Welcome to Kentucky tonight.

Good evening.

I'm bill goodman.

Tonight will discuss optometry.

Bill passed by the general assem and sent to the governor.

Our guest are Dr. Ben Gaddy, president elect of th Optometric Association.

Dr. David Cockrell, a member of the Board of Trustee of the American Optometric Assoc Dr. Cynthia Bradford, Senior Sec for Advocacy with the American A of Ophthalmology.

And Dr. Woodford Woodford Van Meter, President of the Kentucky Academ Physicians and Surgeons.

Thanks to all of you for joining us tonight on Kentuc Tonight, a bill that would expan the practice of optometry has pa the Kentucky House and Senate and been sent to Governor Steve Out of hundreds of bills filed for consideration this yea Senate Bill 110 is the first of session of the General Assembly both chambers.

The governor can sign it, allow it to become law without his signature or veto th And once again, thanks very much for being here on our program to Dr. Gary, let me begin with you and just ask if you will spell o for us the training and the prac You have had the schooling as an optometrist.

Sure.

Once we graduate from undergradu or college university, you enter into a optometry schoo or college of optometry, and there are about 20 programs in North America.

And after you begin an optometry it's four year program, doctoral level program.

I went to the University of Alab Birmingham School of Optometry, we spend the first two years in the same classroom with the d and medical students learning what we call our basic science c physiology, anatomy, biochem chemistry courses such as that.

At the same time, we began almos immediately our training into th We have clinical experience beginning in the first year and that clinical experience bui over the course of four years.

So during our four years of doctoral study, we are expose to patients delivering direct ey patient care from day one.

And after four years of optometr I went to Oklahoma.

I actually did Tulsa and did a residency in Ocular di and that's a four year supervise intensive patient care as well a and some teaching of optometry students as well.

And then I did a fellowship after that in glaucoma and laser therapy there in Oklahoma.

Do most optometrists have the th of the training that you just sp Most optometrists do not do the both residency and fellowship.

We do have probably a third of our profession now that is se residency training, and we like to see that trend co But just like dentistry or podia you can enter straight out of optometry school and start practicing optometry.

Dr. Van Meter Same question to y about your schooling or training and the real difference in the p of optometry and ophthalmology.

Well, after four years of underg training, you go to medical school for fou and during medical school you take three national exams to become an MD.

After medical school, you enter a four year ophthalmol residency training program, of which the first year is spent exclusively in medicine or surge And then you have three clinical of ophthalmology residency, and that's eight years after you finish your undergradu Many ophthalmologists will go on another year or two of specializ in retinal surgery or corneal surgery or glaucoma s We think that on the average, the training of ophthalmologist is far surpasses that of an opto because in terms of clinical hou using the s U. NY program in New York optometri at approximately 1900 clinical hours during their four of optometry school.

In the last three years of ophth residency and ophthalmology rising gets over 17000 hours of clinical hands on Most of this is in surgery and t and dealing with ocular disease.

So again, the question after the credits there.

But the real difference in both your minds between is it fair to that the difference in ophthalmo and optometrist might be the sam Maybe a viewer would think about psychologist and psychiatrist?

Is that a fair comparison?

I would say it's more like chiropractors and bulk surg What's the real difference in in these two professions we're discussing tonight, then, in your mind?

Well, four years of medical scho a much more intensive clinical t of ocular disease and optometris typically get in optometry schoo and the actual work that you're doing on a daily bas Yes, sir.

Dr. Cotterell and Dr. Redford, first of all, welcome to Kentucky, both from O And we appreciate you being here Your practice in Oklahoma, where the legislature passed a similar bill ten years ago in 1998, over ten years ago.

And I want to talk about that a little bit tonight.

But I want you to to, if you wil Cotterill, optometry.

Are licensed in states just like Gaddy has to be licensed here in If you were practicing in Kentuc would your license say as an opt Well, I do assist in Oklahoma and see a fair comparison to wha Optometrists.

Within that we have certifications for and or the surgical procedures t Gary's bill here in Kentucky tal But the licenses licensure is all the same.

Just like an M.D.

licensure is all the same.

And then they, as he said, go on to do a residency in ophth or what have you.

Our particular case, we've got a certification by the Oklahoma St Board of Examiners certify us to to do these laser procedures.

And Dr. Bradford, if you were practicing ophthalmology in Kentucky as a licensed ophthalmologist, what would that license say?

Medical doctor?

And that's the real difference then in what the license Doctor Gary, does your current l to practice in Kentucky mirror w Cockerell said might have be found in Oklahoma?

Well, our our license in Kentuck says optometrist or doctor of op And it also spells out if you're diagnostically or therapeutically certified in just like many other states in this country, in order to hav privileges or scope of practice, we've had to come before the legislature three different and this will be the fourth now starting in the 1970s, to have d agents to be able to dilate the and and do other diagnostic test So in 1986, when we received the or the ability to write prescrip for medications such as glaucoma then 1996 to prescribe oral medi So there are some delineations, although most optometrists 99% that are licensed in Kentucky, a therapeutically certified as of So if the law takes effect when the questions come up about versus non laser surgery, what w be?

Where will that be in the bi that we are discussing tonight?

Any any further privileges that are extended with this legi Anyone that wishes to do any of the procedures will have to be trained and then certified and tested and that testing is being is bei at by the Board of Examiners.

That has not been fully establis because we don't know exactly, y if the bill is going to come to But once that training has been in the certification process, each optometrist that wishes to these procedures will have to un that same set of training.

Proctor cases under direct super of an ophthalmologist or optometrist who is licensed a to perform this documentary.

There's a key difference here that we must show, and that is that when we pass our American Board of Ophthalmol Exam, we're license to practice ophthalmology in any There are 50 different optometry in 50 different states, and there is no national standardized exam.

And so any privileges are reques on a state by state basis.

That's not exactly right.

We take national board examinati two, three and four, just as you did in medical schoo So leaving optometry school, the entry level for the professi is the same across the country.

So you not have to take the stat a separate state exam in differe When you practice in some states you still have to take a separate examination.

So I think all states you do, mo consist of law examinations.

In some states you have examinations that go be Oklahoma is one of those states that for many years has had supp examinations.

Specifically, we do now because of laser privi So if you're going to actually b to utilize a laser, you're going to have to go throu and take testing to prove that y actually utilize those procedure But that would not be useful in except for Oklahoma right now, c That's correct.

Dr. Gary, why this bill at this to expand the scope of Optometric practice in Kentucky?

Well, the bill right now in our minds has to do with acce to care for patients and we are well positioned as optometrists in Kentucky.

We are in 106 of 120 counties, whereas our Ophthalmological col are only in about 40 counties an those are in Louisville and Lexi So this is all about providing better access to care.

We have patients that are drivin one and 2 hours each way, elderl with impaired vision driving across the street across in order to receive eye care that a lot of this can be done in our offices under local anest without putting patients under a And we think it's going to be a great service for the patients of Kentucky.

Dr. Verma, do you have a a well-known analo that most Kentucky basketball fans would adhere to?

What is that?

Well, we think that this bill is by the optometrists, and there has never been a patie an advocacy group, a consumer gr or a citizen group that have said we need this care Citizens of Kentucky are not lined up to get eye care No one has yet said we can't get our surgery if we want it.

The bill addresses those that are in unde areas predominantly, and most pe that 95% of Kentuckians live within an hour of an ophtha And my analogy is that there are more people that will travel on over an hour to get to a basketball game at R than everyone of these patients would travel if they had to go to an hour to see an ophthalmologist.

And unfortunately, it's in Oklah What we've seen is there's patients who get loca But it's not up to the standard who have lesions on their eyelid that were treated inappropriatel And they were cancers and some o patients presented months later, they had had injections of stero into their eyelid for skin cancer patients with unusual skin cance that were treated for months with warm compresses.

And by the time they finally mad to an ophthalmologist, they had metastatic lesions in t from the cancer.

And these are documented cases.

This is not just anecdotal.

Corr I'd like to respond to that.

You know, unfortunately, that ma I also said on the Oklahoma State board of E that have for the last 14 years, and none of those cases have act brought forward by ophthalmology or by medicine or by anyone in t not one single one.

So I'm not about to say she's wr I'm not to say that it's never o At the same time, as Dr. Bradford knows, we have many cases of ophthalmol or the same types of things have that we've also recorded where something's been treated inappropriately, something may have been treated appropriately and still had an a outcomes, so we can go back and with a he said.

She said, I knew what was right, what was wrong when in fact some things are tre properly and don't work out.

Some things may or may not have We won't know until those cases are actually presented in Oklaho before the Oklahoma State Board of Examiners.

All that is a public record.

So it's open to there's a public there's a difficulty there.

And and what some patients have I do not want to they live in a and they don't want to report the optometrist becaus the pushback and the ophthalmologist also has because if an ophthalmologist re a bad outcome like that, they'll be blackballed by optome in terms of referrals.

So it's there should be a better way of But unfortunately, it's it's very difficult and it's difficul for the patients, It's difficult for the physician taking care of And yes, I mean, no, nobody's pe You can't you're always going to have comp We all know that.

But why would you want to lower the experience, lower the education process and say so we're going to get better outcom It doesn't make sense.

My response to that would be if follow that to its logical concl that means in medicine, absolute no procedure would ever come alo No technique would be done, no new technique would be done by an ophthalmologist the first because they would never have do before, nor would anyone who's been in p for 20 or 30 years who got out of school before those techniques came alo Would they ever go forward, those new techniques?

I understand your point, but the is experience builds on experien And the more procedures you do, you can bring that experience fo which is what medicine to say, which is why they can do new pro So I don't think the analogy hol well that the problem we have is it's not just a procedure.

I teach cataract surgery to the ophthalmology residents and I can teach someone to do su But the question is, do you know all the ramification of making that decision for doin And can you live with the consequences of it?

And it's the same thing as making a decision of when to cut a lesion off and I have patients come in all the time for a second opinio they had a little cyst near the and optometrist wanted to cut it You know, we've had patients who've had bl from glaucoma that were needled that would very good judgment.

And I think the problem is, is there's not enough experience with these type patients.

And I'm very concerned when you give a group of people the right to go out and do these And there's a lot of things that this law allows.

Well, that's what I want to talk and we'll get into that in just a few minutes with some follow up questions.

But I do want to invite you to join us tonight.

We are discussing the optometry passed by the General Assembly and sent to the governor.

We do invite your questions and and you may send an email to K tonight at Katie Borg.

Please include first and last na or county in your message.

You may also use the web form at WW w on Katie dawgs k y tonight click on Contact us or you may c one 800 4947605.

An email tonight from Carol Muns from Scott County asks this ques for the optometrist on the panel Geographically, the states of Ok and Kentucky seem to be similar.

Is what happened in Oklahoma a good comparison for how the law will work in Ken I'd like to address that.

Having practice both and still maintaining my li in Oklahoma and obviously practicing here in I've been on both sides of that.

I perform these procedures of hundreds of these procedures, and I think it's a great case st especially if you look at malpra rates and notwithstanding what D Bradford mentioned of a few scattered cases, if you look and Cockrell can certainly attest to his malpractice rates have gone $80 in 30 years of practice.

And our insurance here in Kentuc is very similar to that in Oklah between five and $600 a year.

And I think that speaks volumes.

And to go back to what Dr. Bradford was just discussing, about knowing when to do a proce and knowing the complications, we've been co-managing these sur for many, many years for at least 30 co-managing.

What does that mean?

What that means is we see a pati we follow them in our practice for cataracts or glaucoma or wha the condition may be.

And when it's time for surgery, we refer that patient to our local ophthalmologist, or having to travel several hours to go to that ophthalmologist.

And once the procedure is perfor the next day, we are seeing the patient and fo and we take care of that patient for hopefully the rest of their And so we we know how to recognize complic We manage complications on a daily basis from cataract s in the hands of ophthalmology.

And we also know when the indica are to refer that patient for su So we think we are well equipped to handle what we' and what we're asking to do in t Under this bill, the co-management would stay the That's correct.

Dr. VanMeter, let's talk about the malpractice insurance issue, because that's utterly ridiculou What's the downside risk of prescribing glasses?

There's not much downside risk to giving diagnostic drops.

And to say that your malpractice haven't gone up is literally jus you're not doing retinal detachm surgery or corneal transplant su that we're treating glaucoma, we're treating infections, eye diseases, managing the complications of di And we've been doing that legally since 1986.

Are you doing that here in Kentu or are you doing that in Oklahom doing that here in Kentucky?

How are you managing the complic of diabetes here in Kentucky, working with primary care physicians to inter to control the blood sugar, tigh patient education, working with the retinal surgeon special testing to determine if someone needs laser intervent Of course, not everyone with diabetic probl or retinopathy, as we call it in actually requires surgery or int and we follow those patients.

I do it all day long.

Okay.

Let me go back to Dr. Cochran's question about experie You've said that experience is i but you you didn't end up with a logical conclusion because if experience is importa then this is probably not a good for the people of Kentucky to turn a bunch of optometrist loose doing laser surgery.

Let me ask you a question.

When you get on an airplane, does it give you any sense of se to know that that pilot is exper or are you a little bit uneasy if the pilot maybe is brand new and if the weather's nice, it probably doesn't make any dif But if the weather turns bad, you want an experienced pilot in the front of that plane.

And if Sully had no experience, then that plane might not have l carefully in the Hudson River.

But fortunately, ask the right g I hold a private instrument, commercial pilot's license.

All of those are certificated by the United States government, check rider.

And in each of those cases, that Trek rider might or might n a high school degree, might or might not hold a colleg certainly doesn't hold doesn't have to hold any degree in order to be approved by that.

They've been certificated by the federal government say these people have been trained t So the analogy holds.

You certainly want someone who's been trained, whic You want someone who's been cert you want someone who's been test We've done all those things.

I'm tickled you brought the anal up on the other on the other sid Let me finish.

This is in Oklaho We have a 20 year track record of doing laser procedures I've done for 20 years, 19 years in my case, if that being the ca 19 years, and perhaps Oklahomans might not be as litigious as oth But in 19 to 20 years, if we had an experience of bad o I think we'd see a plethora of legal actions talking about one person and one We're talking about letting I'm about all the optometrists have been doing these procedures in Oklahoma for That's over 500 docs.

So they're not all doing lasers.

No, no, no.

I'd say that over 500 dogs.

Over I said these procedures.

This bill isn't just about laser This bill is about surgical proc This bill is about other things.

We have 340 that are laser certi So some have chosen to take the some have not chosen to take the The issue is you're never going to approve of our tr The question is whether or not we're trained well enough to do the job and take care of it.

As Dr. Gaddy said, our job, whether we do those procedures o is to identify the problems ther And if they don't do it, refer i ophthalmologist for appropriate And then if a complication occur our job is still to find the com before they're sent back to opht In many cases.

I think we're going to disagree because the level of training is very clearly different.

It's very clearly different.

And I've seen patients that have they came in for a sec opinion that didn't need the las that was going to be recommended So I think we're going to come t where we disagree.

We do not believe you have enough education and training to And I know you're convinced you but why don't we shift to money?

Well, so when you when you do.

Okay, when you're following your you charge them for it.

What is it?

It's a it's a scan to look at di patients retina to see if they have swelling.

And that's what I presume you me when you said you did testing.

So you charge for that.

Okay.

And you refer them to a retina, doctor, I presume, you're doing a testing, what hap We do the testing and we do a clinical examination where we dilate the eyes and we look for findings of what we call diabetic retinop and that's bleeding inside the e And a lot of diabetic retinopath require treatment or laser inter And the main areas that require intervention is when you get bleeding in the cen part of the retina that's responsible for your fine detail vision.

And many times it's difficult to just by the clinical examination whether or not that criteria is met for referral for surgery.

So now we have a tool called LCT Bradford referred to that helps us identify whether o this patient needs treatment or So many times it's difficult to We will do the OCT to determine if the patient needs to be refer many times it looks like they ma therapy when they actually don't So yes we do.

And we actually bill for cases w there is a pertinent finding of edema, if there's no macular ede then then billing for a no is no Why is that important about the Doctor Bradford Well, because first of all, if you see macular and you're going to refer it, do the test is a waste of money.

And whenever you do it and then you refer it to the retina doctor, they're going to be repeating it So there there's there's redunda Well, obviously you may not have a lot of diabetic retinopathy because it is oftentimes very difficult to tell if there's macular edema present just by the clinical examination And that's why the retinal specialists also the test is to confirm whether o they need to do laser interventi So I would disagree.

I think I've managed a lot of di Let me ask you this.

I want to talk about specificall what is in the bill and is there language in the bill that authorizes laser surgery?

Y What kind?

Well, the main areas that are legislated here after cataract surgery, sometimes you get a cloudy membr over the implant that the catara surgeon places inside the eye.

And we do something called a yaa capsule.

Pardon me.

And that's where we use laser li to clean the surface of those le The capsule that covers those or holds those lenses into And then there's also language i for glaucoma, laser procedures, one for acute glaucoma to prevent acute glaucoma and th to facilitate or help fluid flow through the eye better as fluid to back up the pressure inside t and be a contributing factor to And are all optometrists trained to do that today?

Not all optometrists are trained to do that today, and everyone that wishes to perform these pro would have to undergo the traini necessary as set forth by the Board of Examiners.

But the bill says that will be either signed, vetoed or left to be law But the governor allows that today, does it not?

That is not correct.

They would, of course, have to b or if it becomes law, that will be in July, that will actually be a live bil and that legislation enacted and then the board will begin its process of deciding who they to actually license to perform i And how will that process?

Well, I'm not on the Board of Ex but I know there is a committee being formed of optometrists, other health care practitioners, ophthalmologists at best, to dec the training curriculum that nee Were there parts of that, Dr. VanMeter, that you objected to?

I want Ben to tell me right now how many laser procedures you want permission to do.

Well, it just depends on how technology advances you a A cornea specialist, of course, and I think you graduated from your medical school and residency prior to 1996, cor That is correct.

And so LASIK, which is a procedu by a general ophthalmologist and cornea specialist, became approved by the FDA in 19 So not answering my question.

So you had to be able to learn how to do that.

And it will be in the same manne that other surgeons have learned new techniques as time as new te becomes a big difference here because you're talking about the that we went through in medical school and in residency training.

We learned skills that you don't and you're talking your acting l you're piggybacking on the educa that we had and you're not.

Are you permitted to do Lasik su that is excluded in this bill?

What about cataract surgery that is also excluded in this bi Specifically, what glaucoma proc would you be allowed to do?

A procedure card called argon la trabecular plastic?

And there's also a newer procedu that just came out within the last ten years called select trabecular plastic to different wavelengths to treat glaucoma.

But they both work in the same area of the eye, and that's the trabecular mesh w to help open up that pathway to allow mo to flow freely through the eye.

What about Lasik?

Lasik also the difference in tho Lasik and Lasik Lasik, you cut the cornea and flip it back in the struggle Then Lasik, you're just lifting the epithelium off and then lase So I want to know, well, the LASIK is a procedure that is not performed very frequ at least not with the Lasik surg that I work with.

And it is essentially PRK becaus you have to remove the epitheliu Braugher noted.

And once you remove that feeling then you perform PRK So that procedure will be exclud as the Board of Optometry makes the regulations, but the l it correct as a law, the law prohibits.

PRK.

And once you remove the epitheli they're different for me, but they're different procedures come out of your colleagues with with disagreemen with the cornea first.

And I don't disagree.

She's righ And I'm still waiting for you to what laser procedures you want t I just went through I just one o procedures encapsulated one laser peripheral.

You're data me to the two laser trabecular plastic three and four, and possibly a little plastic if necessary.

Okay.

And then whatever new technologi might be available down the road And so you would do cataract sur if you could do it with the lase Cataract surgery is excluded.

Now it says non, it says non las but you still have to get into t You have to do a full thickness which is excluded in the legisla You have to get the cataract out of the eye, which is also here's why I'm asking about numbers, becaus the Oklahoma bill requested for procedures, which are the same f You have just told me two years you went back to Medicare and Medicaid Services and said, you wanted a host of other proce that had to be reimbursed and demanded reimbursement for t Now, is that your plan here in K to come back in two years and take on a number of other pr just like you did in Oklahoma?

Because the wording of this bill is almost identical to the Oklahoma bill, down to th Maybe you could clarify, since I who wrote that legislation in Ok I'm the guy who wrote that that produced what you just said in b Okay, Just go ahead.

The wording I looked at it this I don't have to produce what you said occurred in 1998 and then produce what you see every year to Medicaid, Medicare He's talked.

He has the years of What he's talking about is when because there was actually two b There was a bill in 98, which is the lasers, and then there was the incisiona the scalp, a law that passed in And that's the open ended legisl like you have here.

I understand what you're talking but that's not what he said.

I know he got the days, he got the dates of my confusion I'm concerned about what this bi going to do to the citizens of K And what you did to the citizens of Oklahoma was a sleight of hand coming in with two separate bill Do you really want to get into t Well, I want to know if the Okla if the Kentucky law down to the is mirrored after the Oklahoma bill, it's actually either one that bi almost exactly like the Oklahoma It's it's actually more restrict than the Oklahoma bill is.

These doctors both ask about PRK in Oklahoma.

We're actually allowed to do PRK which is a type of laser procedu to allow you to be glasses free, or less to permit some of the su that are permitted in the curren that is on the governor's desk.

Will you have to go to a board o you have to go back to the legis to get approval of these?

If there's something that's spec excluded in the there's 17 exclu and there are too many to to list every single one right h But if we decided we wanted to g do something that's specifically in the bill, then yes, we would have to return to the l to to ask for those privileges.

And is this your point, Dr. Van Is that there are privileges are listed by exclusion, and as changes, it's possible that you might be able to take cataracts out with a laser in two years.

And what happened in Oklahoma was as technology changed, these exclusions became really w And that's why it makes more sen And credentialing to ask permiss to do this procedure.

This procedure, this procedure by CPT code.

And what you've done is you've s we're going to eliminate these p and we want to do everything els Kind of like your daughter sayin going out tonight, darling, where are you going?

I'm not going to go here.

I'm not going to go here.

And well, who are you going with?

I'm not going with this.

I'm like, You have no idea where she's goi and you have no idea who she's g The difference in what they're a is in their particular cases, their bills are completely open into their legislation.

It's completely open ended.

All these health care professors or professions or legislative pr their legislation, I don't know exactly what Kentuc but Oklahoma's is wide open.

They're able to do whatever it i they're trying to do at any poin Whenever that new technology com regardless of how many years ago they got out or what their training was at th they don't have to list the proc that they can do by zip code.

As the doctor knows, the CPT codes are owned by the AMA and they define what a surgical procedure is.

And I think that's part of what getting to.

In our particular case, what they'd like to see is our p different than theirs and ours be specifically tied to specific things as opposed to theirs, having no tie to anything in Oklahoma's case and sensibilities, choosing to i When I wrote that particular informatio I excluded areas.

The I that we don't work in peri And I can't think of a single pr that's come on.

Since that language was written that optometry is doing.

Since that language is written, I can't think of one single one.

I sit on the board today, so perhaps you can tell me what Let's take our first phone call night from Tom Wood in Woodford Mr. Wood, welcome to our program Mr. Tom Wood Yes, my my question is, is Oklahoma really on the cutting edge of medical t and do we really want to to reflect what Oklahoma is doin All right, Mr. Wood, thanks very much.

Dr. Carter, I'll turn to you.

Is Oklahoma on the cutting edge?

Good choice of words there of of technology.

I don't know if Oklahoma's on the cutting edge of technolog not in I care if the question is are we on the cutting edge or the leading edge of what opto do, we absolutely are.

And I think that might be what he's asking.

One of the the other questions I in some research I did on the on The Veterans Administration permitting Oklahoma optometrists to perform laser surgery in VA h in other states besides just Okl Would this also be permitted in Well, that the VA had a broad ru allowing you if you had a licens in Oklahoma, you were licensed to do X procedure in Oklahoma.

If you worked at a VA hospital a because you were Oklahoma licens you could do that.

The VA now has a prohibition aga optical optometrists using laser and that occurred I'm not sure how many years ago when the Oklahoma law was passed What the optometrist said was it was allowed in the VA and it wasn't allowed in the VA and their congressional hearings saying, no, it wasn't allowed in the VA. And do you remember that?

Actually, I have the I have the actual language of th of what was came from what came from the actual under secretary of the VA where it says specifically what your what your license allows yo what we can do.

Nothing, said Laser.

I'm not disputing that.

But it also didn't say you could do a refraction.

Well the the the maybe we're tal about two different things.

So optometrist one would not be allowed to prac laser surgery in the VA hospital They don't know that.

That's rig And they wouldn't be.

That was decided.

But we had to, we had to get that all straighte because it was very confused and it was used to help pass the legislation in Oklahoma.

If it's good enough for the vete good enough for Oklahomans.

What else is in the bill that wo optometrists to do a procedure that they're not allowed to do N in terms of aside from laser is already disc and we're not being authorized t any new pharmaceutical agents me We already have access to all the medications that can be used orally or directly into the eye.

As long as it pertains to eye co we are permitted to use that.

This legislation allows all rela administrations of those agents we already use with the exceptio controlled substances, level one It also allows us to or clarifie our ability or there is no prohi in our bill currently on using injectables around the The most common use of that woul if you were going to have a grow or a mole removed around the eye to what you would experience at a dermatologist removing a le from somewhere on your body.

A small amount of local anesthet so that it can be removed.

And you're not allowed to do tha But if this bill becomes law, yo But it's not prohibited in our current language.

But we went ahead and clarified just so that it was it was clear What about malignancy?

So are you going to remove malig If I saw something that I though a malignancy, I would I would certainly refer to ocular plastic surgeon.

It's not my intention to remove a malignancy.

We always want to anything we take off the eye wil biopsied in a pathological repor And of course, if it comes back as there's some suspicious findi we'll of course employ a ocular.

But there's today our ophthalmologist and optometr trained to identify malignant tu or other diseases like a multiple sclerosis or even AIDS.

Yes.

Are we receive this training in medical school as part of our medical training.

And even before you get to ophth residency, you learn the signs and symptoms of age and multiple and malignant tumors.

Malignant tumors.

Optometrist Yes.

So we are also trained in that w The Kentucky law, based on down to the commas, the Oklahoma legislation for nonsurgical procedures, including the use of scalpels, i of needles directly into the eye Our law specifically excludes inserting a needle into the eye.

In other words, from the outside of the inside.

But the Kentucky legislation does allows that with the except as Dr. VanMeter likes to point out, of called emergency para synthesis.

And that's a procedure where that is very infrequently used t if someone had a problem where the pressure went up inside of the eye to a malignant state, that you could insert a needle t What's saying that state Well, I guess it depends on the on phy treating the patient at that time.

Pressure.

I think it's pretty easy to do t That's pretty there's only a few situations where that happ And unfortunately, we had a case of a child with a in the eye that an optometrist d to try to lower the pressure and stuck a needle and drew bloo which is actually contraindicate cause a traumatic cataract.

So, you know what?

What they may think is a malignant was reported and ruled on by the board.

No family want to let me make th to the viewers.

What we're talking about is a ch who had blood in the eye and the pressure went up.

So to relieve the pressure, the optometrist inserted a needle into the eye and stuck it into the lens.

So when you stick a needle into that makes the cataract form, and then the child has to have cataract surgery.

So technically no damage is done except the ten year old has had operation, has a lens implant for the rest of her life.

Under the cataract surgery, perm will you be allowed to insert le that is prohibited as well?

All right, Dr. VanMeter, this is a question for from David Woody in Bardstown.

He writes, Is there any time that ophthalmology has an oppose that would update optometrists a to serve their patients?

No, sir.

Dr. Bradford, You know, Have you always stood in the way of optom updating their ability to serve I would say no, we haven't, beca Cockerill and I, whenever you pa ophthalmology, kind of like in K wasn't invited into the discussi I was sitting outside, and when you came out, I said, You've been talking to the legis and you've been telling him you want four things.

I think even though I'm the only ophthalmologist here, will agree to that because I don't have any problem But you said no because you wanted to do lip sur Actually, that's not right.

Part of that's right.

We sit on the same room and I wa the room when we had the discuss We were in the same room.

Assure you we didn't talk to wal and the four things she's allude to were the four things that oph wanted us to limit what we wante I didn't want to do that because we were already doing far more t Oklahoma had a very open law from the time I went into practi and when we redefined our law in and then again in 2004, each time we restricted our a li more because it was so wide open And the four procedures that Dr. Bradford is alluding to were four procedures that the okay, you can do those when in many states they've actu they've actually opposed those particular procedures.

You know, we were doing far more than those procedures, as Dr. Bradford knows, which is why I d want to limit it to that.

Let's go back because the 1981 l you put in the language by means including but not limit and what optometry took that to they could do absolute lutely an And you actually started doing l before you had any certification You had no basis in the law.

And the reason you went back 24 is because we found out you were cutting on people and w for an attorney general opinion, and the attorney general said, N you shouldn't be cutting all tho The statutes didn't allow that.

So, yes, you may have been doing some stu but you did it without statutory authority.

Well, let me see if I can clear that u Dr. Bradford may or may not be aware of it, but we learned how to do lasers on the floor of the American Aca of Ophthalmology right alongside ophthalmologists who didn't do them either.

So we did actually take the same from the same people, from the same manufacturers in 1 and she's talking about 1986 and So we all learned the same place So they had they had a basis of I'll let you finish.

Okay.

So we learned the same place and The her reference is fact.

If they didn't know what we were the surgery we were at or weren' or their procedures, you know, there was certainly nothing hidd All those procedures you talked about billing while ago were bil to Medicare and other insurances to private You wrote the check.

So there's nothing hidden along any of those lines.

It wasn't that.

It just became aware of the in d the attorney general's opinion.

They did a senator did query whether or not we could do those whether or not we could do surge Specifically, the attorney general said your l say surgery, therefore you can't Go back and put it in statute, which is exactly what we did.

Because when we sit down with the attorney general and sa literally, here are all the proc that we do, he said, and I quote those aren't surgery.

And we said, yes, they are.

It's doctor referenced the CPT c The CPT codes owned by the AMA define surgery.

So we don't define what surgery is or isn't.

We work within that structure.

But we did go back and put the w specifically surgery in our law to get rid of the ambiguity issu Once again, that's just a little bit because the Attorney general said, what is that CPT does not define surg just a way of putting things in and nobody ever held this is sur This isn't.

And punctured plugs, okay?

It's in the surgery codes.

There is a procedure.

What is that?

It's where you put little plugs in the tear ducts and nobody had any problems with It's a treatment for dry eyes.

But the cutting part, the surgery part, there's no surgery part to it.

It's just putting plugs in.

But what the attorney general wa his ruling on at the time now it it was their complaint is that i in the surgery codes in the codi It's true.

It is listing the sur codes, coding book.

But had we not fixed that, we could no longer do that, period.

I don't control how many other s have used the Oklahoma law as a The exact law that we're talking with Kentucky?

None.

To my knowledge.

This is the first one to use the So how many other states have allowed optometrists to expand the scope of their pra Of all, 50 states have allowed different ex of one type or another over the last 35 year All 50 states and the district have allowed different expansion progressively.

But even though the Oklahoma law was passed in 1998, Kentucky, what what's happening in New Mex or California?

Well, Mexico passed a surgery la a few years ago, two or three ye They didn't pass a laser law.

They passed the surgery law that specifically says you may r allows them to use a scalpel to do procedures about North Car To my knowledge, they've had passed no legislation long time California.

They passed the law a year or tw or four years ago, allowing them to treat glaucoma, not a surgery law.

Optometrist Yes, treat glaucoma It allows them to treat other ey with medication.

So Kentucky is indeed the only o other than Oklahoma in the United States that is all the scope of their practice to e That's correct.

All right.

Let me let Dr. Van Meter, let's we'll catch up in just a moment.

Let's take a phone call from Mik Oliver and Scott Cowen.

And Mr. Oliver, welcome to the p Thank you.

I guess my question is, um, do you think just one second we need a little bit more audio Oliver or Mr. Oliver, if you can speak up, we' appreciate it.

Okay.

Can you hear me now?

Just barely.

We'll all be real quiet and listened intently.

Okay.

Sorry.

My question is, do you think you should be able to go through your legislation to get a medical degree instead of going to actual med s If I understood your question, should you go through legislatio to get your medical degree?

Security did?

You agree with the question, Should you go through the legisl to get your medical degree rather than going to medical sch All right.

Well, obviously, do you want to respond to that?

Someone?

Well, I have a medical degree, a I feel that you didn't get atten No, I did not get it through the legislation or through a weekend weekend course as reference to w surgical procedures that are fre how the claim is that optometris to a weekend course instead of three years of medica Yes, sir.

Is that accurate?

Well, that's not exactly accurat As he knows, We do it up time before school.

That's not what is alluding to, is alluding to specific training and a new p that, of course, may be a weeken It may be longer no different than it is for all If they're trained on a new proc And, you know, one of the distractions that we're discussing here is when a new procedure comes after we're doing our training and education is not held in esteem I might not if I was them.

Their training is held as valuab to be able to learn a new proced in a short period of time.

That's the distractor that we're discussing.

Well, but but you're you're talk about a different base.

And the base is these people hav to do cataract surgery.

They've learned to do glaucoma s And you're adding on to that.

You're not adding on to that ski And when you certify people in O when they come and they do the weekend course, what do they do when you stamp t So you're certified to do lasers What are they?

Laser Because you can't I mean, there aren't that many people that need those kind of lasers that you can pull them in.

Well, the as you know, the cours And what you can see time the course is laid out.

You may or may not have seen it.

I don't have the answer that the course is laid out and you can actually look it up and the Oklahoma State border.

But what do they laser?

So in that you mean those particular courses in the those courses, they're either going to be laser they're going to be laser in eit some type of animal eye, they're going to be laser in some type of cadaver, either going to be lasering, depending on what the procedure But so you would certify somebod to go to another state and so they can do these lasers when they've never done it on a living person and finish.

Okay.

Okay.

You know, so they're going to be those procedures on people as we So it depends upon the procedure in question how many people are being traine for those procedures as to what Let me get back to some question from emails to both of you.

Doctor, getting Dr. VanMeter from Clay medicine in Fayette Co Dr. VanMeter, the question to yo didn't you claim that it would b to let optometrists put eyedrops people's eyes and prescribe cont when they tried to do this befor He's probably referring to two p optometric bills that came about but optometrists mostly prescribed glasses prior and in 1978, they were granted the ability to use diagnostic dr which meant they could dilate pu to check the back of the eye.

I was not here practicing at tha Would you have objected to that, knowing what we know now?

Probably not.

But at the time this is a new.

It's a new way.

It's a new paradigm, if you will, because nobody knew they were going to handle drops.

I don't know if there were compl or not.

Mm hmm.

I was here in 1978 when therapeutic were granted, and that was to treat glaucoma and to treat infections.

And I'm a cornea person, and I have seen a number of comp related to Optometric treatment of patie I've also seen complications from ophthalmologist treating pa So this isn't really fair to say just because I've seen complicat from both camps.

Who's better?

Who's worse?

It goes back to you really want the most experienced people trea And I think that there's no subs for four years of medical school and four years of ophthalmology Doctor, you disagree with that?

Well, I disagree that we've put patients in harm' I think our track record in the state of Kentucky, much like Oklahoma and our malpr rates, have proven that we've be shepherds of the responsibilitie we've been granted.

What has happened?

This question for you, for Mr. Medicine, what has happened when optometri been allowed to perform these pr in other states?

You don't really have a record o do you?

Because a lot of these procedure been have been practiced in othe Is that correct?

Well, to a certain degree, laser is the one place where Oklahoma is the sole state with that auth But other minor surgical procedu with the scalpel are, as we've discussed, available in other states, as close as Ten There's at least nine other stat that allow some form.

So you said Tennessee would allo From my understanding, they're a injectables around the island.

Of course, I don't practice in T or hold a license.

Do so in surgery and cutting.

I'm not exactly sure I know they can do injections around th was Talk about lasers for just a between 2007 and 2009, the AMA, the American College of and the American Academy of Ophthalmology defined lasers as surgery.

They defined surgery as permanen alteration or change in tissue.

That's intentional.

And they said that surgery should only be performed by MDS, meaning medical doctors or doctors of osteopathy.

So all of this would suggest tha medical minds that have weighed this have said that probably opt should not be using laser.

I know they do in Oklahoma, but let me finish.

In response to this bill in Kent three other national organizatio which are the American College of Surgeons, the Society for Exc in Eye Care and the American Gla Society have all issued statemen saying that laser surgery should only be performed by surg And the American Glaucoma Societ said glaucoma is a complex neurological diseas and surgery should only be performed by MDS Now, how can you go against the medical minds that we have in th Well, I answer that that all these societies represent ph And as we've already discussed, especially the American Academy of Ophthalmology has banned from attending educational meeti There is a monopoly on knowledge I suppose, if you're not getting with them, are you?

I mean, it's obvious and that's unfortunate because in our commu we work together very, very well hand in hand on a day by day bas taking the best care of the pati So I think that's I'm sick of it So if you work hand in hand, how come opht that worked with optometrists didn't know at all about this bi Well, maybe it was that organize medicine in the state was in the Well, we'll get to that.

I'll try to get to that in just Doctor, all this web form messag from Mike Carter in Louisville.

Have there been any studies in O that would suggest that outcomes are better or worse when performed by an ophthalmolo I've not seen any study that's been performed in Oklahom alone or even nationwide.

That suggests, one, there may be I haven't seen that study.

All right.

To all of you, why was this bill if you agree that it was on such track to your question?

Dr. Bradford, was it better orga by the Optometric Association in or was this call came in at a light speed and it came in was posted on Monday of last week, exactly two weeks ago today.

And we had absolutely no word of until it was posted.

Not that we should have, but Optometric community was very or and they admit that they've been working on this for a year and a And any decent legislation ought to stand up to scrutiny.

You've said it doesn't pass the smell test.

I said that this particular piec of legislation came in under the screen, was never vetted by orga medicine, by any patient advocac And when it hit the committees, the most of the legislators didn't know much about it.

Given the fact that any good pie legislation ought to stand up to there were no medical advice in If this is a medical bill, then you would have thought that medical opinions would have been And it looks like that optometri don't feel they're part of the medical comm All right.

Let's go to Mr. Donna meyer in Campbell County.

If you have a very quick questio or comment.

Mr. Donna meyer.

Yes, I have.

Question, actually.

Yes, I have two questions.

The first question is how much more money will the optometrist make if this bill is signed by the go And are you worried about your i premiums going up because of all procedures you're going to be do if it's signed by the Government Mr. Downer Mark, thanks very much for the quick q Dr. Gary.

Well, in terms of financial impa I think it'd be impossible to st These procedures that we're asking the privilege are not what we would consider l Lasik surgery that are three or to have the procedure.

These procedures generally are reimbursed by third party and Medicare Medicaid payers.

If you're not in a surgical faci or a hospital, they typically re I would guess we could.

Dr. Cockrell could probably answ since he performs them in Oklaho But 150 to $200, a few hundred to several hundred dollars.

So it's not going to.

That's right.

All right.

Dr. Van Meter in Kentucky, the range for your laser procedu is between 150, up to 300.

That's the high low.

So YAG laser costs about 25,000.

So you've got to do 100 of them to pay for your instrument.

Dr. Van Meter And Dr. Gaddy, I'm going to give you the last respo what you would say to the govern if you were given a chance to try to persuade him one way or the other on this.

Dr. Van Meter, you first.

We encourage the governor to veto this bill because it came in under the radar and was not properly v When we are asked to present our opinion in the first time we were shut down from 30 minute discussion and gi The second time we went with six speakers and on three of them were allowed to sp And so we feel like the informat this bill has not been passed ou to committee members or legislat All right, Dr. Gary.

Well, actually, this bill has re more time on the floor of the Ho and Senate than any other bill this session.

Actually, there was a first comm hearing and each side got 10 min and you would set it.

Dr.. To Governor Beshear.

I would say, well, 87% of the le in the House and Senate approve this bill.

Both Democrats and Republicans, rural and urban legislators.

I think that they trust our trac and they obviously feel that we're prepared to take on t WVU Doc had a survey on telephon a AM to 12 noon asking people what they thought about this bil and the call and vote was 70% ag Think it's a bad idea and 30% fo All right.

Thank you all for bei Of our Oklahoma friends, we welcome you to the state, too Please come back under more frie confines and visitors once again Katie is covering the 2011 Gener Assembly on the air and online informatio is available at Katie.

That Oregon legislature.

Thanks for watching Kentucky tonight and 4k.

I'm Bill Goodman.

Good evening.