Optometrists, ophthalmologists not seeing eye to eye

Dr. Jeffrey Klosterman is an optometrist in Harrodsburg. Dr. Linda Katz is an ophthalmologist in Danville. Ordinarily these two professionals would have a cordial relationship because both work for the welfare of their patients.
However, this once amicable relationship between the two professions has become a battleground in Kentucky over a proposed law to expand what optometrists can do.
“This may very well be the most important piece of legislation to affect my profession in my lifetime,” says Klosterman. And Katz agrees.
The debate surrounds Senate Bill 110, which passed the state Senate on Feb. 11 by a vote of 33-3-1 and the House on Feb. 18 by a vote of 81-14. The bill is on Gov. Steve Beshear’s desk where he may either sign it into law, veto it, or ignore it in which case it would automatically become law within the next week.
The legislation essentially would allow optometrists:
n greater latitude in drug administration;
n to remove lumps and bumps from the eyelid;
n perform certain laser surgical procedures; and
n would grant more authority to the Board of Optometric Examiners.
Klosterman, membership chairman for the Kentucky Optometric Association, says the primary motivation for the legislation is to better serve Kentuckians, particularly those in more rural communities.
“Doctors of optometry practice in 106 of Kentucky’s 120 counties whereas ophthalmologists are only present in one out of every three counties with 52 percent of ophthalmologists located near the Lexington and Louisville region,” he says.
Klosterman cites a study by the University of Kentucky that projects the state’s number of ophthalmologists will have to increase by 81 percent to accommodate Kentucky’s needs by the year 2020.
“But the biggest thing we have going for us,” says Klosterman, “is that the optometry field has a proven track record when it comes to asking for a ‘scope of practice expansions.’”
He believes he and his fellow optometrists aren’t given credit for the amount of research they’re invested in this decision. He also believes the other side is, at times, relying on scare tactics instead of addressing the issues.
Katz, however, believes she and her fellow ophthalmologists are justified in discussing the possible risks of individuals without her medical background performing surgical procedures that have been the domain of ophthalmologists.
“Ophthalmologists are M.D.s who have graduated college, medical school, trained in medical and surgical internships, completed years of specialty surgical training in residencies, and passed both medical and ophthalmology board examinations,” says Katz. “Bottom line, surgery should be performed only by medical doctors who have graduated from medical school and trained for years in surgical residencies.”
Klosterman contends, though, that the medical procedures pending approval by the governor are well within his abilities.
“We are not asking to perform cataract, retinal or Lasik surgery,” says Klosterman. “Also, the passing of this bill doesn’t mean we go run out tomorrow and perform these procedures.”
Klosterman says optometrists would have to go through a certification process, and since some procedures are brand new, they would incorporate new medical techniques that are also unfamiliar to ophthalmologists.
Katz, however, believes her training in surgery means she has an inherent advantage when it comes to any type of surgery.
“This law would allow optometrists to perform laser surgery for glaucoma, create full thickness incisions into the eye (called paracentesis) and operate on the eyelids along with other procedures.”
Katz says in the worst case scenario, this could result in death. She notes that 25 other states have tried unsuccessfully to pass a bill similar to this one.
But Klosterman points to the one state that has passed a similar bill. “Oklahoma passed this law in 1998, and they have not had any complaints throughout the course of working with 250,000 patients.”
Klosterman believes the fact that malpractice insurance didn’t go up on the optometry profession in Oklahoma is an indication the risk is not all that high.
The issue is not only debated by Katz, but by her husband, Douglas, who also happens to be an ophthalmologist in Lexington and is an associate professor in the Department of Ophthalmology at UK.
“There can be no training in optometry school for surgery as it is illegal in 49 states,” says Doug Katz, who also believes the numbers aren’t correct when it comes to Kentuckians accessing an ophthalmologist.
“The statistics the optometry lobby puts out conveniently leave out ophthalmology satellite offices,” says Doug Katz. “No one currently has to drive more than 45 minutes for a qualified surgeon.”
Doug Katz says many optometrists send their patients for surgery to city locations when an eye surgeon might be right down the road.
The issue of geography, however, is one that Klosterman believes is overlooked. “What some consider to be a short drive of an hour or so is not so short to my patients who have trouble just getting down to see me on Main Street,” says Klosterman. “For some of my patients here in Harrodsburg, Lexington or even Danville might as well be another state.”
“I really hope the governor signs this bill into law,” says Klosterman, “and not just for me, but my patients.”
But Drs. Linda and Doug Katz have something else to say to the man who can make this bill law with one stroke of the pen. “Do the right thing, governor, and veto SB110.”