Kentucky bill expands laser scope for optometrists

Frankfort, KY-Ophthalmologists are reacting with shock and anger after a bill giving optometrists authority to perform certain laser surgical procedures was rushed through the Kentucky state legislature and signed into law in just 3 weeks.

The law, based on Senate Bill 110, authorizes optometrists to perform any laser surgery procedures, unless they are specifically excluded from the measure. For example, as in Oklahoma, the measure effectively allows optometrists to perform YAG capsulotomy, argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT), and laser peripheral iridotomy (PI) for narrow-angle or angle-closure glaucoma.

Like the Oklahoma law, it does not permit retina laser procedures or LASIK. Although Oklahoma optometrists may perform PRK, the Kentucky legislation prohibits it. The new law also excludes a host of nonlaser surgical procedures, including enucleations, cornea transplants, lamellar keratoplasty, cataract surgery, intraocular implants, and removal of eyelid malignancies.

On Feb. 11, the measure passed the Senate, 33 to 3, with one member abstaining. On Feb. 14, the bill was received in the House, and on Feb. 18, it passed 81 to 14. Six days later [Feb. 24], Gov. Steve Beshear signed it into law.

Dr. Van Meter, who learned of the bill on Feb. 7, said the legislation is similar to Oklahoma's law, which in 1998 allowed optometrists to perform anterior segment laser surgeries. That law was expanded in 2004 to allow the state's Board of Examiners in Optometry to determine optometric scope of practice. Similarly, the Kentucky legislation gives its state Board of Optometric Examiners sole authority to determine what constitutes the practice of optometry.

Since 1998, some 25 states have considered -and rejected-expanding optometric scope to include surgery, Dr. Van Meter said.

"This bill went through at the legislative equivalent of light speed," Dr. Van Meter said, noting that optometrists had 18 lobbyists working on the measure before ophthalmology was aware it existed. "They intentionally kept it under wraps. It went through so fast there was no time for discussion, and discussion was not invited. They clearly did not want any scrutiny, nor did they invite any scrutiny on this."

Upon learning of the bill, Dr. Van Meter hustled to shore up ophthalmology's position, calling in help from the American Academy of Ophthalmology and 14 lobbyists, to little avail. A few opponents of the bill, including Dr. Van Meter, were permitted limited testimony at two hearings, where ophthalmologists gained the support of two physicians in the legislature.

Rep. David Watkins, a family physician in Henderson, KY, agreed that optometrists should not perform surgery. "They haven't had any residencies," he said. "They haven't had any training in this area."

He said most Kentuckians-including many legislators-likely are unaware of the differences in education, training, and experience between optometrists and ophthalmologists. "They (legislators) think they understand, but I don't think they really know," Rep. Watkins said. "But I guarantee you they won't be going to an optometrist for surgery."

Supporters of the measure say it will increase access for Kentucky residents, some of whom live in rural areas not served by ophthalmologists. According to the Kentucky Optometric Association (KOA), two-thirds of the state's 120 counties do not have an ophthalmologist, but 550 optometrists practice in 106 counties, including 77% of those counties classified by the government at medically underserved.

Gov. Beshear said in a statement that the measure makes it easier for Kentuckians to receive necessary eye care. "Access to quality health care is a critical issue for families across the Commonwealth," he said.

However, Dr. Van Meter said access is not a problem in the state, and no citizens had complained that they were unable to get treatment. "There is no waiting list to have surgery of any kind in Kentucky," he said. "There are more than enough ophthalmologists to take care of all the needs of the citizens of Kentucky."

Instead, he thinks optometrists interested in "a bigger piece of the pie" sense a financial opportunity.

"It's really not a turf battle any more than when a fox chases a rabbit," Dr. Van Meter said. "The fox is running for dessert, and the rabbit is running for his life. Most ophthalmologists are not anxious to do more refractions."