SOCIALIST MEDICAL ASSOCIATION,

33,Murray Road,Northwood,Mx.

Prepared for the information of the Executive Committee by D. H. Lewis B. O. A.

While the history of the optician goes back beyond the year 1528 when the Worshipful Company of Spectacle Makers (S.M.C.) first obtained their charter, it is sufficient for our purpose if we begin with more modern institutions. Various attempts at forming a controlling organisation culminated in 1895 in the founding of the British Optical Association with its object, as “the encouragement of the science of optics and its application to the improvement of human vision”. During the period which followed, both the S.M.C. and the B.O.A. held examinations for, and granted diplomas to, successful candidates.

Before 1914 a further optical organisation was formed, the National Association of Opticians (N.A.O.) which catered chiefly for opticians in the North of England and primarily included those who were not Fellows of the S.M.C. or B.O.A. After the 1914/18 war, a further organisation was formed in Scotland, the Scottish Association of Opticians (S.A.O.) These are the four main examining bodies in existence at the moment as far as sight-testing opticians are concerned.

Owing to the peculiarities of the Spectacle Makers’ charter, opticians themselves have very little say in the control of affairs in that organisation and therefore diploma holders formed the Institute of Ophthalmic Opticians (I.O.O.) to represent their interests in 1904; this organisation was non-examining.  In 1904, those chemists who also did eye work formed the Society of Chemist Opticians, but very little is known about its early years; generally its members took the S.M.C. or B.O.A. examination. It was reconstituted in 1925 to form the Institute of Chemist Opticians (I.C.O,) with its own separate examination.

After the 1914-18 war, big changes took place. The Government, in conjunction with the Approved Societies, decided to include Ophthalmic Benefit in the National Health Insurance Scheme.  The result was the formation of a special organisation, the Joint Council of Qualified Opticians, to represent the interests of the opticians for this particular work, and was composed of representatives from the B.O.A., the I.Q.O., and the S.M.C., (1923). The J.C.Q.O. was concerned with main­taining a register of optical practitioners, and the establishment of a clearing house for optical treatment letters, as well as dealing with the parliamentary and legal interest of opticians.  The J.C.Q.O. is a non-examining body.

In 1924 nine firms of dispensing opticians decided to form a joint organisation to be called the Association of Dispensing Opticians (A.D.O,) In 1928 the British Medical Association, in conjunction with the dispensing opticians formed a company called the National Ophthalmic Treat­ment Board (N.O.T.B.) in an endeavour to implement the promise made by Mr Bishop Harman that he would set up a medical scheme for State Insured persons “within a reasonable time”.

The failure of this promise to fructify, coupled with various anomalies in the administration of Ophthalmic Benefit, led to the setting up by the Minister of Health in 1927 of the Ophthalmic Benefit Approved Committee having equal representation on it of opticians and Approved Society members with an independent chairman. This Committee has the responsibility of administering N.H.I. ophthalmic work in accordance with the regulations laid down under the National Health Insurance Act. The Ministry authorised the Committee to compile and maintain a list of opticians, and gave it definite powers regulating the admission and exclusion of opticians for N.H.I. purposes. While it was necessary, in the first instance, to admit several men who were not diploma holders of the previously mentioned optical organisations, admission is restricted now to holders of diplomas granted by the approved examining boards. Such opticians are recognised as capable of undertaking eye examination, detecting pathological conditions, measuring and prescribing for refractive errors and supplying optical appliances if necessary. For these services the regulations authorise a consultation fee. The O.B.A.C. does not itself maintain a clearing house, but use is still made of the existing machinery of the J.C.Q.O.

Since the war, various developments have necessitated the formation of two organisations, one set up by the optical profession itself, the Joint War Emergency Committee, consisting of representatives from the J.C.Q.O., B.O.A., I.O.O., N.A.O., S.A.O., and also the Society of Opticians. This last organisation is one formed by managing directors of optical firms. The optical press and the Association of Wholesalers and Manufacturing Opticians also send representatives to this Committee with re­gard to special items. At the same time the Committee of Imperial Defence set up the Central Emergency Committee to advise the Minister of Health as to the beet utilisation of optical man-power. The enclosed chart (not included) gives some idea of the various bodies mentioned, and their derivation and linkage.

The present position of the various organisations is approximately as follows:-

O.B.A.C. – approx. 9,100 of whom: 7, 000 are sight-testing opticians, either employed or in the vast majority of cases in own practice, 2,000 sight- testing firms. 59 Dispensers with 50 dispensing firms.

In connection with the small number of dispensers, it should be noted that the A.D.O. is divided into four grades: directors,  managers, assistants and mechanics. It is probable that only the assistants and managers are included in the O.B.A.C. figures,

J.C.Q.O.  approx. 5,000.

B.O.A.    approx. 3,000.

exact figures for others are not known.

From the preceding section it is possible to say that Refractionists or optical practitioners, or, as they have been called, sight testing opticians, constitute the overwhelming majority of the opticians of the country, and that there are two main types °of organisations looking after their interests; examining and non-examining bodies.  Private practice is controlled only by the organisations set up by the profession itself , but for control of National Health Insurance work there is a joint organ­isation set up by the Ministry of Health, with ministerial representatives on it,- and to which opticians and approved societies also send repre­sentatives.

It can be stated that the optical profession is here to stay, that it is an essential part of the health services of the nation, and that it ranks as an individual specialised profession within which mechanical optics is an integral part. An optical practitioner can be described as one qualified to diagnose ocular defects and to render any service incidental to the amelioration or correction of these defects. For detailed arguments supporting this thesis, see “Interim Report on Post-War Planning”, J.W.E.C. , June 1942.

It is necessary to examine the education and the training under­taken by opticians. Fundamentally, there is a minimum standard laid down by the Ministry of Health through the O.B.A.C., and since 1936 no optician has been admitted to the O.B.A.C. register unless he has passed the Fellowship examination of one of the recognised examining bodies, which only differ slightly in scope, and which in most cases demand a general education of Matriculation standard. Such opticians receive their training at technical Colleges or other approved institutions, most of whose courses are under the Board of Education Inspection. The syllabuses cover:

a) Theoretical and practical physical optics,

b) Anatomy and Physiology: 1. General, 2, Detail in relation to the visual apparatus and its appendages.

c) Subjective and objective methods of measuring refractive errors and prescribing.

d) Manufacturing and assembling and fitting of optical appliances.

e). Principles, construction and use of diagnostic apparatus.

f); Study of occular pathology. 1. To gain perfect acquaintance with normality, 2. To recognise abnormalities,

g). Non-operative methods for the treatment of occulo-motor defects. The period of training covers three to four years.

While it is not yet laid down that every optician shall attend a Refraction Hospital for clinical training, some 3,000 students have undergone such training, and only the incidence of the war has prevented the establishment of such institutions in various parts of the country. Other Technical Schools, etc. hold special clinics for this purpose

The different bodies award scholarships of varying amount, and some post-graduate research scholarships are also available in London and Manchester,

Post-graduate education is carried out at the Refraction Hospitals, and the Library of the British Optical Association is one of the most valuable in the world; its books may be obtained in any part of the country through the facilities of the Central Library.

Research work is continuously carried out, partly through local associations, partly individuals and partly laboratories, all inspired within the profession and not state subsidised.

Among a number of legal decisions affecting opticians, the one of outstanding importance is the Markham v. Thomas case in 1910. The verdict had a profound influence upon the optician’s training; it made the recognition of abnormal conditions a legal responsibility. His con­sequent liability for damages have compelled the optician to develop the recognition of early pathological conditions to very high levels.

In spite of this constant search in every eye for pathological conditions, statistical analysis of N.H.I. cases shows their incidence to be less than 5%. For all cases seen this figure becomes reduced to between 2 and 3%.

A great deal of official recognition has been accorded to opticians, although their position had not been regularised by legislation. The following is a summary of this recognition:

a) Administration and carrying out of Ophthalmic Benefit, a fee being authorised for these services. The Optical Treatment Letters for 1941 were approximately half a million with a turnover of Society Grants of a quarter of a million £.

b) 1914-18 war. Army Spectacle Depot formed, and over one million pairs of spectacles, two million goggles, ¾ million artificial eyes, etc. supplied and fitted.

c) During the present war over 400 opticians have been selected for specialists duties with the R.A.0.C. , A number have been specially selected for radio-location work where University or equivalent optical training was essential. About one hundred, have been selected for special naval duties, while in the R.A.F., duties in connection with visual examinations, including colour perception, binocular and stereoscopic tests are in the hands of the opticians.

d) The supply of Civil Defence Personnel with respirator spectacles has been handled to the satisfaction of the Ministry of Home Security and of the War Office,

e) The Ministry of Supply has chosen the optical profession to take care of the visual welfare of all workers in Royal Ordnance Factories, and the Treasury authorises the payment of the fees incidental to the work done. This includes visual examination and grading of “intakes”, refraction of defective visual cases, technical advice on lighting problems and the design and fitting of facial masks for workers in special departments. The dispensing of the pre­scriptions issued is done by registered opticians in the areas where the workers live.

LIST OF ABBREVIATIONS

A.D.O.    Association of Dispensing Opticians.

B.M.A.     British Medical Association.

B.O.A.    British Optical Association.

C.E.C.   Central Emergency Committee.

F.B.O.A. Fellow of the British Optical Association.

I.C.O.   Institute of Chemist Opticians.

I.O.O.   Institute of Ophthalmic Opticians.

J.C.Q.O. Joint Council of Qualified Opticians.

J.W.E.C. Joint War Emergency Committee,

N.A.O.  National Association of Opticians.

N.H.I.  National Health Insurance.

N.O.T.B. National Ophthalmic Treatment Board.

O.B.A.C. Ophthalmic Benefit Approved Committee.

S.A.O.  Scottish Association of Opticians.

S.M.C. Worshipful Company of Spectacle Makes

S.O.   Society of Opticians

Undated, but probably 1943 or 4

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