I recently had the pleasure of meeting Dr. Robert Greenberg, an 86-year-old optometrist from Tallahassee, FL who still practices 2 full days and 2 half days a week. A couple of months ago he achieved a milestone that few doctors can claim: caring for 4 generations of a family. After spending an evening listening to Bob’s life story and the changes in eye care over the years I decided to make that the subject of my first blog post.
Harriet, Bob’s wife of almost 59 years, died on Sept 3, 2009. In April Bob adopted Lady, an 8-year-old black Lab that had been abused. Lady was a little skittish in the beginning but she soon warmed up to Bob. In June, Bob came up with the idea of taking Lady on the cross-country road trip he and Harriet always talked about but never got the chance to take.
The internet brought Bob to our house. I have been a member of the Optcom List, an email list for optometrists, since the late 1990s. Over a thousand optometrists from across the US (and many other countries) share interesting cases, business advice and anything else you can imagine. About 5 years ago Bob joined Optcom (proving you’re never too old to embrace new technology). He announced his upcoming trip on Optcom and said he would love to meet any Optcommers along his route. I’ve become friends with many Optcommers over the years but I never knew Bob. However he was an Optcommer and we had plenty of room so I sent him an invitation to stay with us.
On Aug 3, 2010 Bob started out on his adventure with his faithful companion, Lady, a cell phone, a GPS and a list of addresses and phone numbers of friends, family and Optcommers. His daughter acted as his travel agent finding hotels that would accept dogs. Fellow Optcommers reported Bob sightings as he traveled across the country: on the top of Pike’s Peak, flying in a private plane in Iowa, boating in Pennsylvania, checking out Niagara Falls. Then I got a call from Bob saying he was planning to be in Cary in two days if I still wanted to host a “wandering eyeball mechanic”.
When Bob arrived we sat down and chatted just like old friends. I told him about my family and practice and he shared his amazing life story with me. He served in the Navy during World War II from 1943-1946. He was stationed in the Mediterranean and North Atlantic until the Germans surrendered in 1945 and then he was sent to the Pacific Theater. On Sept 2, 1945, he was aboard the USS Benson as she sailed past the USS Missouri in Tokyo Bay while the Japanese were signing the surrender agreement with General MacArthur, marking the end of WWII.
When the War ended, schools were flooded with returning veterans thanks to the newly passed GI Bill. Bob had wanted to become a veterinarian but there was a 3-year waiting list for vet schools. Then he saw a flyer for the Southern College of Optometry (SCO) in Memphis, TN and decided to become an optometrist. He was just a few hours short of his Bachelor’s degree and they had an accelerated OD program that was a little less than 3 years long (year-round). The program included general and ocular anatomy and pathology, optics, refraction, lens manufacturing and dispensing, refraction, binocular vision and vision therapy.
When Bob graduated from SCO in 1950, contact lens fitting wasn’t even in the optometry curriculum yet but Bob had heard about contacts and wanted to learn how to fit them. Immediately after graduation he took a contact lens fitting course taught by an optometrist in Memphis. These first lenses were made out of a rigid PMMA plastic material that was very stable and wet well. They were scleral lenses, which meant they covered the entire cornea and part of the sclera or “white” of the eye. A mold was taken of the eye and the lenses had to be made by hand. Since the lenses were so large and the PMMA plastic did not breath, small holes or “fenestrations” were drilled through the lenses to provide oxygen to the cornea.
Back then optometrists were not allowed to use or prescribe any drugs, including anesthetics, so it wasn’t easy to find someone willing to go through the fitting process! Bob’s first CL fit was a former girlfriend that was very nearsighted (about a –7.00D). They didn’t have the thin, lightweight plastic lenses like we have today so she was very motivated to get rid of her “Coke bottle” lenses. She was thrilled to be able to wear her contacts “long enough to see a movie”. What a contrast to contact lenses today.
At the time, state boards were only given once a year so Bob worked for his father selling insurance in Tallahassee while maintaining a long distance relationship with Harriet, still in Memphis. Bob and Harriet got married on Christmas Eve, 1950 when he returned to Memphis to take the Tennessee board exam. Then they moved to Tallahassee and he passed the Florida board exam and opened his practice. He did some vision therapy to treat problems with binocular vision and focusing but concentrated on exams and contact lenses.
Bob was one of the first doctors in the area to fit contact lenses. The closest alternatives were in Atlanta, Orlando and Pensacola. In the early ‘50s, Wesley and Jessen held seminars all over the country introducing their PMMA corneal lenses and contact lenses took off. The lenses still didn’t breath but they were much smaller and moved with each blink, providing more oxygen to the cornea and much longer wear. Even so, patients had to slowly build up their wear times and, if they wore their lenses too long, they were likely to wake up in the middle of the night with severe pain from starving the cornea of oxygen. The lenses were practically indestructible. Bob had several patients that wore the same pair for decades. They’d come in once a year for polishing, re-edging and a power change, if needed, and it was all done in the office while they waited.
Bob was also active in the Florida Optometric Association working to advance the profession of optometry. He convinced other optometrists to learn how to fit contact lenses and encouraged them to emphasize exam services instead of concentrating on eyeglass sales. In 1964, Bob was elected president of the Florida Optometric Association.
In the early ‘70s Bob started fitting soft contact lenses from Seymour Marco, an optometrist in Jacksonville, FL that owned a hard lens lab. Marco lathed buttons of rigid HEMA plastic into thin lenses, similar to making hard lenses. Then the lenses were soaked in saline and the HEMA absorbed the solution, became pliable and, hopefully, ended up with the desired parameters. In 1971 Bausch & Lomb received FDA approval for its Soflens soft contact lens manufactured with its more consistent, and much less expensive, liquid plastic spin-cast technology. Marco’s lenses were pretty good but he couldn’t compete with B&L’s national advertising and low cost.
Early soft lenses tore easily, didn’t correct astigmatism and their lens care was burdensome. Patients had to make fresh saline solution using salt tablets and distilled water every day and used a bulky heat disinfection unit to disinfect their lenses every night. But patients loved the immediate comfort and longer wear times soft contact lenses provided and sales of B&L’s Soflens soon exploded. Gas permeable rigid lens materials came out in the late ‘70s but they weren’t able to compete with the comfort of soft lenses.
During the ‘70s, optometry pushed for state laws giving optometrists the authority to use drugs to diagnose and treat eye diseases. American Optical’s new NCT (the universally dreaded air-puff test) and Monocular Indirect Ophthalmoscope let optometrists measure eye pressure without an anesthetic and gave a much better view of the retina without dilation, but ODs couldn’t provide optimum care to their patients without the ability to prescribe drugs. While West Virginia and North Carolina passed drug bills in 1976 and 1977, respectively, Florida had a powerful medical lobby that fought long and hard to block optometric drug use. Florida optometrists didn’t win prescription drug privileges until 1987. Bob spent almost 3 months away from his practice and his family to take an intensive pharmacology course at the University of Missouri College of Optometry in St Louis. Then he had to pass a certification test in order to prescribe drugs in Florida once the law took effect. That’s a lot of effort to go through at age 63!
Of all the advances in eye care that Bob witnessed during his career, he said the evolution of cataract surgery was one of the most dramatic. With the development of Intraocular Lens implants (IOLs), phacoemulsification (ultrasonic destruction) of the lens and foldable IOLs , cataract surgery went from a risky surgery requiring several days in the hospital and mediocre results to safe, simple outpatient surgery done under local anesthesia. Patients no longer have to wear thick, heavy lenses that distort their vision and make objects suddenly jump into view when they turn their head like they did 30+ years ago. Now most patients achieve good distance vision without any glasses at all.
In his mid 60s, Bob decided to close his practice because he was tired of “selling eyeglasses” but he is anything but retired. He works 2 full days a week at a Walmart Vision Center and two ½ days in the private practice of Ed Walker, OD. That way he can still see patients while letting someone else have the headaches of running a business and dealing with insurance companies. Bob is no fool!
You’d think that seeing patients 4 days a week at age 86 would be enough to keep Bob out of trouble but you would be wrong. He also volunteers as a mediator for small claims court; serves as an ombudsman for patients in nursing homes; and is an active member of the Elks. His 5 children, 9 grandchildren, 1 great-grandchild (and another expected any day) keep him on his toes too. Oh and did I mention that he went skydiving (for the first time) for his 85th birthday?
It was such a treat to meet Bob and learn about the history of optometry from someone who was there making it. The next morning Bob and Lady hit the road again headed for Charleston, SC. He completed his journey on Sept 5, 2010, covering 9963 miles in just 32 days. Except for a 10-minute sprinkle while in Yellowstone, he had sunny skies the entire trip. Harriet must have been looking after him.
True to form, he was back in the office seeing patients two days later. We would all be lucky to have the work ethic, zest for life and quick wit that Bob has when/if we hit 86. Heck, I could use it now!
Coincidentally, Bob closed his practice about the same time that I started mine. Although I’ve witnessed the transformation of the contact lens industry with the introduction of disposable contact lenses and the evolution of refractive surgery, many of the major changes in eye care took place before my time. Thanks to the efforts of previous generations of optometrists like Dr. Robert Greenberg, I was able to practice full scope optometry from day 1 of my career. I hope that my generation will continue to advance the optometric profession like they did.
I’d like to thank Bob for taking many calls from me with follow-up questions and the members of the Optcom list that helped with details and links for this article. If you’d like more information about the history of optometry see the American Optometric Association Archives and Museum.