RADIATION PROTECTIVE ACTIVITY DURING IMPLEMENTATION OF THE STATE PROGRAM FOR THE PROTECTION OF POPULATION OF ZHOVTI VODY TOWN

The town of Zhovti Vody is a 'capital' of uranium mining and processing industry of Ukraine. The mining and processing of uranium has been carried out in this area for more than 60 y. During this period, due to increasing production activities, the town has grown significantly. As a result of production activities and also due to the human factor, the territory of the town was contaminated by radioactive rocks. In addition, out of ignorance, radioactive rocks were used in the construction of houses and roads. To normalize the radiation situation in the town, a targeted State Programme was adopted in 2003 for a period of 10 y. In 2013, the Programme was subsequently extended until 2022. In accordance with this Programme, decontamination of the urban territory, measurements of radon isotopes in houses and anti-radon reconstructions of the premises have been performed. The results of these works are described in this article.

Charge transport in thin layer Na x CoO2 (x ∼ 0.63) studied by terahertz spectroscopy

Charge transport in Na0.63CoO2 thin film deposited by a spin-coating method was investigated experimentally by time-domain terahertz spectroscopy and theoretically using Monte Carlo calculations of charge response in nano-structured materials. The dominating type of transport mechanism over the entire investigated range of temperatures (20-300 K) is a metallic-like conductivity of charges partly confined in constituting nano-sized grains. Due to the granular character of our thin film, the scattering time at low temperatures is limited by scattering on grain boundaries and the conductivity is strongly suppressed due to capture of a major fraction of charge carriers in deep traps. Nevertheless, our experimental setup and the applied model allowed us to distinguish the parameters related to the grain interior from those influenced by grain boundaries, and to conclude that the metallic type of conductivity is the intrinsic property relevant to single crystal materials.

Complete sequences of maternally inherited mitochondrial genomes in mussels Unio pictorum (Bivalvia, Unionidae)

Mitochondrial genomes are frequently used to infer phylogenetic relationships. Some taxa are, however, poorly represented. To facilitate better understanding of the potential of mitochondrial genome data in freshwater mussels, we present here, for the first time, the mitochondrial sequences of 4 complete F-type mitochondrial genomes from the European freshwater bivalve Unio pictorum (Unionidae). These genomes are very compact (15,761 bp) but have a typical gene complement for bilaterian mitochondrial genomes and a very similar organization to other unionid genomes available in databases. Very low nucleotide diversity within the species suggests a small effective population size of Polish U. pictorum, a phenomenon of potential importance for environmental management policies.

Optometry and ophthalmology: the Internet connection--assessing consumer health web sites

BACKGROUND

The Internet is a major conduit of health information. Consumers frequently rely on it without verifying its validity. The purpose of this study was to assess the accuracy and currency of Internet-based information on the roles and practice of optometrists, which has been found to be misleading, inaccurate, and often outdated.

METHODS

Using search engines and ranking directories, 16 popular health Web sites were examined for differentiation between optometry and ophthalmology. Each site's eye care content was reviewed for syndication, definitions, provider directories, linkages to eye organizations, and provider recommendations in treatment of certain conditions.

RESULTS

Many Web sites use a syndicated source for their health content and several use Merriam-Webster as their primary dictionary. A majority of sites provided poor definitions for optometry. Most Web sites were biased in recommending ophthalmologists and do not include optometrists as licensed providers in treatment of certain eye diseases. For example, Intelihealth, Aetnaushc, and Noah-Health recommend only ophthalmologists for the treatment of conjunctivitis.

CONCLUSIONS

Inaccuracies and misleading information about optometry do exist and undermine the role of optometrists in delivery of eye care. When alerted, several Web sites were receptive to proposed changes. While some efforts have been undertaken to monitor Web sites, the profession must develop a concrete effort to ensure that it is correctly represented on the Internet.

Eye care providers in managed care

The integrated relationship and roles in managed care of ophthalmologists, optometrists, and opticians have changed profoundly in recent years. The change is in part the result of the advancement of optometric education and license in the diagnosis and treatment of ocular disease. The change has also evolved because of the influence of managed care and its objective to reduce costs while elevating quality of care. The authors explain that vertical integration of all ophthalmic services, ranging from eye examination to eyeglass dispensing to ocular surgery, can help MCOs maximize quality and minimize costs.

Optimal clinical management of eye problems: the role of optometrists in managed care plans

BACKGROUND

Recent developments in the education and licensure of optometrists have created new opportunities for more-efficient provision of eye care. This study was conducted to determine the extent to which optometrists provided various kinds of eye care independently in managed care organizations. We compared optometric practices in health plans located in states in which the legal authority of optometrists was limited, to optometric practices in plans situated in states in which optometric licensure permitted broader prescribing authority. The volume and nature of referrals to ophthalmologists were assessed in relation to state law and organizational protocols.

METHODS

A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a 4-week period in 1998. Specific conditions were selected and criteria developed to help determine whether referrals to ophthalmologists were appropriate, or if they could have been managed by the optometrist These referrals were assessed by an independent panel of four optometrists.

RESULTS

This study documented that optometrists provide a substantial range of eye care, and their individual scope of practice is influenced not only by legal boundaries, but also by financial and organizational factors found within managed care organizations. The pattern of referrals to ophthalmologists helped indicate the extent to which optometrists were underutilized or used appropriately in various settings.

CONCLUSIONS

There is no single reliable predictor of whether optometrists will be used at the highest level of their abilities and scope of license. Although state licensure sets the overall parameters for care, optometric practice in managed care plans may be modified by internal protocols and organizational factors.

Optometry as practiced in health plans within different state jurisdictions

This study was conducted to determine how managed care plans use optometrists to provide vision and eye care. The study documents the variety of optometric practice patterns found within six health plans in several states, each having different organizational characteristics, professional staffing patterns, and payment arrangements, and each regulated by dissimilar state licensure laws. A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a four-week period. The instrument included information on patient demographics, medical/ocular history, reason for the visit, procedures performed, diagnosis, therapy provided, ocular medications prescribed, prognosis, disposition, referrals, and duration of the visit. A variety of patterns were found, some of which did not necessarily closely follow the legal boundaries of optometric care. This study documented that optometrists provide a substantial volume and range of vision care, and their scope of practice is influenced by legal, financial, and organizational factors. In some plans, optometrists' skills were underutilized relative to their legal authority in certain situations; in others, creative, cooperative arrangements extended the benefits of optometry beyond the existent practice laws. Licensure is certainly a major influence on the scope of practice of health providers. This study revealed, however, that licensure alone does not appear to be the only determinant of use, delegation, and division of labor among health professionals, and that organizational factors seem to play a very significant role.

[The occurrence of Ixodes ricinus in the select recreative areas in the Province of Szczecin. Part I]

Among Polish ticks species the most common Ixodes ricinus has the biggest medical importance. Within the last few years, the incidence of disease transmitted by ticks has rapidly increased. We have made a thorough analysis of the quantative and rate per cent of occurrence of various stages Ixodes ricinus in the forest areas of some places in Szczecin province and in the parks of Szczecin, that are known as highly recreative and frequently visted by many people. A total of 426 (68% numphs) specimens collected there show that ticks frequently occupy habitats closely associated with man.

Quality assurance in managed vision benefits

Quality assurance is an important responsibility of those who purchase managed vision care benefits. In conducting a quality assurance program, it is important to respect patient confidentiality and the practitioner's right to exercise professional discretion. An effective program will not only accomplish its main objective of attaining high-quality care, but it can also enhance member satisfaction and improve provider relations.

The future of Medicare and managed care: implications for optometry

BACKGROUND

Medicare, the major health entitlement program for the elderly, is faced with many challenges. Health costs and managed care have been instrumental in restructuring delivery of health care in this country. The Medicare program, the last bastion of unmanaged and fee-for-service care, is now under pressure to conform to the changes already embraced within the private sector.

METHODS RESULTS

Data obtained from the Health Care Finance Administration (HCFA) demonstrate how marketing strategies and enrollment programs are successful in enrolling Medicare beneficiaries into health maintenance organizations (HMOs). Enrollment in Medicare risk-contract HMOs has doubled in the last 2 years as HMOs actively market the Medicare population. New managed care options are being developed for Medicare patients.

CONCLUSIONS

HMOs are marketing their plans specifically toward Medicare beneficiaries and are offering increased benefits-including vision care-to encourage increased enrollment. Optometric participation in the Medicare program will be affected Freedom of choice will be restricted to panel practitioners who participate with these HMOs. Practitioners will be subject to credentialing criteria established by the HMOs, site visitations, audits, and other aspects of quality assurance implemented by the HMOs.

Medicaid, managed care and optometry: a review

BACKGROUND

Significant changes are restructurng the U.S. health care delivery system. National health reform is now extending itself into the public sector. Increased health and medical costs by federal and state governments are forcing a reevaluation of major entitlement programs, especially Medicaid.

METHODS/RESULTS

Because Medicaid is the single largest item in many state budgets, states are now enrolling Medicaid patients into managed and coordinated care arrangements as a means to control costs and increase access to care. HMOs are not only competing for private patients but also actively seeking the Medicaid population. Nationally, almost one-fourth of all Medicaid patients are now enrolled in managed care plans. Various models and approaches have been developed by individual states.

CONCLUSIONS

Because managed care enrollment in the Medicaid program has increased substantially in recent years, selected services including vision care are no longer rendered by any practitioner willing to accept Medicaid fees. Freedom of choice is now restricted to pre-selected and panel practitioners participating with the managed care program. The rules, regulations, billing procedures, fees, and program requisites will differ under managed care programs. Private optometric practitioners must consider entering economic and organizational relationships and linkages that make them attractive to managed care organizations.

Medicare, managed care, and vision services to the elderly

Proportionately, fewer Medicare patients are enrolled in HMOs than in fee-for-service programs. Despite the advantages of selecting the HMO option, only 2.9 million beneficiaries are enrolled. Integrating Medicare into health care reform will be a major challenge to this administration. There is general recognition that it will be difficult to control health costs if people at least 65 years of age remain outside the system. With renewed marketing programs directed toward the elderly, we can expect further increases in Medicare HMO enrollment.

Delivery systems for vision care benefits

The best way to provide a vision care benefit is with a managed care plan. With this type of design, there is cost containment without cost shifting, and quality assurance and member satisfaction are readily attainable at relatively inexpensive rates.

Long term follow up after percutaneous mitral commissurotomy with the Inoue balloon-incidence of restenosis

The long term outcome of 300 consecutive patients following percutaneous mitral commissurotomy (PMC) with the Inoue balloon was analyzed with regard to the incidence of restenosis. There were 256 females and 44 males (mean age 44.4 +/- 9.9 years, range 18-69 years), 52 had previous surgical commissurotomy, 96 were in atrial fibrillation, and 16 had a history of embolism. PCM was carried out with a success rate of 84% (no significant mitral regurgitation and mitral valve area (MVA) > 1.5 cm2). Two hundred and seventy patients were available for clinical and serial echocardiographic studies at six months, 12 months and once a year thereafter (18 patients operated on for mitral regurgitation less than six months after PMC, three patients lost to follow up, nine patients refused to return). MVA increased with PMC from 1.18 cm2 +/- 0.3 to 2.0 +/- 0.3 cm2 and then decreased to 1.8 +/- 0.3 at a mean follow up of 24.0 +/- 13.5 months (range 6-55). Echocardiographic restenosis (RS) (MVA at follow up < 1.5 cm2 with a 50% loss of the initial gain) was found in 38 patients (14%). Twenty-five (66%) of them remained in NYHA class I or II. Restenosis free survival according to the Kaplan-Mayer curve was 93%, 86%, 77% and 73% at 12,24,36 and 55 months respectively. None of the 24 clinical, hemodynamic, echocardiographic or procedural variables used on the Cox proportional hazard regression analysis identified predictors of restenosis free survival.

CONCLUSIONS

The overall incidence of echocardiographic restenosis post PMC is low (12.6%) in patients followed for a mean period of two years and often occurs without worsened clinical symptoms. It may be difficult to define clinical, echocardiographic or procedural factors as significant predictors of restenosis free survival.

Guideline development process for optometric care of the patient with diabetes mellitus. American Optometric Association

BACKGROUND

The aim of this project was to develop a standard of optometric care for patients with diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. These guidelines are intended to assist optometric practitioners in the prevention, diagnosis, treatment, management, and rehabilitation of their patients. The guidelines are based on the best available research and professional judgment regarding the effectiveness and appropriateness of optometric care and procedures.

METHODS

This paper details the methodology used by the AOA's Clinical Guidelines Coordinating Committee, Consensus Panel and the Center for Vision Care Policy of the State College of Optometry, SUNY, to develop practice guidelines for patients with diabetes mellitus.

A meeting of the mindsets: chart completion vs. clinical pertinence

The authors describe their hospital's success in addressing a delinquent record crunch. As a result of its program, the hospital reduced accounts receivable by 45 percent.

A contribution to the structure-activity relationship in glutamate receptor ligands: 2. Characterization of 2-amino-4-oxo-5-pentanoic acid as NMDA receptor antagonist

Pharmacological properties of 2-amino-4-oxo-5-phosphonopentanoic acid (AOPA) on excitatory amino acids mediated responses have been tested in CA1 rat hippocampal neurones, using intracellular recordings and current and voltage clamp techniques. These properties were compared with those of the well-known NMDA antagonist, D(-)2-amino-5-phosphonopentanoic acid (AP-5). AOPA completely abolished the response to NMDA but had no effects on the responses to AMPA, quisqualate and kainate. In voltage clamp experiments AOPA antagonized NMDA-induced currents and produced a parallel shift of the NMDA concentration-response curve. Schild analysis gave a Kd value of 26 microM. AP-5 also produced a similar shift in this curve with a Kd of 6.9 mu.

A contribution to the structure-activity relationship in glutamate receptor ligands: 1. omega-Aminophosphonic acids do not antagonize NMDA receptors

Pharmacological properties of a series of alpha, omega-diamino-omega-phosphonocarboxylic acids and alpha, omega-diamino-alpha, omega-bis(phosphonic acids) on different excitatory amino acids mediated responses have been tested in CA1 rat hippocampal neurones, using intracellular recordings and current and voltage clamp techniques. In contrast with known antagonists as D(-)2-amino-5-phosphonopentanoic acid (AP-5) and 2-amino-4-oxo-5-phosphonopentanoic acid, which completely abolished the NMDA-response, no antagonistic activity was found. We conclude that the introduction of an omega-amino function abolishes the NMDA-antagonistic activity of alpha-amino-omega-phosphonocarboxylic acids.

Specialty differentials, limited license practitioners, and Medicare's new fee schedule

The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.

Standards of care

The health care community is quickly progressing in the direction of the development and acceptance of the concept of standards of care. Optometry has lagged behind other health disciplines in this process and must develop its own or face the likelihood of having to conform to standards created by others. The argument is no longer whether standards should be created, but rather the creation of appropriate standards and guidelines that will best serve the profession and the public.

The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and ophthalmologists

This paper compares various costs estimates for the expansion of optometric services under the Medicare program that were developed prior to the enactment the Medicare Parity Amendment of 1986. The new law, effective April 1, 1987 redefines the conditions of optometric participation and expanded coverage to include all Medicare covered services for which optometrists are authorized to perform under the state law. The paper describes the impact of the Medicare amendment with regard to payments to optometrists and ophthalmologists. Payments to optometrists increased from $12 million in 1986, a year before the Medicare Amendment to $81 million in 1988, the first full year after the law's implementation increasing their market share of Medicare payments from 2.6% to 11.1%. Ophthalmology incurred a significant decrease in market share from 97.9% to 88.9% during this period.

Predicted and observed effects of the Medicare Optometry Parity Amendment

The Medicare Parity Amendment of 1987 redefined the conditions of optometric participation and expanded coverage to include all Medicare-covered services which optometrists are authorized to perform under state law. Prior to the law, a number of studies projected costs to Medicare as a result of a change in Medicare policy. This paper reviews these studies in relation to actual Medicare expenditures from 1986 to 1988. The paper describes the impact of the Medicare amendment on payments to optometrists and shows how payments increased from $12 million in 1986 to $81 million in 1988. Optometrists substantially increased their market share of Medicare payments from 2.6 percent in 1986 to 11.1 percent in 1988. Indications suggest that a shift of patient visits from ophthalmologists to optometrists has occurred.

A comparison of charges by optometrists and ophthalmologists under the Medicare program

Medicare data obtained from the Health Care Financing Administration was analyzed in relation to average allowed charges by optometrists and ophthalmologists. Optometric charges are considerably lower than ophthalmological charges for all services compared. The policy of different reimbursement levels is currently a major issue being considered by the Physician Payment Review Commission. Optometry must demonstrate that the procedure codes for which they submit Medicare claims are comparable and identical in service content to those provided by ophthalmologists.

Comparison of examination fees and availability of routine vision care by optometrists and ophthalmologists

A national telephone survey of eye care practitioners shows that the average fee for routine eye examinations was less among optometrists than ophthalmologists. The average wait for the earliest appointment was 5 days for optometrists and 20 days for ophthalmologists. Weekend and evening appointments were also more obtainable among optometrists. The study did not determine what tests were included in the routine examination of each practitioner. Optometrists are licensed to use diagnostic drugs in all 50 States and prescribe therapeutic drugs for the treatment of ocular diseases in 25 States. Legislation that would update State laws permitting doctors of optometry to prescribe and use pharmaceutical agents for the treatment of eye diseases has been introduced in many of the remaining States. Supporters of bills permitting therapeutic pharmaceutical optometry contend that these changes would ensure the availability of quality eye care at significant savings, since optometric fees are generally lower than ophthalmological fees. In addition, it has been argued that optometrists are equitably distributed geographically and are more likely to have weekend and evening office hours, thus enabling increased patient access to eye care. When considering cost-effectiveness and accessibility, this study may provide information to those States considering changes in the scope of optometric licensure.

A survey of optometric practice in New York State: trends and policy considerations

A mail survey of actively practicing optometrists in New York state revealed information about present and future manpower supply, modes of practice, procedures and instrumentation used, services rendered, third party reimbursement and involvement in continuing education. The survey illustrates the need to increase the gathering of such data in order to analyze practice patterns and more accurately initiate short- and long-term planning within the profession.

Comprehensive vision care under third party programs: increased services and increased scrutiny

Physician reimbursement under Medicare has been rising by about 15 percent each year. Part of this increase is due to an increase in unnecessary tests and procedures. To control provider billing, Congress passed legislation that will establish a Medicare fees schedule and expenditure targets. Increased surveillance and monitoring of Medicare claims are taking place. Diagnostic procedures are being questioned and denied when deemed inappropriate in relation to a diagnosis. Managed care techniques also are being implemented by private insurance carriers to prevent overutilization. Clinic practice guidelines are being developed by the health professions. Optometry, as well as all other health professions, will be subject to increased utilization and quality review.

Vision care benefits and optometric services in HMOs

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.

Vision care and health insurance coverage

This paper presents an overview of third party coverage for optometric services. A questionnaire survey of insurance companies was conducted to determine the extent of major medical coverage for specific optometric services. The influence of freedom of choice laws, expanded scope, pharmaceutical agent legislation and the Medicare program is discussed. The proper use of accepted diagnostic and procedural codes is underscored.

Vision care in the Medicare program: renewed political and professional debate

An examination of proposed changes in the Medicare regulations indicates that there is a wide divergence of views and many unrealistic arguments advanced by both optometry and ophthalmology. Current financial considerations make it unlikely that any changes will be made if they raise costs.

Vision care policy, ophthalmological practices and the Medicare program

Medicare specifically excludes routine eye examinations and refractive services. In optometric circles, it is widely believed that ophthalmologists are currently receiving payment for routine eye care and refractive services. A survey of ophthalmologists and optometrists in New York State is presented with respect to their fees and participation in the Medicare program. The use of procedures and diagnosis codes and its impact on billing practices by ophthalmologists is reviewed. Data from a Medicare intermediary and from a provider of health care services raise serious issues regarding Medicare's policy of excluding routine eye care. A review of existing rules and regulations and its implementation appears in order.

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.

Vision care for the nation's elderly: a plea for policy direction

Eye care services are largely provided by two professional groups--optometrists and ophthalmologists. Professional rivalry between the two exists mainly because both are in direct competition for patients with routine diagnostic and treatment needs. With the advent of Medicare and Medicaid, a substantial amount of health care services rendered to the elderly has been financed by the federal government. The use by the elderly of eye care services and the cost of such services are influenced by Medicare reimbursement policies. Medicare specifically excludes routine eye care and refractive services, but includes diagnosis and treatment of ocular disease. This article examines the impact of eye care benefit exclusions and restrictions and their effect upon the use of ophthalmological and optometric services by the elderly.

Optometric and ophthalmological eye care under the Medicare program

A questionnaire survey was administered to more than 600 elderly persons within several senior citizens centers in New York City. Data was collected on the elderly's use of eye care services, particularly the site where eye care was obtained, the type of provider chosen and the source of payment, i.e. Medicare, Medicaid or self pay. The second stage of the survey was to screen all participants for the absence or presence of visual problems. Significant differences were found when comparing the use of optometrists and ophthalmologists with the method by which the respondent paid for their last eye examination. Among those who were seen by an ophthalmologist and reported that Medicare paid for their examination half either passed or failed the vision screening test due only to poor visual acuities. Statistical evidence seems to indicate that Medicare payments to ophthalmologists may not be solely for actual or suspected disease conditions. Implications for the Medicare program seem evident.

Knowledge and use of eye care services by college and health professional students: implications for the profession

A questionnaire survey of 1277 students in colleges of liberal arts, medicine, pharmacy, nursing, dentistry, and podiatry was undertaken in an effort to determine their knowledge and use of vision care services. Students were asked to define the differences among optometrists, ophthalmologists, and opticians. Utilization, type of practitioner used, and site of examination are reported. About 56% had had an examination within the past year. Optometrists provided at least 40% of the examinations, but the confusion in the minds of the students is revealed by the fact that some said they were examined by opticians, some by the Department of Motor Vehicles, and some by a person they were not able to identify. Clearly, optometry and the related disciplines have a responsibility to clarify the public confusion.

The supply of optometric manpower

Approaches to determining health manpower requirements are reviewed. The paper identifies a source of error in determining the present supply of optometric manpower which will ultimately influence any policy or program intended to either correct or adjust future health manpower supplies. The study also demonstrates a need to refine the data on health manpower supplies with particular reference to the characteristics and practices of the optometrist.

A national optometric-student attitudinal survey

This paper contains the results of a survey of 1549 optometry students who responded to a questionnaire that was sent to all optometry schools and colleges in the United States. The results reflect student attitudes and opinions about such issues as commercial optometry, malpractice suits, price advertising of glasses and professional services, and the cost of professional education. In addition, the survey results disclose the reasons students enter the profession, their anticipated modes of practice and their expected incomes. We believe that the issues encompassed in this survey will affect the future practice of optometry.