S. veteran population for future.

Purpose: To evaluate if using the Ehlers correction factor on the intraocular pressure (IOP) measured using the Goldmann applanation tonometer (GAT) improves its agreement with the PASCAL dynamic contour tonometer (DCT).Patients and methods: A total of 120 eyes of 120 individuals were examined. Participants underwent IOP measurement with both the DCT and the GAT and central corneal thickness -measurement. The Ehlers correction factor was applied on the GAT IOP measurements to calculate Ehlers-corrected GAT IOP. The agreement between the DCT and GAT, and DCT and Ehlers-corrected GAT IOP was analyzed. The analyses were repeated by stratifying the data by race.Results: The mean IOP of the GAT, DCT, and the Ehlers-corrected GAT was 15.30, 16.78, and 14.68 mmHg, respectively. The agreement as assessed by Bland-Altman plot for the GAT with the DCT and DCT and Ehlers-corrected GAT IOP was +4.1 to -6.9 and +4.15 to -8.25 mmHg, respectively. The results were similar even when stratifying the data by race.\Conclusion: Using Ehlers correction factor to account for the effect of corneal parameters on the IOP measured by the GAT worsens the agreement with the DCT. This effect remains even when stratifying the data by race.

Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S. public health science and policy beginning in the 20th century. This paradigm was reflected in federal government reliance on infectious disease physicians as the primary scientific decision makers in the COVID-19 pandemic. Similarly, epistemic conflict over challenges to behavioral and social well-being in 2020 may highlight discordance between the dominant biomedical paradigm used in making federal policy and the inherently holistic impact of that policy on population health, suggesting need for a new paradigm of multidisciplinary scientific engagement. Because population-wide public health initiatives affect many aspects of health—physiological, psychological, behavioral, and social—that are best measured and interpreted by experts in these respective fields, multidisciplinary scientific engagement would facilitate optimal, holistic evaluation of policy benefits and harms. This multidisciplinary approach, analogous to that currently recommended in medical management of chronic disease, would advance epidemiological research to inform evidence-based policy for public health crises in which U.S. population-wide interventions are contemplated.

During a recent renovation at The Ohio State University College of Optometry, I discovered some very early issues of our Journal, which may have been part of Dr. Glenn Fry’s personal library at one time. In these dusty old volumes, I discovered fascinating addresses by our founding fathers, minutes of business meetings, and copies of scientific papers that were presented at our annual meetings. When I was President of the American Academy of Optometry (AAO), I used several of these references in my “AAO President Calling” messages in an attempt to link our rich history and time-honored traditions from 1922 to a new generation of Academy fellows. The earliest edition of the Academy’s Journal that I have was published in 1929. Its pages record the proceedings of our sixth annual meeting, which was held in December, 1927 at the Hotel Pennsylvania in New York City. The program that year consisted of papers presented on a wide range of scientific and clinical topics, including anatomy and physiology, binocular vision, myopia, theories of light, and evolution of the visual system. Also included in this volume are comments made by Chairman E. G. Wiseman from Buffalo, New York, who stated: “It is expected that the American Academy of Optometry will constitute essentially a study group and a mutually helpful group, and that it will gladly pass on the results of its investigations to the entire optometric profession.”1 For the next 35 years, education at the annual Academy meeting consisted of scientific and clinical papers that, in large measure, were given by Academy Fellows sharing their research and clinical experiences with their Academy colleagues. There was much interaction between the speakers and the audience, both in classrooms as well as social settings. This educational format remains today; Fellows frequently refer to it as the Scientific Program (which now includes posters and special lectures/symposia such as the Monroe J. Hirsch Memorial Research Symposium and the annual AAO-ARVO joint symposium). Sections of the Academy were formed in 1945 to provide special interest groups that could discuss a narrower topic in greater detail; our first two sections were in the areas of Contact Lenses and Orthoptics. In 1950, the Academy’s Executive Council adopted a resolution that called for “short courses” in aniseikonia, orthoptics, and contact lenses that would be offered in cooperation with the school or college of optometry located in the convention city. These short courses were to be scheduled during days immediately before the start of the annual meeting.2 Dr. Vincent J. Ellerbrock, a respected and beloved professor at the Ohio State University School (now College) of Optometry for 25 years, was chosen to chair the organizing committee for what was then called the Post-Graduate Education Program. This 3-day program began in December of 1955; that year, there were 40 courses presented that covered the breadth of optometric practice at that time. Table 1 shows the list of topics and speakers on the program that year, which was held at the Drake Hotel in Chicago.TABLE 1: Postgraduate Courses: 34th Annual Meeting of the American Academy of Optometry, Chicago, December, 1955These courses were immensely popular and, by 1986, had grown to 110 courses and 14 workshops. This year in Tampa, we will have over 200 hours of courses, workshops, and special topic symposia thanks to Dr. Brett Bence, Chair of our Education Committee, and to his hard-working colleagues on that committee. Vincent J. Ellerbrock received his B.S. degree (in optometry), M.S., and Ph.D. degrees from the Ohio State University. Throughout his academic career, he served his alma mater, his profession, and his community with great distinction. He was a member of the Academy’s Executive Council and our Editorial Board. But his finest contribution to the Academy, and ultimately to the profession, was beginning the program of postgraduate courses at the beginning of our annual meeting. He served as chairman of the Committee on Instruction for 10 years.3 He was so highly respected and beloved by the Academy that, following his sudden and unexpected death in December of 1965—just 2 days before the opening of the Academy’s annual postgraduate courses—the Executive Committee honored his memory by naming that portion of our annual meeting after him. Dr. Bradford W. Wild, a contemporary of Dr. Ellerbrock’s at Ohio State and later a President of the Academy, said in a eulogy to him in 1966: “The sudden unexpected passing of Dr. Vincent J. Ellerbrock on December 4 has created an irreplaceable loss in the educational family of optometry and sadness in the hearts of all who knew him. For Vincent Ellerbrock was an unusual man steeped in the love of education and dedicated to the betterment of a profession he was proud to serve.”4 Academy CE in the 21st Century In January of 2001, members of the Executive Council and major Academy committees, along with our Executive Director and meeting planners, met to discuss a new format for our annual meeting in December of that year.5 The over-riding purpose was to shorten the meeting from 5 days to 4 without losing any of our traditional component parts (i.e., scientific program, sections, Ellerbrock courses, awards, business meeting, banquet, social events, etc.). But at this historic meeting, the participants also articulated a troubling cultural phenomenon that had occurred over many years. It was that our annual meeting, which had been designed in 1922 to bring scientists, educators, and clinicians together for the purpose of advancing the profession and ultimately improving the care rendered to patients by optometrists, had become two separate meetings held sequentially. Our meeting registration form even had options for Ellerbrock, Scientific Program, or Combination. The Ellerbrock courses that were held during the first 3 days were mostly attended by clinicians; the 2-day scientific program, including section meetings and posters, were attended mostly by educators and researchers. In response the planning group worked very hard to integrate all components of our meeting into a new 4-day format, thus encouraging all attendees to participate during all 4 days. We reasoned there would be more interaction among the clinical, education, and research communities if we could design an integrated program that was not split between postgraduate courses in the beginning and the scientific program at the end. This certainly is the mission of the American Academy of Optometry and the reason the Academy meeting is unique among other optometric continuing education meetings. We still have two separate Academy committees that plan all educational aspects of our annual meeting. But we do not refer to the educational committee now as The Ellerbrock Memorial Continuing Education Committee. Our new format in no way diminishes the unique contributions that Dr. Ellerbrock made to our organization in the 1950s and 1960s, or to the hundreds of Academy volunteers who served on the Ellerbrock committee for over 45 years. But by having clinicians, educators, and researchers sit in a room together, the Academy Board of Directors are trying to facilitate greater integration of the science and art of optometry at our annual meetings. As Drs. Monroe J. Hirsch and Ralph E. Wick said in their 1968 textbook titled The Optometric Profession: “Membership in the Academy is really a way of thinking. The yearly contact of research scientists and faculty people with clinicians keeps an avenue of communication open in a way not possible by any other means.”6 See you in Tampa. This will be the 50th year of postgraduate courses in the Academy!Figure: Vincent J. Ellerbrock. Color version available online at www.optvissci.com.

Fellows of the American Academy of Optometry, thank you for the privilege of serving as your President during the past 2 years. In my final communication as your president, I would like to look back on our rich history, and then look forward into our bright future. One of the great advantages of being a faculty member at a school or college of optometry is having wonderful access to vast library resources. At The Ohio State University Health Sciences Library, we have a copy of a January, 1923 journal entitled Optical Age,which contains some of the first papers ever presented at an Academy meeting. In this historic text, the following words from the Academy’s first Chairman, Dr. Morris Steinfeld, are recorded: “We must be students. The impression that study is only for those who attend school is decidedly wrong; and if carried into practice would prove disastrous to our professional success. There is no period in our professional lives when we can afford to be otherwise than constantly studious….” Dr. Steinfeld, and the other visionary optometrists who founded and then nurtured the American Academy of Optometry in those early years, would surely be proud of the way this organization has expanded its scope and audience but, at the same time, preserved its goals and ideals. We now have almost 5,000 members, who represent over 30 different countries, an Annual Meeting that features symposia, courses, papers, and posters not only on the diagnosis, treatment, and rehabilitation of eye and vision conditions, but also increasingly on their etiology and prevention, our own prestigious journal, Optometry and Vision Science, which chronicles our significant scientific and clinical advancements, annual regional chapter meetings, as well as biennial international meetings, and increasing collaboration and influence with other health professional organizations, educational and research institutions, and governmental agencies, just to cite a few of our many accomplishments. We made history at the 2001 Annual Meeting in Philadelphia, when we invited 22 other professional and health-related organizations to join with us in signing a document that pledged our diverse organizations to work together to eradicate preventable vision loss worldwide by the year 2020. Furthermore, at the 2002 Annual Meeting, we expanded the boundaries of traditional eye and vision care by emphasizing optometry’s prominent role in caring for the many needs of our diabetic patients, and not just their eyesight. In 1922, Dr. Steinfeld closed his remarks with the following observation and charge to the Academy’s membership. I think it still provides us with a roadmap to the future: “No profession offers greater opportunity for good to humanity than does optometry. The health, the comfort, the efficiency and the safety of the workers of the world depends on their eyesight…. If we should relieve the great amount of inefficiency, bad health, headache and nervous troubles due to eyestrain that can be relieved by proper optometric procedures, the work of the world would be materially increased. It is our duty, therefore, to continue our study and research to find newer and better methods of doing our work.” How will we accomplished this big job? I propose five guiding objectives. We must continue to: attract and maintain creative and energetic members in the American Academy of Optometry, provide the best post-graduate educational meetings in the profession, publish a highly-respected scientific journal that is read by both optometric and non-optometric clinicians and scientists, promote the art, science, and research of eye and vision care by our generous support of the American Optometric Foundation, and finally, maintain the values and traditions of ethical practice established by our founders over 80 years ago. If we, as an organization, adopt these five objectives and use them as a roadmap to our future, the AAO will continue to be the premiere education and research organization in optometry throughout the world. I know we can do it; I know we will do it. Put on your sunglasses, and join me in looking at the Academy’s bright future!

The day after our annual meeting ends, planning begins for the next year’s meeting. Dr. Tom Lewis, our current President-Elect and chair of the 2001 and 2002 annual meeting planning committees, met with section and committee chairs in Philadelphia on Tuesday, December 11 to announce the theme for Academy 2002, which is Caring for Patients with Diabetes. With this as our overall theme, Dr. Tony Adams, our current Past-President, and Dr. Sarita Soni, a current member of our Board of Directors, have already been busy organizing some very special events to emphasize this general theme. We are planning a large and unopposed Diabetes Symposium on the first day of our meeting; we are also exploring ways in which members of the general public in southern California can be part of this year’s meeting because good doctor-patient communication and accurate patient health education are essential for managing the complex disease of diabetes. On January 25, 2002, a historic planning meeting for Academy 2002 was held in Columbus, Ohio. Those in attendance were five members of our Board of Directors (Drs. Eger, Lewis, Weisbarth, Zadnik, and myself), the Chair of the Scientific Program Committee (Dr. Tom Raasch), the Chair of the Ellerbrock Memorial Continuing Education Committee (Dr. Morris Berman), two staff members (Executive Director Lois Schoenbrun and Ms. Gloria Nehemiah, who works with Dr. Art Epstein and his Exhibits Committee), and Mr. Steve Marlin from our meeting management company, Prestige Accommodations. There was only one agenda item for this meeting: to plan the best Academy meeting we have ever had. We knew that the dates of this meeting, which had been reserved over 6 years ago, were unusually late in the month of December and immediately began to consider a change in this year’s meeting format that would allow everyone to depart San Diego on Monday morning, December 16th, after Sunday evening’s Roundtable Banquet. We wondered if we could “fit” our traditional 5-day meeting format into one that spanned only 4 days. There were several ground rules we all agreed to respect: Do not sacrifice the quality of any part of our program. Do not have any events that oppose our opening symposium, our traditional Awards Ceremony, or our two business meetings. Do not reduce the number of Ellerbrock Memorial Continuing Education Lectures and workshop hours. Retain all of the “core” elements of our meeting, including Leadership Courses, Student Receptions, the Exhibit Hall Welcome Reception, Lectures, Workshops, Symposia, Papers, Posters, the Press Conference, the Chapters Lunch, the AOF Luncheon, the Joint Alumni Reception, Section Business Meetings, the Hirsch Memorial Research Symposium, and of course, the Australia Party on Saturday night. Dr. Tom Lewis led our discussion through each day of the Philadelphia meeting, and Dr. Rick Weisbarth used poster boards to help us construct a new meeting format for San Diego that retained all of the critical elements of our meeting. At the end of the day, a 4-day meeting format for Academy 2002 was recommended to the entire Board of Directors, and it was approved on a February 7th conference call. This new format will be fully explained in the registration information you will receive prior to this year’s annual meeting. I believe there are many advantages for having a 4-day meeting in San Diego this year. First, we have finally designed one comprehensive and integrated educational and scientific meeting where both optometric clinicians and vision science researchers can interact everyday. We will no longer have the majority of clinicians attend the “first part” and the majority of vision science researchers attend the “second part” of our meeting. Second, we actually increased the number of hours for continuing education, scientific papers, and unopposed time in the exhibit hall. Third, we moved our impressive Awards Program to the first time slot on Saturday morning and linked the Hirsch Memorial Research Symposium and the AOF Luncheon together on Sunday. Fourth, our meeting will open with a general plenary session for everyone on Thursday afternoon, and close with our celebratory annual Roundtable Banquet for everyone on Sunday evening. Fifth, if every attendee fully supports the Academy by staying in the main hotel for 4 nights (Thursday, Friday, Saturday, and Sunday), the Academy will not suffer any financial loss due to room attrition penalties. I want to emphasize that we have committed the Academy to a 4-day annual meeting format for 2002 only. We will certainly evaluate the pros and cons of this new meeting format before making any changes to our 2003 annual meeting in Dallas, which is earlier in the month (December 4–8). I hope you will plan to attend Academy 2002 in San Diego next December and, after the meeting, I hope you will tell me the advantages and disadvantages of our new meeting schedule from your own unique perspective as a Fellow of the American Academy of Optometry.

Standards of Practice for Primary Eyecare John G. Classé. Columbus, OH: Anadem Publishing. 1998. Pages: 134. Price: $44.00. ISBN 1-890018-22-8. If you have ever taken a continuing education course from Dr. John Classé, who is both an optometrist and an attorney, you may have scribbled some lecture notes that resemble parts his newest publication. In 134 spiral-bound pages, this soft-cover book includes 45 tables of clinical risk management issues for optometrists, ranging from suggested standards for impact resistance of ophthalmic lenses (which he assesses as a “significant” risk) to endophthalmitis (which he assesses as a “minimal” risk). In each table, he includes his own assessment of the risk, his recommended standard of practice, and several pearls of wisdom based upon his considerable experience as an optometric clinician, educator, and scholar of optometric legal issues. Although he states in his introduction that “Readers are cautioned to use their own judgment in making decisions on the issues covered in this book… (and) the material is not intended to substitute for the advice of a qualified attorney or other professional… ,” he has obviously provided his learned opinion on a standard of practice in optometry that he recommends for his patients, students, and colleagues. Although, logically, he directs this book to the optometric profession, I feel most of it is equally applicable to the practice of ophthalmology [i.e., “Optometrists or ophthalmologists (my emphasis) who do not wish to diagnose or manage binocular vision anomalies should refer patients to practitioners who will provide the appropriate care”]. In fact, in sections 5 (Posterior Segment Disease), 6 (Anterior Segment Disease), and 7 (Ophthalmic Drugs), he emphasizes that “a medical standard of care applies… . ”FIGUREFigureIn addition to the tables, Dr. Classé has included 12 useful appendices in his book, some of which are the American Optometric Association’s Clinical Practice Guidelines for the frequency of Adult and Pediatric Eye and Vision Examinations, a general algorithm for the treatment of primary open-angle glaucoma from a 1996 paper authored by Dr. Jimmy D. Bartlett, a sample patient fitting agreement for extended wear (overnight) contact lenses, a triage checklist for patients with eye emergencies, and a protocol for postoperative care of cataract patients. Also included for Ohio-licensed optometrists are 2 hours of continuing education credit if they elect to complete the multiple choice test and return it for grading to The Ohio State University College of Optometry. The shortcomings of this easy-to-read book are minor. In my view, the title is not well matched to its content. Standards of Practice for Primary Eyecare implies more to me than simply knowing how to avoid optometric malpractice suits. There are no discussions of social, economic, ethical, or moral codes of conduct that are also critically important standards of practice for a healthcare provider in any discipline and this book does not even attempt to address standards of practice in traditional optometric specialty areas of binocular refraction, low vision, or vision therapy. Although the author has chosen a sub-title of “Risk Management Guide” for his book, most of its pages contain selected ocular disease diagnosis and management topics, along with some helpful practice management issues, such as record keeping and professional liability insurance, without any mention of many other important quality assurance and risk management topics, such as unrestricted state licensure, credentialing, privileging, certification, continuing education, infection control procedures, and emergency preparedness. However, the author readily admits to these limitations: “Emphasis in this manual is on the reasons that liability claims were brought [against optometrists] so that clinicians will better understand current liability risks and thereby take appropriate steps to reduce these risks in clinical practice.” To stress this point, the first table lists “100 Malpractice Claims, 1977–1997”; however, he provides no explanation for how this information was researched or how it might apply now that U.S. optometrists in all 50 states and the District of Columbia can use therapeutic pharmaceutical agents. Another minor criticism of this book is that it is written in an outline format, which appears to be a quick “checklist” of things to do or think about, rather than as a narrative, in which more information could be provided to establish a rationale for each of his proposed standards. In fact, even though hundreds of standards for primary eyecare are proposed, most have no justification(s) or reference(s) for them other than the author’s considerable erudition and clinical experiences. There is no reference or suggested reading list provided for readers who wish to learn more about this subject, and there is no index for readers to easily locate specific items of interest. In summary, despite the aforementioned minor shortcomings of limited scope and lack of reference material, I liked this book very much. For $44.00, it is a concise, clinically relevant, and “user-friendly” manual that should help every optometrist in his or her primary eyecare practice.

An otherwise healthy 12-year-old boy was evaluated for an enlarged blind spot in his left eye. Neither optic nerve edema/neuritis nor a retrobulbar mass explained this finding. Consultation with a neuro-ophthalmologist over a period of 14 months resulted in a diagnosis of acute, idiopathic blind spot enlargement syndrome, a rare and poorly understood ocular condition. To the author's knowledge, this is the youngest case ever reported.

As optometric practitioners, we all gather and then analyze large quantities of clinical data every day. We understand that some of these data will be normal (or negative), and some will be abnormal (or positive); some will even be questionable (unreliable or suspicious). However, all clinical data used to prevent, diagnose, treat, and/or rehabilitate our patients are important; therefore, patients--as well as third-party payors--should be reminded of this fact.