AMA Reaction to AOA’s 1954 Seattle Resolution
The Medical Reaction to the 1954 Seattle Resolution
Second in a 3-part series
By Irving Bennett, O.D.
In our last Historical Gem, we reported on Resolution No. 4, adopted in June 1954 by the American Optometric Association at its Congress in Seattle, WA. The resolution stated:
“Resolved, that it is the stated policy of the American Optometric Association in convention assembled that the field of visual care is the field of Optometry; and should be exclusively the field of Optometry; and be it further
“Resolved, that the individual state associations are recommended to make serious study of the Optometry laws prevailing in their states to the end that exemptions be restricted, limited and ultimately eliminated and that encroachments by untrained, unqualified and unlicensed persons into the exclusive field of Optometry be prevented through the established enforcement agencies in the respective states.”
No one is really certain if the delegates at that meeting, or the leadership of the AOA at that time, were referring to lay individuals working with others in the health care field, or to practicing ophthalmologists themselves. Perhaps, reference was to both. There was no open discussion of the resolution among the delegates in Seattle and many non-optometric publications and groups concluded that the wording of the resolution stated, or at least meant, that “optometry wanted to halt MD-refracting.”
The reaction at the American Medical Association (AMA) was both swift and decisive. At the AMA House of Delegates Meeting in Atlantic City in June 1955, nearly a year after the AOA adopted its resolution, came the reaction in the form of several resolutions, the main of which officially stated:
“RESOLVED, That it is unethical for any doctor of medicine to teach in any school or college of optometry or to lecture to any optometric organization, or to contribute scientific material to the optometric literature, or in any way impart technical medical knowledge to nonmedical practitioners.”
The AMA Convention of 1955
A report of what actually went on at the AMA convention reads like a soap opera. We have managed to get a copy of the “confidential” letter written on June 15, 1955 by AOA General Counsel Harold Kohn to the Officers and Trustees of the AOA. It was a five-page single-spaced typewritten report of the AMA convention, based on reports, correspondence and communications he had gathered from MDs and others who attended the convention or, if they did not, had heard about it from others who did attend.
Space does not permit the publication of this full report but some direct and unedited quotes from Attorney Kohn’s letter will give readers a good idea of the strong feelings that existed at that time:
• “The first thing to appreciate and understand is the highly volatile and explosive nature of the meeting. First of all, the usual attendance at the Ophthalmological Section meetings run between 300 and 400. This year  there were 800. They came because they were highly incensed and emotionally excited over two topics – optometry and dispensing by ophthalmologists.”
• “One description was that upon occasion, the discussion became so heated that the meeting almost verged upon a howling mob.”
• “….. a large number of attendants were ophthalmologists who dispensed their own glasses – which, by the way, is progressively becoming the trend….This group was not only vocative, but viciously vituperative at the meeting.”
• “The final reason for the tone and atmosphere was the violently anti-optometric nature of the Committee that formulated the resolutions……I am told that the Chairman was Dr. Ralph O. Rychener, of Memphis, Tenn. He was fresh out of the Tennessee Optician bill fight and furthermore has been at loggerheads with Southern College [of Optometry] claiming in the past that the college improperly indoctrinated its students.” [Editor’s note: Mr. Kohn proceeded to name the AMA Resolutions Committee members and noted each one’s ‘credentials’ for being anti-optometry.]
• “All of the resolutions begin with ‘WHEREAS’ clauses and preambles which excoriate optometry. They not only belittle, demean, and slur optometry, but they accuse optometry of the greatest of all mortal sins in the medical mind – that optometry is a cult. This medically constitutes excommunication and optometrists are placed on a level where not only a decent and respectable physician will have no converse with them, but the public mind is poisoned….”
There actually were five resolutions pertaining to optometry and to optical dispensing discussed at this AMA Convention and four were adopted. Briefly, what follows are the foci of the resolutions:
• The first resolution made it unethical for any ophthalmologist or physician to teach in an optometric school or college; to lecture before any optometric or other lay group; to impart knowledge, directly or indirectly, to optometrists and forbidding the writing of articles for optometric magazines.
• The second resolution criticizes the National Society for the Prevention of Blindness, and other lay organizations, for having any relations whatsoever with optometry. This resolution, among other things, asked for a repeal of Public Law 734 permitting optometrists to certify blindness in patients, and it demanded that all commissions issued to optometrists in the Armed Services be recalled and that no further commissions to optometrists be issued.
• The third resolution denounced as unethical the association of an ophthalmologist in practice with an optometrist, but it countenanced the employment of an optometrist by an ophthalmologist if the relationship was that of employer/employee. This resolution was defeated because it was pointed out that its passage would amount to “stultification.”
• The fourth resolution, which was adopted, asked that “suitable criteria” be set up for optometrists to refer patients to ophthalmologists. The resolution does not establish the criteria, but it denounces referrals by optometrists for “an eye affliction” to a general medical practitioner, dentist or anyone else other than an ophthalmologist. The resolution states that the first referral must be to an ophthalmologist and it is up to the ophthalmologist to make any subsequent referrals.
• The fifth and final resolution involving eye care which was adopted at this 1955 AMA convention reversed more than a century of medical ethics and permitted ophthalmologists to dispense spectacles and contact lenses, furnishing materials above cost and at a profit.
AOA Clarifies its Seattle Resolution
The AOA response to the AMA resolutions resulted in a strong effort to “clarify” the 1954 resolution. Unfortunately it was too little, too late. AOA members individually worked with local ophthalmologists with whom they had referral relationships; and the AOA collectively worked hard on many fronts to improve inter-professional relations. There were but few tangible results.
The AOA at its annual congress in June 1955, held in Milwaukee, WI unanimously adopted Resolution No. 5 that attempted to clear up what optometry really meant by its Seattle action. It was a long resolution with three Whereas clauses and seven Resolveds. Essentially the resolution declared it had no intention to eliminate the exemption granted to ophthalmology to practice optometry, and that optometry had no intention “to enter into or engage in the practice of ophthalmology.”
The damage had been done and the AOA clarifying resolution did little to quell the medical reaction; the breach between the two professions was out in the open and it began to fester. Years went by until July, 1964, a Chicago optometrist named Cyrus Bass filed a lawsuit against the American Medical Association and eight Chicago ophthalmologists charging violation of the Sherman Act, and later when the AOA brief of complaint against the AMA was filed with the U.S. Department of Justice. More on those legal actions in the next Historical Gem.
1. Gregg, JR. American Optometric Association – A History. St. Louis: American Optometric Association, 1972: 251-253
2. Classe, JG. Legal Aspects of Optometry. Boston: Butterworths, 1989:16-17