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Dr. Arthur K. Rivard has been an eye doctor in Danville for more than 20 years and is not shy when lending his view point on a just who should engage in eye surgery and who shouldn't.
"For the record, ophthalmologists such as myself are eye doctors that have a medical degree and have spent at least three years in residency performing actual surgery under the supervision of other medical doctors," said Rivard who, along with the majority of his fellow ophthalmologists, is unhappy with a new Kentucky law sets the stage for optometrists to perform various types of surgery, including laser.
The issue has been reignited thanks to a public forum held in Lexington last month in which optometrists, who Rivard points out are not medical doctors, began the process of determining what type of surgeries they may and may not perform under the new law, which was approved overwhelmingly in both the House and the Senate.
"This only serves as a example of our legislators turning a blind eye to the welfare of the patient," said Rivard who contends that surgery of any kind represents a 'knowledge base' which takes years to develop. "My advice to anyone considering any type of eye surgery is to seek out an M.D. regardless of the procedure."
Fellow Ophthalmologist Dr. Woodford Van Meter is the president of the Kentucky Academy of Eye Physicians and agrees with Rivard. "Surgical proficiency is acquired through years of medical education and clinical training," said Van Meter who is also a professor of Ophthalmology at the University of Kentucky and Chief of Ophthalmology at Central Baptist Hospital in Lexington.
"We complete a four-year medical education program, one-year hospital internship and an additional three years as an ophthalmology resident where we must complete more than 17,000 hours of hands-on clinical training before we're licensed to perform surgery," said Van Meter.
Kentucky joins Oklahoma as only that states in the country that allow optometrists expanded surgical privileges. Optometrists claim there have been few problems in Oklahoma since the law was first passed 13 years ago, but 26 other states have rejected similar bills.
Optometrists such as Tammy G. Hoskins in Harrodsburg are certainly happy with the new law, but she is careful not to get personally involved when commenting as to just how broad the spectrum of procedures her profession should be allowed to perform. Hoskins declined to comment about the issue, referring questions to the Kentucky Board of Optometric Examiners.
KBOE Vice President William Reynolds thinks opthalmologists are overreacting.
"For one thing, optometrists in Kentucky have already been performing 30 different surgical procedures since 1986, with few problems and little controversy," Reynolds said. "Since the bill is now law, it's now our responsibility to put into writing the scope of our new responsibilities. And those decisions will be based on much input from many members of the public, all of whom will have their comments taken into consideration.
After Reynolds and his fellow KBOE members establish guidelines, it's up to the Administrative Regulations Review Committee, a joint group made up of the House and Senate members, to pass it along to the Legislative Committee which could forward the recommendations to Gov. Steve Beshear for final approval.
"However, the Administrative Regulations Review Committee could very well send the regulation back to KBOE, in which case, we'll have to make revisions and then send it back them," he said.
Regardless of the outcome, there are still 19 different areas of surgery that will remain the sole domain of ophthalmologists, Reynolds said.
"This law does not allow optometrists to perform any surgical procedures that require general anesthesia and it does not allow us to perform LASIK surgery. Moreover, we will not be performing any retinal surgery, said Reynolds.
What the law will allow is for optometrists to perform surgeries that remove lumps and bumps from the eyelid and the use of a YAG laser for minor, in-office procedures.
"Please keep in mind these are all simple in-office procedures. In fact, we're not talking about a single procedure that will take over five minutes to perform," continued Reynolds.
Optometrists argue that many of these procedures are less expensive than when performed by an opthalmologist. And optometrists have practices in 106 of Kentucky's 120 counties, compared to the 40 counties served by an opthalmologist, making the procedure more convenient for more Kentuckians.
But ophthalmologists like Rivard believe it's a question of patients making the most informed and safest choice, particularly when using what he believes is a complex surgical tool such as the $60,000 YAG laser."If you wake up one morning and find your transmission is out on your car, do you go to a transmission specialist, or a guy down the road with a filling station who just took a 'fix-up-course?" he asks. "Sure, the guy dow the road may be a nice person, and maybe he's even your friend, but in the end most people would go to the person that has extensive and specialized training. And if you ask me, I think most people believe their eyes are more important than their cars. At least I hope so."