A proposal to allow optometrists to prescribe oral medicines is ‘deeply concerning’, according to the Australian Society of Ophthalmologists.
Australian optometrists jockeying for the right to independently prescribe systemic oral medicines to patients are facing strong opposition from ophthalmologists, as scope expansion continues to cause tension.
The latest development was a proposal from the Optometry Board of Australia (OBA) in October to allow endorsed optometrists to prescribe oral medicines for potentially sight-threatening eye conditions, bacterial infections, eye pain and allergies.
It is not necessarily a new idea.
Over a year ago, Optometry Australia officially adopted the position that optometrists should be able to prescribe oral and topical medicines for the purposes of practising optometry.
Optometrists with an endorsement from the OBA can already prescribe a range of topical Schedule 2, 3 or 4 medicines.
These include anti-infectives and anti-inflammatories like ciprofloxacin, bacitracin and dexamethasone, as well as anti-glaucomas and some local anaesthetics.
The OBA estimates that around 80% of the 7000 registered optometrists in Australia have a prescribing endorsement, putting the number of prescribing optometrists at around 5600.
If the proposal goes through, these endorsed prescribers will have their scope expanded to include oral medicines.
The additional medicines in the OBA proposal include proton pump inhibitors, antibiotics like azithromycin, amoxicillin and doxycycline and anti-glaucoma acetazolamide.
“The changes will give people with eye conditions more options and reduce the need for the patients of optometrists to see multiple practitioners for treatment,” OBA chair Stuart Aamodt said.
“It promises to remove barriers to effective treatment, such as access, time and cost. That is good for patients and good for the system.”
Australian Society of Ophthalmologists CEO Katrina Ronne begged to differ.
“What appears to be a straightforward eye condition can be early signs of systemic diseases like diabetes, autoimmune disorders, cardiovascular disease or serious infection,” she said.
“Ophthalmologists undergo more than a decade of medical and surgical training to understand these complex relationships and to recognise when urgent systemic investigation is required.
“We note that some of the medications the Optometry Board proposes that optometrists prescribe are associated with serious adverse events including renal failure, electrolyte disturbances, liver injury, cardiac complications and life-threatening allergic reactions.”
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While the OBA chair argued that expanded optometrist prescribing “could very well be the difference between a patient making a full recovery and being left with lasting damage or permanent loss of vision”, Ms Ronne said that recognising and managing these risks early could be the difference between full recovery and permanent harm.
Instead of scope expansion, the ASO is calling for enhanced collaboration between optometrists and ophthalmologists, protected referral pathways and investment in team-based care models.
Submissions on the OBA proposal close on 24 December.
