The Meeting That Changed the Profession
By Irving Bennett, O.D.
This is third in a series of vignettes on historical events that occurred in and about the profession of optometry. Readers looking for more information on the subject of this vignette can consult Hindsight: Journal of Optometry History, the official publication of the Optometric Historical Society. Copies of the articles like this can be obtained by contacting David Goss, OD. Ph.D., School of Optometry, Indiana University, Bloomington, IN 47405 or e-mail him at email@example.com
To many historians in optometry the tipping point, the exact time that optometry began its change from a purely vision care profession to a health care profession, was January 16, 1968 in a hotel room at the La Guardia airport in New York. The meeting was called by the then dean of the College of Optometry, the State University of New York (SUNY), Dr. Alden N. Haffner. If there ever was a visionary in optometry it was, and still is, Norman Haffner. The meeting involved about two dozen participants, according to Dr. Haffner, most of whom were then connected to schools and colleges of optometry. Three were not “school leaders”: Milton J. Eger, O.D., then editor of the Journal of the American Optometric Association, Irvin M. Borish, O.D., a private optometrist who was heavily involved in optometric education and research, and Charles Seger, O.D., a private practitioner in California, and then chairman of the AOA Council on Education.
No minutes of the meeting were taken; no report of the happening was reported in the press until 20 years later when Dr. Eger wrote a report of the meeting from his personal notes and memories. It is surprising that to this day relatively few optometrists knew of this meeting, what its alleged goals were, and what would transpire in the next two decades as a direct result of that meeting. In one sentence, the results changed optometry forever.
Who attended the La Guardia meeting is still not exactly known. We can positively identify, in addition to Haffner, Eger, Borish, and Seger only five more: Dr. Gordon G. Heath, dean of the College of Optometry at Indiana University; Dr. William R. Baldwin, then president of the Massachusetts College of Optometry (now called the New England College of Optometry); Dr. Richard Hazlett, administrator at the Massachusetts College of Optometry; Dr. Norman Wallis, then assistant dean of the College of Optometry at the University of Houston; and Dr. Spurgeon B. Eure, then president of the Southern College of Optometry. Haffner recalls that there were more in attendance, but can recall only those listed above.
Keep in mind that the first state to license optometrists was Minnesota in 1901. By 1924 licensure for all states was complete. Haffner noted: “The 1901 statute like all of the others defined the scope of the legal practice of optometry. In spite of there being a steady growth of educational requirements from six months to six to eight years, there was no growth in the scope of practice notwithstanding the enormous growth in educational background.”
There was an obvious imbalance of the scope of responsibility of optometrists and the educational requirements needed to become an optometrist. This led to rumbling and discontent among the younger optometrists who were dissatisfied with the imbalance between the scope of responsibility and educational requirements.
Eger in his article in the Journal (Volume 60, Number 4, April 1989) described the picture of the profession at the time of the La Guardia Meeting: “Historically, optometry was a drugless discipline with little legal responsibility for the health of the eye and the welfare of the patient. Its enemies refused to recognize optometric practitioners as ‘doctors’ and optometry as an academic profession, let alone a health care profession. They maintained that optometrists were over-trained technicians qualified only to provide vision examinations and eyeglasses to the public. They charged that optometrists had neither the educational or clinical background nor the legal right to use the necessary pharmaceutical agents to anesthetize the eye or dilate the pupil to better detect or diagnose abnormal conditions.”
Eger stated that “no agenda or preconceived philosophy was brought to the informal table (at La Guardia) for discussion and no one was restricted as to the type of idea that could be brought forth. They agreed that both meritorious and farfetched brainstorming ideas would receive the same intellectual scrutiny. Many suffered the ignominious fate of the waste basket.”
Participants at the La Guardia Meeting debated for two full days attacking such thorny and difficult subjects on how to roll out a philosophy to the optometric community on its need to expand its scope of responsibility. Participants questioned whether the schools and colleges could handle the large burden that would be placed upon them, to wit, provide those in practice as well as students in the schools the necessary tools to diagnose and use therapeutic pharmaceutical agents.
Also debated was how to get the state optometric associations and the American Optometric Association to change its previous course and embrace the parameters of an eye health profession. Conclusions for the group were recalled by Eger in his 20-year after the meeting report. They are as follows:
- Optometry must discard its original concept of being a drugless profession dedicated solely to function and must expand its responsibilities to include at least the detection, recognition, diagnosis, and monitoring care of diseases that affect the structure of the eye.
- Optometric education should be encouraged to enrich its curriculum and provide the necessary courses of study that would sustain all challenges to provide the optometrist with the expertise to become a primary eye care provider and a primary entry point into the health care system of the United States.
- The state laws that govern the practice of optometry in the United States must be brought up to date and include provisions that would allow the optometrist to practice that which he or she is taught….including the appropriate use of pharmaceutical agents.”
After the La Guardia Meeting in March 1968, Norman Haffner delivered the keynote speech at the New England Congress of Optometry and laid out optometry’s future. It was a trailblazing speech, aptly entitled “The Evolving Health Care System in the American Democracy’s Welfare State and the Potential Role of the Profession of Optometry.” It was published in the New England Journal of Optometry, Vol.19, No.6.
In February 1969 the Arlie Conference, a think-tank, was conducted in Virginia under the auspices of the AOA, at which many of the La Guardia ideas were explored with arguments carried mostly by those who attended La Guardia.
In 1971, the state of Rhode Island became the first state in the nation to permit optometrists to use diagnostic pharmaceutical agents. West Virginia became the first state to pass legislation to permit optometrists to use both diagnostic and therapeutic pharmaceutical agents.
Dr. Norman Wallis, one of the La Guardia participants who went on to become the President of the Pennsylvania College of Optometry and later the Executive Director of the National Board of Examiners in Optometry, wrote in a personal communication in 1996: “I believe the consensus (of the La Guardia Meeting) was that optometric education should lead the charge on the use of drugs by optometrists.”
And, indeed, they did.