History of the section on cornea, contact lenses and refractive technologies of the american academy of optometry




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HISTORY OF THE SECTION ON CORNEA, CONTACT LENSES AND REFRACTIVE TECHNOLOGIES OF THE AMERICAN ACADEMY OF OPTOMETRY

Dennis M. Kuwabara, O.D., F.A.A.O. (Revised: 12-22-08)

On January 11, 1922, nine optometrists and two physicians met at the Planters Hotel in St. Louis, Missouri for the express purpose of developing an organization for the “optometric study in higher branches and for the exchange of ideas in optometric work.” Morris Steinfeld, the organizer of the group, was elected temporary chairman. A second organizational meeting was held at the Claypoole Hotel in Indianapolis, Indiana. On June 29, 1922, the American Academy of Optometry (AAO) was officially formed with Morris Steinfield as Chairman, C. S. Brown as Vice-Chair and Carel C. Koch as Secretary/Treasurer. The stated goals of the newly formed AAO were to raise the standards of optometric practice, education, and ethics. The First Annual Meeting of the American Academy of Optometry was held at the American Annex Hotel in St. Louis, Missouri on December 9-13, 1922. At this inaugural meeting, papers were presented, luncheons and dinners held, business sessions conducted, and officers elected much in the same way they are today. The same officers were re-elected for another term with the only addition being E.E. Fielding as the Treasurer.


The roots of the Cornea, Contact Lenses and Refractive Technologies Section can be traced back to the Twenty-Third Annual Meeting held at the Stevens Hotel in Chicago, Illinois, December 10-12, 1944. A proposal to incorporate special sections in contact lenses and orthoptics was put forth and adopted. The formation of these early sections had great historical significance because they would eventually lead to the development of “diplomate” status within the Academy. It was three years later at the 26th Annual AAO Meeting held at the Palmer House in Chicago, December 13-16, 1947, that the Contact Lens Section (CLS) took the first step towards establishing itself. John C. Neill, the first CLS Chairman, proposed the creation of an examining board to qualify Academy members who desired to become a contact lens specialist. The Executive Council carefully considered this proposal and voted unanimously to establish this examining board. Academy members who passed the qualifications drawn up by this examining board were to be awarded diplomas certifying their ability to fit contact lenses. Appointees to this examining board were to be faculty members of optometric schools who taught contact lens fitting.


Considering contact lenses were still relatively new and the number of optometrists fitting them relatively small, the idea of declaring contact lenses fitting a specialty must have met with mixed reactions. From 1935 to 1939, at least 10,000 pairs of contact lenses, all made of glass, were sold in the United States. Plastic began to be used in the contact lens industry in 1937 with William Feinbloom’s combination glass corneal section/plastic scleral section contact lenses. The “U” series of 1937 was followed by the “T” series in 1940. In 1938, Theodore Obrig discovered the advantages of using blacklight observations with a 2 percent aqueous solution of fluorescein in the fitting of scleral fluid or fluidless contact lenses. In 1939, plastic polymethylmethacrylate contact lenses were introduced into the United States by either Mr. Theodore Obrig or Mr. Ernest Muller, or Istvan Gyorrfy, MD. Solon (Bud) Braff and Edward I. Goodlaw were early pioneers who worked closely associated with Kevin Tuohy and Phil Salvatori in the development of fitting scleral lenses. Braff’s discovery that scleral lenses could be fit without anesthesia and Goodlaw’s observations that contact lenses affected the osmotic character of the corneal epithelium (causing the corneal edema) laid the groundwork for the eventual transition from the scleral to the corneal lens as the design of choice. The introduction of PMMA simplified the fitting of both scleral and corneal contact lenses. Its only drawback was its impermeability to oxygen and carbon dioxide. Had it not been for this shortcoming, today’s RGP lenses probably would never have come into existence. The Tuohy lens received its patent on June 6, 1950. After the Tuohy lens was introduced in 1948, the attention slowly shifted away from the scleral lens to the corneal lens. In 1946, 50,000 pairs of lenses were sold. By 1949, these numbers increased to 200,000 pairs primarily due to the introduction of the Tuohy lens. By today’s standards, it is difficult to imagine that this lens design revolutionized the contact lens field. Tuohy’s lens was large (11.5mm to 12.5mm), thick, fit flat (2.50D to 6.00D flatter than flat K), and had blunt edges. It is important to understand that the CLS was founded during the mid to late 40s and how difficult it must have been for the early founders of the Section to persevere in the early stages of the development of contact lenses.


“The Certification by Contact Lens Section” as stated in the February 1948, American Journal of Optometry and Archives of the American Academy of Optometry gives an overall perspective of how serious the CLS envisioned their role to be in the perpetuation of the art and science of contact lens fitting and the importance of the certification process.


PURPOSES OF CERTIFICATION AND THE EXAMINING BOARD

  1. To elevate the standards of contact lens practice.

  2. To determine the competence of practitioners professing to be specialists in the application of contact lenses.

  3. To arrange and conduct examinations to test the qualifications of candidates who appear before the board for certification as specialists in the application of contact lenses.

  4. To grant and issue certificates of qualification as specialists in the application of contact lenses to candidates successful in demonstrating their proficiency.

  5. To establish a control panel of Diplomates who will act as advisors to candidates for the examinations.

  6. To serve the public and the professions by indicating with a designated symbol in the Directory of the American Academy of Optometry that the individual has been certified as a contact lens specialist.



NO LEGAL OR PROFESSIONAL RESTRICTIONS

The certificate does not, of itself, confer on the Diplomate any legal qualifications, privileges, or license to practice the application of contact lenses. It is not the purpose or intent in any way to interfere with, or to limit the professional activities of, any duly licensed optometrist. The chief aim is to elevate the standards of qualification for specialists in the application of contact lenses and to certify as specialists those Fellows of the American Academy of Optometry who appear before the examining board and are successful in meeting the requirements.


VALUE OF CERTIFICATION

The American Academy of Optometry recognizes the certificate as evidence of academic and clinical fitness in the practice of contact lens application. Diplomates will be recognized by a suitable symbol opposite their name in the Directory. This Directory listing will serve as a guide to other optometrists desiring to refer patients for consultation services in this specialty.


REQUIREMENTS

All candidates who are presently engaged in contact lens practice and who file application for examination before December, 1948, will be required to submit the records of 20 successful contact lens cases which he has completed, together with evidence of formal instruction or its equivalent in the application of contact lenses. Upon acceptance of these prerequisites by the examining board the candidate will be notified to appear before the board for oral, written, and practical examinations which will be given immediately preceding the December 1948, meeting of the American Academy of Optometry.

Those candidates who file application before December 1948, and who have not completed the prerequisite number of cases will be notified to appear for examinations but the awarding of the certificate will be withheld pending completion of the required number of cases.

Candidates who file application after December, 1948 must:

  1. Submit a statement from an accredited optometric institution showing satisfactory completion of a post-graduate course of instruction in the application of contact lenses.

  2. Submit the records of 20 successful contact lens cases which have been completed under the supervision of a member of the control panel who has been assigned to the candidate.

  3. Appear before the examining board for a practical, oral and written examination.



THE CONTROL PANEL

Diplomates of the 1948 and subsequent examinations will serve as a control panel for the certification of candidates who apply after the 1948 examination. A member of the control panel will be assigned to each candidate and it will be the duty of the panel member to assist the candidate with each of his cases. Within geographic limitations an effort will be made to bring together the panel member and the candidate with his patient, for the purpose of consultation. Where for geographic reasons, it is impracticable for the candidate to consult personally with the panel member; the candidate will keep the panel member informed by correspondence with his progress in application of contact lenses to each of his patients.

When the candidate has successfully completed the prerequisite number of cases under the supervision of the panel member assigned to him, the panel member will validate each case to the examining board.


PREPARATION FOR CERTIFICATION

All candidates will be examined in the subjects basic to the application of contact lenses. These subjects will include the anatomy, histology and physiology of the anterior segment of the eye and its adnexa, the chemistry of contact lens solutions, the optics of contact lenses and the pathology and the therapeutics associated with contact lens practice. The candidate will also be examined in the historical development of contact lenses as well as the modern forms of such lenses, including both molded and trial case types. The practical examination will be limited to the particular method or methods employed by the candidate in applying contact lenses to the cased reported by him to the examining board; however, he will be expected to be able to discuss intelligently other methods of contact lens application.

In preparing for the examination the candidate will be guided by the syllabus prepared by the examining board. A sample of the form to be used in submitting case records will be furnished the applicant.


FEES

An applicant form will be furnished to each applicant and this form must be filled out completely and accurately and returned to the secretary together with an application fee of $10.00. The examination must be taken within three years of date of application. When the candidate is notified to appear for examination an examination fee of $25.00 must be remitted to the secretary.

Following the 1948 examination, examination fees will be carefully computed on a basis of the cost of administering the examination. All fees will be used entirely for administrative expenses. Examiners will serve without compensation other than actual expenses.


RE-EXAMINATION

Candidates who have failed one or more subjects may be re-examined upon satisfactory evidence of adequate additional preparation and payment of the examination fee. A minimum of one year must elapse between examinations.


REVOCATION OF CERTIFICATE

The Certificate of Qualification may be revoked in the event that:

  1. Any representation or statement made to the board by the Fellow, including statements contained in his application for certification, shall have been false or intentionally misleading.

  2. The Fellow so certified shall violate the standards of practice of optometry required by the American Academy of Optometry; or the revocation, forfeiture or suspension of his license to practice optometry.

  3. Upon revocation of any Certificate of Qualification by the Academy as aforesaid, the holder thereof shall return his Certificate of Qualification and all other evidence of qualification to the secretary and his name shall be removed from the list of Diplomates.


The first contact lens certification examination was given at the Twenty-Seventh Annual Meeting held at the Robert E. Lee Hotel in Winston-Salem, North Carolina, December 4-7, 1948. The first twenty-one candidates who took and passed the certification examination were: L. Lester Beacher, Otto J. Bebber, Henry B. Day, Jr, Vincent J. Ellerbrock, William Feinbloom, Isadore Finkelstein, Eugene Freeman, Robert C. Graham, Arthur E. Hoare, D.G. Hummel, Russell S. Manwiller, Bernard Mazow, Meredith W. Morgan, Jr., John C. Neill, J.S. Nupuf, William W. Policoff, Nathan A. Robbins, I. Irving Vics, Irving Weiss, and S. G. Weiss. The members of the first examining board were: V.J. Ellerbrock, Meredith Morgan, John Neill, D.G. Hummel (an ex-officio member).


Under the direction of John C. Neill, the examining board mapped out the examining program for 1949 as follows. The chairman would prepare study outlines to aid candidates in the following subjects:

  1. optics in contact lenses

  2. chemistry of contact lens solutions

  3. anatomy and physiology of the anterior portion of the eye and its adnexa

  4. pathology involved in contact lens fitting

  5. (a) history of contact lenses,

(b) types of contact lenses

(c) methods of fitting and adjusting contact lenses.


The 1949 certification examination was divided into three parts:

  1. Written examination based on the questions submitted by board members

  2. Oral interview

  3. Practical examination in which the candidate will fit lenses to a patient, using the method of his choice.


By the 1960's, the Academy had reached nearly 1,000 members. The Sections continued to grow in prominence as informal discussion groups devoted to their particular area of special interests. Although papers were presented, they were not of the formal variety presented today. The Sections maintained an open door policy welcoming anyone interested in their particular subject matter to participate by entering into the discussions or presenting a paper. Since these papers or discussions were not reported on in the Academy journal, attendance was imperative, if one was to benefit from these presentations. While they were clinical in nature, they were not formal courses or education sessions as were the postgraduate courses.

H.B. Peters, in a July 1961 article on the “Sections of the American Academy” published in the Am J Optom Arch Am Acad Optom., reported on how Robert Graham, CLS Chairman described the Section on Contact Lenses and Subnormal Vision, Aids.

“In recent years the upsurge of interest in contact lenses has been reflected in the activities of this Section. A large and lively group of fellows have regularly attended these discussion sessions. The Section has been called upon to arrange a two-hour symposium on contact lenses for the general session. The Section carries on a certification program and regularly examines and certifies as contact lens specialists those candidates who qualify.

The programs for the coming meeting will be shaped around the following subjects: (a) the accurate determination of corneal topography; (b) bifocal contact lenses; (c) toric, bitoric and perforated contact lenses; (d) current advances in subnormal vision aids; (e) the latest significant developments in the field of contact lenses. Interested Fellows are invited to participate.”

1964 was the year of the “Stone Blind” scare. Dr. William Stone issued a statement that methacrylate acid was being released from PMMA lenses causing blindness in PMMA contact lens wearers. Chairman of the AOA Contact Lens Section at the time, Maurice G. Poster recalled this sensational statement created a tremendous amount of controversy, involving a U.S. Senate hearing, before this allegation was proven to be completely false and having no basis in fact.


C.A. “Ted” Bayshore, a CLS Chairman (1967-1968) and Section Secretary for 16 years, remembers the mid 60's as a time of revolution and change within the organizational structure of the CLS. As a 1962 Diplomate, he found the Section to be loosely organized and made up of Fellows who were active in the evolution of contact lens fitting. They met at the Academy’s Annual Meeting and utilizing an informal examination process passed those who met the qualification requirements and demonstrated potential in fostering the development of contact lenses. He viewed the Section as an elite “club” of specialists which tended to be self-perpetuating. This club atmosphere did not sit too well with the newer breed of optometrists affiliated with the Universities and in more formal academic settings. He found himself in the middle of this discord and soon became the spokesman for the CLS with the Executive Council. In 1965, the stage was set for the CLS to undergo a dramatic change. Dan Elliott was CLS Chairman at that time and Harold Moss was Vice-Chair. Bayshore recalls that in an uncustomary manner for the Academy, this two-year CLS appointment was cut off in mid-term with Harold Moss elevated to Chair and he to the Vice-Chair position for a period of one year (1965-1966). The following year he assumed a two-year term as Chair with Maurice G. Poster as Vice-Chair. It was during this term that he secured the assistance of Morton D. Sarver and others of university stature to write up a formal examination and revamp the Section. The format established by Sarver and his colleagues served as the model for the other Academy Sections. This formalization of the Academy Sections moved the Sections from an informal level to a higher level of academic quality with a credible, valid examination process. In a major concerted effort, the CLS recruited, examined, and conferred Diplomate status on many of the contact lens leaders, who had previously boycotted the Section because of its “club” atmosphere. From this point forward, the CLS gained considerable prominence and became a more dominant force within the Academy hierarchy.

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