FRANKFORT, Ky. — Morehead State University student Chandra Burnett, 23, a longtime user of contact lenses, said it gets old going every year to the eye doctor and paying around $90 to have her prescription renewed, as required by Kentucky law.
“It’s only good for a year,” she said. “My prescription hasn’t changed for three years.”
Burnett, who orders her contact lenses online, said she would love to also get her prescription renewed online for as little as $20 through a relatively new but expanding business that allows people to get such renewals from a licensed eye doctor.
But Kentucky’s politically powerful optometrists — also generous political donors — are fighting to stop the practice with a bill they say is meant to protect patients.
House Bill 191 “is truly a consumer protection act,” said Dr. Ben Gaddie, a Louisville optometrist and representative of the Kentucky Optometric Association, as he testified last week before the Senate Health and Welfare Committee.
But critics, including medical doctors who treat eye conditions, say the bill is meant to protect optometrists’ turf and income rather than help patients.
“We feel strongly that it limits access to patient care and it is a bad bill from that standpoint,” said Dr. Carl Baker, president of the Kentucky Academy of Eye Physicians and Surgeons.
Moreover, the bill has alarmed some physicians including state Sen. Ralph Alvarado, a Winchester Republican, who say it also would cut ophthalmologists out of the rapidly advancing field of telehealth, a practice of electronic patient care Alvarado is seeking to advance in Kentucky.
“We have a millennial generation coming up that wants to do more things remotely,” said Alvarado, who is sponsoring a separate bill to expand telehealth in Kentucky. “We need to adapt.”
HB 191 pits the state’s optometrists, professionals trained to conduct eye exams and prescribe eyewear, against the state’s much smaller group of ophthalmologists, medical doctors who treat eye disease, perform eye exams and prescribe glasses and contact lenses.
Currently, people who already have a prescription for glasses or contacts from an eye doctor can go online to a website of one of several national companies operating in Kentucky and renew the prescription online for a modest charge, generally about $20 to $40. By contrast, a visit to an eye doctor costs about $100 to $150.
While online eye service vendors vary, in general, the consumer submits information, including a medical history and previous prescription for glasses or contacts and takes an online vision test. The vendor submits that information to a licensed optometrist or ophthalmologist, who reviews the information and issues a prescription for new glasses or contact lenses.
Kentucky has about 850 optometrists licensed in Kentucky and 250 ophthalmologists.
Optometrists also have spent far more on political donations in recent years than ophthalmologists and wield considerable influence in Frankfort, most notably in 2011 when they pushed through a measure to expand their practice to include laser eye surgery over objections of ophthalmologists.
The state’s optometrists and their political action committee, the Optometric PAC, have donated $503,862 since late 2014 to state elected officials and others, according to the Kentucky Registry of Election Finance.
Ophthalmologists gave about $26,000 during that period through individuals and the Kentucky Ophthalmological Political Action Committee, according to registry records, though it may not have captured all individual donations if contributors listed themselves as physicians instead of ophthalmologists.
Now optometrists are working hard to pass HB 191, described by sponsor Rep. Jim Gooch, a Providence Republican, as a “consumer protection in eye care” act. The bill is moving rapidly through the 2108 General Assembly, having passed the Senate committee last week and the House last month.
The conflict is over a single line in HB 191 that requires a “simultaneous interaction” between the patient and eye doctor, either in person or live online.
Advocates insist such interaction is necessary for eye doctors to provide quality care to patients.
“These standards will help ensure patient safety and protect local eye care providers,” Gaddie said at last week’s hearing. Under the online system, “there is no interaction with a provider,” he said.
But ophthalmologists and other opponents say HB 191 would eliminate online access for patients because it depends on patients entering information and taking vision tests on their own time with eye doctors reviewing the results later.
“We’re paralyzing the online vision companies if we pass this bill,” said M. Peter Horkan, head of government affairs for Opternative.com. “We will restrict access to care for patients.”
Horkan, who was among representatives of several online eye care companies who spoke at the hearing, said the optometrists’ measure would effectively put them out of business in Kentucky.
Advocates for such businesses say they have built-in safeguards.
Many prospective patients get screened out, such as those with any history of eye diseases such as glaucoma or health problems including diabetes or high blood pressure, said Nick Schilligo, director of government affairs for 1 800 Contacts, who testified last week.
Schilligo said his company accepts only patients ages 18 to 55 because of age-related eye problems that occur in older patients.
About one-third of customers get screened out at the front end for such reasons.
Of those who qualify for the online test, about 15 percent get screened out when the eye doctor reviewing the results detects a potential problem and recommends an in-person visit to a specialist.
“This is in no way a replacement for a complete exam,” Schilligo said, adding that the online service has the approval of the American Academy of Opthalmology.
Baker, the Paducah ophthalmologist, said his group also supports online eye services although it would be in his members’ financial interests to oppose it in hopes of getting more patients into their offices for exams.
“This bill would make people come see me,” he said of HB 191.
But the ophthalmologists’ organization would rather see an expansion of access for patients through online services, especially in rural areas or communities without eye doctors.
And as a specialist in retina conditions, Baker said, he’s especially concerned the legislation would block him from viewing medical images of eyes other physicians send to him to review because it requires the “simultaneous interaction” with a patient.
“This bill is broad,” he said. “It puts a different standard on telemedicine for ophthalmologists than it does for any other practice.”
Deborah Yetter: 502-582-4228; firstname.lastname@example.org. Support strong local journalism by subscribing today: www.courier-journal.com/deborahy. Reporter Tom Loftus also contributed to this story.