Citing greater access to eye care for Kentuckians and overwhelming bipartisan support in both houses of the state legislature, Kentucky Gov. Steve Beshear signed the Better Access to Quality Eye Care bill (SB 110) into law on February 24. The bill passed 81-14 in the House and 33-3 in the Senate.

SB 110 amends the definition of the practice of optometry, enabling O.D.s to:
• Use the most up-to-date methods of drug administration. This takes into consideration current eye research into contact lenses with medication embedded or periodic injections rather than daily medications.

• Use laser technology to treat conditions optometrists already manage in an office-setting. This makes Kentucky the second state in the nation to allow optometrists to use lasers. Optometrists in Oklahoma have performed laser procedures since 1998.

• Perform minor surgical procedures to correct ocular abnormalities.

SB 110 does not cite specific procedures and treatments that now fall within the scope of optometry. Instead, it gives the Kentucky Board of Optometric Examiners the authority to determine which technologies or procedures, other than those specifically prohibited in the legislation, fall within the scope of optometry and to set competency standards that O.D.s must meet for each specific procedure.

“We did not want to legislate certain procedures, because as new technology becomes available, we don’t want to have to go back to the legislature,” says Ben Gaddie, O.D., president-elect of the Kentucky Optometric Association (KOA).

Examples of procedures that fall within the scope of SB 110 include Nd:YAG laser capsulotomy, argon and selective laser trabeculoplasty, Nd:YAG laser peripheral iridotomy and argon laser peripheral iridoplasty and chalazion removal.

After Gov. Beshear signed the bill, Richard L. Abbott, M.D., president of the American Academy of Ophthalmology, released a statement in which he described SB 110 as “a serious blow to patient safety in Kentucky.” He and other critics claim that the legislation allows optometrists to perform complicated eyelid surgeries, laser glaucoma surgeries and corneal punctures with little training.

Not so, Dr. Gaddie says. In fact, SB 110 specifically prohibits O.D.s from various surgeries—such as LASIK, retinal laser procedures and cataract surgery.

Also, the bill requires that the optometry board must establish a training and certification process for each optometrist to undergo before performing each class of procedures.

“It’s not a free for all for whomever to do whatever they want,” Dr. Gaddie says. “ Legislators and the Governor had to make tough decisions. We think we owe accountability, and we’ll work toward that as we implement the law.”

Meanwhile, the KOA and the Governor say that the law will offer Kentucky residents greater access to eye care. According to numbers from a KOA study and from the

Kentucky Board of Medical Licensure, there are 550 optometrists in 106 counties throughout Kentucky, while two-thirds of the state’s counties do not have an ophthalmologist. That means patients, especially those in rural communities, often must travel to another city or county for treatments.

The Better Access to Quality Eye Care bill should mean fewer lost work days, fewer co-pays and reduced Medicaid expenses due to fewer referrals, fewer visits to multiple offices and lower transportation costs, the KOA says.

In Kentucky, new laws usually take effect 90 days after the legislative session ends. Barring any last-minute changes to the calendar, this bill will go into effect June 29.