Online vision retailer Warby Parker will pay Ky. civil penalty for letting 69 Kentuckians to take its online vision test, illegal in Ky.

Image on Warby Parker's "Get a Prescription" page

Kentucky Health News

Warby Parker, an online retailer of prescription glasses, contact lenses and sunglasses, has agreed to pay at least $55,200 to the Commonwealth of Kentucky for allowing 69 Kentuckians to take its online vision test, contrary to state law, Attorney General Russell Coleman's office said in a news release Friday.

Coleman's office alleged that from July to October 2021, 69 Kentuckians were improperly given Warby Parker’s online test. "When the attorney general’s Office of Consumer Protection alerted Warby Parker of the problem, the company cooperated with the investigation and took the test offline," the release said. "Following a voluntary settlement process, Warby Parker will be penalized $138,000. If there are no further violations for five years, the amount will be reduced to $55,200."

The "Get a Prescription" page on Warby Parker's website says the online vision test is available to people who "reside in an eligible state, due to state-level regulations," and disqualifies residents of Alaska, Connecticut, the District of Columbia, Georgia, Idaho, Kentucky, New Mexico, South Carolina, South Dakota, Washington and West Virginia, using their two-letter postal abbreviations.

Kentucky consumers may complain about a business operating in the state to Coleman’s office at https://www.ag.ky.gov/Resources/Consumer-Resources/Consumers/Pages/Consumer-Complaints.aspx.

How to protect your eyes while watching Monday's solar eclipse

NASA map, adapted by Kentucky Health News

Journal of the American Medical Association

On Monday, April 8, a solar eclipse will pass over Mexico, the U.S., and Canada. The eclipse will be total in parts of Kentucky along the lower Ohio and Mississippi rivers. In Paducah, totality will last about 1 minute and 45 seconds, starting just after 2 p.m. Central Time; in Henderson, it will last 2 minutes and 10 seconds, starting at 2:02 p.m. CT. Maximum totality, at the center of the eclipse path, will exceed 4 minutes. A NASA map is here.

A total solar eclipse occurs when the moon completely blocks the view of the sun in a narrow path across the earth’s surface. In a partial solar eclipse, the moon only partially blocks the sun, so it can be observed an area that is thousands of miles wide. But clouds can obscure it; the National Weather Service is updating Monday's cloud forecast daily.

What Are the Dangers of Watching a Solar Eclipse? Watching a solar eclipse without proper eye protection can cause vision loss, including blindness, due to burning of the macula, which is part of the retina, the light-sensitive tissue at the back of the eye that enables people to read and recognize faces. Some individuals mistakenly believe that it is safe to view a total eclipse without eye protection during the time when the moon completely blocks the sun. However, totality of this eclipse will last from a few seconds to more than 4 minutes, based on geographic location, and bright sunlight will suddenly appear as the moon moves. Even a few seconds of viewing the sun can temporarily or permanently burn the macula. Once retina tissue is destroyed, it cannot regenerate, resulting in permanent central vision loss.

Safe Ways to Watch a Solar Eclipse: Exact times and locations of the upcoming solar eclipse can be found at science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/. Worldwide, 8 total solar eclipses will occur in the next decade.

Never view the sun or a total solar eclipse with the naked eye or by looking through binoculars, telescopes, or a phone camera. Sunglasses alone also are not safe. Make sure to supervise children using solar filters. Some safe ways to view an eclipse include:

• Direct viewing through shade No. 14 welder’s glasses
• Direct viewing through aluminized Mylar filters: These plastic sheets can be used for viewing an eclipse but should be used only if totally intact, with NO scratches.
• Pinhole projector: Make a pinhole in a piece of cardboard; hold it in front of the sun just before the eclipse. With your back to the sun, focus the light going through the pinhole onto another piece of cardboard beyond the pinhole so that you see the sunlight focused onto the second piece of cardboard. As the eclipse occurs, you can see the focused sunlight become blocked by a dark circle (the shadow of the moon). Look only at the image on the paper. Do not turn around and view the eclipse with the naked eye.

A list of recommended solar filter vendors can be found at the American Astronomical Society’s website.

If Vision Loss Occurs After Viewing a Solar Eclipse: Individuals with vision loss after viewing a solar eclipse should promptly visit an ophthalmologist, an eye doctor who can recognize symptoms and signs of solar burns on the retina. The diagnosis might be made on clinical evaluation or with diagnostic tests such as optical coherence tomography, a noninvasive imaging technique that can identify solar damage to the retina. There is no definitive treatment other than observation; sometimes individuals have partial recovery of vision.

Glaucoma, leading cause of irreversible blindness, can be detected and treated; get an eye exam every 2-4 years after 40

Regular eye exams are the key to detecting glaucoma.
(Photo from peakSTOCK, iStock/Getty Images Plus via UK)

By Dr. Elham Ghahari
University of Kentucky

Glaucoma is a disease of the optic nerve that can cause vision loss. It is the second leading cause of blindness in the U.S. and the leading cause of irreversible blindness worldwide, and 111.8 million people worldwide will have glaucoma by the year 2040.

Glaucomatous damage is the loss of optic nerve cells, which leads to changes in the head of the optic nerve at the eye, with damage to the field of vision. Glaucoma cannot be cured, but it can be controlled and stabilized with proper treatment.

The most common form of glaucoma is primary, open-angle glaucoma. It is associated with several risk factors such as family history, African ancestry, other eye diseases such as diabetes or inflammation, past eye injury, and elevated eyeball pressure.

High eye pressure is the most important risk factor because it is the only effective target of therapy for glaucoma. Although some forms of glaucoma develop even when the eye pressure is normal, the risk of abnormally high eye pressure increases with age.

Early detection and intervention can help prevent vision loss from glaucoma. However, most patients don’t know they have the disease because it is generally asymptomatic in the early stages, which means symptoms don’t present themselves.

A routine eye exam can identify the risk for glaucoma and early signs of the disease. During an eye exam, glaucomatous optic-nerve damage can be assessed by clinical examination of the optic nerve head and eye pressure can be checked.

The risk of having abnormally high eye pressure as the most important risk factor for glaucoma increases with age. Glaucoma screenings are suggested beginning at age 40 and should continue after that in intervals suggested by your eye doctor, usually every two to four years.

There are usually no early symptoms of glaucoma, so screening exams are very important. Gradual dimming or weakening of vision is sometimes reported. Some patients with acute glaucoma develop severe eye pain and rapid visual changes.

Glaucoma treatment consists of reducing eye pressure using medications, lasers or surgery. Most glaucoma patients can be stabilized with prescription eye drops or in-office laser treatment.

Once the pressure is stabilized, it is important to continue regular follow-ups to make sure the pressure remains low enough. Less frequently, glaucoma surgery may be required.

Elham Ghahari, M.D., is an assistant professor of ophthalmology at UK HealthCare Advanced Eye Care.

Senate President Stivers, long the key obstacle to medical marijuana in Kentucky, now says he sees 'a narrow path' for it

Senate President Robert Stivers

By Melissa Patrick
Kentucky Health News

The most important legislative opponent of legalizing medical marijuana in Kentucky said Friday that there is a "narrow path forward" for it. Senate President Robert Stivers said that the day after a medical-cannabis bill was filed in his chamber.

Senate Bill 107 has bipartisan sponsorship from 11 of the Senate's 38 members. It is a companion bill to House Bill 136, with 44 co-sponsors, including House Speaker David Osborne.

The House bill's prime sponsor, Rep. Jason Nemes, R-Louisville, told Tom Latek of Kentucky Today that most House Republicans support it and he is optimistic it will pass this year.

Stivers has said he wouldn't support a medical-marijuana bill without medical studies to back it up, but Friday he said it would be a balancing act to weigh the good and the bad of passing such a law.

"I know that Representative Nemes is trying hard and that he is modifying and amending, and I think there is a path, but it is a narrow path," he said.

Stivers said that in the 20-plus studies that have been delivered to him, he has found there are "statistically significant indicators" to use medical marijuana, such as nausea from chemotherapy, or spasticity in people with multiple sclerosis. But he cautioned that the studies were small and of short duration, and he said there are better medicines for glaucoma, an eye condition that many medical-cannabis supporters mention.

He also said that like all medicine, the good must outweigh the bad, noting "statistically significant indicators" in studies showing marijuana exposure to those under 25 hurts brain development; that prolonged exposure increases the likelihood of psychotic experiences; that it has 50 percent more carcinogens in it than tobacco; and can cause heart disease.

"So, it becomes a balancing test," he said. "And nobody has really come, in my opinion, to give us that good path forward."

He added, "Does anybody here in this chamber or the other chamber want to see individuals suffer? No, we don't. But we also don't want to exacerbate a drug problem or a problem with cancers, heart disease, anything like that."

The 160-page medical-marijuana bills offer a list of conditions for which cannabis can be prescribed, such as terminal illness and epilepsy, but don't limit prescribing to those conditions, and would allow physicians to prescribe marijuana to their patients as long as they have a "bona fide" relationship.

The 11 sponsors of SB 107 are Sens. C.B. Embry Jr., R-Morgantown; Perry Clark, D-Louisville; Denise Harper Angel, D-Louisville; Jimmy Higdon, R-Lebanon; Morgan McGarvey, D-Louisville; Gerald Neal, D-Louisville; Michael Nemes, R-Shepherdsville; Dennis Parrett; D-Elizabethtown; Reginald Thomas, D-Lexington; and Robin Webb, D-Grayson.

A medical-marijuana bill passed the House Judiciary Committee 16-1 last year, but with only five days left in the legislative session and opposition in the Senate, it did not get a vote in the full House.

This year's House bill awaits a hearing in the House Judiciary Committee. The Senate bill has not yet been placed in a committee.

Marijuana is legal medicine in 33 states and the District of Columbia. Recreational marijuana is legal in 10 states, most recently Illinois, the first bordering Kentucky.

If approved, the medical marijuana program would start Jan. 1, 2021.

State restores dental, vision and non-emergency transportation benefits for 460,000 people covered by 2014 Medicaid expansion

Susan Wells of Louisville, who lost her dental benefits during a
series of extractions of decayed teeth, got them out at Shawnee
Christian Healthcare. (Photo: Mike Clevenger, Courier Journal)

By Al Cross
Kentucky Health News

State officials reversed course Thursday and said they would resume paying dental, vision and non-emergency medical transportation costs for 460,000 Kentuckians on expanded Medicaid.

The benefits were supposed to become optional July 1, under a new Medicaid plan in which those members could regain the benefits by participating in certain self-improvement activities, such as such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion, which began in 2014, work.

On June 29, two days before the overall plan was to take effect, a federal judge in Washington, D.C., blocked it, and state officials said that left no way for people to earn the benefits, or for the state to keep providing them.

The abrupt change created confusion, chaos and complaints. Democrats demanded that the administration of Republican Gov. Matt Bevin restore the benefits. At 5:40 p.m. ET Thursday, the Cabinet for Health and Family Services issued a press release saying that it would.

In a statement that quoted no one directly, the cabinet said "We had hoped for a quick federal re-approval" of the plan, which it calls Kentucky HEALTH for "Helping Engage and Achieve Long-Term Health." However, this week federal officials said they would not act for at least 30 days, as they sought more public comment on the plan. That move that could allow them to submit evidence aimed at overcoming the judge's concerns that they had not addressed the state's forecast that the plan would cause tens of thousands of people to lose their medical coverage.

Since "the program will not begin as soon as we hoped," the cabinet said, "In order to mitigate the consequences of the judge’s ruling, and avoid a prolonged coverage gap prior to the re-approval of Kentucky HEALTH, we have begun the process to reinstate vision and dental coverage, as well as non-emergency transportation services, for those whose benefits were affected by the June 29 court action."

The cabinet said it had "spent the last few weeks working on a temporary solution for restored benefits to be implemented by Aug. 1," and "is close to completing a manual system work-around that will allow payment of claims incurred by any eligible Medicaid beneficiary for dental, vision, and non-emergency transportation services incurred during the month of July."

The issue arose in the latest skirmish between Bevin, who has not said whether he will seek re-election in 2019; and Democratic Attorney General Andy Beshear, who announced his candidacy for governor this month, and Beshear's father, who expanded Medicaid under the Patient Protection and Affordable Care Act when he was governor in 2014.

When Bevin doubled a $500,000 contract with a Cincinnati law firm to investigate Steve Beshear's administration, the ex-governor said Bevin “has now decided to waste another half a million dollars and another two years to continue his fruitless search. Mind you, a million dollars wasted at a time when he is ripping vision and dental care away from hundreds of thousands of Kentuckians.”

State officials have said that about 10 percent of the eligible beneficiaries use those benefits.

"Advocates were delighted with the prospect that dental benefits would be restored," Deborah Yetter reports for the Louisville Courier Journal, quoting Jennifer Hasch, manager of dental services for the Shawnee Christian Healthcare Center in West Louisville: "That is such good news. I think people are going to be thrilled. I think it's weight lifted for our office, both for our patient population and our team."

Yetter writes, "While health advocates say all three services cut—dental, vision and transportation are important—the loss of dental services were most critical because of the very poor dental health of some Kentuckians and the fact that dental abscesses and infection can be life-threatening."

The legislature's top Democrat, House Minority Leader Rocky Adkins, told the Lexington Herald-Leader, “The governor and his administration were wrong to blame this cruel action on the federal court ruling . . . but I’m glad they appear to be back on the right track. I’m hopeful that our citizens will not be faced with the devastation of losing these benefits again.”

Medicaid dental and vision cuts worry patients and health-care providers; Democrats want answers, restoration of benefits

Kentucky Health News

Kentucky is in the third week without dental, vision or non-emergency transportation benefits for 460,000 Kentucky adults on Medicaid, and Democratic lawmakers, health advocates and dentists are continuing to voice their concerns, prompting the state health cabinet to respond online, including a Facebook video that cites "misinformation that is circulating in the media."

The 460,000 who lost their benefits are people covered by the state's 2014 expansion of Medicaid, under the 2010 Patient Protection and Affordable Care Act, to those who earn up to 138 percent of the federal poverty level.

Under a Medicaid plan that was vacated by a federal judge in Washington, this expansion group was supposed to move to a "My Rewards" program that allowed them to earn dental and vision benefits by participating in certain activities, like self-improvement classes or wellness activities or passing a GED exam. But when the plan was vacated two days before it was to take effect, the state says this left this group without any way to earn these benefits.

The abrupt removal of benefits created confusion among providers and beneficiaries, and prompted Democrats to hold news conferences questioning the reasons for the action and its legality.

Jessica Clark-Boyd, manager of the Healthy Smiles clinic in
Prestonsburg, told the Lexington Herald-Leader that half its
appointments were canceled after the state limited coverage
for some on Medicaid. (Photo by Silas Walker, Lexington Herald-Leader)

Will Wright reported for the Lexington Herald-Leader July 10 that the schedule of a Prestonsburg dentist showed five and a half hours of vacancies because more than half of her patients had lost their dental benefits.

Misty Clark, the dentist and owner of Healthy Smiles Family and Cosmetic Dentistry, told Wright that she normally has three patients per hour. The office manager, Jessica Clark-Boyd, told Wright that they have rescheduled dozens for appointments next month, hoping their insurance will be restored by then. "If not, Healthy Smiles could be in big financial trouble," he writes.

Wright also tells the story of Lynda Joseph of Pikeville, a Healthy Smiles patient who was scheduled to get a tooth pulled this month, but is one of those who lost dental benefits. Joseph wondered why the Bevin administration would cut benefits to people who are so close to the poverty level.

Joseph, who works part-time at Walmart, told Wright that she doesn't know when she'll be able to get the extraction. "I don’t mind paying the premium," she said. "Even if the premiums became higher, I wouldn’t mind that. The question is, am I going to be able to pay for it out-of-pocket?"

Democratic legislators from Eastern Kentucky, and a few others, held a news conference July 10 to "criticize both the moral and economic impacts" of these cuts, and called on Republican Gov. Matt Bevin to reinstate the benefits. The lawmakers said the cut "unnecessarily strips health-care benefits from working families and could hurt the state economy, particularly in Eastern Kentucky," Wright reports.

He adds that a report from the left-leaning Kentucky Center for Economic Policy found that the Medicaid expansion "has pumped billions of dollars into the economy and created thousands of jobs -- half of the net job growth in Kentucky since December 2007 came from the health care sector."

At a time coal has declined, "The industry that we have seen in our region that has actually been able to grow some, to be able to invest in its infrastructure, to be able to provide quality health care throughout our region, has been the health-care industry because of the expansion of Medicaid," House Minority Floor Leader Rocky Adkins said at the news conference in Pikeville.

Rep. Chris Harris of Forest Hills and other Eastern Kentucky
lawmakers, and former state auditor Adam Edelen, left, spoke
at a news conference against the cut of dental and vision cuts
to those on expanded Medicaid. (Image from WYMT-TV)

Rep. Angie Hatton of Whitesburg said, "We can't stand to lose more jobs, and our health- care industry will lose jobs because of this," reports Christina Bates of Hazard's WYMT-TV.

Bates also tells the story of Cory McCauley, who said she was one who lost her dental and vision benefits, and that she had learned about it on the news. "We got no notification in the mail whatsoever," she said. McCauley told Bates that she and her husband have relied on the program while he is in medical school.

"I actually had an appointment because I have a cavity . . . so now I can't keep that appointment because I'll have to pay for it out of pocket, which is just not realistic for us right now with no income," said Bates.

Kentucky Voices for Health has a video of the news conference, and a blog post about the recent changes, by KVH policy analyst Jason Dunn.

William E. Collins, a dentist in Pike County, wrote an opinion piece for the KVH blog that says the cuts are so harmful to "the working poor." He notes the hundreds of appointments he and his colleagues had to cancel last week because the online benefit system listed patients' benefits as "no current coverage" or "alternative benefits." But he also says that through a team effort between providers and the state, part of the eligibility issues were resolved.

"This is not about politics. This is about humanity," Collins wrote. "Placing blame seems to be necessary for some, but finding and correcting the problem is what the enrollees need."

All 37 members of the state House Democratic Caucus sent a letter July 10 to Health Secretary Adam Meier asking him to answer a long list of questions about the process used to remove the benefits; how the new benefit structure is affecting recipients and providers; the expected impact of removing the benefits; and how premiums already collected will be returned.

Democratic U.S. Rep. John Yarmuth of Louisville sent a letter to Alex Azar, secretary of the U.S. Department of Health and Human Services, that also included a list of pointed questions that asked for "clarification regarding these changes."

“Given that the federal government covers 94 percent of all Medicaid expansion costs in Kentucky, the dysfunction Gov. Bevin has brought to this critical health care system should be of great concern to you and your agency," Yarmuth wrote. "Health care coverage for the people of Kentucky is too important to be jeopardized by politics and dysfunction."

Meanwhile, the Poor People's Campaign protesters, who were finally allowed entry into the Capitol July 10 for the first time since a judge ruled police broke the law by denying them entry, delivered toothbrushes to the governor's office in protest of the dental and vision cuts, WKYT reports.

In a July 6 letter to the Centers for Medicare and Medicaid Services, three advocacy groups asked the agency to disapprove the withdrawal of dental and vision benefits, saying the state failed to comply with procedural requirements, including an appropriate public-notice period or a 30-day public comment period required by federal law. They also cite that the judge's intent was that the program remain status quo until after Azar's further review of the plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health."

In a July 10 Facebook video, Kristi Putnam, deputy secretary for the health cabinet, says there has been a "good deal of confusion and misinformation" about Kentucky HEALTH since the federal judge "temporarily stopped its implementation."

Putnam who is also the program manager for Kentucky HEALTH, asks "media partners" to call the cabinet if they learn about beneficiaries or providers who are having issues, explaining that the Pikeville dentist who spoke to the Louisville Courier Journal last week had his problems resolved within two hours, but this wasn't reported in the article. "Please let us help," she said.

Putnam added that Medicaid systems have been checked and are running properly, and that eligibility was in place for pregnant women, children and foster children up to the age of 26. She said the kentuckyhealth.ky.gov website has been updated with new resource pages and the computer screens used by providers have been improved to allow for better understanding of who qualifies for dental and vision benefits and who doesn't.

Kentuckians are encouraged to let the pros handle the fireworks; even sparklers, firecrackers and bottle rockets are dangerous

By Melissa Patrick
Kentucky Health News

Fireworks are often synonymous with the Fourth of July, but they are also a common cause of injury, so the state Division of Fire Prevention recommends attending a community firework event instead of celebrating with fireworks at home.

"Let the professionals entertain your family," Mike Haney, state fire marshal and director of fire prevention for the Department of Housing, Buildings and Construction, said in a news release. "By celebrating at a public event instead of at home, you reduce the risk of injury and property damage. You may also avoid violating the law."

Consumer Product Safety Commission graphic, using data from the 2017 Fireworks Annual Report

The latest U.S. Consumer Product Safety Commission fireworks report found that in 2017, 12,900 consumers were treated in U.S. emergency rooms for fireworks-related injuries and eight people died from them, with  victims ranging from age four to 57. Seven of the deaths were a result of direct impact from fireworks and one of them was the result of a house fire caused by misusing a firecracker.

The report adds that children between the ages of 10 and 14 were seen most often in emergency rooms for fireworks injuries, followed by young adults between the ages of 20 to 24.

Haney also reminded Kentuckians to pay attention to state and local fireworks laws.

For example, state law prohibits people under 18 from buying fireworks, and from selling them unless supervised by a parent or guardian. The law bans fireworks from being used within 200 feet of a structure, vehicle or other person; and fireworks cannot be sold to anyone who is under the influence of drugs or alcohol.

"Local governments set their own firework ordinances, so be aware of the regulations in your own town," Haney said.

Here are some safety tips from the National Council on Fireworks Safety:

 * Read and follow the instructions on the label.
 * A responsible adult should supervise all firework activities.
 * Never allow children to play with or ignite fireworks.
 * Alcohol and fireworks do not mix. Have a "designated adult shooter."
 * Wear safety glasses when shooting fireworks.
 * Light one firework at a time and then quickly move away.
 * Never light fireworks in a container, especially a glass or metal container.
 * Use fireworks outdoors in a clear area away from buildings and vehicles.
 * Always have a bucket of water and charged water hose nearby.
 * Never relight a "dud" firework; wait 20 minutes and soak in a bucket of water.
 * Do not experiment with homemade fireworks.
 * Wet down used fireworks and place them in a metal trash can.
 * Place disposed of fireworks away from buildings or combustible materials.
 * Report any illegal explosives to the fire or police department.

The CPSC report says that on average,  280 people went to the emergency room every day with fireworks-related injuries in the month around the July 4th holiday in 2017, with about 1,200 of those visits related to sparkler injuries, 800 of them relate to firecrackers and 300 related to bottle rockets.

Michael Spencer, a pilot from Bowling Green, told attendees of a CPSC fireworks event about the dangers of fireworks, having lost several fingers on both hands in 2015 from a shell-and-mortar style firework device. Spencer is now committed to making sure this doesn't happen to anyone else, CPSC writes in a news release about its latest fireworks report, released June 27.

 “Fireworks can be extremely dangerous, even if they are legal,” Spencer said in the release.“My advice would be to leave them to the professionals.”

KidsHealth also stresses that kids should "never play with fireworks," writing that this includes "firecrackers, rockets and sparklers" because they are "just too dangerous."

"If you give kids sparklers, make sure they keep them outside and away from the face, clothing and hair," they write. Sparklers can burn at nearly 2,000 degrees Farenheit and bottle rockets are known to stray off course or to throw shrapnel when they explode.

If a person is injured by fireworks, KidsHealth says to immediately seek medical care.

If the injury is to an eye, KidsHealth says not to rub it, since that may cause more damage; don't flush the eye with water or to put any ointment on it. Instead, cut out the bottom of a paper cup, place it around the eye, and get medical care right away, because your eyesight may depend on it.

If a person is burned, KidsHealth recommends removing the clothing from the burned area and to call your doctor immediately.

Optometry bill delivered to the governor after Senate changes

By Melissa Patrick
Kentucky Health News

A bill to regulate online eye exams has been delivered to Gov. Matt Bevin after getting final passage from the state House.

On an 88-0 vote, the House agreed with the changes the Senate made to House Bill 191 to remove the original bill's requirement for "simultaneous" consultation between online, Kentucky-licensed eye-care providers and their patients, which critics said would have limited access to eye care and tele-health technologies going forward.

The Senate passed the bill 36-0 March 14 with an amendment that changed the word "simultaneous" to either "synchronous or asynchronous." The bill's sponsor, Rep. Jim Gooch, R-Providence, said the change represented a compromise between all sides of the issue.

The bill requires that a person to be 18 to use the online services, that a medical history be obtained, that the person must have had an in-person eye exam withing two years of the online exam, and that a patient is not allowed to get contacts for the first time during an online exam.

This is the first time regulations have been placed on the online eye-care industry in Kentucky. It was supported by optometrists, who have a strong lobbying and campaign-finance presence in the legislature, and opposed by ophthalmologists, who do not.

Optometrists' bill to require online eye exams to be in 'real time' with an eye-care provider clears Senate health committee 6-4

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to require a portion of an online eye exam to be in "real time" with an eye-care provider went to the Senate floor amid warnings it would restrict access to eye care and conflict directly with a tele-health bill that recently passed the Senate.

Rep. Jim Gooch

The Senate Health and Welfare Committee voted 6-4 on March 7 for House Bill 191, sponsored by Rep. Jim Gooch, R-Providence, after lengthy debate. As amended by the panel, the bill would require a "simultaneous interaction between the patient and the Kentucky-licensed optometrist, osteopath, or physician" for an eye exam or prescription online.

The bill also requires a person to be 18 to use the online services, that a medical history be obtained, that the person must have had an in-person eye exam within two years of the online exam, and that a patient is not allowed to get contacts for the first time during an online exam.

Gooch told the committee that his bill doesn't keep technology out of Kentucky, but does set reasonable standards that ensure patient safety, and also "supports our local eye-care providers." Independent optometrists are one of the most powerful lobbies of the legislature.

Dr. Ben Gaddy, an optometrist and lobbyist for the Kentucky Optometric Association, told the committee that HB 191 simply establishes "safeguards on technology" for an online eye exam that the consumer takes on their own, with no interaction with a provider. "It does not limit where a consumer can purchase contact lenses or glasses -- it's the same as it is today. And it does not interfere with fair trade," he said.

Gaddy said 25 percent of diabetes cases, a real problem in Kentucky, are diagnosed during an in-person eye exam, and a "simultaneous interaction" with an eye-care provider during an online exam would be the only way diabetes and other health conditions could be caught. He added that his association is also concerned that individuals think they have had an eye health exam when they use these online services, when they haven't.

Much of the committee's debate was around that word "simultaneous," which means "at the same time," and the word "asynchronous," which means "not at the same time."

Sen. Ralph Alvarado, R-Winchester, argued that the bill is in direct conflict with his tele-health bill, SB 112, which passed the Senate Feb. 26. It says a requirement for a face-to-face encounter "is satisfied with the use of asynchronous telecommunications technologies" if the provider has access to the client's medical history prior to the encounter.

Alvarado, a physician, said the House bill includes safeguards needed to let eye-care providers participate in an asynchronous interaction, and said the word "simultaneous" must be removed not only because of this conflict, but because it limits technologies going forward and limits care to "a lot of people."

Gaddy replied, "Simultaneous doesn't always mean real-time-to-the-second interaction, but it means that there is more than just the issuance of a prescription."

Sen. David Givens, R-Greensburg, said it is legislators' responsibility to define what "simultaneous" means, or courts would, and they wouldn't be looking at the law's intent, but would "take a strict interpretation." But he voted for the bill.

Sen. Reggie Thomas

Sen. Reginald Thomas, D-Lexington, voted no, saying, "Simultaneous means simultaneous. Words do matter, and what this bill will do in effect is eliminate the ability of people to get glasses or contacts, when they've already gone to a physician and they've already gone to a followup exam,  from using those resources at a much cheaper rate without any risk of having their eyes damaged."

Sen. Julian Carroll, D-Frankfort, originally voted yes but changed his mind. "We are creating an enormous problem for our courts to decide this issue if we don't decide it legislatively," said Carroll, a former governor. "I feel a responsibility as a legislator to avoid a fight in the court over something that is so obvious. We passed one bill that provides for asynchronous and another that provides for synchronous, and that's irresponsible on us as legislators. Now we need to change one of them."

Sen. Danny Carroll, R-Paducah, also voted against the bill, as did Alvarado.

Earlier, Alvarado, referring to Gaddy's suggestion that a simultaneous visit is needed because a health or eye condition could otherwise be missed, called that "a silly example." He described a scenario where a tele-health patient calls in because they have a cough or a cold. "Could they have lung cancer?" he asked rhetorically. "They could," he said. " But we're not going to say you're not going to be able to have a telemedicine visit because we might miss a lung cancer, so you've got to come in and be checked."

Dr. Carl Baker, president of Kentucky Academy of Eye Physicians and Surgeons, spoke in opposition to the bill. He reminded the committee that it would affect more than just glasses and contact-lens prescriptions. He said it also affects how eye-care providers can assess and treat eye diseases.

Baker, a retina specialist practicing in Paducah, said the House bill would limit new technologies that allow for asynchronous, in-home assessments for diseases like diabetes, macular degeneration and glaucoma.

He said the bill would make it illegal for him to continue working for an insurance company that hires him to assess patients for "diabetic retinopathy" by looking at pictures of their retina that were taken by a technician in the patient's home. He said all his patients are given a recommendation to get an eye exam within the next 12 months, but those with a positive diagnosis for the disease are encouraged to see their provider immediately, and receive frequent follow-ups.

"We are enhancing the access to care," Baker said, "and I will tell you that the way this bill is written, that is not possible."

Baker said the bill would also affect specialists who do remote glaucoma screenings and the use of iPads to monitor macular degeneration remotely. "This technology would be illegal under this bill," he said.

Earlier, Gaddy said the bill differentiates between "doctor-directed tele-health" and "consumer-initiated telehealth," and said the procedures described by Baker were doctor-driven, and therefore not affected. "This bill only addresses consumer-driven technology," he said.

Peter Horkan, who represents Opternative, an online company where consumers get a renewed prescription for contacts or glasses, said current safeguards are working. He said 33 percent of people who sign up for the test aren't allowed to take it: “Thirty-three either hear from either an ophthalmologist or a representative of an ophthalmologist that they need to go and have a comprehensive eye exam.”

He said about 15 percent of their patients are "denied for deviation" because there is such a difference between their old and new prescription.

House passes optometrists' bill to thwart online eye exams by requiring 'real time' consultation with an eye doctor

The state House has passed a bill to restrict the growing practice of online eye examinations, a threat to one of the most powerful lobbies of the legislature: independent optometrists. The Senate may give it a closer exam.

House Bill 191, which passed the House 90-7 on Feb. 13, would require a visit with an eye doctor in "real time" for an eye exam or prescription online. Its sponsor, Rep. Jim Gooch, R-Providence, said in a news release that it aims to keep patients safe. "Companies like Opternative already have doctors sign off on the results and prescription, but not in real time," notes Garrett Wymer of Lexington's WKYT-TV.

Dr. William "Chip" Richardson, a Georgetown ophthalmologist and secretary-treasurer of the Kentucky Academy of Eye Physicians and Surgeons, testified against the bill in committee, saying online assessments can reach people with eye problems that may otherwise go undiagnosed.

"While allowing those online options may hurt his financial bottom line (particularly with his sales of glasses and contacts), the bottom line, he says, is they improve access to care," Wymer reports. "Richardson said he is afraid the bill would essentially run those online options out of Kentucky and hurt some patients' access to eye care."

"The bill also requires someone wanting an online eye exam or prescription to have had an in-person exam in the last two years," Wymer notes. "Richardson said that part of the bill could be helpful."

Gooch told Wymer that his bill does not ban "safe technology," but improves it by requiring real-time interaction between a person and a doctor. On the House floor, he noted that online exams are unregulated in Kentucky.

Rep. Kim Moser, R-Taylor Mill, unsuccessfully tried to amend the bill. She said it would be "burdensome, especially to those with disabilities This effectively shuts down e-commerce."
The other six House members who voted against the bill were Republicans Robert Benvenuti of Lexington, Brian Linder of Dry Ridge, Sal Santoro of Florence, Diane St. Onge of Fort Wright and Scott Wells of West Liberty, and Democrat Susan Westrom of Lexington.

The bill is now in the Senate Health and Welfare Committee. "South Carolina's legislature passed a similar bill two years ago," Wymer reports. "The governor vetoed the bill, but it was overridden. Just last month a judge threw out a lawsuit challenging the law."

At Pikeville building dedication, national optometry leader says new college will be a national leader in training of optometrists

UPike Health Professions Education Building

The University of Pikeville dedicated its newest facility, the Health Professions Education Building, Oct. 27. The building houses the school's new Kentucky College of Optometry, the only such college in Kentucky, and UPike’s growing nursing program.

“Our nursing students are enjoying their new space in the HPEB,” said Karen Damron, Ph.D., dean of the Elliott School of Nursing. “They utilize study areas that were not available prior to moving in the facility. In addition, the faculty offices are highly professional and conducive to meeting with current and prospective students. This new building will be key in the continued expansion of our nursing program.”

U.S. Rep. Harold “Hal” Rogers told more than 600 people at the dedication that UPike is helping close the gap on health disparities in Central Appalachia. “Today Central Appalachia has the highest rates of preventable blindness in the nation,” he said. “So what does UPike do? They build a state-of-the-art facility with the very best equipment, cutting-edge technology and a first-class team.”

The $72 million for the building came from grants by the U.S. Economic Development Administration and the Appalachian Regional Commission, and a low-interest stimulus loan from the Department of Agriculture’s Rural Development Administration, according to a university news release.

ARC Federal Co-Chair Earl Gohl said, “It’s a beautiful day in Appalachia because this building and school are going to help support and move forward the culture of health in Appalachia.”

The news release noted that Kentucky is one of only three states in the nation in which optometrists have the ability to perform laser and minor surgical procedures. That is a broad scope of practice authorized by those states' legislatures after lobbying from optometrists.

William T. Reynolds, secretary-treasurer of the American Optometric Association, said the college is developing a national model for access to vision care in rural communities.

“They will be the drivers of optometric education for years to come,” he said. “This school will be showing the entire nation how to properly educate and train students in this new frontier of our profession.”

The college emphasizes rural optometry and projects that more than 30 percent of its graduates will practice in medically under-served areas of Appalachia. It operates rural clinics that will serve an estimated 18,000 unique patients annually, the university said.

State health department offers safety tips for Aug. 21 solar eclipse; cautions to not look directly at it without eye protection

In an eclipse, the moon shadows part of Earth.

The Kentucky Department of Public Health is warning the public to not look directly at the solar eclipse without proper eye protection.

“Looking at an eclipse without proper eye protection can cause permanent and irreversible eye damage, including blindness” Health Commissioner Hiram C. Polk Jr. said in a news release. “We encourage everyone to enjoy this special celestial event, but urge the public not to look directly at the uneclipsed or partially eclipsed sun without special-purpose solar filters such as eclipse glasses or handheld solar viewers.”

This long awaited celestial event Polk is talking about will happen Monday, Aug 21. While Hopkinsville, Paducah and the Land between the Lakes are in the 70-mile path of totality, all of Kentucky will be able to see a "deep partial eclipse." Totality will last less than three minutes, but the sun will be partially obscured for more than two hours. Online interactive maps and guides give the times; one is https://www.vox.com/science-and-health/2017/7/25/16019892/solar-eclipse-2017-interactive-map.

State officials offers tips on how to safely view a solar eclipse and avoid permanent eye damage:

• Only use eclipse glasses or handheld solar viewers that meet the International Organization for Standardization international standards.
• Homemade filters or ordinary sunglasses, even very dark ones, are not safe for looking at the sun.
• Telescopes with solar filters on the large end can be used, but older telescopes that have small solar filters that attach to the eyepiece are not safe.
• It is safe to use pinhole projectors and other projection techniques that offer indirect viewing of the eclipse. These can be made with paper or cardstock.
• Do not look at the eclipse through an unfiltered camera, telescope, binoculars or other optical device.
• Do not look at the sun through a camera, telescope, binoculars or any other optical device while using your eclipses glasses or handheld solar viewer. The concentrated solar rays will damage the filter and enter your eye(s), causing serious injury.
• Seek expert advice before using a solar filter with a camera, telescope, binoculars or any other optical device.

The state health department also offers safety tips for those who will be spending the day outdoors while waiting on the eclipse, including: stay hydrated and drink plenty of water; avoid drinking alcohol, which causes you to lose fluid; wear light colored, loose fitting clothes and a hat; apply and reapply sunscreen throughout the day with at at least a SPF 15 rating; use an Environmental Protection Agency-registered insect repellent, and keep your hands washed to avoid spreading germs.

State health officials will deploy portable medical tents at an upcoming eclipse event in Hopkinsville and all food vendors in the region will be inspected, says the release.

Click here for a link to the state released video about eclipse eye safety. Click here for one directed toward children.

Young diabetes coalition coordinator forms partnerships to uncover and fight the disease in five Eastern Kentucky counties

By Mallory Powell
University of Kentucky

Growing up in Hazard, Brittany Martin was familiar with diabetes. Many of her older relatives had been diagnosed with the chronic condition, and her younger family members were starting to develop it as well. In a state with one of the highest rates of diabetes — 11.3 percent of adults had a diagnosis in 2014 —Martin’s family wasn’t out of the ordinary, but she found the status quo unacceptable.

Since she graduated from the University of Kentucky in 2014 with a dual degree in biology and sociology, Martin’s family history and her interest in health have converged in her current role as coordinator of the Big Sandy Diabetes Coalition, where she serves as an AmeriCorps Vista volunteer.

Brittany Martin administers a diabetes screening. (UK photo)

The coalition, based at Big Sandy Health Care in Prestonsburg, aims to improve detection, prevention and treatment of diabetes through screening and connection with local resources; it serves Floyd, Johnson, Magoffin, Martin and Pike counties, the Big Sandy Area Development District.

Diabetes is especially prevalent in the region, with 13 percent of adults diagnosed with it. In Pike County, the rate is at least 16 percent.

The rates are based on surveys that ask people if they have been diagnosed with the disease. An estimated 138,000 Kentuckians are thought to be living with undiagnosed diabetes.

As diabetes coalition coordinator, Martin juggles many responsibilities, from hosting community screenings to planning board meetings and writing a regular newsletter. It didn’t take her long to observe that irregular screenings, a lack of follow-up, and shortage of robust data inhibited diabetes prevention and care at both individual and community levels.

“We decided we wanted to set up more systematic screenings, instead of opportunistic screenings, and eventually set up a diabetes registry and keep track of participants,” Martin said.

She is now leading a project to determine whether regular community screenings and targeted follow-up can help to identify undiagnosed cases, measurably improve health, and reduce the emotional and economic burden of diabetes through connection with local resources.

"Brittany’s important work, receptivity to our input, and unparalleled enthusiasm have made her a stellar CLIK participant," said Nancy Schoenberg, co-director of community engagement and research for the CCTS. "She is an ambassador for UK, the CCTS and CLIK, sharing her expertise and her commitment to the health of residents of the commonwealth."

Martin, a registered phlebotomist, has personally screened 586 people since she began working with the coalition in August 2015. At each initial screening, she gathers baseline data and provides diabetes education. She then follows up with people who are diabetic or pre-diabetic to connect them with local resources and encourage them to come back for screening in six months.

Much of Martin's work has been supported by grants and training from the University of Kentucky Center for Clinical and Translational Science, which facilitates interdisciplinary and community-engaged health research with a focus on Appalachia. A CCTS community engagement grant provided funding for a pilot study of diabetes screening at a senior living center in Pike County.

Martin, 25, has since received further funding and research training through the CCTS Community Leadership Institute of Kentucky, which aims to enhance the capacity of local leaders to address health challenges.

Through CLIK, Martin received training on evidence-based interventions, data mining for research, and data collection and analysis — essential skills to assess the impact of a project. Equipped with this additional expertise, she is now researching the effectiveness of her diabetes screening system in Martin County.

The opportunity to work in several Appalachian counties, especially Kentucky's two easternmost, has enlightened even a native of the region about its diverse needs and challenges.

“People speak of Appalachia as a whole, but Martin County has so much less than Pike County,” she said. “Martin County doesn’t have a hospital. They have such a lack of access to care. They have one grocery store. It was very hard for me to find the resources to give them.”

Depending on the month, Martin hosts up to 10 community screenings across the five counties served by Big Sandy Health Care.

The results alarm her. “It’s actually kind of scary. Roughly 24 percent of people are pre-diabetic and 25 percent are diabetic. That’s roughly half of my sample in the red zone,” she said.

Martin sees particular challenges for individuals who face multiple health issues and dire socioeconomic circumstances. “Sometimes we’ll go do screenings in the homeless shelter. Imagine being homeless and diabetic. Sometimes people are also recovering from addiction. Really, can you imagine being homeless and diabetic and recovering from an addiction?”

At some of the community screenings, people have been surprised to learn that they’re diabetic or at immediate risk. In a screening at Big Sandy Community and Technical College, she said, many students “learned that they had pre-diabetes, and they were in their early 20s. It was scary for them. One person was diabetic and didn’t know it. At all ages we’ve screened, there’s been at least one person who’s said ‘Oh my god, I didn’t know, I didn’t know the signs.’”

However, the data she has gathered encourages her about the potential impact of systematic community screening with targeted follow-up.

Her initial screening study in Pike County found that 50 percent of people who received follow-up information and returned for their six-month screening had lower A1C levels, the essential measurement for a diagnosis of diabetes.

Martin's demonstrated success has also yielded nearly $20,000 in outside funding to pay for community screenings and upcoming educational classes. The Anthem, Aetna and Passport health plans have provided a total of $11,000 in sponsorships for screenings. It costs about $7 to screen one person.

Martin also recently received a $9,000 grant from Marshall University in West Virginia to support diabetes education classes in Big Sandy communities, with “gentle yoga” exercises for their clients in order to increase movement and activity, especially for individuals who are wheelchair-bound or have trouble exercising.

“There are a lot of positive health effects of gentle yoga,” she said. “We work with the aging population, and as they age we want to keep them moving. Safe, slow movements, even if someone is wheelchair-bound, can help keep away chronic effects of things like diabetes.”

Martin is developing yet another partnership to integrate retinopathy eye screenings at some community-outreach events. Over the course of nearly 600 diabetes screenings, Martin observed the a great need for eye care, and engaged both UK and the new Kentucky College of Optometry at the University of Pikeville to provide retinopathy screenings at some of her events.

When Martin isn’t busy with her full-time (and mostly unpaid) work as the diabetes coalition coordinator, she works at least 30 hours a week as a waitress. She is also studying for the Medical College Admission Test and the Optometry Admission Test, with plans to apply to medical and/or optometry school at Pikeville. Her ultimate goal is to become a practicing physician in a rural community.

She has a demanding portfolio of responsibilities, and says she sleeps about five hours a night but doesn’t tire of her work: “I’m right where I’m supposed to be.”

Kentucky College of Optometry about to open in Pikeville

Artist's rendering of Kentucky College of Optometry, Pikeville

The University of Pikeville says it is about to open the nation's largest optometric college in terms of floor space, the Kentucky College of Optometry.

"Dr. Andrew Buzzelli, vice president for optometric education and the college’s founding dean, said that, at 130,000 square feet, KYCO is the largest optometry college in the country," Josh Little reports for the Appalachian News-Express in Pikeville. "The cost to build the college is $55 million, plus $9 million for equipment."

Students at the college will perform optometric services for local residents, under the supervision of doctors of optometry. "Pikeville Medical Center will still continue to be the main provider in the area, but they only have two providers, so the care is in here," Buzzelli said. "In the other schools around the country, care is all around the city, that’s not true here. ... This will be for our specialty clinics, such as laser surgery." He said The college will offer electrophysiological tests, which now require residents to travel to Lexington or Huntington, W.Va.

The university is already home to the School of Osteopathic Medicine.

UK study finds HIV drugs could be repurposed to treat age-related macular degeneration, now untreatable in up to 90% of cases

Drugs that have been used for the last 30 years to treat HIV and AIDS could also be used to treat age-related macular degeneration in the eye and other inflammatory disorders, says a University of Kentucky news release.

The "landmark study" was led by Dr. Jayakrishna Ambati, professor and vice chair of UK's Department of Ophthalmology and Visual Sciences and has been published in the journal Science.

Age-related macular degeneration is a progressive condition that is untreatable in up to 90 percent of patients and is a leading cause of blindness in the elderly worldwide. There are two forms of AMD, wet and dry.  Wet AMD has several therapies available, which are not always successful. Dry AMD has no approved treatments.

The most widely used class of anti-HIV drugs are thought to work as a treatment for HIV/AIDS patients because of how they target a specific enzyme that is critical for the replication of HIV. The drugs are nucleoside reverse transcriptase inhibitors.

The study found "NRTIs prevented retinal degeneration in a mouse model of dry AMD," the release reports. The toxic molecule that causes dry AMD requires the same enzyme to fulfill its life cycle as the enzyme that is responsible for replicating HIV; NTRIs target that enzyme. Surprisingly, the study found that NRTIs target it indirectly, by blocking an immune pathway, says the release.

"Repurposing of NRTIs could be advantageous, for one, because they are very inexpensive," Benjamin Fowler, the lead author and a postdoctoral fellow in the Ambati lab, said in the release. "Moreover, through decades of clinical experience, we know that some of the drugs we tested are incredibly safe. Since these NRTIs are already FDA-approved, they could be rapidly and inexpensively translated into therapies for a variety of untreatable or poorly treatable conditions."

Sun exposure can damage eyes; sunglasses decrease risk

Sunscreen, sunglasses. This should be your mantra as you step into the great outdoors this summer.

Your skin needs protection from the damaging rays of the sun but so do your eyes, says the Kentucky Optometric Association.

“People spend a lot of time outdoors in the summer, so too much exposure to the sun is common,” Dr. Lynn Shewmaker, an optometrist with offices in Fort Mitchell and Dry Ridge says in a news release. “Sunglasses are more than just a fashion accessory because overexposure to ultraviolet rays fast forwards aging of the eyes and increases the risk for serious diseases.”

The Optometric Association reports that the sun’s UV radiation can cause cataracts; cancer of the eyelids and skin around the eyes; benign growths on the eye’s surface; and what is commonly known as snow blindness, which is a temporary but painful sunburn of the eye’s surface. Long-term exposure can cause damage to the retina, a lining of the eye that is used for seeing.

Extended sun exposure can also create visibility problems for drivers. “Spending just two or three hours in bright sunlight can hamper the eyes’ ability to adapt quickly to nighttime or indoor light levels,” Shewmaker said in the release. “This can make driving at night after spending a day in the sun more hazardous.”

Long-term sun exposure is also a risk factor for macular degeneration, a disease that destroys the part of your vision that allows you to see objects clearly, says the release.

Wearing a wide-brimmed hat or cap can block about 50 percent UV radiation from the eyes, which is not enough protection, according to the release. You must also wear sunglasses.

The Kentucky Optometric Association recommends choosing lenses that:
· Block 99 to 100 percent of both UV-A and UV-B radiation
· Screen out 75 to 90 percent of visible light
· Are perfectly matched in color and absorption and are free of distortion and imperfection
· Are gray for proper color recognition.
In addition, Shewmaker said some contact lenses also can block out both UV-A and UV-B radiation.

Infants’ and children’s eyes also need to be protected from the sun at all times especially because they tend to spend more time in the sun than adults.

Remote Area Medical plans to bring more local clinics to Kentucky and other areas in the 'distressed corridor' of Appalachia

More help could be coming for Appalachian Kentuckians who need health care. Remote Area Medical is launching a two-year campaign beginning in September called "Stop the Suffering in Appalachia," designed to work with community organizations, health-care professionals and volunteers in Kentucky, Tennessee, North Carolina, Virginia, West Virginia, Ohio and Mississippi to raise funds to provide free care to as many people in the "distressed corridor" as possible, according to the group's website. RAM lists 15 percent of the Appalachian population, or 180,000 people, as needing the services. The cost per patient is $22.22. A clinic is scheduled Oct. 25-26 at Rowan County Middle School in Morehead. (Los Angeles Times photo by Genaro Molina: Patients at a clinic in California)

RAM, which has more than 84,000 volunteers, has provided more than $75 million worth of free medical care in more than 700 mobile clinics to 545,000 patients, according to the organization. Despite those staggering numbers, they say they want to reach even more people in need "to establish RAM Affiliates based in Appalachian states to provide ongoing services and healthcare access beyond 2016." (Read more)

The solution is to "work with local organizations and doctors in each state organizing clinics on a local level by donating two trucks to help with health care procedures," Laura Halm reports for WATE-TV in Knoxville. That means, RAM founder Stan Brock told Halm, that when RAM holds the clinic in October in Kentucky, "those people in the middle of Kentucky don't have to drive all the way down to Knoxville or come and find us in some other part of the country." It also means RAM can hold more clinics each year, raising its average total from one or two to five or six. Brock told Halm, "We really need to have an intense focus on Appalachia in our own backyard, because the need is so great." (Read more) For the clinic schedule click here.

November is National Diabetes Month; here are some tips to stay healthy and keep the disease from stealing your vision

November is National Diabetes Month, and if you're one of more than 370,000 Kentuckians with the disease, in addition to watching your diet and keeping track of your blood sugar, it’s also important to have regular eye exams.

A comprehensive dilated eye exam can catch
diabetic eye disease early, before symptoms appear

Diabetic eye disease is the leading cause of vision loss among working-age Americans, says a release from the National Institutes of Health.  Diabetic retinopathy is the most common form of this disease, affects=ing more than 7 million Americans, a number that is expected to reach 11 million by the year 2030.

Since diabetic retinopathy has no symptoms until it reaches an advanced stage, it is important to get regular dilated eye exams so it can be detected early, says the release. Fortunately with early detection and timely treatment, the risk of severe vision loss from the diabetic retinopathy can be reduced by 95 percent.

If you have diabetes, controlling the disease will reduce your risk of developing diabetic eye disease. It’s now a good time to remember these health tips too:

• Get a comprehensive dilated eye exam at least once a year. 
• Tell your doctor if you're feeling down or if your eyesight changes.
• Control your blood sugar, blood pressure and cholesterol levels.  
• Take your medicine even when you feel Ok.
• Be active for 30 to 60 minutes on most days of the week.
  
• Eat healthy foods like:
• fruits, vegetables, fish, lean meats and poultry, dried peas or beans, lentils, and low-fat or skim milk and cheese
• whole grain foods such as whole wheat bread and crackers, oatmeal, brown rice, and cereals
• food prepared with little added fat, oil, salt, or sugar
• smaller servings of meat, fish, and poultry
• larger servings of fruits and vegetables. 

Click here to learn more about diabetic eye disease from the National Eye Institute. Click here to learn more about preventing and managing diabetes from the National Diabetes Education Program or here for additional tips on staying healthy with diabetes.

Get a prescription before buying decorative contact lenses for Halloween, optometrists recommend

Many people incorporate decorative contact lenses into their Halloween costumes, and not all of them are purchased legally. They can be found on the Internet, beauty salons, convenience stores and some national retailers.  The Kentucky Optometric Association recommends that you never buy lenses from these sources.

Wearing decorative contact lenses purchased illegally and without a prescription can lead to serious health issues and potentially damage your eyesight, the association said in a news release.

The Food and Drug Administration classifies all contact lenses as medical devices, whether they correct vision or not. When considering decorative contact lenses as part of your costume, the optometrists say you should obtain a prescription from a doctor, who can also teach you how to properly care for your eyes while wearing contacts.

“Even though these are non-corrective lenses, they still pose the same potential health and safety risks as other contact lenses,” said Dr. Bill Reynolds, an optometrist in Richmond and a trustee of the American Optometric Association. “When purchased over the counter, decorative contact lenses can put people at risk for bacterial infections, allergic reactions or even significant damage to the eye’s ability to function with the potential for irreversible sight loss.”

Clinics in 9 Appalachian counties will offer high-tech eye screenings to head off common ailment that blinds diabetics

Kentucky has one of the nation's highest rates of diabetes, but half the diabetics in rural Kentucky don't have annual eye exams – even though nearly 30 percent of diabetics over 40 have diabetic retinopathy, the leading cause of blindness among diabetic adults.

To stem that threat, units of the University of Kentucky are using a three-year federal grant to bring diabetic eye screening to diabetics in nine Kentucky Appalachian counties. Diabetic retinopathy can be treated, or avoided altogether, if the disease is detected early enough.

While studies have found that 90 percent of diabetics consult their doctor about their disease, about half the diabetics in rural Kentucky do not have annual eye exams. The grant will make technologically advanced exams available at clinics in Bath, Carter, Elliott, Estill, Jackson, Madison, Menifee, Rockcastle and Rowan counties, sending digital images of the eyes to UK's Department of Ophthalmology.

The specialists will screen the images for cataracts, glaucoma, macular degeneration, and other retinal abnormalities that can lead to vision loss and blindness. They will also enter the results into the patient's electronic medical record, for reference by other health-care providers. Currently, only a fraction of the results of community-based eye exams are imported into such records.

The partnership between the UK ophthalmologists, the university's Kentucky TeleCare, and primary care centers where the screenings will be done, is called the Appalachian Eye Network. It will reach nine counties with a combined population of 206,000. All the counties have diabetes rates higher than the national average. The project is expected to screen 4,860 people over the three-year term of the grant.

"Our goal is to reach patients with diabetes and those with high risk factors for diabetes who do not get annual eye exams and help uncover potentially devastating eye disease so it can be treated before the patient loses their vision," said Rob Sprang, director of Kentucky TeleCare. "I believe we have the opportunity to save people’s vision and change lives."