March 2011




Kentucky governor signs law to expand optometric scope of practice

by Jena Passut EyeWorld Staff Writer

Woodford Van Meter, M.D.

Ben Mackey, M.D.


A controversial bill that allows optometrists in Kentucky to perform laser and scalpel procedures as well as injections has been signed into law by Gov. Steve Beshear, despite fierce opposition from the state's top ophthalmologists.

The governor said he signed the bill to give Kentuckians greater access to eyecare.

"I believe this new law will mean more Kentuckians can get the eyecare they need," Gov. Beshear said in a prepared statement. Senate Bill 110 grants optometrists authority to perform laser procedures, including laser trabeculoplasty, peripheral iridotomy, iridoplasty and capsulotomy, YAG capsulotomies, LASEK, and laser "only" clear-lens extraction. The bill will also allow optometrists to perform some scalpel procedures and administer pharmaceutical agents, including by injection into the vitreous. "The law is dangerous, expensive, and will allow optometrists to perform surgery on unsuspecting patients who don't know the difference between ophthalmologists and optometrists," said Woodford Van Meter, M.D., president, Kentucky Academy of Eye Physicians and Surgeons, and professor of ophthalmology, University of Kentucky, Lexington. "Optometrists have limited surgical experience, and this legislation unfortunately grants surgical privileges in front of training and education, the reverse of what usually happens. Another problem is that optometrists have not asked to perform specific procedures but to perform all procedures except for certain exclusions." SB 110 also includes the creation of an independent optometric board that would solely decide scope of practice for the profession.

"No other board or state agency will have any authority to question what constitutes the practice of optometry," Dr. Van Meter said. "There's no national optometric standardized test to determine competency. This board could expand the optometric practice as it solely determines, outside the influence of the Kentucky Board of Medical Licensure."

SB 110 moved at warp speed through both the state Senate and House. It was introduced on Feb. 7, passed the state Senate 33-3 on Feb. 11, and passed the state House on Feb. 18 by a vote of 81-14. SB 110 easily cleared the House, after being discussed in the committee on licensing and occupations.

"That was a little bit suspicious," Dr. Van Meter said about the committee choice. "That committee deals with air conditioning regulations and fishing licenses." The timing of the Senate and House votes also caused some to question the influence of monetary contributions to the state's legislative process. Members of the General Assembly received more than $400,000 in campaign contributions from optometrists and their political action committee, according to a story published in The Courier- Journal of Louisville. Money was donated to the campaigns of 137 of the 138 members of the state legislature, as well as to the governor's re-election campaign.

The Legislative Ethics Commission said the Kentucky Optometric Association had increased its lobbying force at the capitol from four to 18 lobbyists this session. Thirteen of those lobbyists started working on Feb. 1, the Commission said.

"We were told by the legislature that this bill had a lot of support, but there has not been one consumer, patient, or advocacy group saying it is a good idea," Dr. Van Meter said. "My fear is that this bill is going to make Kentucky look bad on the national scene. I am embarrassed." Ben Mackey, M.D., Corbin, Ky., is one of the state's many ophthalmologists who spoke out against the legislation. "My basic problem with the bill is that it lowers the standard of healthcare in general," Dr. Mackey said. "I don't think optometrists are qualified, and I don't think they meet the standard that should be there to perform this sort of procedure, which should be performed by a licensed physician."

Dr. Mackey, whose father and brother are optometrists and did not campaign for the bill, pointed out that ophthalmologists spend thousands of hours training to do surgical procedures and have to go through a residency program. Gov. Beshear said that more training for optometrists would be a priority. "In order to ensure the highest degree of oversight, I will be meeting with the Board of Optometric Examiners to make sure that providers of these services undergo extensive training," he said.

Dr. Van Meter said the Kentucky law is the same as the 1998 bill in Oklahoma that allowed optometrists there to perform surgical procedures. Since then, similar legislation has been presented and rejected in 25 other states. "The American Medical Association (AMA), the American College of Surgeons (ACS), and the American Academy of Ophthalmology (AAO) have all issued policy statements advising that surgery should be performed by surgeons," Dr. Van Meter said, adding he disagrees with the argument that allowing the privileges will give Kentuckians better access to surgical care. "There is no backlog of eye surgery in Kentucky," he said. "We have statistics that show 95% of Kentuckians live within an hour of an ophthalmologist. There are more than enough ophthalmologists to do all the surgery that needs to be done." Dr. Van Meter said he is worried that since Kentucky has adopted the same law as Oklahoma, other states will be pressured to follow suit.

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Kentucky governor signs law to expand optometric scope of practice Kentucky governor signs law to expand optometric scope of practice
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