HINDSIGHT: Journal of Optometry History 3

A NEW VERSION 
OF “SEVEN, FOUR, 
AND OUT THE 
DOOR”?

I attended Pacific University College 
of Optometry in the early 1970s. For 
a part of the standard examination 
procedure we were taught the 
Optometric Extension Program 21 
point sequence. Tests were numbered 
from 1 to 21. For example, number 
1 was ophthalmoscopy, 2 was 
keratometry, 4 was static retinoscopy, 5 
and 6 were dynamic retinoscopy, and 
7 was subjective refraction. Numbers 
8 through 12 were dissociated 
phorias and fusional vergence ranges 
at distance. Numbers 13 through 
21 involved nearpoint testing – 
dissociated phorias, fusional vergence 
ranges, cross cylinder tests, and relative 
accommodation. We were taught 
that a complete examination should 
include the 21 points, plus entrance 
tests such as visual acuity, cover test, 
eye movement tests, etc., and ocular 
health tests, such as intraocular 
pressure and others as indicated. 

While the intervening years 
have seen significant expansion in 
optometric knowledge and scope 
of practice, advances in technology, 
changes in analytical philosophies, the 
dropping of such a test numbering 
system, and many other changes, one’s 
view of what constitutes a complete 
examination might not differ too 
greatly from what was taught four 
decades ago. In other words, adequate 
care then and now should involve 
careful assessment of the entire visual 
system, including refractive status, 

accommodation, binocular vision, 
visual perception, ocular health, and 
ocular indicators of systemic health.

A slogan that I recall hearing during 
school years to represent inadequate 
patient care was “Seven, Four, and Out 
the Door,” indicating an examination 
consisting of only retinoscopy and 
subjective refraction, substandard 
care then and now. Some of the 
procedures on smart phones or similar 
technologies being touted now as 
an “examination” appear to be only 
attempting an evaluation of refractive 
status. Are these new versions of 
“Seven, Four, and Out the Door”? 
What lessons can we learn from our 
history to assure that adequate care of 
patients is achieved? It seems to me 
that knowledge of optometry history 
will always be a valuable aid to the 
challenges and changes the profession 
faces.

David A. Goss, OD, PhD
Editor 
dgoss@indiana.edu

David A. Goss, OD, PhD

Letter to the Editor

When I opened my new HINDSIGHT, 
I could not believe how “refreshing” 
the new look is - terrific job!

Then I turned the first page and 
what did I see? My ‘mug’ and the 
announcement of my ‘retirement’ 
from the Board which was very 
complimentary, by the way. Thank 
you. Since I lost my collection of 
past HINDSIGHTS in a house fire on 
September 15th, I can begin my 
new collection with this historic 
ISSUE.

I shall miss serving and am hopeful 
that someone younger will take 
my place, encouraging younger 
ODs to take a greater interest in 
Optometry’s past. I do feel that 
the infusion of younger ODs into 
our Society will cause us to grow 
to a level that will enhance the 
Profession and further preserve our 
proud history.

Sincerely,

Bill Sharpton, OD  
sharpton@windstream.net

FROM THE EDITOR DAVID A GOSS, OD, PHD