MAJORITY REPORT. 
taken to give effect to it. If the insurance practitioner advises a 
further medical examination of the patient’s eyes the proper 
course is for the latter to consult a medical practitioner with 
special experience of ophthalmic work, who would diagnose the de- 
fect and provide such treatment as might be required. This would 
in the great majority of cases take the form of the testing of sight 
and prescription of the necessary glasses. It was claimed by wit- 
nesses representing various bodies of opticians that this work was 
within the competence of a qualified optician ; and we are prepared 
to admit that where no doubt can exist that the defect is merely 
an error of refraction the task of prescribing the requisite glasses 
should not be beyond the skill of an optician who has undergone 
the course of training and passed the examination required by 
certain of the opticians’ organisations which gave evidence 
before us. 
90. In this connexion, however, two difficulties arise. In the 
first place, in contrast with the position in medical practice and 
dentistry, there is not in this country any State registration of 
opticians and it is open to anyone to test sight and supply spec- 
tacles, however, unfit he may be to undertake the work. 
Secondly, in a proportion of cases, which may be no higher 
than 5 per cent., eye trouble may be due to some cause 
other than a mere error of refraction and may be a symptom 
of serious disease, and it is essentially a task for the 
qualified medical practitioner to differentiate between cases 
of this kind and cases of mere refractive error. It 
was admitted, even by medical witnesses who appeared 
before us to support the case of the opticians, that, other things 
being equal, it would be preferable, for the purpose of testing 
eyesight, to have recourse to a properly qualified eye-specialist 
rather than to the most highly qualified optician (Joint Council of 
Qualified Opticians, (). 17,660). It is true that there has hitherto 
been a shortage of medical practitioners specially qualified in 
ophthalmic work and this, no doubt, has contributed to the result 
that the testing of eye-sight has very largely fallen into the hands 
of opticians. We are informed, however, that the British Medical 
Association has compiled a list of approximately 600 doctors in all 
parts of the country who possess special ophthalmic experience 
and who are willing to undertake this work for insured persons at 
a moderate fee. It isnot within our province to consider the argu- 
ments for or against the prohibition of the testing of eye-sight 
by persons other than medical practitioners. But as to the pro- 
vision to be made for insured persons as part of the Health 
Insurance Scheme, we consider that a satisfactory solution 
could be found in connexion with a proposal which we make in 
Chapter X directed to the provision of a specialist ‘medical 
service as part of medical benefit. Such a specialist service 
would include ophthalmic specialists whose services would be 
at the disposal of insured persons requiring them, and the