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.

Legislators nix Beshear's 2nd regulation to expand Medicaid dental, vision and hearing services, but it'll remain in place for now

Kentucky Voices for Health graphic supports the expansion,
which legislators say they oppose on procedural grounds. 

By Melissa Patrick

Kentucky Health News

The legislature's Administrative Regulation Review Subcommittee voted May 9 to find Gov. Andy Beshear's new regulations to expand Medicaid's vision, dental and hearing services deficient, based largely on process. 

"This deficiency vote has nothing to do with the regulation itself," said Co-Chair Sen. Steve West, R-Paris. "As far as expanded dental services, I think every single person up here on this committee would be in support of expanded dental services. I don't think there's any question about that. But our job in this committee is to protect the legislative process and protect the legislative branch and our role in the process. I don't think we would be here if there was some level of effort from the cabinet to meet us halfway, to discuss it, to show up in our office and work through this thing together. But in my case personally, there has been none of that." 

Beshear, asked what the deficiency means for Kentucky adults who are receiving these new services under the regulation that was recently found deficient, said, "They're still in place, at least until the next legislative session." 

At his weekly news conference, Beshear also talked about how important these basic services are to getting Kentuckians back into the workforce.

"This is about helping people with very basic needs . . . being able to see, being able to hear, being able to get the dental appointment, because we lose millions of productive hours at work due to emergency dental procedures that could otherwise be prevented," he said. "So this is a no brainer when you look at the low costs versus the number of people we can get back into the workforce."

This is the second set of regulations aimed at expanding these Medicaid services to be found deficient by the subcommittee. 

The original set was also found deficient by the 2023 General Assembly in Senate Bill 65, thus ending the benefits. SB 65 also stated that the Cabinet for Health and Family Services was prohibited from promulgating any new regulations unless they were "substantially different" from the original one. 

Within two weeks of SB 65 becoming law, the health cabinet filed the new regulations to expand vision, dental and hearing services for people on Medicaid, with each of the regulations stating the reasons that they were "substantially different" from the original regulation. 

West said in a news release, “What we are witnessing here from CHFS is an overt effort to ignore duly enacted legislation and, to make it worse. It is a poor administration of the Medicaid program and those it serves. We want to provide the highest-quality services to the most people we can, but this isn’t the appropriate way to achieve that goal. We can’t afford the current Medicaid program, so why would we expand services in an already unsustainable program? The regulation discussed today is irresponsible, strains the system, and picks winners and losers. Taxpayers and Kentucky residents deserve better.”

Officials from the state Department for Medicaid Services told the committee that the new regulations were in compliance with SB 65. Medicaid Commissioner Lisa Lee said the new regulations were "substantially different" because they added services and increase fees for a number of services in each category. 

Lee also called the expansion of these benefits a great "return on investment" because federal funds will cover $31 million of the $36 million total cost. The state's share is coming from savings that Medicaid achieved by moving to only one pharmacy benefit manager, the middleman between drug manufacturers and the managed-care organizations that deal with Medicaid beneficiaries. 

Several subcommittee members voiced concern that Kentucky’s Medicaid program does not adequately cover behavioral-health services, emergency medical services and other services, and that those programs should have been considered when deciding how this money is spent.  

"What we should be doing is having a holistic conversation about how do we appropriately raise rates to take care of our most vulnerable population, so that we don't just have one winner, that we can have a lot of different winners," said Sen. Julie Raque Adams, R-Louisville. 

The expanded services cover 900,000 adults on Medicaid. 

Rep. Daniel Grossberg, D-Louisville, noted that because of these expanded services, "We've gotten 60,000 Medicaid members who have received glasses who would not have otherwise received glasses, 932 dentists have received reimbursement for crowns on more than 5,600 individual members who would not have otherwise been reimbursed or received crowns. We have nearly 1,200 members who have received dentures who would not otherwise receive dentures. And providers have received over $11 million that would have not otherwise yet received." 

Just a few more days remain for Kentuckians to offer public comment about the new regulations. The cabinet is accepting written comments until May 31. Comments should be sent to Krista Quarles, policy analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort KY 40621. Her phone number is 502-564-6746; her fax is 502-564-7091; and her email is CHFSregs@ky.gov.

Meanwhile, Kentucky Voices for Health is still collecting comments from anyone who would like to make a public comment on these regulations, as they have done before for other rules. KVH will submit the comments for anyone who fills out one of their comment forms.

Legislature nixes Beshear's expansion of Medicaid dental, hearing and vision benefits; dentists' lobby says it took no stand on the bill

By Melissa Patrick
Kentucky Health News

The Republican-controlled General Assembly stood by its repeal of Democratic Gov. Andy Beshear's expansion of dental, hearing and vision benefits for 900,000 Kentucky adults on Medicaid.

Beshear expanded the benefits in October through an executive order and regulations that have been in effect since January. Senate Bill 65 declares the regulations deficient, which kills them because the legislature overrode Beshear's veto of the bill March 29 on party-line votes, 30-7 in the Senate and 75-20 in the House.

The bill allows providers to get paid for services initiated before its effective date, which was March 29 because the bill declared an emergency. Bills normally take effect 90 days after a legislative session ends.

Sen. Stephen West

While presenting SB 65 earlier in the legislative session, Sen. Stephen West, R-Paris, said the regulation was deficient because funding for it came from the $38 million in savings that came when the state moved to a single pharmacy benefit manager, a middleman between drug manufacturers and companies that manage Medicaid. West said lawmakers should  have been involved in how those savings were spent. 

Beshear's veto message said SB 65 "will harm Kentuckians and frustrate efforts to increase Kentucky's workplace," noting that research shows that on average nearly 100 million work hours are lost annually in the U.S. because of emergency dental care, that coverage of adult vision services increases a person's likelihood of working full time and that about 16% of Kentuckians have some degree of hearing loss."

Beshear wrote, "Since the regulation, more than 1,000 Kentuckians in all 120 counties have received nearly 3,330 dental services, including from a dentist in Clay County, who since January 1, 2023, has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester. 

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place." He also contended that the regulation-deficiency law is unconstitutional.

Beshear said at a news conference March 23, "I believe a new regulation will allow for the continuation of vision, dental and hearing benefits." That said, SB 65 requires any new regulation to be substantially different from the original.

The Kentucky Dental Association said it took no position on the bill.

Asked if the association supported SB 65, KDA President Don Heine gave Kentucky Health News a letter to KDA members that said, "It doesn’t serve our members or their patients to opine upon the political question of whether a regulation is deficient or not. Accordingly, we took no position on that political question." 

Heine said KDA would like to see both an expansion of basic dental services in Medicaid and larger reimbursements for providers, saying, "I don't think there's been a reasonable increase in Medicaid fees in 20 years."

Low reimbursement rates are often cited as a reason dentists won't accept Medicaid patients, but Heine said, "I think we have plenty of providers." At other points in the interview, he said dental providers "will accommodate far more Medicaid patients when they're at least not losing money" and "We've got to get the legislature to work with Medicaid providers to at least make the funding where people can be seen and we can prevent them from going to the emergency room."

He cited a Texas A&M University study that found patients who go to the emergency room to treat preventable dental conditions costs U.S. taxpayers, hospitals and governments about $2 billion a year. 

Earlier, KDA Executive Director Richard Whitehouse told Kentucky Health News, "We are not opposed to expanding Medicaid services. However, to expand those services and meet the needs of that population, we need to expand the network. We believe incentivizing more providers to join that network and enabling those already in to take on more patients does that. It also lowers the cost of health care by detecting disease earlier and avoids more costly emergency room visits."

When the Senate initially passed the bill, Sen. Stephen Meredith, R-Leitchfield, said a reimbursement increase is especially needed in medically disadvantaged areas. In explaining his vote for SB 65, he also said the money could have been used to help the 5,000 children who are waiting for services from one of the state's special Medicaid waiver programs. 

In the House, as he supported Beshear's veto, Rep. Chad Aull, D-Lexington, said, "We know that Kentucky has many challenges when it comes to some of our health outcomes. Why do we continue to shoot ourselves in the foot by taking away the opportunity to pay for health care for our citizens? I do not understand this legislature's motive in trying to override this veto."

Cabinet for Health and Family Services spokeswoman Susan Dunlap told the Courier Journal in October that federal funds would cover 90% of the expansion's cost. Medicaid is primarily funded by the federal government.

How to avoid vision problems from diabetes, which 13.6% of Kentuckians have, 7th in U.S.; 33.8% more have pre-diabetes

Diabetes can cause blindness. (smirart/iStock/Getty Images)

By Joseph Brown

University of Kentucky

Diabetes is a disease so prevalent in the U.S. that it is considered to be an epidemic. In Kentucky, according to the American Diabetes Association, approximately 13.6% of the adult population has diagnosed diabetes, seventh in the nation.

Another 33.8% of Kentuckians have been diagnosed as having pre-diabetes. Diabetes can result in devastating consequences financially and physically for the families and those who have it.

With a diabetes diagnosis, you must be aware of the risk factors you face. One of these risk factors is that you can develop a serious eye condition called diabetic retinopathy. It causes vision loss and blindness in those who have diabetes by causing issues with the blood vessels connected to the retina.

If you have diabetes, it is important to get an eye exam once a year, since you may not notice any symptoms in early stages. Catching this condition early on will be the best course of action in preventing vision loss.

What are the symptoms?

• Changes in vision such as trouble reading or blurred vision
• Fluctuating vision
• Spots or dark streaks floating in your vision
• Dark or empty areas in your vision
• Eye pain or redness
• Difficulty seeing in the dark

What can I do to prevent diabetic retinopathy? The best course of action is managing your diabetes with a healthy diet, regular exercise and following your doctor’s instructions with medications. You should also ensure you get a regular eye screening, and monitor your blood sugar, cholesterol and blood pressure at all times.

What kind of treatment is available? If caught early, your doctor will likely recommend more regular eye exams. However, in the later stages, there are a variety of treatments available to stop your vision from worsening, such as injections, laser treatment or eye surgery. Overall, it is important to see your doctor with any concerns you may have to find the right course of action for you.

Beshear announces initiative that will expand Medicaid dental, vision and hearing benefits for more than 900,000 Ky. adults

Dept. for Medicaid Services graphic

By Melissa Patrick

Kentucky Health News

Pitching it as a way to expand the state's workforce, Gov. Andy Beshear announced Thursday the expansion of dental, vision and hearing benefits for 900,000 Kentucky adults on Medicaid.  

"One of the major obstacles in getting some people into the workforce is they're simply not healthy enough to do it. Challenges in their health are preventing them from either looking for or securing a job," Beshear said at his weekly news conference.

"These are really basic things, folks. If  you can't see, it's really hard to work. If you can't hear the instructions that you're getting, it's really hard to work. If you have massive dental problems that are creating major pain or other complications, it's really hard to work.. . . Today, we're announcing that for many Kentuckians, we're removing the roadblocks that they face in accessing dental, vision and hearing care." 

Beshear said the vast majority of the program will be paid by the federal government and the rest of it will be absorbed into the existing Medicaid budget. "It will require no changes to our budget in this next session," he said. "In other words, it is easily affordable, which means we absolutely should do it."  

Susan Dunlap, spokeswoman for the  Cabinet for Health and Family Services, told the Louisville Courier Journal that federal funds would cover 90% of the estimated $36 million annual cost for the expansion, with the state covering the rest. She added that the state's move to one pharmacy benefit manager last year "has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward."

Medicaid is a state-federal program that provides health insurance for low-income adults and pregnant women, the disabled, and families with incomes at or below 138% of the federal poverty level, which amounts to about $18,700 per year for an individual or $38,200 for a family of four. Youth 21 and under who are enrolled in Medicaid already qualify for dental, vision and hearing services.

Kentucky adults on Medicaid already have access to some dental and vision benefits; the hearing benefits are very limited. Starting on Jan. 1, those benefits will be greatly expanded.

For example, the only dental services Medicaid now covers for adults are an annual cleaning a year and extractions based on certain medical conditions. Dunlap said fillings are not covered for adults, but the expansion will add coverage for fillings, dentures, implants,  root canals, extractions, restorations, periodontics and an additional cleaning each year. 

Dunlap said the new hearing benefits will cover screening tests and hearing aids for adults. Now an adult can be evaluated only if they had a referral from their primary doctor. 

The vision changes will cover eyeglasses and contacts for adults. Now, vision exams are covered by Medicaid, but glasses and contact lenses are not. 

Managed-care organizations, which provide care for Kentuckians on Medicaid, were already offering some of these services as extra benefits to incentivize beneficiaries to choose their company. 

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded Beshear's decision to expand benefits, noting the value of employment as one of the most important "social drivers of health." 

“All of the data shows that when you work, you've got a much better chance of having good health," he said. "So, it's a circular thing. You have to have good health to be able to work and you have to be able to work to have good health.”

One of the challenges that people on Medicaid already have when it comes to getting dental care is that there aren't enough dentists who will accept Medicaid insurance, mainly because the rates are so low. 

Asked about this, Beshear said, "We are going to have to make sure that there is access all across Kentucky," he said. "When you think of health care, it has to be affordable. . . . So it's going to be hard work. We're going to see what those barriers are, but it's about commitment and being intentional to make sure we get health care to those folks. " 

Dunlap said Kentucky is submitting the state Medicaid plan amendment to make these changes to the Centers for Medicare and Medicaid Services and that they do not anticipate any issues with approval. 

Open enrollment for Medicaid members runs through Dec. 1 for coverage beginning Jan. 1. Medicaid open enrollment gives Medicaid members a chance to change the insurance company that manages their care.  Medicaid members who chose to not participate in open enrolment will keep the same managed care organization, or MCO, that they are currently enrolled in.

Bill to require Kentucky drivers to pass a vision screening exam at each driver's license renewal nears the legislative finish line

Update 4/9/2021: This story has been revised to reflect that when this law goes into effect July 2024, all drivers license and any vision testing requirements will be done through the Kentucky Department of Transportation, and not the circuit court clerks. 

By Melissa Patrick

Kentucky Health News

Kentucky is close to becoming the 43rd state to require drivers to have a vision screening every time they renew their license. The rule is in a House bill that has passed the Senate is back in the House for consideration of changes made to it in the Senate.

Photo: Depisteo

“House Bill 439 is a commonsense piece of legislation that will save lives by ensuring drivers on Kentucky roadways have the necessary visual acuity to operate a vehicle," Senate Republican Caucus Chair Julie Raque Adams of Louisville told the Senate. “Kentucky only requires a screening when you get your license the first time, even though studies show that visual acuity declines with age.”

If the bill becomes law, its effect would be delayed until July 2024 to allow circuit court clerks, who issue licenses, the Department of Transportation,  time to prepare for it.

Kentuckians would continue to have the choice of renewing their license every four or eight years, and a vision screening test would be required at each renewal. Drivers would have the choice of getting their screening at the renewal office or by a medical provider. Anyone who failed the screening would be referred to a vision specialist for further evaluation. The visual acuity standard in Kentucky is 20/40 or better. 

“It is time for us to join the 42 other states and protect Kentuckians and our roadways,” Adams said. “House Bill 439 does that and makes it convenient for the driver at renewal.”

Adams said HB 439 was supported by ophthalmologists, optometrists, nurse practitioners, transportation officials, state police, the Kentucky Medical Association and the American Automobile Association. She added that AARP didn’t oppose the bill because it does not target older drivers.

Sen. Robin Webb, D-Grayson, said that as a daughter of an optometrist, she was voting for HB 439,  but also shared some concerns. 

"I'm going to vote yes and hold my nose on this bill," she said. “This just to me comes across as another layer of bureaucracy and maybe even prompted by insurance companies, and it's going to be a hardship. There are open-ended fees and administrative allowances that I think we just have to . . . continue to monitor this program and make sure there's valid avenues for appeals." 

Sen. Ralph Alvarado, R-Winchester, noted that it had taken seven to eight years to get all of the stakeholders to agree upon the same language for the bill.

“If you are on the road having trouble reading signs, please get those exams done prior to 2024,” said Alvarado, a physician. 

When HB 439 passed out of the House on Feb. 25, on a 89-5 vote, sponsor Kim Moser, R-Taylor Mill, said the state Transportation Cabinet has said it expects any increase in fees to be "nominal" and will largely be used to cover the cost of equipment. 

Citing several studies, Moser said every state that has implemented a vision screening requirement has seen a reduction in crash-related deaths and hospitalizations.  

The bill passed the Senate 31-4 on March 12 with a committee substitute that clarifies which applicants get a vision test administered by the cabinet or the State Police. If the House approves the changes, the bill would go to Gov. Andy Beshear. If not, the Senate would have to drop the change or send the bill to a House-Senate conference committee. 

FDA proposes new, graphic warnings for cigarette packs and ads

A Food and Drug Administration photo illustration shows three  of the 13 proposed warnings.

The Food and Drug Administration has again published a proposed rule to "require color graphics depicting the negative health consequences of smoking be added to cigarette packages and in cigarette advertisements," Inside Health Policy's Beth Wang reports.

The warnings would be the first update to cigarette package warnings in more than 30 years. They were authorized by a 2009 law, but a tobacco-company lawsuit blocked FDA's first attempt.

Wang describes the proposed warnings:

“Tobacco smoke can harm your children,” with an image that shows the head and shoulders of a boy 8 to 10 years old, wearing a hospital gown and receiving a nebulizer treatment for chronic asthma.

“Tobacco smoke causes fatal lung disease in nonsmokers,” with an image showing gloved hands holding a pair of diseased lungs containing cancerous lesions.

“Smoking causes head and neck cancer,” with an image showing the head and neck of a woman 50 to 60 years old who has a tumor protruding from the right side of her neck, just below her jawline.

“Smoking causes bladder cancer, which can lead to bloody urine,” with an image of a gloved hand holding a specimen cup with bloody urine.

“Smoking during pregnancy stunts fetal growth,” with an image of an infant on a medical scale with a digital display reading 4 pounds.

“Smoking can cause heart disease and strokes by clogging arteries,” with an image of a 60- to 70-year-old man with a large, recently sutured incision in his chest as he undergoes monitoring.

“Smoking causes COPD, a lung disease that can be fatal.” There are two versions of the COPD warning. One will have an image of gloved hands holding a pair of diseased, darkened lungs removed from a smoker; the other will have an image of the head and neck of a 50- to 60-year-old man who has a nasal canula under his nose supplying oxygen, with the oxygen tank behind him.

“Smoking reduces blood flow, which can cause erectile dysfunction,” with an image of a 50- to 60-year-old man sitting on the edge of a bed and leaning forward with one elbow resting on each knee. The man’s head is tilted down with his forehead pressed into the knuckles of his right hand while his female partner sits behind him on the bed, looking in another direction.

“Smoking reduces blood flow to the limbs, which can require amputation,” with an image of feet with several toes amputated due to damage resulting from peripheral vascular disease caused by smoking.

“Smoking causes type 2 diabetes, which raises blood sugar,” with n image of a personal glucometer device showing a high blood sugar level.

“Smoking causes age-related macular degeneration, which can lead to blindness,” with the image of a senior man getting an injection in his right eye to prevent additional macular degeneration.

“Smoking causes cataracts, which can lead to blindness,” with the image of a man who is at least 65 years old who has a cataract covering his right pupil.

A lawsuit by public-health and anti-smoking advocates prompted FDA to issue the proposal, Wang notes: "The proposed warnings are required by law to be displayed on half the front and rear panels of cigarette packages, and on the top 20% of the area at the top of advertisements.

"This marks the second time FDA has issued a proposed rule to require graphic warnings on cigarette labels and advertisements," Wang notes. "The first rule was blocked in 2012 by the U.S. Court of Appeals for the District of Columbia in R.J. Reynolds Tobacco Company v. FDA, which argued the proposed rule violated the First Amendment by not justifying why there is a need to issue regulation on commercial speech. In March, however, a federal court ordered FDA to issue the proposed rule by Aug. 15, and a final rule by March 15, 2020."

The Family Smoking Prevention and Tobacco Control Act of 2009 "required nine new health warning statements to be included on cigarette packages and in cigarette advertisements, and it directed FDA to develop color graphics depicting the negative health consequences of smoking to accompany warnings," Wang notes. "After having their initial proposed rule rejected by the court in 2012, FDA undertook a research and development process to consider whether the TCA’s textual warning statements would promote greater public understanding of the risks associated with smoking. Through that process, FDA determined there was support to propose adjusting some of the TCA statements. FDA ended up with 16 statement-and-image pairings to test in a final quantitative consumer research study, which resulted in the 13 cigarette graphic health warnings listed in the proposed rule."

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.

Patients confused, providers worried, Democrats and advocates upset over decision to limit Medicaid dental and vision benefits

The end of dental and vision benefits for 460,000 Kentuckians on Medicaid caused some pregnant women and children to be denied care because of a reported glitch in the system. It also prompted complaints from Democrats and others that the move violated federal law.

The Bevin administration blamed the cuts on a federal judge's ruling that vacated the state's new Medicaid program, which was to launch July 1. Judge James Boasberg of Washington, D.C. sent the plan back to the U.S. Department for Health and Human Services for review, ruling that Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

The state's action mainly affects Kentuckians who gained access to Medicaid when then-Gov. Steve Beshear, a Democrat, expanded it in 2014 to those who earn up to 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act.

Deborah Yetter of the Louisville Courier Journal reports, "Dentists have been forced to turn away children and other patients who are mistakenly showing up in the state's computer system as having lost coverage," including pregnant women and disabled adults who are clearly exempt from the cutoffs.

Yetter offered examples, including a Floyd County dentist who said he turned away at least 10 children since Monday for lack of Medicaid coverage; another in Louisville who said her patients were coming in for appointments with no idea they had lost their coverage and couldn't pay the $30 required for those without insurance; and another in Pikeville who said he had had to cancel multiple appointments for people who had lost coverage but should have been exempt.

The Kentucky Oral Health Coalition says that they too have heard from multiple KOHC dental providers across the state that the state's changes to the dental program have resulted in the denial of routine dental care to eligible children and pregnant women. 

"Due to a shortage of dentists who accept Medicaid in Kentucky, particularly in rural areas, we know that some families travel several hours just to get to a dental appointment," KOHC writes in a statement, adding that summer vacation is typically a prime time for caregivers to schedule these visits. "This timing adds to the urgency. We cannot allow families to show up only to be turned away and miss their opportunity to access the dental care they need to stay healthy." 

Doug Hogan, spokesman for the state Cabinet for Health and Family Services, told Yetter that he needed more specifics to determine if people were being wrongly classified or if providers had gotten incorrect information. "According to system checks, eligibility is being correctly applied to children and pregnant women," he said, adding that those with concerns can call 1-800-635-2570.

Dental providers who serve the poor are worried

Jennifer Hasch, a dental hygienist at the Shawnee Christian Healthcare Center, which serves people regardless of income in west Louisville, at a July 2 news conference in Louisville with local Democrats, said that 70 percent of their patients were on Medicaid, with an estimated half of those in the expansion population, Joe Sonka reports for Insider Louisville.

Photo from Family Health Centers website

Hasch added that when poor people can't see a dentist, they go to the emergency room, which she said was at least three times as expensive as a normal dental visit. She later told Sonka that the abrupt end of dental benefits for so many had created much uncertainty about who did or did not still have dental coverage.

Bill Wagner, CEO of Family Health Centers, federally qualified clinics that treat patients regardless of income, told Louisville's Metro Council last month that the center feared 8,400 of their patients could lose Medicaid coverage over the next five years under the plan.

"Wagner added that with the dramatic increase in patients covered by Medicaid expansion over the last five years, the city has lowered its annual amount payments to the center for uncompensated care by roughly $1.1 million," Sonka reports.

While speaking at the news conference, Wagner  said that the clinics likely will have to start charging a basic fee of $30 per visit, an amount some can't afford, Yetter reports.

On Thursday, July 5, the Kentucky Rural Health Association sent out a list of codes from the state Department for Medicaid Services that are to be used for Medicaid members who are listed under the "Alternative Benefit Plan" created for the expansion population.

What's it all about?

Medicaid is a joint state and federal health insurance program that spends $11 billion a year to cover about 1.4 million Kentuckians, more than 600,000 of them children. Before the expansion, it was mainly limited to very poor pregnant women and children, disabled people and low-income elderly in nursing homes.

Bevin and his administration have long argued that any money spent on the "able-bodied" expansion population takes money away from those who are truly in need. Others, including Judge Boasberg, hold that "where Medicaid's fundamental purpose and statutory protections are concerned, expansion beneficiaries stand on equal footing with 'traditional' populations," Sara Rosenbaum writes for The Commonwealth Fund.

The plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long-Term Health," included requirements for work, volunteering, job training or drug treatment; monthly reporting; lock-out periods for failure to comply; and small premiums and co-payments based on income.

Under Kentucky HEALTH, people covered by the Medicaid expansion were to earn dental and vision benefits by participating in certain activities, such as accessing preventive-care services or participating in job training. (Most people on the expansion work.)

Separately, the state moved to end the free benefits for the expansion population starting July 1 because of Boasberg's ruling.  "There is no longer a funding mechanism in place to pay for dental and vision services," the health cabinet said in a statement. 

MaryBeth Musumeci, associate director for Medicaid and the uninsured at the Kaiser Family Foundation, told Lisa Gillespie of Louisville's WFPL that it’s perfectly legal for the state to limit dental and vision benefits, but that it could also restore them.

“The court’s decision is not prohibiting Kentucky from continuing to offer vision and dental as they have prior to the waiver,” Musumeci told Gillespie. “Those benefits continue to be optional and they could include them in the benefit package, or not.”

State officials said they limited the benefits to reduce expenses in Medicaid, but that was illogical, the Lexington Herald-Leader said in an editorial, "because emergency-room visits for dental problems will increase," and are three times as expensive as a dental visit. The editorial noted that administration "officials have said they can’t say how much eliminating the dental and vision benefits would save or cost and that fewer than 10 percent of Medicaid recipients use those benefits."

The elimination of vision and dental coverage does not apply to pregnant women, children, individuals who are considered medically frail, former foster youth up to age 26, and groups covered by Medicaid before the expansion, including parents who make below 28 percent of the federal poverty limit, Gillespie notes.

Louisville Democrats voice outrage over cuts

Democratic politicians gathered Monday at a news conference in Louisville to blast the Bevin administration's handing of the matter.

At a news conference, U.S. Rep John Yarmuth of Louisville called Kentucky HEALTH illegal, and said it was driven by Bevin's "ideological motivations," Sonka reports.

“Medicaid is not a work program," Yarmuth said. "It is not a program designed to familiarize people with commercial health insurance, as the governor has said. It is a program to provide medical coverage to the poor and working poor."

Rep. John Yarmuth and other Democrats spoke against the
Bevin administration's cuts to dental and vision benefits for
some on Medicaid. (Photo by Joe Sonka, Insider Louisville)

Yarmuth added that if Bevin ends the expansion, as he has said he would do if courts ultimately block the plan, it would cost the state an estimated $30 billion in economic activity for hospitals and providers over the next 10 years, while the state would pay only 10 percent of that, because the federal government covers the rest of the expansion costs, Sonka reports.

Yarmuth told Nick Storm that he had asked the Centers for Medicare and Medicaid Services on July 2 if Kentucky had cut off these dental and vision benefits legally, and they told him they didn't know.

Nick Storm of Spectrum News reports that former state auditor Adam Edelen, who is considering the 2019 race for governor, also spoke at the news conference, saying “What we need is leadership in Frankfort that understands it’s not that the poor are not working hard enough, it’s that the work they’re doing doesn’t pay enough.”

Rep. Joni Jenkins suggested that patients with unresolved dental pain created a "gateway to addiction," which is "like throwing gasoline on our opioid epidemic here in Kentucky."

Sen. Gerald Neal said that he and Sen. Morgan McGarvey plan to file a bill in next year’s legislative session to require that all Medicaid recipients in the state have dental and vision benefits.

So what's next?

While the state and federal governments have been expected to appeal the court decision, Rosenbaum reports that the Trump administration could also decide to rework Kentucky's plan, which she writes "would seem to be the prudent choice, since the decision leaves open the door to Medicaid work experiments, and since multiple state proposals are potentially waiting in the wings."

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements as had been requested in Kentucky HEALTH.

The Associated Press sums up the judge's fundamental question as this: "Are poverty programs meant to show tough love or to help the needy?"

Local coverage

Bobbie Curd of The Advocate Messenger in Danville offers an example of how to localize this story. She notes that Boyle County has 5,700 people on Medicaid, equal to 20 percent of the county's population. (County totals of people on Medicaid, the expansion and other categories are at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.)

The director of the Boyle County Health Department, Brent Blevins, told Curd that he, and many others weren't told of the limitation of dental and vision benefits.

“If we don’t have a good program or option for those people to pick up quickly, you’ll have people going without coverage for extensive lengths of time,” Blevins said.

Blevins added that it "would be a significant issue in our community" if 1,000 or even 500 people in Danville lose their ability to afford dental and vision care.

Proposed changes in Medicaid, especially making beneficiaries earn dental and vision benefits, alarm them and health advocates

Family Health Centers in Louisville built a dental clinic after Medicaid
expanded; under proposed changes people in the expansion would
have to engage in self-improvement activities to get dental or vision
benefits. (Angela Shoemaker photo, special to The Courier-Journal)

Gov. Matt Bevin's plans to change Kentucky Medicaid alarm people who are on the federal-state program, reports Deborah Yetter of The Courier-Journal.

The first example is Louisville construction worker David Thompson, who was able to get his first heath coverage in years through then-Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act in 2014. "Thompson is hurrying to schedule dental and eye exams — care he said he urgently needs but realizes could be eliminated," Yetter reports.

Bevin's changes would initially eliminate basic dental and vision benefits for "able-bodied" adults in the expansion, which covers people with household incomes up to 138 percent of the federal poverty level. That makes a family of four with annual income of as much as $33,400 eligible for Medicaid.

For the first three years of the expansion, the federal government paid the full cost. Now states are paying 5 percent, and by 2020 that share will rise in annual steps to 10 percent, the ACA's limit — unless the ACA is changed, which also seems likely.

Bevin says the state can't afford the cost and expects the Trump administration to let him make changes that his aides say will leave Kentucky Medicaid with 85,000 fewer people on its rolls in five years than it would have without the changes. About 1.3 million Kentuckians are on Medicaid.

The governor and other state officials say the changes aren't just about saving money. Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, said the plan will "better engage members in their own health, wellness, education and employability," as well as improving Kentuckians' health outcomes.

The plan would charge small, income-based premiums and co-payments for Medicaid coverage of people with incomes above the poverty line, and would require able-bodied people on the program to work, look for work or take job training unless they are a primary caregiver. They could earn rewards points to get dental or vision benefits by "passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes.," Yetter notes.

"Advocates and public-health officials are increasingly concerned about what they believe will be an adverse effect on Kentuckians," Yetter reports. "Advocates worry consumers won't understand the complex changes to the program and, as a result, will lose coverage."

They especially worry about the "loss of dental benefits in a state with poor overall dental health," Yetter writes. She quotes Muriel Harris, associate professor of public health at the University of Louisville and board chair of Family Health Centers: "We're all very, very concerned. Those who have made the decisions are not considering the population we serve. It's just undermining any gains we have made in the past."

As for vision benefits, Yetter reports, "Kentucky optometrists have argued routine eye exams often uncover other serious health problems including diabetes, high blood pressure and eye disease that can result in blindness."

Yetter writes, "Collecting premiums and co-payments, tracking work or volunteer activity and managing the rewards accounts all will involve major technology systems changes and likely, hiring of outside vendors to manage such systems, advocates say. That adds to expense and potential complications, they said. . . . Kentucky is proposing monthly premiums of $1 to $37.50 per month, based on income and length of time enrolled in Medicaid. The longer people remain in Medicaid, the more it will cost, since Bevin's plan is aimed at pushing people to move to the commercial insurance market through employer coverage when available."

Most private employers in Kentucky don't offer health insurance to employees. The Kentucky Health Issues Poll has found that the percentage of Kentuckians on employer-provided insurance rose from 37 percent to 50 percent in 2014, but fell to 41 percent in 2015 and rose to 45 percent last year.

Kentucky rises to No. 3 in diabetes, increasing concern about removing dental and vision coverage from basic Medicaid

Gov. Matt Bevin's plan for Medicaid "would have a profound effect in a state with the nation's third-highest rate of diabetes," The Courier-Journal reports, because it would remove dental and vision care from the regular package of benefits.

Reporter Deborah Yetter cites a Louisville optometrist who often discovers diabetes during routine eye exams, and an Eastern Kentucky dentist who "is seeing many more patients thanks to Kentucky's 2014 expansion of Medicaid that added coverage for those he describes as the 'working poor'."

"Dr. Bill Collins, a dentist and president of the Kentucky Dental Association, sees many patients with diabetes, which can worsen oral health," Yetter writes. "Some patients are in such bad shape they must have all of their teeth extracted" because, he said, they have gone "so many years without care and without insurance."

Kentucky had the nation's sixth highest diabetes rate until Friday, when the federal Centers for Disease Control and Prevention issued figures for 2015 and ranked the state third.

"The percentage of adults with diabetes went from 11 in 2014 to 12 in 2015, the statistics show, as the state continued to struggle with the disabling and potentially fatal disease. Only Mississippi (14) and West Virginia (13) had higher percentages," Yetter reports. "Moreover, diabetes rates among those on Medicaid are nearly double that of the rest of the population, according to a 2015 state report" based on 2013 figures.

Dentists and optometrists asked Bevin not to remove dental and vision coverage from basic Medicaid, "arguing visits to the dentist and eye doctor are often the first step in identifying more serious health conditions, including diabetes," Yetter notes. "But the administration made only slight changes to its proposal, allowing dental and vision benefits only for the first three months of Medicaid coverage." Afterward, dental and vision benefits would be optional, "available only through a 'rewards' program where Medicaid members can earn points to pay for them through activities such as work or volunteering."

Cabinet for Health and Family Services spokesman Doug Hogan told Yetter there would be several "easy ways" for Medicaid members to gain dental and vision coverage, including weight-loss programs and classes about diabetes.

Hogan "said Bevin's proposal was designed to mirror commercial health plans, which do not typically include dental and vision benefits," Yetter writes. "And Medicaid does not require dental and vision benefits to be included."

Bevin's proposal to the federal government "also promotes moving many people off Medicaid to commercial insurance through their employers," Yetter notes. "Collins said the problem with the governor's plan is that many of the adults added through the expansion work at low-wage jobs that don't offer health insurance."

"I don't think they understand who they are trying to take off," Collins told Yetter. "These are the working poor. You're taking off working people who are trying to make a living."

Yetter writes, "Collins said diabetes is especially problematic for people with poor oral health because it makes them more susceptible to infection, tooth decay and other oral diseases. Such patients require careful monitoring and access to regular dental care, Collins said. Without it, he worries Kentucky will never drag itself up from its low rankings in tooth decay and its high rate of toothless adults - for many a barrier to jobs or well-paying jobs."

"I know something has to be done to address the Medicaid funding," he told Yetter. "But we need to find ways to fund it."

The 2014 expansion made anyone in a household with income up to 138 percent of the federal poverty level eligible for Medicaid. Before that, Yetter notes, "Medicaid was limited to very poor pregnant women and children, disabled people and low-income elderly in nursing homes."

The federal government is paying the full cost of the expansion through Dec. 31. On Jan. 1, the state will begin paying 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. Bevin says the state can't afford the cost.

New cases of diabetes decrease, but experts continue to call it an epidemic in Kentucky and the U.S.

The number of new diabetes cases in adults has significantly decreased in Kentucky and the U.S., reversing a trend, according to a federal Centers for Disease Control and Prevention report, but experts say there is still a diabetes epidemic.

In 1991-2009, adult diabetes cases in the U.S. increased sharply from 573,000 per year to more than 1.7 million. But in 2009-14, they "decreased significantly to approximately 1.4 million," says the report.

"This has been really encouraging, but we do need to recognize that those rates are still 60 percent higher than what they were in the '80s," Dr. Edward Gregg, chief of the epidemiology and statistics branch at the CDC, told The Huffington Post. "Even though we’re seeing a reduction, we had such a large increase that we're still at such a high level." Since 1980, the number of cases has more than tripled, says the CDC.

Gregg said he believes the recent decrease in new cases could be a result of people getting more exercise and eating healthier, along with increased awareness of the diabetes epidemic.

Kentucky’s statistics are mostly paralleling the national figures, Ja'nel Johnson reports for WFPL after interviewing Theresa Renn, manager of the Kentucky Diabetes Prevention and Control Program.

“They are also coming down as well,” Renn said. “It looks like we may have had a little bit higher peak and are also coming down nicely as well.”

Kentucky's most recent figure was 7.6 new diabetes cases per 1,000 adults Its peak, in 2007, was 11.2 new cases per 1,000 adults, Johnson reports.

In 2013, 10.6 percent of Kentucky adults (359,000) had diabetes. In 2000, the numbers were 6.5 percent and 240,000 adults, according to the 2015 Kentucky Diabetes Report. The current national rate is 9.7 percent. And 289,000 Kentucky adults have been diagnosed with prediabetes, making them at high risk of progression to diabetes.

Diabetes can cause heart disease, blindness, kidney failure and leg amputations. In The Great Diabetes Epidemic: A manifesto for Control and Prevention, Dr. Gilbert H. Friedell and J. Isaac Joyner, offer some details, excerpted in an op-ed for the Lexington Herald-Leader.

"This year an estimated 72,000 Kentuckians will develop significant visual impairment, including blindness. There will be some 1,000 amputations, about three a day in the state, and an estimated 800 people will develop kidney failure, many of whom will start dialysis," they write.

"The cost of dealing with the complications is enormous. Dialysis alone costs about $80,000 per person per year. Diabetes patients on Medicare cost three times as much per year as those without diabetes, $15,000 versus $5,000. The annual price tag for those with diabetes on Medicaid in Kentucky is about $1 billion. The total annual cost of diabetes in Kentucky for 2015 is estimated to be $5.6 billion."

Friedell and Joyner also say it is time for Kentucky to recognize diabetes is an epidemic, and adopt a public-health approach that includes widespread preventive screening, as the CDC has recommended since 1994.

Teri Wood, chronic-disease epidemiologist for the Kentucky Department of Public Health, told Johnson that the poor and less educated are more likely to get diabetes.

“Whether it’s because people have less access to healthy food, less knowledge about how to eat healthfully, perhaps less access to places to be physically active … and access to health care can be very important,” Wood said.

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

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."

Get those eyes examined, or a 'sneak thief' might steal your sight

January is Glaucoma Awareness Month, so the Kentucky Optometric Association is emphasizing the need for an annual dilated eye exam.

Glaucoma is the second leading cause of blindness in the U.S., but awareness surrounding the disease is relatively low, says the American Optometric Association. A poll taken for the AOA "found that 90 percent of Americans incorrectly believe glaucoma is preventable, and 72 percent mistakenly think glaucoma has early warning signs," KOA said in a news release. "Regular eye exams are the first line of defense for early detection of glaucoma."

The optometrists' group says more than half of Americans who have glaucoma remain undiagnosed, mainly because people don'y get regular eye exams. “Glaucoma is often referred to as ‘the sneak thief of sight’ because it can strike without pain or other symptoms,” said Dr. Ben Gaddie, a Louisville-area optometrist who is president of the international Optometric Glaucoma Society. “Vision lost to glaucoma cannot be restored, so early detection and treatment are extremely important.”

Treatment for glaucoma includes eye drops and medicines to lower pressure in the eyeball. In some cases, laser treatment or surgery may reduce pressure. To find a optometrist in your area, through the KPA, go to www.kyeyes.org