Contact lenses, prescribing privileges were major milestones in optometry's evolution
Primary Care Optometry News assembled a group of highly respected pioneers in the field of optometry to discuss the past and future of optometry. John W. Potter, OD, senior director at TLC The Laser Center and a charter member of the Primary Care Optometry News Editorial Advisory Board, asked these experts to reflect on optometry's past and to speculate on its future: What were the most significant changes in the optometry during their lives? What do they see in the future of vision care? What's the place of contact lenses and vision care in the primary care practice? What are the most significant forces in contact lenses and vision care today? How can optometry cultivate leaders for the future?
John W. Potter, OD: What three events in your professional life do you feel have had the most significant impact upon optometry?
Willard B. Bleything, OD: A wearable contact lens comes to mind initially. When I was a student, it wasn't really available. Wesley Jessen convinced us we could fit patients with lenses. Also, the Federal Trade Commission action and the court cases that made it illegal to ban advertising. The third item is being able to use drugs. That had tremendous ramifications.
I would also say the development of the McKay-Margtonometer was another important event. Ophthalmology said optometrists couldn't deal with glaucoma. That instrument turned that argument around overnight.
Irvin M. Borish, OD: Contact lenses saved optometry in the late 1940s. We were on a plateau, and ophthalmology was muscling in on refraction. This was after the war when the government was developing many medical programs. Ophthalmology residencies burgeoned everywhere. Contact lenses saved us.
The second thing would be optometry gaining the ability to use drugs. When I entered optometry that concept didn't even exist. We made the first move in 1967 or 1968 at the LaGuardia Field conference, and later we had conferences with the American Optometric Association (AOA) trustees in Virginia and Tucson, Ariz. Those conferences led to acceptance of the idea. However, I have a great letter that starts out, "Dr. Borish, what did you do to clinical refraction?" Many ODs felt we should stay drugless. But drug use changed our relationship to pharmacy, to the drug companies and to medicine as a whole, and it changed our public image, because when most people think "doctor," they think medication.
The third is when we established educational accreditation by the Council on Education of the AOA and by regional agencies. When I entered optometry we had 2-year doctors' degrees at many schools, and most people certainly educators and people in other professions looked at them wryly. The accreditation had a tremendous psychological impact on our cohorts in other disciplines. In conjunction with that was Glenn Fry staying on at Ohio State University after he had resigned as the dean so he could establish a university doctorate degree.
Richard L. Hopping, OD: The most significant event in my lifetime was the Airlie House Conference on optometry's role in health care, Feb. 10-12, 1969, Warrington, Va. Eighteen people were invited as participants. One of the recommendations was that we move into diagnostic pharmaceutical agents (DPAs), and while it was an overwhelming vote, it was not a consensus. We wanted to submit the 50 bills simultaneously, but 3 years later Rhode Island went ahead on its own. I was assigned by the board to appeal to Rhode Island not to do it, because we wanted to do it all at once, but the state went ahead anyway.
The second item was the AOA Future Conference in January 1975 in Tucson, Ariz., where we decided to go into therapeutic pharmaceutical agents (TPAs). West Virginia and North Carolina followed with TPA legislation that year. I chaired that conference, and I said then it would take 25 years for us to get all 50 states.
The third thing is Medicare parity. The Omnibus Reconciliation Act of 1986 finally gave us the same level of fees as ophthalmology, bringing parity between the professions. That was a major milestone.
Harold E. Davis, OD: My professional life has been spent as a participant in the development of contact lenses both in research and clinically. The practice of contact lenses has gone through specific eras. Firstly, art has always preceded science. The 1950s was the era of instrumentation. This enabled the manufacturing community and the clinician to provide better techniques for contact lens practice. The 1960s was the era of new materials. Soft and rigid gas-permeable lenses made a significant improvement in the wearability of contact lenses. The number of lens wearers increased dramatically. The 1980s was the era of immunology, where we learned how to control giant papillary conjunctivitis and other similar types of contact lens complications. The 1990s was and is the era of the mantle layer and the understanding of the tear film and its role in successful contact lens wear.
Primary care and the use of diagnostic and therapeutic drugs has had a significant impact on the practice of optometry, as has managed care and the commercialization of contact lenses as a product and not a professional service.
W. David Sullins Jr., OD: The most monumental thing in my life that affected eye care is when optometry was brought into the Doctors' Draft during the Vietnam War. Previously the draft included only physicians and dentists.
Many of us were from Ma-and-Pa operations I am a fourth-generation optometrist. Being in the Doctor's Draft allowed those who went in as enlisted personnel in World War II to use their skills to come in as officers in Vietnam. That made us aware that it was no longer a Ma-and-Pa operation, so it was easy for our academicians to talk about residency programs for the first time. We appreciated our own worth, and it enabled the Airlie House and other conferences to whet the appetite of our young. It was an insult to me that when I wore the uniform of my country I could use DPAs, but when I came home I couldn't.
The second was diagnosis and comanagement centers, which much of our off-campus education has now become. This happened in the early 1980s when we realized optometrists should be consulting with other colleagues. We had consulted with and befriended ophthalmologists, but then your patients would transfer to their practices. During that time there was also Medicare discrimination, which fueled those fires. Optometry had not realized the clout we had until we started our own centers of excellence. They allowed optometrists not to fear patient attrition through consulting with other professionals and made off-campus learning an increasingly new phenomenon, because the centers provided patients and a diversity of encounters.
The final thing for me, because of my family history, is the amazing power of the profession. Nothing is stronger than organized optometry. It is incredible how, considering our diversity, organized optometry has been able to make such monumental health care decisions.
Irving Bennett, OD: The thing that affected me most was the acceptance of me as an equal in the healthcare community. That acceptance happened after World War II with efforts by optometric educators and optometric public relations to support our profession. The plan by the AOA and the schools and colleges to make optometry a course with 3 years of undergraduate studies gave it the image of a profession. What also brought that about was the Helling case, which is what Dr. Bleything was referring to when he mentioned the McKay-Margtonometer. A woman in Washington State sued an ophthalmologist for not diagnosing her glaucoma. He never took her pressure because she was a 23-year-old contact lens wearer. She won, and it made every optometrist and ophthalmologist begin doing glaucoma and field testing. That, along with the image built by the colleges, made optometry a true profession rather than a spectacle-selling trade.
A negative thing was when eyeglasses became a commodity because of European fashion trends the frames became more important than the lenses. Another negative issue was the fact that soft lenses became a commodity you could buy over the counter. Those issues made the examination of the eye and the detection of disease less important.
DPA and TPA brought us into professionalism, but managed care is taking us backward. Managed care is making optometry less of a profession than ever before. We have reduced fees, so we're seeing optometrists shrink their examinations and try to get patients quickly out the door. We're becoming salespeople who sell glasses and contact lenses for a living. The professionalism we gained from the Helling case and the TPAs is being dwarfed by commercialism.
Dr. Davis: At the present time the pendulum has swung to managed care. However, this is not permanent. Eventually patients will want to return to more traditional forms of clinical practice. Managed care entities, as we know them today, will have to modify their business practices. It has also been my observation that contact lens practitioners have long felt equal to other health care professionals, because they know more about lenses than anybody else. I hope that same feeling of confidence can be transferred to all optometrists by both education and dynamic leadership.
Dr. Potter: What do you see in the future of eye care based upon observations during your professional life?
Dr. Bleything: We are more mainstream in health care. That's a good news-bad news story. We are inheriting all the restrictions that have been put on mainstream health care, and that's the bad news part. I have mixed feelings about whether we are gaining ground.
In the future, I see people getting more involved with the neurological community. Neurorehabilitation has taken off. There's a tremendous future there, because it builds on the strengths across our discipline and makes us a good team member with other professions.
Dr. Borish: What worries me is that the great economic impact of eye care lies in refraction and contact lenses. Dr. Bennett once said that out of $18 billion worth of eye care, about $1.5 billion to $2 billion is in surgery and implants, about $1.5 billion to $2 billion is in eye examinations and about $1 billion is in eye disease. The rest is spectacles and contact lenses. We know there's a movement on ophthalmology's part to take over refraction, because surgery represents only a small part of most ophthalmologists' income.
If ophthalmology had paid attention to refraction, optometry might not exist. We can't leave a vacuum; however, I see lousy refraction by optometrists. A student told me that a patient was complaining about near point trouble and had 18 D of exophoria and almost no convergence ability. The student called the instructor, who told him, "Don't pay attention to that; we'll just give him some medication." If we lose refraction, somebody will step into it. Opticianry is looking on with greedy eyes.
Also, as people are living to be much older, I see low vision as a growing niche for optometry.
Dr. Potter: What's going to happen in managed care?
Dr. Borish: Managed care is taking over. In Florida, managed care is now 60% or 70% of the health care market. These big outfits are buying everybody up. There's a scandal here because the trustees of the Boca Raton Hospital wanted to sell the hospital to a managed care institution, and the public rose up in arms because it's a public hospital. Managed care is here, and it's going to grow in strength.
Dr. Hopping: As far as the future, I think it's solid. We've been so preoccupied for almost 30 years with creating parity with ophthalmology, now we've got to get back to optometry. We are not doing as well as we should because the curriculum is so crowded, and we don't dare expand to a 5-year curriculum. The cost is too great. I agree we're getting sloppier. We're throwing lots of things out of the curriculum. However neurorehabilitation is an example this profession is loaded with opportunity, and we need strategists to lay out where the profession is going. As a small profession, we must do more of that positioning in the future: maintaining primary care but doing the things that made optometry great. There's not enough economics for the anterior segment.
Dr. Davis: In the future I think there will be a continuous shift from private patients to managed care. Optometrists will also de-emphasize contact lenses because of managed care reimbursement limits. This is of deep concern to me.
Dr. Sullins I agree with Dr. Hopping that we must create a plan. Lately we haven't had our boards or our dreaming conferences, where we plan for the future. Also, as we become increasingly involved in the mainstream of health care, we must not do it at the expense of our heritage. I would like to create a master plan to create a resurgence of what made optometry great. Having said that, we must realize there will be an ever-increasing scope of practice because of technology, and this will further stress our education as we decide what should be taught.
I think optometry will become increasingly more marketable. As we continue to push our colleagues in ophthalmic surgery into a less-defined space and a more specialized area, we will have broader areas.
Finally, organized optometry has the unique ability to put together legislative coalitions to correct the ill-conceived stupidity of managed care and gag rules, things the American public will not stand for! Optometry is a combination of art and science to care for a human being. Also, we delivered when everyone tried to oppress us. Because of those things, we have the ability to represent Americans to battle insurance companies and managed care. When we tell the public why we were left out of managed medical eye care and that we offer well-distributed, cost-effective, quality care, we will be able to align ourselves with other health care providers and combat insurance companies.
Dr. Bennett: I don't see the future as bleak. But unless the profession changes and tries to resurrect things such as low vision, vision therapy and sports vision, and becomes less infatuated with medical therapy, I think we'll become like my internist. We'll see patients for 10 minutes, and we'll have technicians doing exams and salespeople selling eyewear and contact lenses.
Dr. Potter: What's the place of contact lenses and eye wear services in the primary care continuum?
Dr. Bleything: Contact lenses have been the mainstream of optometry. It's key to remember that we developed this field; we own the literature and science behind contact lenses.
Dr. Hopping: The place of contact lenses and eye wear services is fundamental to the profession. We have to get back to that. Yet I believe that in my lifetime optometrists will diagnose and treat hypertension in the office. That has to happen in the best interests of providing care for the people of this nation. How do we create a curriculum that allows us to do what we're good at and yet remain as the entry point into the health care system? Contact lenses are vital, and we must move toward group practices and group associations. Independent private practice is not dead; however, with group practice we can get back some of things that used to be within optometry but are slowly fragmenting away.
Dr. Sullins Those things will continue to be the financial underpinning of optometry. That doesn't mean we can't expand. We can't afford to be thought of as second-class physicians. We have to provide leadership to make sure our educational institutions and new practitioners understand our niche.
Dr. Bennett: If the soft lens trend continues, I see fitting being done by technicians and lenses being sold over the counter as a commodity.
Dr. Potter: What are the most significant forces in the contact lens and eye wear business today that could influence the future practice of optometry?
Dr. Bleything: Everybody's trying to make a bifocal contact lens, and nobody's pulled it off yet. Also, look for new applications in sports vision. We need to look for continued opportunities to apply the science of optometry. I am concerned that while we have enlarged our scope to include ocular disease, we have not supported this with a research base. We have a good research base for vision science and other aspects of eyecare, but we are still borrowing other people's ocular disease literature. This puts us into a softer position. We need to build a research base behind our work in this area.
I see less dedication to professionalism now. As managed care takes control away from us, I fear ethical principles may take a back seat because we're losing control of professional care decisions.
Dr. Davis: Managed care and the lack of development of breakthrough contact lens products have had a definite effect on contact lens practice. Refractive surgery will become more accepted, but I don't believe it will be a significant factor. There will be other noninvasive procedures to correct refractive errors other than photorefractive keratectomy (PRK) or contact lenses as we know them today. We must be alert to legislation by opticians that will affect the practice of contact lenses by optometry. We must learn from the past and remember that where there is a void, others will fill it.
When physicians did not accept contact lenses, that helped optometry to become successful. What is optometry going to be? If you want to be an optometrist, be one. But don't be a junior ophthalmologist. You can't be an expert in everything. It is estimated that 13 million contact lens wearers have dropped out because of dry eye or other reasons. New developments will help dry eye patients wear contacts successfully, which will increase the number of lens wearers dramatically. I also believe the genetic causes of myopia and keratoconus will be ferreted out.
I think there is a void in the teaching of contact lenses; students don't want to fit rigid lenses because it's more difficult than fitting soft lenses. There should be specialty clinics for students who are interested in contact lenses. I would say that fitting contact lenses is 70% science and 30% art. Graduates come to our office and don't understand the basics. There should be a clinical setting where there's hands-on training as well as training in the science of contact lenses and sophisticated designs. There should be training in lenses for keratoconus, bifocals and torics made in rigid gas-permeable materials, so graduating optometrists can come into clinical practice with skills. It's easier to fit and teach soft lenses. But to be a successful fitter, you have to understand rigid lens design and its function on the eye, which will relate to all materials.
Dr. Borish: I agree. I have been in different school clinics. Students have no idea of the fundamentals.
Dr. Potter: What about refraction? Same problem?
Dr. Borish: Refraction is understanding the coordination of the eyes as much as the lens optics of the eye. Nobody pays attention to those things anymore. But how do you proportion what you've got to teach in the present curriculum?
Dr. Hopping: With difficulty. None of us knew how to do most of this when we graduated, and we're the experts. We built on a basic knowledge. Today's graduate has more clinical time alone than the entire curriculum was up through 1970. They're coming out with more patients under their belt and a better scientific background, but they cannot be expected to be experts right away. None of us were. There's a human limit to what they can do.
Dr. Sullins: The most significant force in the contact lens business is managed care. And because of that and the pay-me-now phenomenon, you're going to see a decrease in research and development. That's hurting the industry. I think that PRK and laser in situ keratomileusis are bringing about changes in corneal physiology. There's no one here who doesn't believe optometry must take its rightful place in deciding the long-term effects of what is being done to human corneas, as we did in the prospective evaluation of radial keratotomy [PERK] studies.
As for the future, we must be vigilant in optometric research. Surgeons don't like taking care of glaucoma and don't know anything about contact lenses. They steer away from chronic diseases because there's no sex appeal. ODs must assume those roles. But I fear we're not producing aspiring leaders who want to change the world. We must instill in our young people that when you leave the things you've come from, you leave a vacancy for someone to move in.
Dr. Bennett: Managed care and contact lenses can mix. There's the continued perception that contact lenses are something you go into a store and buy in quantities, and you throw them away at the end of the day or week. I think the contact lens future can be a downer. The same thing holds true for spectacles unless we recoup the field of vision science. We have to get away from the infatuation with medicine.
Dr. Davis: I don't agree with the consumer factor of contact lenses. Disposable wearers have about 20% of the U.S. market share. Their market share isn't significant, however, their usage level is huge.
Dr. Bennett: But the market share of soft lenses is significant. I can go to Walmart and buy a soft lens from nearly any company, and it's a commodity. They've taken the profit and professionalism out of it.
Dr. Borish: I said years ago that soft lenses took away most of the aura and the skill in fitting contact lenses. Students come up to me in clinics and say, "Would you help me fit this patient?" It's like a salesman trying on different shoes. They try to find an eye that a lens works on rather than determining which lens fits the eye.
Dr. Bleything: Dr. Sullins is right in that we need more planners. We need optometrists in health policy positions, people working for the Department of Health and Human Services and at the state level. Also, we need graduate professional and degree programs in interdisciplinary settings with people who are in neurorehab interacting with physical medicine, neurology and geriatrics to develop those disciplines in optometry. And we need people doing graduate research in materials, molecular biology and neuroscience. Our plan should be aimed toward these goals to bring us into the next era.
Dr. Potter: How do we get future leaders for optometry?
Dr. Hopping: We're doing it. We just did a summit series of eight conferences that laid out master plans to the year 2000, and that was 18 organizations and 400 or 500 people. There are remarkable things resulting from that summit. We must have groups that come together and lay out master plans. And that's the great strength, as Dr. Sullins said, of this profession.
There are leaders today, but they're different. There are many people younger than 40 who have done remarkable things. They can't rise to the surface in this changing health care pattern. They have to survive economically. But when you see Bonderud in Montana come along and put a comanagement system together that does two-thirds of the Medicare dollar in the state at a clinic driven by optometry, that's remarkable. I'm bullish on the future.
Dr. Sullins: Me too, but if you look at the AOA House of Delegates where many of us cut our teeth, there's not a lot of dialogue there. We need to get involved to develop more people. Some thing happens from the time we lose our brightest students until they come back (in smaller percentages than we'd like) to changing the destiny of the profession. We ought to pick 15 or 20 people per generation and push them to the top.
Dr. Bennett: We need visionaries, who are different than planners or leaders. We need someone who looks ahead. They're not in the House of Delegates or in the AOA trustees. Those people are tied up attending meetings, so there's no time for them to be visionaries. We need people with gray hair to sit back and say, "Where are we, and where can we go?"
Dr. Sullins: The way I was going to do it is by using our people who have got some tenure and giving them some opportunity to sharpen their teeth. People like Dr. Hopping have given a lifetime. The young people today are different as far as the commitment they're willing to make. They want to give a 3-year, 5-year, even, at maximum, a 10-year period of their life and then go back to raising kids.
Dr. Bleything: You're right. We do a profile on entering classes, and there's a shift over the years in the personalities of people entering our profession. They're more engineer, hands-on thinkers, people who want the facts and want to make a living, as opposed to being intuitive future thinkers. That's worrisome. But the cost of education now is extremely high. When they graduate, their options are more limited than ours were. They're in debt, and they need a job. They're not given freedom to explore. We don't have enough people going on for graduate work in health policy, because they don't have that option anymore.
Dr. Hopping: And because of the cost and pace of business today, you can't afford to screw up, while our generation could afford to flounder for a while. But their options today are much greater than what we had.
Dr. Borish: But most of us grew up in an era when we were driven by the desire to improve our positions, and we felt we had to take the profession with us to do that. Today's kids enter a much better profession. When optometrists reacted to deprivation and to prejudice, that made many of us fight. Today the profession is so good that perhaps they don't have the same motivation.
Dr. Davis: It seems to me that young people coming out of school don't have the entrepreneurial drive my generation did. They seem more content in a working environment.
Dr. Hopping: That's America, not optometry. They're not backed against a depression. Leaders can be developed, and leaders are there. We need to concentrate on creating visionaries, unique individuals who can see out 20 years and have the faith to put the pieces together.
Dr. Borish: You're right. Sometimes what's needed is that you have to have people like the group of you in constant contact with young people who might have the potential for this. I'm a great believer in the preceptorship system. If you see kids on a corner, one of them is the leader. Nobody elected him, nobody appointed him. We've got to find the kid who has it.
Dr. Bennett: The visionary and the leader are different. A leader, I realize, has to guide and has to see the big picture. But there are very few who look at things from an entirely different standpoint, who disregard tradition. They are the visionaries.
Dr. Bleything: The leaders and visionaries are there. They need a field to be planted in and someone to cultivate them. That's where the profession needs to take more responsibility. When the House of Delegates has to recruit people to run for national offices, that bothers me. I see a lack of zeal at the association level, but the raw material is being graduated. Something needs to encourage the development of these people.
Dr. Borish: Throughout the years, somehow the profession developed leaders. Whether we continue to do this I can't say, but when emergencies arise, somebody will face them, and if not, anything we say here won't do the profession any good.
Dr. Davis: I have great confidence in young people. I think the people we need will be there.
Dr. Hopping: I agree people will rise to the occasion as leaders, but that doesn't mean they're visionary, as Dr. Bennett said. The preceptorship approach can help young people learn from the older generation. Where do you go after you graduate except into the field? We need think tanks. If you are around a Bennett or a Borish, things rub off, and if that's combined with some of these people's innate abilities, it geometrically progresses.
Dr. Sullins: I have no doubt we can meet any challenge full force and win, but I would like to be more proactive in placing people in positions of authority. Because we are a young profession we have little or no advocacy at health policy determination tables. We need to bring together great minds and enormous experience so our leaders and future leaders can interact. We ought to be more proactive in creating a center for optometric analysis and debate and discussion about issues.
Dr. Bennett: I love this profession, but I'm concerned about the long term. That's probably why I injected the word "visionary." I remember when Henry Hofstetter and Borish started a think tank in Bradfordwoods, Ind. We started a similar thing in Pennsylvania called Allenberry. Those informal meetings allowed us to project things that were far beyond our realm of what we thought would become reality, yet some of those did become reality. We cannot look for that in the AOA Board of Trustees. They're dedicated and they spend considerable time for us, but their environment is small town. If anything could come out of this discussion, it's that we have to bring back the Allenburys and the Bradfordwoods. We have to get people together to sit down and say, "What do we want from our field? What can we accomplish?" The sky's the limit.
For Your Information:
- Harold E. Davis, OD, graduated from Illinois College of Optometry in 1945. In 1984 he was named by the National Eye Research Foundation as "Contact Lens Man of the Year" and was elected as a fellow into the National Academy of Practice. He has lectured and written extensively, and has been selected as a clinical research investigator for numerous Food and Drug Administration studies. He can be contacted at 4663 W. 95th St., Oaklawn, IL 60453; (708) 636-0600; fax: (708) 636-0606.
- Willard B. Bleything, OD, is a professor of optometry and public health/director of international affairs at Pacific University College of Optometry. He also served as dean there for 17 years. Dr. Bleything is the chair of the Future Planning Committee of the World Council of Optometry. He serves as the secretary-general of the Asia-Pacific Council of Optometry. He has been president of his state board, state optometric association and the Schools and Colleges of Optometry. He can be reached at Pacific University College of Optometry, 2043 College Way, Forest Grove, OR 97116; (503) 359-2170; fax: (503) 359-2929; email@example.com.
- Richard L. Hopping, OD, has served as president of the Southern California College of Optometry for 24 years. He is past-president of the Ohio Optometric Association, and served as president of the American Optometric Association (AOA) and the Association of Schools and Colleges of Optometry. He is the only person to receive both the AOA's National Optometrist of the Year and Distinguished Service Awards. He can be reached at the Southern California College of Optometry, 2575 Yorba Linda Blvd., Fullerton, CA 92631; (714) 449-7450; fax: (714) 526-3907.
- Irving Bennett, OD, has practiced optometry in Beaver Falls, Pa., for 45 years. He was editor and publisher of numerous optometric publications including Optometric Management and The Journal of the American Optometric Association. He authored Management for the Eyecare Practitioner. Dr. Bennett originated OptiFair, the forerunner of Vision Expo. Last year he received the American Optometric Association's Distinguished Service Award. He can be reached at 3307 Seventh Avenue, Beaver Falls, PA 15010; (412) 843-2040; or 1520 Pelican Point Dr., Sarasota, FL 34231; (941) 966-1035.
- Irvin M. Borish, OD, was voted International Optometrist of the Year in 1996 by the World Council on Optometry. He holds five patents in the contact lens field, and has filled numerous state and national association offices. He has written the bylaws for a number of agencies, and has been a full-time or visiting faculty member at most of the schools and colleges of optometry. He is one of the original founders of the School of Optometry at Indiana University. He can be contacted at 23371 Blue Water Circle, Apt. 114, Boca Raton, FL 33433; (561) 392-5807; fax: (561) 392-6756.
- W. David Sullins Jr., OD, DOS, FAAO, is president of the Athens, Tenn., Eye Care Clinic. Dr. Sullins is a Rear Admiral, Medical Service Corps, U.S. Navy Reserve and is the only OD to have attained flag officer rank. He is past president of the American Optometric Association and a founding member of the National Academies of Practice in Optometry. He has received the Tennessee Optometrist of the Year and Distinguished Service Awards and has been named Optometrist of the South. He can be reached at 517 N. Jackson St., Athens, TN 37303; (423) 745-4910; fax: (423) 745-2230.
- John W. Potter, OD, can be reached at 18352 Dallas Pkwy., Suite 136, Dallas, TX 75287; (214) 732-6175; fax: (214) 732-1475.
- Drs. Borish, Bleything, Davis, Hopping, Bennett and Sullins have no financial interest in any of the products mentioned in this discussion, nor are they paid consultants for any of the companies mentioned.