History of Optometry in the VA

Robert D. Newcomb, OD, MPH

College of Optometry, The Ohio State University, Columbus, OH, 43210, newcomb.2@osu.edu
VAOptometry
Optometrists were first placed on the staff of Veterans Administration (VA) hospitals in 1947; and in 1957, Public Law 85-96 provided specific authority (38 USC) for subsequent employment of additional optometrists. In 1958, Public Law 85-462 amended section 4105 (5) of 38 USC to require that all optometrists employed by the VA must hold valid state licenses to practice optometry and must have graduated from an accredited and approved United States school or college of optometry. In 1958, Public Law 85-857, and later in 1960, Public Law 86-598, made further modifications to 38 USC so that the services of staff optometrists were defined under the rubric of “medical services.” The purpose was to enhance the VA’s ability to render optometric care to eligible veterans. Although veterans had been receiving limited optometric care since 1947, Congress felt it was necessary to emphasize and clarify the fact that staff optometrists were duly authorized to render care to eligible veterans. Thus, by these laws, a veteran eligible for “medical services” was eligible for the services of an optometrist.

In 1972, the VA Central Office’s Department of Education and Research formally approved and funded the first program in the nation for the training of optometry students at the VA hospital in Birmingham, Ala. This historic event, which was a cooperative effort among the VA Central Office, the administration of the Birmingham Veterans Administration hospital, and Henry Peters, Dean of the School of Optometry at the University of Alabama in Birmingham, laid the groundwork for all future optometric academic affiliations with VA medical centers and outpatient clinics throughout the country.

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One year later, in 1973, Public Law 93-82 created a position for a full-time Director of Optometry within the Department of Medicine and Surgery; and this position was filled in September of 1974 by Kenneth J. Myers.1 Following his appointment, Dr. Myers immediately placed increased emphasis on building a viable VA optometry program to (1) provide primary eye and vision care services to eligible veteran patients and (2) expand the low vision care available to eligible visually-impaired and legally-blind veterans.  To accomplish these two goals, he worked with the American Optometric Association and the Association of Schools and Colleges of Optometry to recruit new staff optometrists and to develop optometry student and residency programs within the VA. The nation’s first optometry VA resident, Thomas Stelmack, completed his one-year post-graduate program at the Kansas City VA hospital in 1976.

StelmackAlso in 1976, Congress passed Public Law 94-581 which established an Optometry service within the VA’s Department of Medicine and Surgery, with a Director of that service who was on the same administrative level in VA Central Office as other independently-licensed health care disciplines such as medicine, dentistry, nursing, and pharmacy. Public Law 94-581 also removed staff optometrists from the former Title 5 Civil Service personnel system and placed them administratively in the Title 38 personnel system which had been used to recruit and maintain highly-qualified physicians, dentists, and nurses since 1946. It is easy (and correct) to conclude that this single piece of legislation in 1976 was absolutely vital for the development of optometry within the VA system, since it permitted the VA to compete for young staff optometrists who could now find professional satisfaction in a VA career.

A report accompanying the landmark law, prepared by the Senate Veterans Affairs Committee (#91-1206) gave the following rationale for strengthening and enhancing the VA’s optometry program:

1.  Compared to military hospitals, civilian HMOs, and the public health service hospitals, the VA employed extremely few optometrists.

2.  The committee felt Civil Service salaries for VA optometrists were non-competitive and, further, that VA hospitals should appoint optometrists solely upon the basis of their professional qualifications as judged by the VA medical staff and that these medical staffs – and not the Civil Service – should select and promote optometrists.

3.  The committee felt existing low salaries resulted in many full-time optometrists maintaining part-time private practices and this was counter to high quality patient care. If the VA could pay a competitive salary, full-time VA optometrists could be prohibited from seeing private patients.

4.  The committee felt the creation of an Optometry Service in VA Central Office would revise the present situation of optometry having a somewhat low professional status within the agency and improve morale among staff optometrists. Also, this would allow recent graduates to be recruited and retained by the agency.

The year 1977 was a banner year for VA optometry. The National Association of VA Optometrists was founded that year at the annual meeting of the American Academy of Optometry in Birmingham, Alabama. The ten founding members were Drs. Arnie Adler (Florida), Allen Cohen (New York), Ed Mehr (California), Kenneth Myers (Washington, DC), Robert Newcomb (Alabama), Robert Perlin (Connecticut), John Potter (Alabama), Cliff Scott (Massachusetts), Gerald Selvin (California), and Thomas Stelmack (Illinois). Also in 1977, the Southern California College of Optometry received a $936,050 VA manpower training grant for seven years under Public Law 92-541. And a joint project team of the American Optometric Association and the Association of Schools and Colleges of Optometry submitted a detailed report to the VA’s Central Office Department of Medicine and Surgery which outlined their recommendations for the development of a comprehensive program of optometric service, education and research within the VA. This significant document, as well as the one authored by the General Accounting Office in 1978 entitled “The Role and Use of Optometry in the VA Need Improvement,” provided much of the documentation for policy decisions promulgated by the VA for staff doctors of optometry under the legislative mandate of Public Law 94-581.

In the spring of 1977, Chester Pheiffer published an editorial in the Journal of Optometric Education in which he said:

“…Through Congressional mandate the VA has the responsibility to help train all health professionals. Optometry represents the largest independent health profession following physicians, dentists and nurses. It is more than obvious that the VA has a duty to help in the training of future practitioners of optometry and, more importantly, to provide proper health care to the veteran which has not been fully realized…”2

DrCartyIn the history of optometry in the VA, it is important to note several key individuals and organizations which have nurtured the optometric growth in this large medically-dominated health care system. Henry B. Peters, founding Dean of the UAB School of Optometry, served as the first Chairman of the Optometric Advisory Committee to Kenneth Myers. Richard Hopping, President Emeritus of the SCCO, submitted the application for the 1977 manpower training grant. Ron Fair was President of the American Optometric Association, and Norman Wallis was President of the Association of Schools and College of Optometry in 1977 when the AOA and the ASCO wrote their historic report.  Norman Wallis, now Executive Director Emeritus of the National Board of Examiners in Optometry, also served as the first optometric representative to the prestigious Special Medical Advisory Group to the VA’s Chief Medical Director, a position that has been capably filled by Norman Haffner for the past twenty years.  Jeffrey Keller was the first Chief of Optometry at the Birmingham VA hospital, and Robert Carty was the first Chief of Optometry at the Kansas City VA hospital.

JeffreyKellerOD copyPrior to 1976, there were only eight full-time doctors of optometry in the entire organization! In Fiscal Year 2009, there were 600 full and part-time staff optometrists, 1,025 optometry students, and 145 optometry residents working and learning in VA health care facilities throughout the country. This phenomenal growth did not come easily or haphazardly.  It occurred because optometry had a handful of visionary leaders and dozens of excellent young clinician-educators in the early years who identified the dual challenges of veterans with unmet vision needs and optometric trainees who needed off-campus interdisciplinary learning opportunities.  And they worked together to build enduring symbiotic relationships throughout the nation that addressed both needs.

References

1. Interview: From the Inside – VA’s Myers on the growth of optometry. J Optom Ed 1977;3(1):9-12.

2. Pheiffer CH. Editorial. J Optom Ed 1977;3(1):3.

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