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Rules outline how Kentucky optometrists could perform surgeries

The state's optometrists say access to eye care would improve statewide, but ophthalmologists maintain that the regulations threaten patient safety.

By Carolyne Krupa — Posted Aug. 9, 2011

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Debate continues in Kentucky over how to expand optometrists' scope of practice after the governor enacted a law enabling optometrists to perform certain surgeries.

The Kentucky Board of Optometric Examiners recently released proposed regulations outlining qualifications required for optometrists to perform a range of new procedures allowed under the law, enacted in February, including postcataract laser surgery and some forms of laser glaucoma surgery.

Several physician organizations, including the American Medical Association, American Academy of Ophthalmology and American College of Surgeons, have voiced opposition to the regulations. Several ophthalmologists testified against the recommendations at a July 21 public hearing, calling them vague and a threat to patient safety.

But Kentucky Optometric Assn. officials say patient safety is their top priority and that the regulations would help improve access to eye care statewide.

"History is proof that every expansion of optometric scope of practice has resulted in more Kentuckians receiving safe, quality eye services in a cost-effective and efficient manner," said KOA President Ben Gaddie, OD, a Louisville optometrist.

Opponents say the regulations don't specify how long training courses to qualify optometrists to perform the surgeries should be or what credentials will be required of instructors. Optometrists also wouldn't be required to perform the surgeries on humans before being certified.

"Because the document is so vague, we think it is virtually meaningless," said Woodford Van Meter, MD, an ophthalmologist and president of the Kentucky Academy of Eye Physicians and Surgeons. "They would be really dangerous to the people of Kentucky, and they really put patients at risk."

To be credentialed, optometrists must complete a "course approved by the board" covering about 30 topics, including laser physics and safety, common complications, minor surgical procedures and emergency surgical procedures, the recommendations say (link). The board expects about 300 optometrists to seek the credentials.

In a July 28 letter to the board, AMA Executive Vice President and CEO James L. Madara, MD, said the requirements are in stark contrast to training required of ophthalmologists, which include four years of medical school and experience as the primary surgeon on at least 200 surgical procedures during residency training.

"After careful review of the proposed new regulation, we are not even sure that optometrists who will be using scalpels, lasers and needles on patients' eyes in Kentucky will be required to do much more than read books and watch surgery performed by others," Dr. Madara wrote.

The Board of Optometric Examiners is reviewing feedback and will determine any changes to be made, said board Vice President William Reynolds, OD.

Next, the regulations, which were developed by a task force of five optometrists and five ophthalmologists, would be considered by the Administrative Regulatory Review Committee, a joint committee of the state House and Senate. They then would be considered by a second joint committee before going to the governor for final approval, he said.

No time frame had been set for submitting the regulations to the legislative committee as of this article's deadline. "We're still reviewing testimony from the hearing," Reynolds said.

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