Kentucky law extends selected surgical privileges to optometrists

Kentucky Optometric Association calls the law an improvement to patient access, while the American Academy of Ophthalmology says it undermines safety.

A new Kentucky law allows optometrists to perform injections and some laser procedures that were previously limited to ophthalmologists. Gov. Steve Beshear signed the bill into law in late February.

In addition, the law gives the state optometric board of examiners exclusive authority to determine scope of practice.

The American Optometric Association issued a statement praising the Kentucky Optometric Association’s collaboration with state lawmakers.

“They planned, implemented and perfectly executed a multi-year strategy to educate legislators on the need for this legislation,” Sherry L. Cooper, associate director for the AOA’s State Government Relations, said in the statement.

The legislation improves residents’ access to quality eye care, the Kentucky Optometric Association said in a news release. Ophthalmologists are located in only one-third of the state’s counties, while optometrists are located in 106 of 120 counties.

The law is a “serious blow to patient safety,” American Academy of Ophthalmology President Richard L. Abbott, MD, said in a statement released in response to the bill’s signing. Dr. Abbott added that complicated eye surgeries should be performed only by medical physicians with proper clinical training.

“Just like we only rely on trained pilots to fly our airplanes, surgery should only be performed by surgeons,” Dr. Abbott said in the statement. “Optometrists simply do not have the training necessary to perform these procedures or manage the kinds of serious complications that can arise during surgery. … For the sake of patient safety across the commonwealth, Gov. Beshear and the legislature need to take another look at the complications and impact of this dangerous law, before it’s too late.”

A similar law was enacted in Oklahoma in 1998. Proposed laws to expand optometrists’ privileges have failed in other states, most recently in West Virginia in 2010.

Improved access to eye care

In an interview with Primary Care Optometry News, a sister publication of Ocular Surgery News, Kentucky Optometric Association President-Elect I. Ben Gaddie, OD, said that provisions of the law grant optometrists privileges to administer pharmaceutical agents, remove non-cancerous growths around the eyelid and eye, and perform some therapeutic laser privileges, excluding PRK, LASIK and retinal procedures.

Even though Dr. Gaddie trains other optometrists to perform these procedures in Oklahoma, he had been unable to perform them in Kentucky.

“I routinely performed these procedures in Oklahoma,” Dr. Gaddie said in a statement issued by the Kentucky Optometric Association. “When I decided to return home to Kentucky, I soon realized that the Kentucky optometry law was not up-to-date here, so my patients were denied access to the care I could safely provide to them.”

Training and proper diagnosis

Cynthia A. Bradford, MD, the AAO’s Senior Secretary for Advocacy, said optometrists lack the education and clinical training to make accurate diagnoses. Dr. Bradford is a professor of ophthalmology at the University of Oklahoma.

“The most important thing is knowing to make the right diagnosis,” Dr. Bradford said in an interview with OSN. “It doesn’t matter how well you can do a procedure. If you don’t know who to do it on and who not to do it on, then you’re not there yet.”

After the Oklahoma law was enacted in 1998, many patients underwent laser procedures when they did not need them, and other patients did not have the procedures they needed, Dr. Bradford said.

“If you don’t have the right diagnosis, you can’t choose the correct treatment, whether it’s medical or surgical,” she said.

Dr. Bradford likened optometrists performing ocular surgery to general surgeons performing cardiac procedures.

“If you were to say, ‘Well, we don’t really have heart surgeons, so we’re going to let the general surgeons start doing heart surgery,’ most people wouldn’t go to them because they think, ‘That doesn’t sound quite right. This doctor has been here forever doing appendices. Now he’s going to do heart surgery?’ It doesn’t resonate,” Dr. Bradford said.

In addition, Dr. Bradford said that while the law excludes optometrists from performing LASIK, PRK and retinal procedures, it does not bar them from undertaking other laser refractive procedures.

“Any future variations of corneal laser refractive surgery, if called by another name, would be allowed by the legislation passed in Kentucky,” Dr. Bradford said.

She also questioned the process by which the bill was reviewed and passed. For example, the bill was not subjected to the level of scrutiny normally devoted to pending legislation in the state, she said.

“Hearings were held in a shorter period of time than is designated. It was sent to a committee that didn’t have to do with health,” Dr. Bradford said.

Some state leaders have called for an inquiry into the bill’s review and passage, she said. – by Matt Hasson, Nancy Hemphill and Courtney Preston

• Cynthia A. Bradford, MD, can be reached at Dean A. McGee Eye Institute, 608 Stanton L. Young Blvd., Oklahoma City, OK 73104; 405-271-1819; fax: 405-271-7873; e-mail: cynthia-bradford@dmei.org.
• I. Ben Gaddie, OD, can be reached at Gaddie Eye Centers, 7635 Shelbyville Rd., Ste. 101, Louisville, KY 40222; 502-423-8500; fax: 502-339-0571; e-mail: ibgaddie@bellsouth.net.
• Disclosure: No products or companies are mentioned that would require financial disclosure.