KY optometrists, among few allowed to perform surgery, now want an easier, Canadian licensing exam
Republished from Kentucky Lantern
For decades, optometrists in all 50 states have been required to pass a standard, national exam for a license to perform eye exams, prescribe eyeglasses and contact lenses and treat eye conditions.
In a few states including Kentucky, optometrists provide advanced care including laser and other eye surgeries.
But in a change that has stirred national opposition, Kentucky’s state board that licenses optometrists proposes no longer requiring part 1 of the three-part standard exam — considered the most difficult — instead allowing candidates to take a Canadian version critics say is far less rigorous.
“No state has ever accepted a foreign licensure exam as a valid substitute for initial licensure,” Dr. Rich Castillo, dean of the optometry school at the University of North Carolina-Pembroke, testified at a recent Kentucky legislative hearing. “They are not interchangeable.”
Castillo called the move “unprecedented and unnecessary.”
But the Kentucky Board of Optometric Examiners says the change is needed to ensure the state has enough eye care providers and because the difficult test may discourage prospective optometrists.
After the COVID pandemic of 2020-23 disrupted in-person learning, “there were a number of optometry students that could not pass the national boards as required in current Kentucky regulation,” the state board said in written comments in support of allowing the Canadian exam.
And that could lead to fewer optometrists and reduced access to eye care in Kentucky, according to Dr. Joe Ellis, president of the board and a Benton optometrist.
“If they see that testing seems unsurmountable, they may not choose this profession down the road,” Ellis said at the April meeting of the legislative Administrative Regulation Review subcommittee.
Opponents say that’s no reason to adopt what they argue amounts to lowering standards for licensure.
A ‘tough exam’
Dr. Aaron Oberster, a 2023 graduate of the University of Pikeville’s optometry college — Kentucky’s only optometry school — spoke against the change at the hearing.
“Part 1 is a tough exam,” said Oberster, who said he practices at a rural hospital outside Kentucky. “But it’s an important step in the process to provide trustworthy care to the patients of Kentucky as well as the rest of the country.”
Licensure should be based on competency and not convenience
– Dr. Aaron Oberster, UPike optometry graduate
Part 1 is a multiple-choice exam that tests optometry graduates on applied science and medicine, as well as anatomy, physiology and pharmacology. Critics of the change say that passing that exam is especially important in Kentucky, where the legislature, under a lobbying blitz from optometrists in 2011, agreed to significantly expand their practice to include eye surgery and other advanced procedures.
As a result, Kentucky “has one of the broadest scopes of practice for optometrists in the United States,” according to the National Board of Examiners in Optometry, which administers the licensure exam in all 50 states.
By substituting part of the exam from Canada — where optometrists have a more limited scope of practice — Kentucky candidates would not be tested at the same level, Oberster said.
“Licensure should be based on competency and not convenience,” he said.
But the Kentucky optometric board is pressing ahead with a change to state regulations regarding licensure that Ellis said will give optometry graduates “an additional path to secure a Kentucky license.”
Asked for comment, Christi LeMay, executive director of the Kentucky board, said in a brief phone call the board would be issuing a statement on the subject but couldn’t say when it might be available. She also couldn’t immediately say how many optometrists are licensed in Kentucky, saying numbers had changed because of recent renewals.
The Courier Journal reported in 2018 the state had about 850 licensed optometrists, who hold a four-year, doctorate degree in optometry. Kentucky has about 200 ophthalmologists, medical doctors who have received advanced training in eye treatment.
Scores ‘trending up’
Dr. Jill Bryant, executive director of the national optometry exam board, said while scores on the test dipped nationwide after the COVID pandemic, they “are trending up” since students returned to the classroom.
“It looks like they are moving in the right direction,” Bryant said in an interview.
She was among opponents to Kentucky’s change who testified in April.
But while outside groups including the national board adamantly oppose the change, Ellis, president of the Kentucky board, told the legislative panel allowing the Canadian exam has broad support among Kentucky optometrists, long a politically powerful group.
“I assure you the Kentucky Optometric Association, the Kentucky College of Optometry (at Pikeville University), the doctors and the students in the commonwealth support this amendment,” Ellis said.
Ellis also is a former president of the Kentucky and the American optometric associations.
The Kentucky association said in a statement that it “strongly supports the sole authority of the Kentucky Board of Optometric Examiners to oversee the practice of optometry in Kentucky, which includes the legal authority to approve an alternate examination for licensure.”
Dr. Renee Reeder, dean of Pikeville University’s optometry college, said in an email that its graduates over the past two years have “surpassed” the national first-time pass rate on part 1 of the test, “reflecting the strength of our academic preparation.”
Candidates are allowed to take the test six times.
As for the proposal to allow the Canadian exam, Reeder said “we do appreciate the board’s thoughtful deliberation and commitment to ensuring that all pathways to licensure continue to meet the high standards of care Kentucky citizens deserve.”
‘I trust the providers’
The proposal next goes before the joint House-Senate Health Services Committee in July, which could find the proposal “deficient,” signaling disapproval. But that doesn’t stop the board from enacting the change; only the Kentucky General Assembly can do that when it next meets in January.
Lawmakers at the April hearing seemed inclined to support the change. No one on the panel criticized it and Rep. Derek Lewis, R-London and committee co-chairman, said he had contacted optometrists “who have never led me astray” who told him they support the change.
“I trust the providers I spoke to,” Lewis said. “I trust your authority of the board.”
Lewis also noted no one from Kentucky appeared to speak against the change.
“Does anyone that is speaking in opposition currently live in Kentucky?” he asked.
No one responded.
But Dr. Chip Richardson, a Georgetown ophthalmologist who has been following the proposed change, said in an interview he opposes it as a matter of “patient safety” since optometrists in Kentucky are allowed to do far more than conduct routine eye exams.
“As we expand the optometrists’ privileges in the state of Kentucky, we should increase the rigors of licensure as opposed to decreasing it,” he said. The proposed change is “offensive to those who got licensed under rigorous standards and it devalues an optometric education.”
‘Ongoing monopoly’
Among arguments the optometric board made in favor of allowing the Canadian exam is that it is more accessible because it is offered online.
Ellis, at the hearing, suggested opponents are “trying to protect an ongoing monopoly of the testing industry in the United States.”
And he pointed out candidates for licensure in Kentucky would still be required to pass parts 2 and 3 of the national exam, which cover patient diagnosis and treatment, including simulated encounters with patients.
Supporters of the national exam say it is offered in a more secure setting, with part 1, the multiple choice test on scientific and medical knowledge, offered at testing sites under supervision.
Other opponents who have submitted written comments against the change include the Association of Regulatory Boards of Optometry (of which Kentucky’s board is a member), the Federation of Associations of Regulatory Boards and the National Association of VA Optometrists.
The Nevada Board of Optometry also has submitted a letter opposed to the change, saying it could affect reciprocity, in which state boards accept credentials of optometrists from other states.
Under the proposed change, candidates unable to pass part 1 of the national exam could become licensed in Kentucky by passing the Canadian exam, then seek licensure in another state, the letter said.
To prevent such a situation, the Nevada legislature recently passed legislation mandating that Nevada permit licensure of candidates licensed in other states only if they have passed each part of the national optometric exam, it said.
Candidates unable to pass the national exam “need additional education to improve their knowledge and skills, not a lowering of the standards for licensure,” it said.
The Kentucky optometric board next meets June 20, where the national exam board hopes to make its case against the exam change. It has submitted written comments for the meeting outlining its concerns.
Bryant, director of the national examiners’ board, said members of the national exam group will attend the board meeting.
“The U.S. and Canadian exams do not represent interchangeable parts,” she said. “It puts the validity of the licensure exam at risk.”
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