#21: Dr. Haffner & the LaGuardia Meeting that Changed Everything

[AdminWolf]

Episode 21: Dr. Norman Haffner & the LaGuardia Meeting that Changed Everything

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Former dean of the SUNY College of Optometry & genuine "Optometric Living Legend", Dr. Norman Haffner sits down with us to talk about optometric history, and the fateful day in January 1968, when he was part of a clandestine meeting that took place in a LaGuardia Airport hotel room.

That meeting shook eye care to its foundation, and it was the day that changed optometry from a purely vision care profession to a true health care profession.

If you've ever wondered how you came to have prescribing rights, Dr. Haffner goes over the long bloody struggle, and tells what it was like to be at the center of it all.

The outspoken Dr. Haffner also goes on to talk about the current state of eye care, the AOA, and the current board certification issue.

Feel free to ask follow-up questions of Dr. Haffner & leave comments in this thread.

 

[Bill C. Thompson OD]

Wow

Wow!

 

[AdminWolf]

Wow!

heh.. "Wow good", or "Wow, what did I just listen to?!"

 

[Mark Bullimore]

Recommended Listening

Outstanding job guys.
Dr. H doesn't pull any punches and does an excellent job of identifying the key challenges (with the possible omission of the ACA) facing our profession.

 

[Merrill Bowan]

I've been talking about this LaGuardia thing for 7 years!

I've mentioned this a bunch of times before. I saw the whole thing transpire from a different direction.

http://www.odwire.org/forum/threads/6786-Donation-to-ODWire-com?highlight=allenberry

Here's what I understand: In 1965, I worked doing VT for Milt Eger, right after he'd been named Editor of the JAOA. He and a few others had a secret meeting at the Allenberry Conference Center. They had just preplanned another secret meeting that occurred about two years later, at LaGuardia.

Eger MJ. Now it can and should be told. J Am Optom Assoc. 1989 Apr;60(4):323-6. No abstract available. PMID: 2723329 [PubMed - indexed for MEDLINE]

The idea was to lay out a strategy for beginning the introduction of diagnostic and therapeutic drugs into optometric practice. By 1974, West Virginia became the first state to pass an optometric therapeutic law. Milt came back from Allenberry, was dancing in his seat. "Optometry is going to get diagnostic and therapeutic drugs, Merrill!"

"Why?" I asked, "When most optometrists don't know how to practice optometry properly!" (I was a smart-mouth from early on....)

"So we get the respect we deserve!"

Ah!

We've been chasing the bright elusive butterfly of respect.

It was hubris, not market or intellectual goals drove that initial foray into the curricula changes that led us to where we now are: mini-OMD's, but still dissatisfied with the respect that we (don't) get. The average practice in the 70's saw about 1200 patients a year, now we see 2200, give or take. Better care? (More toys, for sure!) Maybe, but mostly just faster care. Can't slow down to actually talk to the patients (for cause, perhaps, in cases like Richard Hom's situation). Less loyalty among patients. Higher grosses, higher cost of delivery, less net %-age at the bottom line.

Low vision affects how many?

2%? 5%? 10%? -- 1%?

Pathology, for sure: maybe a whopping 10%.

The right (meaningful) questions start with: what unidentified visual needs are there in the populace? Refractive error for sure, low vison for sure, ocular path for sure, but is there a need that is being overlooked? A problem that exists in, oh say, 22-30% of the population?

Higher order visual processing problems as it affects behavior and perception is not popular in our vocation, but it is no less valid as a dimension of our art and science. Post-concussion syndrome is addressed marvelously with microprisms and convergence therapy -- NOBODY else is in a position to even begin to deal with it, but whether you feel inclined to do so or not, you ARE.

God forbid that we drop the ball, but head injury is definitely in our bailiwick.

Do you, as a trained vision professional, see visual processing as a dimension of your profession's concern? Why or why not?Since I wrote the above italicized response, my understanding has changed about VT -- PPTVS has ben added in, and at least half of my patients are now TBI's - it's bigger than I ever dreamed.

Anyone?

 

[Merrill Bowan]

...of great changes.

The great change in optometry has yet to come.

What happened at LaGuardia was merely a mouse roaring at a big bully. Changes occurred, but only because the Medical Bully couldn't defend its indefensible position, not because we had something new and unique to offer the consuming public.

VT is not embraced, I believe, because of the "Corporate Antibodies" who diss anything that they haven't invented (you know, the "not invented here syndrome?"), not because of any lack of evidence. The idea of Evidence-based Science sounds great, but there are serious criticisms of the whole EBM concept, I've mentioned them here before (David Hunter's "Must we have evidence for everything?").

In my critique of the AAP/AAO/AAPOS position paper on vision and reading, I cite over 250 references with positive results in the correlation of Vision and Reading. (Realize that the 42-year position of medicine has been that there is NO correlation of vision to reading. True story.) That is beginning to change, with a French study, among the few that have been published:

Vision Res. 2013 May 18. pii: S0042-6989(13)00127-2. doi: 10.1016/j.visres.2013.05.006. [Epub ahead of print]Gaertner C, Bucci MP, Ajrezo L, Wiener-Vacher S. Binocular coordination of saccades during reading in children with clinically assessed poor vergence capabilities.
​

Also,

Predicting Cognitive State from Eye movements: http://www.plosone.org/article/fetc....1371/journal.pone.0064937&representation=PDF


​

Medicine is starting to move in on the turf that we (or, at least some of us) have claimed as unique to optometry.

We need another LaGuardia meeting, somebody let our "keen observer" Dr. Haffner know, OK?

 

[Jonathan Warner]

I've mentioned this a bunch of times before. I saw the whole thing transpire from a different direction.

http://www.odwire.org/forum/threads/6786-Donation-to-ODWire-com?highlight=allenberry

Here's what I understand: In 1965, I worked doing VT for Milt Eger, right after he'd been named Editor of the JAOA. He and a few others had a secret meeting at the Allenberry Conference Center. They had just preplanned another secret meeting that occurred about two years later, at LaGuardia.

[SIZE=-1]Eger MJ.[/SIZE]

Now it can and should be told.
[SIZE=-1]J Am Optom Assoc. 1989 Apr;60(4):323-6. No abstract available.
PMID: 2723329 [PubMed - indexed for MEDLINE][/SIZE]

The idea was to lay out a strategy for beginning the introduction of diagnostic and therapeutic drugs into optometric practice. By 1974, West Virginia became the first state to pass an optometric therapeutic law. Milt came back from Allenberry, was dancing in his seat. "Optometry is going to get diagnostic and therapeutic drugs, Merrill!"

"Why?" I asked, "When most optometrists don't know how to practice optometry properly!" (I was a smart-mouth from early on....)

"So we get the respect we deserve!"

Ah!

We've been chasing the bright elusive butterfly of respect.

It was hubris, not market or intellectual goals drove that initial foray into the curricula changes that led us to where we now are: mini-OMD's, but still dissatisfied with the respect that we (don't) get. The average practice in the 70's saw about 1200 patients a year, now we see 2200, give or take. Better care? (More toys, for sure!) Maybe, but mostly just faster care. Can't slow down to actually talk to the patients (for cause, perhaps, in cases like Richard Hom's situation). Less loyalty among patients. Higher grosses, higher cost of delivery, less net %-age at the bottom line.

Low vision affects how many?

2%? 5%? 10%? -- 1%?

Pathology, for sure: maybe a whopping 10%.

The right (meaningful) questions start with: what unidentified visual needs are there in the populace? Refractive error for sure, low vison for sure, ocular path for sure, but is there a need that is being overlooked? A problem that exists in, oh say, 22-30% of the population?

Higher order visual processing problems as it affects behavior and perception is not popular in our vocation, but it is no less valid as a dimension of our art and science. Post-concussion syndrome is addressed marvelously with microprisms and convergence therapy -- NOBODY else is in a position to even begin to deal with it, but whether you feel inclined to do so or not, you ARE.

God forbid that we drop the ball, but head injury is definitely in our bailiwick.

Do you, as a trained vision professional, see visual processing as a dimension of your profession's concern? Why or why not?Since I wrote the above italicized response, my understanding has changed about VT -- PPTVS has ben added in, and at least half of my patients are now TBI's - it's bigger than I ever dreamed.

Anyone?

Pathology affects a lot more than 10% of the population in any area you practice.

 

[Merrill Bowan]

New pathologies...

Pathology affects a lot more than 10% of the population in any area you practice.

...walking around on the street, comprise no greater than 10% of the population. To make the number larger, you add it to the ones already under care.

As I've referenced here before, functional vision problems needing care comprise 22% of the general population and 30% of a college population. How many of that population would you think are under care already?

Just wunderin'....

 

[Jeremy Gerritsen]

functional vision problems needing care comprise 22% of the general population and 30% of a college population.

Merrill We all realize that you are a passionate behavioral OD. But really 10% eye disease which can potentially blind people gets dismissed for 22% of people with "discomfort".

And I don't mean the <1% of people with true vergence or accommodation issues due to PATHOLOGY.

 

[Merrill Bowan]

...of pathology Kool-Ayd...

Merrill We all realize that you are a passionate behavioral OD. But really 10% eye disease which can potentially blind people gets dismissed for 22% of people with "discomfort".

And I don't mean the <1% of people with true vergence or accommodation issues due to PATHOLOGY.

Let's step back from this like good little pragmatists.

When I was in optometry school back in the Dark Ages, we were taught to recognize pathology classify it, and refer it to an appropriate medical clinician. We did that well and often, and our malpractice insurance cost us $200 a year. Why? Because we were DAMNED GOOD at what we were trained to do!

The largest optometric lawsuit I've heard of was the one where a FL OD diagnosed a prior (as I understand) 12-YO patient with amblyopia when she actually had a brain tumor. Proper understanding of developmental vision issues would have caused his left eyebrow to twitch and he would have either: referred to a neuro-ophthalmologist, or, referred for amblyopia training which would THEN have revealed the initial error in diagnosis (just in case I need to mention it: amblyopia doesn't develop at age 12). It was his ignorance of vision development that caused the problem, NOT a pathology ignorance.

Paths that potentially go blind don't comprise a majority of path. The majority of path is "dry eye" (for which somebody recently described the GLA treatment I've advocated here for 10+ years). The majority of optometrically-uncovered path is troublesome, not sight threatening.

Am I being too much the gadfly? That's what you guyz 'n galz pay me the big bux for....

 

[Thomas Poswilko]

Non-Surgical Ophthalmologists

Merrill I agree with you 100%.

There's just not enough path to justify having all ODs trained in this to the Nth degree. Most ODs who consider themselves medical ODs really aren't that competent in most path especially retina.

Another example, a speaker at a recent CE session said the incidence of iritis was about one in every 2800 patients. How many ODs are going to get competent managing this type of case when they see one every 18 months.

Had a partner a few years back who took a VA residency and thought he was Mr. junior O-Md and watched him have about 2-3 patients a day considered a glaucoma suspect. Even teens.

It drives me crazy how the schools have been brainwashing graduates for the last 25 years.

 

[AdminWolf]

I'm bumping this interview, again for the benefit of all those folks who might be new to the site.

If you are at all interested in how eye care developed in the 20th century, you should listen to this show.

It is interesting to think about the fact that the way you are practicing had a lot to do with what went on in a hotel room near laguardia airport in the 1960s...

 

[Glen Swartwout]

A few questions I contemplate for the future of Optometry:

• Is there a future role for Optometrists in healing with light (including NIR) and other ‘Space Age’ electromagnetic modalities such as microcurrent and PEMF?
• Since vision is the dominant information processing system in humans, is Optometry in a unique strategic position to enter the field of information medicine?
• Are cancer and other degenerative tissue states a form of cellular blindness?
• With the AMA approval of Integrative Medicine as the newest specialty in 2014, what will Integrative Optometry look like?
• How can Optometry play a role in overcoming spiritual blindness?
• Could Optometry develop into a profession that sees how the causes of disease can be healed, and how the innate healing functions of the body, mind and spirit can be optimized, beyond ‘managing’ the expression of disease with pharmaceutical toxins and surgical intervention which is by definition controlled damage.
• How can we achieve higher levels of diagnostic and therapeutic outcomes and avoid the need for application of pharma and surgery in order to uphold our sacred oath of “primum non nocere”?

My personal journey has led me to ask such questions as I walk a ‘path less travelled by.’ It is my view that most of what passes today for evidence based medicine is based on the error of extrapolation from limited population data.

There are too many variables to measure in chemistry, and most measurements are still too invasive. The answer is in physics, as the field includes a summation of all chemical reactions, and the field at the surface offers a holographic representation of the interior. In my approach, evidence for the use of a medicine must be individual and demonstrate that the energetic effects include an increased functional coherence response.

By the way, I was hired as a research assistant to Dr. Haffner back in the day… Back then, classmates expressed the wish that they could attend the Optometry school that I would one day establish.

I wonder if that day might come… I am open to teaching ODs as well as others who feel called to become healers. Most of what is needed, whether didactic, diagnostic or therapeutic, can now be done remotely, so you don't have to worry about coming to Hawaii (unless you really want to). If you have a situation that could use a completely different, non-invasive approach, whether personal or professional, let me know...

As long as I have time and capacity, the first consultation is on me for fellow ODs.

 

[Paul Farkas]

For those who joined ODwire.org during the past 5 years. Spend an hour with one of optometry's greats.

I re-listened to this interview which was done 5 years ago. The material is as fresh, as it were done yesterday. It is definitely worth a second listen.

 

[Stewart Gooderman]

This brought tears to my eyes. I truly believe that I would not be the practitioner I am today had it not been for Dr Haffner. As a member of the second graduating class at SUNY, he inspired all of us to be the absolute best in what we do. To go further and further, and be proud of who we are. Some of us have already passed away, some are entering retirement, some still actively in practice. But, Dr Farkas, you're absolutely correct, the interview sounds like it was just done today. Everything he's saying has the ring of truth in it.

It saddens me to feel that we've been losing leadership in our profession. Where are the Alden Haffner's of today?

 

[Paul Farkas]

you're absolutely correct, the interview sounds like it was just done today. Everything he's saying has the ring of truth in it.

Another interview that is must listening was done over 5 years ago with Dr Irving Bennett,one of the great visionaries and leader in the AOA. Dr Bennett is 96 years young. Very active at his Sarasota retirement community.

For more visit....
https://www.odwire.org/community/th...-the-practice-management-legend-speaks.78873/