Iris Wilbur Glick & Erica S. Ballard, OD Public Comments on 201 KAR 5:021
Good afternoon. My name is Iris Wilbur Glick. I am here speaking on behalf of the National Board of Examiners in Optometry, or NBEO. I am also a Kentucky resident who relies on optometrists for my own eye health care.
The mission of the NBEO is straightforward: to protect the public through competence assessment. For years, NBEO has worked successfully with the Kentucky Board of Optometric Examiners to administer licensure exams to ensure that Kentucky patients receive safe, high-quality care from fully qualified doctors of optometry.
That process aligned with nearly every other state in the country by requiring prospective optometrists to pass a three-part licensure exam before being granted a license to practice independent optometry. Each part of the NBEO exam series is one element of a whole. Parts I and II test foundational biomedical science knowledge and concepts needed for clinical decision-making. The Part III Patient Encounters and Performance Skills or PEPS exam is like the “road test” element of qualifying for a driver’s license. It tests hands-on practical clinical skills on standardized patients in a simulated clinical environment. This exam was carefully developed alongside over 200 subject matter experts including some from here in Kentucky and utilizes over 90 standardized patients. No written or computerized multiple-choice test can substitute for a performance skills exam like Part III.
The original intent of Kentucky’s licensing standards was that every optometrist in the Commonwealth had to pass all three parts of the licensure exam.
Unfortunately, we are here today because of what went wrong. It has been publicly stated that between 2020 and 2023, the KBOE voted at least six times to waive these vital licensing exam requirements for at least 21 optometry graduates, allowing them to practice independently without having passed the required exams. The Kentucky Attorney General issued a formal opinion in October 2025 that this Board lacked legal authority to waive regulatory requirements and declared these waivers invalid, making the licenses “null, void, and unenforceable”.
The Attorney General directed the KBOE to fix this situation. But rather than requiring these individuals to simply pass the exams as the law intended, the KBOE has created a special, unprecedented loophole that permits the individuals who received invalid waivers to avoid ever having to demonstrate that they can pass the practical skills assessment on the NBEO Part III exam.
Allowing these individuals to substitute the American Board of Optometry’s board certification exam for NBEO Part III has major, dangerous flaws. The ABO exam is a voluntary credential for people who are already licensed. It was never designed for initial licensing. Furthermore, because the Attorney General made it clear that these individuals’ licenses are currently invalid, they technically do not even qualify to take the ABO exam. More importantly, the ABO is a multiple-choice test that does not assess hands-on patient skills, meaning the two exams are patently not equivalent.
There is no reason to create a special, one-time exception for these individuals. Many of them have been practicing optometry for years by now. If they are truly qualified to practice optometry safely and competently, passing the Part III performance skills exam should be easy for them, just like any experienced driver should be able to pass a driver’s license road test unless they have unsafe habits.
This is not just a bureaucratic issue. It has grave patient safety consequences. Shortly after the KBOE issued its emergency regulation, a Louisville TV station reported that one of these invalidly licensed optometrists, who had not passed any parts of the NBEO exam series, was being sued for allegedly causing permanent eye injury to a patient by using incorrect settings during laser surgery. And the risk is not just limited to laser procedures. For example, poor examination techniques can lead to failure to properly diagnose retinal detachment, glaucoma, or tumors. Mistakes like these can cost patients their vision or even be a life-threatening error.
The alarm regarding this issue is widespread across the profession. The Association of Regulatory Boards of Optometry stated that treating this group differently raises serious legal concerns. At least 19 Kentucky optometrists have formally warned that this undermines confidence in the optometric profession and that uniform standards are essential for patient safety. The Nevada State Board of Optometry noted that Nevada’s legislature unanimously passed a law barring Kentucky optometrists from getting a Nevada license unless they have passed all three NBEO exams.
Compounding all of this is a consistent lack of transparency by the KBOE. Meeting minutes are not publicly posted, and key decisions appear to have been made privately without open public discussion, potentially violating Kentucky’s Open Meetings Act. When the Attorney General asked for information, the KBOE only disclosed a fraction of the votes and falsely blamed COVID for waivers that continued long after the emergency ended. Worst of all, the public does not know which optometrists who graduated in 2020 through 2023 received waivers of exam requirements. Patients are in the dark about whether their doctor of optometry has passed the required licensure exams, and other Kentucky optometrists who graduated during that period unfairly have to practice under a cloud of suspicion about their qualifications.
The solution is simple and straightforward. KBOE must require these individuals to pass the exact same exams every other Kentucky optometrist has had to pass, including Part III. We urge the KBOE to return to a single, consistent standard for ALL Kentucky optometrists.