NEWS RELEASE, 07/01/98 From jewelry and microscopes to vision care: 75 years transforms optometry at UC Berkeley

By Patricia McBroom, Public Affairs

BERKELEY -- Optometrists began the 20th century often as jewelers who made frames for glasses or lens crafters who fashioned microscopes and surveying instruments. They are ending the century as the nation's primary eye-care doctors, able to not only diagnose disease but treat it as well. A century of work in vision science has transformed the field from a trade into a health profession, and no institution has been more central in providing that research base than the University of California at Berkeley, where the School of Optometry is celebrating its 75th anniversary this year. UC Berkeley researchers did much of the pioneering work on binocular vision, color vision, focusing and alignment, the development of vision in infants, the growth of the eyes in children, the loss of vision in aging, and respiration of the cornea - the only organ other than the lung that can breathe on its own. Not supplied by any blood vessels, the cornea metabolizes oxygen directly from the air. A UC Berkeley graduate produced the first patented hard plastic contact lens for the cornea. A UC Berkeley professor created the first non-invasive method for detecting high pressure in the eye, making screening for glaucoma a regular component of any eye test. For the past half century, since it was formally established in 1941, the School of Optometry on the UC Berkeley campus has been ranked at the top of its field in the nation. But the path has not been easy. "It was a bootstrap operation for many years. We had to fight the prejudice of the medical profession," said Meredith Morgan, 86, a former dean of the school and professor emeritus of optometry. He is honorary chairman of this year's anniversary celebrations. Indeed, to avoid the ire of physicians, Morgan said optometrists in the early years would say, "a lens is not a pill; it treats light and not the eyes." Established in 1923 as a division of the physics department at UC Berkeley, the fledgling optometry program was housed at first in the basement and attic of the physics building. With no money for facilities or equipment, no fellowships for graduate study and no research equipment, UC Berkeley's first vision scientists relied on sealing wax and string. But for all the disadvantages the group might have suffered in terms of space or status, this was a scientist's paradise, a license to try out new "provocative" ideas that provide the seeds of invention, said Elwin Marg, professor emeritus of optometry and an early graduate of the school. Marg was also, in 1950, the first student to earn a PhD in physiological optics (vision science) at UC Berkeley. Still, optometry was not considered a full profession by the federal government, nor the armed services. At the start of World War II, optometrists could not serve as health professionals. They could not dilate the pupil and look inside the eye. They could not prescribe medicines. As the post-war era began, however, all of that was about to change. One of the first to breach the fire wall between optometry and medicine was Marg. In 1959, he announced the invention of a new electronic instrument the size and shape of a very fat pen which could measure intraocular pressure without the need to use anesthesia on the eye. In other words, without any drug or injection, optometrists could gently touch the cornea with the tip of the pen and in a second determine whether pressure inside the eye had built to dangerous levels. Immediately, thousands of optometrists could evaluate millions of patients for glaucoma at a stage early enough to prevent or limit irreversible blindness - an important event in the transformation of optometrists into health professionals. Meanwhile, physiological optics, as the field was known in university settings, was about to take a deep plunge into biology with new work on eye-brain connections. From animal research and studies on infants, UC Berkeley scientists, including Meredith Morgan, began to piece together the story of binocular vision. They discovered that small difficulties in the alignment of an infant's eyes, a "wandering eye", could lead to permanent losses in neural connections to the visual cortex, so that stereoscopic vision would never develop properly. By the same token, correction of these small ocular deviations at an early age could save stereoscopic vision. From these findings, it became an urgent matter to screen the vision of very young children on a routine basis. Beginning in the 1970s, such screening has been carried out by the clinical arm of the School of Optometry, which has tested up to half a million children in the Bay Area since 1972. The testing continues each year. In the same period, immediately after World War II, the first corneal contact lenses were crafted in the workshop of a UC Berkeley graduate by the name of Solon M. "Bud" Braff. It was a hard plastic thing that fit over the cornea and hardly allowed the eye to breathe, but it was a breakthrough. "People would complain that their eyes were hot and their vision was steaming up," said Anthony Adams, current dean of the School of Optometry. "Those first contacts were incredibly uncomfortable, but people endured them for whatever reasons - vanity, I guess. And they did so for many years while we tried to improve them." And improve them they did. UC Berkeley optometrists set to work to discover how much oxygen the cornea needed and how they could get that through the lens. Four decades of work led to gas permeable contacts that solve most of the cornea's respiration problems, but now raise other issues having to do with tear flow and bacterial infection in extended-wear lenses. Berkeley's optometrists now have taken on the difficult task of finding a way to reinstall the eye's natural garbage disposal system - its tear flow - under lenses that sit on the eyeball for as long as a month. Today, optometrists are required by law to diagnose and treat all kinds of diseases - glaucoma, diabetic-related retinopathy and macular degeneration. They detect cataracts and manage patients after surgery. They do pharmacological therapy in all 50 states. Moreover, with an historic agreement reached between UC Berkeley and UC San Francisco last year, optometrists from this school and ophthalmologists from the medical school teach in each other's programs and see each other's patients, breaking down the last vestiges of the old wall between the two fields. "We have now become health practitioners," said Morgan, whose father helped set up UC Berkeley's program in 1923. "We are the entry point into vision care. The boundaries are falling, and it's a good thing." In addition to a gala celebration held last month, the school will mark its anniversary with two scientific conventions in the fall. In November, contact lens scientists and practitioners from around the world will meet here to assess new developments. In December, the school will host an international symposium on vision science, in conjunction with the annual meeting of the American Academy of Optometry in San Francisco.