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Hannah Massa
Professor Salgat
English 111*2
November 12, 2014
Eye Care Chaos
For centuries, optometry has been an important part of the medical field. From
investigating color blindness, to cataracts, to developing LASIK surgery to correct prescriptions
completely, doctors have worked tirelessly through history to assess certain eye complications.
The human eye is a vital part of the body that should never be overlooked in the medical field. In
early 2011, a law in Kentucky was signed called the Better Access to Quality Eye Car bill
(Eisenberg 4). It sparked a large controversy between optometrists and ophthalmologists and the
general public. The bill tries to cut costs, transportation needs, and ensure patient safety. As a
result, optometrists do not have to go through the same amount of schooling as ophthalmologists,
medical doctors, to perform certain eye procedures. The majority of the public does not agree
with the bill and thinks it should be re-examined. Altogether, Kentucky legislatures passage on
the Better Access to Quality Eye Care bill seems beneficial, but in fact lacks proper
education/training, causes incorrect diagnosis, and threatens patient safety.
To begin with, on February 24, 2011, Steve Beshear, the Kentucky governor, signed the
Better Access to Quality Eye Care bill, also known as SB 110. By signing this bill, Beshear made
SB 110 into a major law. The bill flew through the Senate floor in less than seventeen days,

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resulting in a 33-3 vote in the Senate and another vote of 81-14 in the House of Representatives
(Eisenberg 4). The Senate approved the bill on February 7th while the House passed it on
February 18th. That means that then less than a week after the legislative processes had examined
the bill, Beshear signed it into law (Alessi 1). The bill surpassed many other bills awaiting
examination and confirmation. Debates were brought about regarding if certain fundraising led
to such a quick passage of the bill. The state law allows optometrists to perform a variety of
surgical procedures, such as laser eye surgery, without the training and education that
ophthalmologists must go through (Proposed Regulations for Optometry 1). Optometrists are
not considered true medical doctors. Some of the procedures involve lasers, scalpels, needles,
ultrasound, ionizing radiation and tools that burn and freeze tissue to treat complicated
conditions such as potentially cancerous eyelid tumors, glaucoma and post-cataract surgery
complications (Kentucky Board of Optometric Examiners 1). It also allows optometrists to
inject all drugs expect Schedule I and II types, which are controlled substances (Proposed
Regulations for Optometry 1). This means that SB 110 lets many complicated surgeries be done
by the use of a variety of prescribed drugs. Regulations are proposed in the bill that state
optometrists must take an additional thirty-two hour instruction class over a span of a couple
weeks to get proper certification to perform the eye surgeries (Kentucky Board of Optometric
Examiners 1). SB 110 is a long, complex bill that contains some major advantages and
disadvantages to both optometrists and ophthalmologists.
Even though a majority of the Kentucky population does not favor the bill, the Better
Access to Quality Eye Care bill seems to possess some benefits to the Kentucky population. The
state will lower Medicaid costs because of the reduction of referrals, number of office visits, and
transportation costs (Frequently Asked Questions 1). Patients also have easier access to a wide

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range of eye care, which is usually performed by their family eye doctor that they know and
trust. About two-thirds of Kentuckys counties do not have an ophthalmologist (Frequently
Asked Questions 1). The SB 110 bill would enable patients to visit their local eye doctor instead
of having to travel to an ophthalmology practice in order to receive care. The wait for getting
into the family optometrist is thought to be quicker than the wait on scheduling an appointment
to see a prestigious ophthalmologist (Eisenberg 4). Sure enough, the Medicaid insurance and
transportation costs may go down, but the patient safety rate will drastically increase. Many
individuals in todays society have a world that is centered on money. Being cheap is not a
problem in some aspects of life, but when it comes to an individuals health there is no room to
be frugal. Spending more money on proper treatments of your eye is crucial.
In addition, Ben Gaddie, an optometrist and president-elect of the Kentucky Optometric
Association, favored the bill on public television (Eisenberg 4). Gaddie discussed how his team
of eye doctors worked to get the bill passed because it allowed individuals in rural parts of
Kentucky to have better access to certain eye surgeries. On the other hand, according to the cn|2
poll conducted in 2011 to see if Kentuckians favored the SB 110 or not, the poll showed that
most citizens disagreeing on the passage of the bill were in fact actually from rural areas (Alessi
1). The SB 110 bill only makes optometrists go to training for thirty-two hours, while
ophthalmologists go through more than 17,000 hours of hands-on clinical training (Kentucky
Board of Optometric Examiners 1). Optometrists could incorrectly diagnose their patients with
an eye disease and perform an incorrect procedure because of limited training hours.
Consequently, the result of optometrists lack of training could be blindness or other eye diseases
in patients.

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First off, SB 110 lacks the long, extensive education process that ophthalmologists must
go through. They go through four years of undergraduate school, four years of medical school,
and at the most seven years of residency and surgical training (Krupa 1). As stated above,
ophthalmologists go through more than 17,000 hours of clinical training as opposed to only
thirty-two hours optometrists have to spend gaining knowledge (Kentucky Board of Optometric
Examiners 1). Krupa states: Several physician organizations, including the American Medical
Association, the American College of Surgeons and the AAO, have opposed such efforts, saying
optometrists lack adequate medical education and training to perform surgeries and deal with
potential complications (1). The Kentucky legislature tried to develop statutes correlating
medicine and nursing practices. These statutes did not mention anything about laser eye
procedures (Dellavalle & Gillum 137). According to Dellavalle and Gillum: Without statutory
guidance, the boards quickly came to odds whether a nurse practitioner could supervise laser
procedures (137). Since optometrists do not have a lengthy clinical experience, there is now
being debates over the correct supervision it takes to perform the surgeries that SB 110 already
allows.
On the same note, medical and nursing boards cannot pressure one another and change
the statutes by themselves. SB 110 is a state law that cannot be overridden by a mass of angry
board members (Dellavalle & Gillum 138). It is all of to the legislation system now. The
Kentucky statues regarding SB 110 state that patients do not need an actual physicians attention
when attempting a laser eye procedure (Dellavalle & Gillum 138). Prestigious medical
organizations, not just optical-based ones, are starting to get involved in the passage of the bill.
Medical doctors everywhere are starting to debate SB 110 and the loopholes it contains.

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Since optometrists possess limited experience, they have already incorrectly diagnosed
their patients. One example was an optometrist gave a patient many different drug injections for
a bump on the eyelid. It turned out that the doctor mistook the bump for a cyst. It turns out the
lump was actually deadly skin cancer that was found too late to be corrected (Krupa 1). In
another case, a vulnerable patient showed some vision loss after an optometrist performed a
complex surgery which the patient was not a good candidate for (Krupa 1). Clearly optometrists
are already messing up and putting their patients at risk, but all of these cases were resolved to
keep the public quiet. Gaddie, president-elect of the Kentucky Optometric Association discussed
on national television that SB 110 would allow optometrists to use the most up to date methods
in regards to drug distribution (Eisenberg 4). That may be true, but incorrect diagnosis of patients
leads to prescribing the wrong type of drug to fix the problem. The lumps and bumps on the
eye may be able to be taken care of using less money, but the limited classroom time that
optometrists experience could potentially result in assessing the wrong lump or bump and
making it drastically worse. Other associations such as the American College of Surgeons,
American Academy of Ophthalmology, and American Medical Association have argued
tirelessly on the fact that surgeons should be performing the procedures. Ophthalmologists train
for 8+ years to specialize in surgical procedures and proper diagnosis. They are required to
perform hundreds of surgeries until they are proficient (Kentucky Board of Optometric
Examiners 1). Optometrists are now able to take some training classes that can be done in a
couple weeks depending on the pace they decide and are considered certified to correctly
diagnosis patients eye complications.
Another factor that has become suspicious in the passage of SB 110 is fundraising. Dr.
Van Meter, president of the Kentucky Academy of Eye Physicians and Surgeons, thought that all

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of the money coming in to pass the bill was outrageous (Passut 1). Optometrists and their action
committees raised more than $400,000 toward their case in the Senate (Passut 1). The committee
that proposed the bill and discussed it was a committee that dealt with licensing and occupations.
In all reality, the committee usually discussed issues involving fishing licenses and air condition
regulations (Passut 1). That is a bit odd for that type of committee to be assessing problems in
the medical field. According to Passut: Money was donated to the campaigns of 137 of the 138
members of the state legislature, as well as to the governors re-election campaign (1). It seems
as though all of the fundraising was used to bribe the Senate and House so they would disregard
the actual practicality of it all.
In relation, all of the incorrect eye care diagnoses have led to the biggest problem with
the Better Access to Quality Eye Care bill: optimizing patient safety. A survey in 2010 showed
that over 50% of individuals in the United States did not know the difference between
optometrists and ophthalmologists (Krupa 1). If ordinary citizens do not even know what doctor
is certified or not, then there is a major problem. All of the patient confusion just adds to the
debate. In figure 1, a 2011 consensus was found that showed how many people of the public
agreed or disagreed with the new SB 110 law. Alessi states: The cn|2 Poll was conducted Feb.
28 and March 1 by live interviewers from Braun Research of New Jersey (1). By doing a poll
on two different days, interviewers were able to ask over 800 Kentuckians a question regarding
the new optometry law. As shown below in figure 1, about 79% of people disagreed with the SB
110 while only 15% agreed (Alessi 1). This consensus should show lawmakers that not only is it
the medical doctors that do not necessarily agree, but the general public does not as well. By the
general public not agreeing with the law, this puts patients more at risk. The legislature is

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persuading eye care patients to obey the law and trust optometrists when they do not necessarily
want to.
Similarly, SB 110 has also led to patient safety controversy with medicine, cosmetology,
and nursing boards. Minimally invasive cosmetic procedure, or MICPs, are a huge interest to all
of these boards. MICPs consist of laser skin restoration, which is what SB 110 is letting
optometrists do to their patients (Dellavalle & Gillum 137). There are certain ways to resolve
these issues. Extensive studies and training to create a correct assessment and system to
diagnosing eye problems from all three boards would be the best solution. Dellavalle and Gillum
conclude: Additional factual data may empower boards to make decisions that truly promote
patient safety and may help minimize outside influences from the press or from the political
system (138). This means that by nursing, cosmetology, and medicine-related boards coming
together, important decisions can be made to optimize patient safety. An increasing amount of
persuasion from politics and popular culture is the main concern. The legislature and Kentuckys
governor need to realize that if other medical fields are being brought into the controversy and
disagreeing with the bill for the sake of patient safety, then the bill should be re-examined.

Figure 1. Bar graph showing 2011

Kentucky cn|2 poll and the high
disagreement on the new SB 110. From
R. Alessi, 2011: p.1.

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All in all, Kentucky passage of SB 110 seems beneficial at first glance, but actually
contains large loopholes in regards to training, patient safety, and diagnosis. The idea of
expanding the scope of optometrists roles is a good one, but in the sense that they go through the
exact same schooling as medical doctors do. The eye is one of the most important assets to a
human and cannot be taken for granted. Kentuckys biggest concern right now should be patient
safety. The bill needs to be thoroughly re-examined, added to, and revised completely to please
both parties involved in the eye care controversy. In Nebraska, South Carolina, and Texas,
lawmakers are strongly considering to expand their optometrists practices like SB 110 does for
Kentucky (Krupa 1). Sooner or later, other states are going to follow in the Kentucky
legislatures footsteps and expand their optometric practices as well. All individuals, no matter
what state, need to be aware of the certifications and schooling their eye doctor has gone through
to be making diagnoses and performing a variety of surgeries on their patients.

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Works Cited
Alessi, Ryan. cn|2 Poll: Few in Ky. support optometrist bill that was first to pass legislature in
'11. Time Warner Cable. Time Warner Cable. 2 Mar. 2011. Web. 5 Nov. 2014.
Dellavalle, Robert P. & Gillum, Jason D. Contradictory State Administrative Regulation of
Minimally Invasive Cosmetic Procedures in Kentucky and North Carolina. Jama
Dermatol, 149(2). (2013). 137-138. Jama Dermatology. Web. 26 Oct. 2014.
Eisenberg, Jeffrey S. "Kentucky Expands O.D.'s scope of practice: SB 110 makes Kentucky the
second state to allow O.D.s to use lasers." Review of Optometry, 148(3). (2011): 4.
Academic OneFile. Web. 26 Oct. 2014.
Frequently Asked Questions. Kentucky Optometrist Association. Kentucky Optometrist
Association. n.d. Web. 2 Nov. 2014.
Kentucky Board of Optometric Examiners Alleged To Have Violated Kentucky's Open
Meetings Act in Developing Eye Surgery Regulation. PR Newswire. PR Newswire.
2011. Web. 26 Oct. 2014.
Krupa, Carolyne. Optometrists seek surgery rights in more states after Kentucky victory.
American Medical News. 23 May 2011: 1. Amednews.com. Web. 2 Nov. 2014.
Passut, Jena. Kentucky governor signs law to expand optometric scope of practice. EyeWorld
News Service March 2011:1. ASCRS. Web. 2 Nov. 2014.
Proposed Regulations for Optometry Surgery Law Put Patients at Risk. PR Newswire. PR
Newswire. 2011. Web. 26 Oct. 2014.