History of Berkeley Optometry—Part III

1949-1978
Advancing the Curriculum and Research

"We who are alumni of the University of California can, I believe, point with pride to the clinical training program at our school.… I believe that our clinical training takes a back seat to none." 1 —Frederick Hebbard ('49), 1952

 A complete history of Berkeley Optometry is available --- see History Book.

The Master of Optometry (MOpt) Degree

An expanded, five-year optometry curriculum began on September 15, 1948. The revised curriculum combined four years of undergraduate study with a fifth (graduate) year of training in the practice of optometry and advanced instruction in the science of vision. More than half the graduate year was spent in clinical practice — refraction, dispensing, fitting contact lenses, orthoptics and visual training, and examinations of patients with aniseikonia and "subnormal" (low) vision. Students completing their undergraduate years received a BS-Opt and matriculated into the graduate year. Once there, they had to maintain a 3.0 GPA and pass a comprehensive final examination in the fields of optometry and physiological optics before earning a master of optometry (MOpt) degree (members of the first class to do so graduated in 1951). Students who did not meet those standards graduated with their MOpt classmates but retained the BS-Opt.

The Clinical Program, 1950s-1970s

By the early 1950s each student received two and a half years of clinical experience by the time of graduation — second to none among all schools and colleges of optometry. Beginning in 1952, graduate-year students were required to specialize in one of four fields: contact lenses, orthoptics of strabismus, industrial and school vision surveys, or aniseikonia, each accompanied by extended clinical training. In addition, participation in the contact lens laboratory became mandatory in fall 1952.

By 1959, more than five thousand patients received vision care annually in the standard clinic modules at Berkeley Optometry. Another 400 or so patients were treated in specialty clinics (subnormal vision, contact lenses, strabismus). Substantial renovations to the clinic from late 1963 through early 1965 included a new ophthalmic dispensing laboratory, expansion of the contact lens clinic into eight modules, and a new binocular vision facility.

Clinical training and patient care at Berkeley Optometry followed a standard institutional model. By 1964 there were twelve distinct clinic modules: Refraction, Dispensing Problems, Contact Lenses, Squint Diagnosis, Aniseikonia, Orthoptics, Subnormal Vision, Ocular Pathology, Glaucoma Detection, Color Vision, Ocular Photography, and Extended Service.

As clinic director in the early 1970s, Monroe Hirsch (1917-1982; Class of '40; dean 1973-78) introduced a scheme in which the clinic was divided into a number of comprehensive-care modules, each run like a private practice. Berkeley Optometry was the first optometry school or college to put the modular system into operation and to attempt to determine its effects on an empirical basis. Previously, eye care was rather fragmented, requiring patients to shuttle among various clinics in order to complete their comprehensive examinations. With the reorganization, each module was designed to provide full-scope vision care. Specialty clinics continued to operate, but as referral services when advanced diagnosis or a series of follow-up therapeutic visits were required.

Selected Faculty of the 1950s–1970s

For many students, Merton C. Flom (1926-2010; Class of '51, PhD '57) was the best teacher they ever had (they prided themselves on being "Flom trained"). He was imaginative, entertaining, organized, and dynamic — a born story teller and master lecturer. He could take a difficult subject such as binocular vision and without relaxing academic standards, make it fun and memorable. Flom was also a key figure in physiological optics research at Berkeley, where he served on the faculty from 1951-1980. In September 2005, the Class of 1980 established the Merton Flom Teaching Award. Flom was President of the American Academy of Optometry (1981-82) and editor of its journal, the American Journal of Optometry and Physiological Optics (1976-1978). In 2006 Flom was elected to the National Optometry Hall of Fame, and in 2007 the American Optometric Foundation announced an ongoing pledge drive for the newly established Merton Flom Ezell Fellowship in Leadership.

One of Berkeley Optometry's fine early practitioners of contact lenses was Robert L. Lester (1916-2000; Class of '41). Lester established the contact lens clinic at Berkeley in 1949 and served as chief of contact lens services until 1962. In 1949 he also took over the contact lens laboratory previously taught by Meredith Morgan (see Morgan discussion below).

Another first-class clinician-educator was Morton Sarver (1922-1986; Class of '47, MS '62) who became chair of the contact lens curriculum committee in 1961. The following year he assumed the role of chief of contact lens services (taking over from Lester). Perhaps the best-organized clinical instructor ever to teach at Berkeley, Sarver directed or participated in the basic contact lens course for 25 years (instructing more than 1,500 students) and presented over 150 continuing education lectures to practitioners.

Henry B. Peters (1916-2000; Class of '38) was appointed the first full-time director of clinics in 1962. Peters published nearly eighty journal articles and book chapters, focusing on optometric education, pediatric optometry, binocular vision disorders, and healthcare policy. As assistant dean of Berkeley Optometry, Peters worked with dean Meredith Morgan in establishing the OD degree at Berkeley (see Morgan discussion below).

Peters was a key participant in and coauthor of the celebrated Orinda Study (1959), a statistical survey of 1,221 children in Orinda, California, and the brainchild of Berkeley Optometry faculty. The study became a model for testing the visual health of school-aged children, leading to refinements and the development of vision-screening programs used throughout the U.S. Peters was elected president of the Association of Schools and Colleges of Optometry for two consecutive years, 1967-69. In the summer of 1969, he left Berkeley to become the founding dean of the University of Alabama, Birmingham, School of Optometry.

Academic and clinical training in low vision thrived under the guidance of two generations of renowned faculty. Edwin B. Mehr (1920-1993; Class of '41) was a founder of the Western Blind Rehabilitation Center (part of the Veterans Administration Medical Center) in Palo Alto, where he also mentored Berkeley Optometry students during their training visits. The center developed into the premier low vision clinic in the U.S. Mehr, along with Allan Freid (Class of '52; born 1928), coauthored Low Vision Care (1975), an important text in the field. Freid was also a member of the Berkeley Optometry clinical faculty from 1959-85, serving as director of the glaucoma clinic 1961-68 and as a clinician in Berkeley's low vision clinic 1968-85 (director from 1970-75). The next generation of low vision faculty was headed by Ian Bailey (born 1940), who in 1974 developed (along with Jan Lovie) the Bailey-Lovie logMAR chart, whose principles have since been adopted as the gold standard worldwide for testing visual acuities, especially in low vision clinics. Bailey joined the Berkeley faculty in 1976. At Berkeley, Bailey became a leader in research applied to the development of low vision aids, with many of his publications considered important papers in the understanding and treatment of vision impairment.

Selected Vision Science Research (Berkeley Optometry) in the 1950s–1970s

More than twenty research projects were underway by 1953-1954, including studies of the retina and central visual pathways, fixation disparity, strabismus, orthoptic methods, mechanism of reflex accommodation, convergence-accommodation, physiological nystagmus, and color blindness. After the early 1950s and continuing until the present day, vision science research at Berkeley expanded and developed into a multidisciplinary and collaborative program involving various departments on the Berkeley campus. A detailed accounting of the range of vision science investigations during the 1950s-1970s is beyond the scope of the present synopsis. What follows is merely an identification of selected faculty who conducted notable research during that period.

Gordon L. Walls (1905-1962; ScD 1931 University of Michigan), author of the classic The Vertebrate Eye and its Adaptive Radiation (1942), joined the Berkeley faculty in January 1947. Walls published more than sixty journal papers, monographs, and books, among them the monographs A Theory of Ocular Dominance (25pp, 1951), The Problem with Visual Direction (101pp, 1951), Fundamentals of Vision, Binocular White from Red and Green, and the Three-Component Theory — The Common-Sense Horopter (18pp, 1952), New Means for Studying Color Blindness and Normal Foveal Color Vision (172pp, 1952), The Lateral Geniculate Nucleus and Visual Histophysiology (100pp, 1953); and Typical Total Color Blindness Reinterpreted (55pp, 1954).

Elwin Marg (1918-2010; Class of '40; PhD '50) was the first-ever recipient of a PhD degree from Berkeley Optometry. He published ninety-nine papers in such areas as imaging visual function, visual evoked potentials and infant vision, automated (computer) refraction, single neural unit stimulation and recording from the human brain and functional visual prosthesis, visual neurophysiology and the accessory optic system, ocular electronystagmography and electroretinography, and tonometry and other instrumentation. The latter led to a ground-breaking invention in 1959, the Mackay-Marg Tonometer, which provided optometrists with a reliable method for the measurement of intraocular pressure (IOP) without the need for topical anesthetics (at the time off-limits to optometry).

Convergence and accommodation were the concerns of several faculty, such as Merton Flom (1926-2010; Class of '51, PhD '57; faculty 1951-1980). In 1960 he received Berkeley Optometry's first grant from the National Institutes of Health, for the study of spatial localization in subjects with "deviated eyes" (strabismus). Flom's subsequent research followed several paths, including investigations into the role of eccentric fixation in amblyopia, the effect of interacting contours on visual acuity, and the nature of anomalous retinal correspondence.

Clifton Schor (born 1943; Class of '66 MOpt; OD '68; PhD '72; faculty 1977-present) studied with Flom. His early faculty research at Berkeley investigated abnormal eye movements in strabismus and amblyopia, as well as neural plasticity of sensory motor interactions and how that applies to the field of orthoptics, or the rehabilitation of binocular vision disorders.

Gerald Westheimer (born 1924; OD Sydney Technical College, Australia; PhD 1953 Ohio State University) came to Berkeley Optometry in 1960 as a visiting associate professor, and was granted tenure in 1961. Westheimer remained at the School until 1967, when he transferred to the Department of Physiology-Anatomy at Berkeley (in 1989 he became the founding head of the Division of Neurobiology in the Department of Molecular and Cell Biology). Westheimer's research included linear systems analysis of saccadic and smooth-pursuit eye movements and explorations into various aspects of human spatial vision (sensitization). To this day Westheimer remains the only optometrist to have been elected a Fellow of the Royal Society (FRS in 1985).

Horace Barlow (born 1921; BS-Med and BS-Surgery Trinity College, Cambridge; MD Harvard University) joined the Berkeley Optometry faculty in 1962, remaining until 1967 when he transferred, along with Westheimer, to the Department of Physiology-Anatomy at Berkeley. A great grandson of Charles Darwin. Barlow made a landmark discovery in 1953 when he demonstrated that single nerve cells in frog retina respond to trigger features related to survival. In the 1960s at Berkeley, Barlow and William Levick, MD, elaborated upon this area of research by showing that single nerve cells in rabbit retina fire only when trigger features move in a particular direction (visual inhibition to avoid redundancy via direction-selective ganglion cells), one of the computational aims of motion perception.

Lawrence Stark, MD (1926-2004) joined the Berkeley Optometry faculty in 1968. Stark's achievement during his long career at Berkeley was characterized by seminal research in applying engineering principles to biological systems, especially control theory. He was among the first to do this, conducting research into the way a pupil reacts to light with respect to linear control, which had applications in understanding how pilots control airplanes and why people suffer from motion sickness.

Ralph Freeman (born 1939; OD 1963 Ohio State University School of Optometry; PhD Biophysics UC Berkeley 1969) joined the Berkeley Optometry faculty in 1969. Freeman's early research explored central visual pathways. He also studied visual plasticity and development, an area of investigation emerging from clinical observation of visual disorders in humans.

Theodore Cohn (1941-2006; PhD, Bioengineering, University of Michigan) was appointed in 1970 as an assistant professor of optometry and physiological optics. Intrigued by the brain's ability to detect weak signals from noisy environments, he was possibly the first to apply the principle of signal detection to physiological systems. Cohn found practical applications for his signal detection theory. In particular, he worked in the field of transportation engineering during the last fifteen years of his life, focusing on such issues as transportation accidents and their prevention.

Sheldon Miller (born 1937; PhD, Biophysics, University of Michigan; Berkeley Optometry faculty 1976-2002) focused his research on under-standing the regulation and function of epithelial layers throughout the body, developing animal models of retinal disease to help establish therapeutic interventions.

Richard C. Van Sluyters (born 1945; OD 1968 Illinois College of Optometry; PhD 1972 Physiological Optics, Indiana University; Berkeley Optometry faculty 1975-present) is a third-generation optometrist whose grandfather was one of the pioneering refractive opticians in Michigan. Van Sluyters' early research was primarily in visual development of connections in the central visual pathways of mammals. In particular, he investigated how abnormal visual experience (such as monocular deprivation or strabismus in kittens) affected the response properties of single neurons in the visual cortex, and whether those responses were guided by environmental or genetic factors.

In the area of cornea and contact lens research, Berkeley Optometry was virtually the "center of the universe" during the 1960s-1980s. Before this period, one of its graduates (Edward Goodlaw, Class of '34; born 1913) had been the first to publish a scientific article (1946) identifying contact lenses as a potential barrier to anterior oxygen supply. Goodlaw also helped pave the way for the first corneal contact lenses made by Kevin Tuohy (1921–1968) in 1948, a Los Angeles optician in practice with Berkeley Optometry alumnus Solon "Bud" Braff (Class of '37, 1914–1994). However, it is the names of Berkeley Optometry faculty specializing in cornea and contact lens research that reads like a who's who in the field. The Berkeley researchers, exemplified collaborative effort toward a common goal as they followed three primary paths in investigating corneal physiology during contact lens wear: (1) oxygen transmissibility (Dk) and permeability (Dk/t), developed by Irving Fatt (1920-1996; PhD, Chemistry, 1955, USC); (2) equivalent oxygen percentage (EOP), developed by Richard Hill (Class of '58, PhD '61); and (3) optical pachometry, developed by Robert Mandell (OD, Los Angeles College of Optometry, 1956; PhD, Physiological Optics, Indiana University, 1961). Morton Sarver (1922-1986; Class of '47; MS '62) and Kenneth Polse (Class of '65 MOpt; OD '68; MS '69) were also key contributors to the field of cornea and contact lens research.

Deans of Berkeley Optometry, 1960s–1970s

Meredith W. Morgan, Jr. (1912-1999; Class of '34; PhD Physiology, UC Berkeley, 1941) served as acting chairman (1959-1960) and then became the third dean of Berkeley Optometry (July 1, 1960 - June 30, 1973). Morgan joined the Berkeley Optometry faculty as an instructor in 1942; he became an assistant professor in 1944, associate professor in 1949, and professor in 1951. Morgan had an active research program, especially during the first part of his career, publishing articles in physiological, optometric, and ophthalmological journals. He understood optometric education and training within the context of the profession not being a part of medicine, but "rather … the clinical application of physiological optics." In 1966 he expanded the optometry program from the MOpt to the OD degree, awarding the doctoral degree to an entire class for the first time in 1970. Morgan tirelessly championed the profession of optometry as a health science, not a physical science or merely a branch of physiological optics.

Morgan led the expansion and development of biological research on the eye and vision at Berkeley into a more significant multidisciplinary pursuit. He recruited distinguished basic science faculty who helped establish Berkeley as a center for worldclass vision science research. He served as president of the American Academy of Optometry for two years (1952-1954). Of the first sixteen chairmen/presidents, Morgan was the first who was primarily an educator, marking the start of the modern trend toward educators rather than practitioners leading the academy.

The fourth dean of Berkeley optometry was Monroe J. Hirsch (1917-1982; Class of '40; PhD Physiology, Stanford University). While maintaining a private optometry practice in Ojai, California, Hirsch had a brief tenure at the Los Angeles College of Optometry (1949-1953) as an associate professor and researcher, where he helped redesign the curriculum, forming the basis of modernized optometric education in what would become the Southern California College of Optometry (1972). Beginning in 1955, Hirsch would visit the school several times a year to lecture and interact with students and faculty. Berkeley Optometry dean Kenneth Stoddard especially admired Hirsch's Ojai Longitudinal Study (interim reports first appeared in the early 1960s), a long-term investigation into refractive error conducted in his optometric practice and in the schools of Ojai. Hirsch was elected president of the American Academy of Optometry, serving two terms (1967-1969). By 1967, Dean Meredith Morgan persuaded him to join the Berkeley Optometry faculty on a more regular basis, agreeing to be in residence each spring semester for three years. This led to Hirsch's becoming Director of Clinics in 1970. He succeeded Meredith Morgan as dean on July 1, 1973.

One of Hirsch's notable achievements, begun while still clinic director, was replacing the old-style institutionalized system of a teaching clinic divided into various discrete units (see modular system above). With modifications, it remains in effect to this day. Hirsch also completed the planning and nearly all of the construction of Minor Addition (see next section). Unfortunately, Hirsch's tenure was brief, cut short by cancer. When illness forced him to relinquish his daily activities as dean, Professor Robert Mandell served as acting dean in 1977-1978 and again in 1979-1980. Professor Irving Fatt did the same during the intervening academic year (1978-1979). Hirsch's official tenure as dean ended on June 30, 1978, and he passed away in January 1982.

Minor Addition

From its earliest days in Le Conte Hall, Berkeley Optometry had been challenged by inadequate space. The program benefited from significant expansion of facilities after the renovation of the Optometry Building was completed in 1953.

During the 1960s, enrollment of optometry students increased nearly 250 percent and full-time faculty more than doubled, while space (including temporary acquisitions of offices and laboratories) had increased by less than 50 percent.

By the late 1960s, lack of sufficient space was handicapping Berkeley Optometry's ability to teach and train students in optometry (OD) and physiological optics (MS and PhD), conduct research, expand enrollment, attract new faculty, and provide oversight and administration.

After a protracted struggle with obtaining funds from the State of California, and after a successful fundraising campaign, Berkeley Optometry had a second building, named Minor Addition. The first floor (below ground level at the downward end of a hill) was designed to hold pathology and low vision clinics, plus animal quarters for research laboratories (the latter were relocated to a different facility in 1992-93). General examination clinics were placed on the second (ground level) floor, with the contact lens clinic on the third floor, along with some administrative offices. The fourth and fifth floors housed faculty offices and research laboratories, as well as the alumni office. All told, the new building added 30,000 square feet to the school's facilities for training clinics, classrooms, research laboratories, patient reception and care, and offices.

Other Milestones 1950s–1970s

Optometry Alumni Association

A postwar resurgence after years of relative inactivity brought overall participation in the alumni association from only nineteen dues-paying members in 1946 to one hundred sixty-two in 1951. After a new constitution was adopted in 1947 (guided by Irv Silberstein, Class of '42), activities also expanded in scope, including the introduction of student scholarships and implementation of educational programs. The "Annual Meeting Program" with continuing education (CE) was established on November 17, 1951; it has been held annually ever since. The association established the Alumnus of the Year Award during the presidency of Frederick Hebbard (Class of '49; PhD 1957; alumni president 1952-54) when it presented the first award to Meredith W. Morgan Jr. (Class of '34; dean 1960-73) in 1953. The Optometry Alumni Association of UC (OAAUC) reorganized as an independent non-profit corporation in 1964. [The independent OAAUC was dissolved and reformed as the Berkeley Optometry Alumni Association (BOAA) on July 1, 2011 under the direction of the Office of the Dean, School of Optometry.]

Prepaid Vision Care

In the early 1950s, Richard Peters (1918-2008; Class of '40), Henry Peters (1916-2000; Class of '38), Bernhardt Thal 1917-1999; (Class of '48), Roy Brandreth (Class of '53, born 1922), and other Bay Area optometrists were intrigued by a new challenge: offering insurable vision care in a manner similar to healthcare plans such as Blue Cross and Blue Shield. In June 1955 they made a proposal for the Alameda association to underwrite the plan, called California Vision Services (CVS). On September 30, 1955, CVS filed Articles of Incorporation with the State of California. Initially, CVS courted union officials to gain approval from organized labor and establish vision coverage as part of employee benefits programs. CVS also worked with management trust funds and school districts. Progress was slow at first, as prepaid vision coverage was an untested idea, but by the late 1960s, substantial growth had taken place. CVS was renamed Vision Service Plan (VSP) in 1976, and the following year VSP had its first contract with a health-maintenance organization, thus entering the managed-care market. By the 1980s, VSP membership had grown to around eight million members with a network of 5,000 participating doctors. By 2010, enrollment had reached 55 million members. Today, VSP has more than 4,000 employees and greater than $2 billion in annual revenue.

References