The Royal Australia New Zealand College of Ophthalmologists (RANZCO) has broadcast a strong objection to a proposal submitted by the Optometry Board of Australia (OBA), requesting optometrists be able to independently treat patients with chronic glaucoma, or those at risk of developing the disease, because it says, “patient safety would be at risk”. The Optometrists Association Australia (OAA) does not agree and aims to work collaboratively with the College and OBA to implement a system of integrated care.
Speaking on the matter, RANZCO President Dr. Stephen Best said, “Glaucoma is a serious medical condition, and optometrists simply have no medical training or appreciation of adverse systemic interactions. Optometrists see very few patients in their undergraduate training, and observe a minimal number of serious pathological cases… RANZCO does not believe that it is in the patients’ interests, for optometrists to seek to increase their scope of practice, through legislation rather than clinical education”.
“An optometrist has typically studied an undergraduate degree for four or five years, after which time they can prescribe and fit glasses or contact lenses. An ophthalmologist is a medical doctor, who has, in addition to their medical degree undertaken five years of specialist training in the diagnosis and management of disorders of the eye and visual system,” said Dr. Best. “In the course of their specialist training only, an ophthalmologist will typically have seen more than 7,000 ophthalmic patients”.
“Atypical glaucoma cases can and do occur. These can turn out to be brain tumours, giant cell arteritis or a number of other optic neuropathies linked with autoimmune diseases. Optometrists cannot be expected to detect the subtle differences and presentations of these serious conditions, all of which require urgent and very different medical treatment,” said Dr. Best.
Atypical glaucoma cases can and do occur. These can turn out to be brain tumours, giant cell arteritis or a number of other optic neuropathies linked with autoimmune diseases
He said that because the rate of progression of glaucoma is highly variable and difficult to predict, “the decision to initiate treatment should not be embarked upon lightly. While there is a subset of patients who require aggressive intervention, there are many who do not. It requires considerable skill to differentiate between these groups,” said Dr Best.
Andrew Harris the OAA President said RANZCO’s assertions about optometrists’ capabilities are wrong. “While optometrists do indeed prescribe and fit glasses and contact lenses, for many decades optometrists have been trained in the detection, diagnosis, monitoring and treatment of eye disease and have held prescribing rights for the treatment of eye disease since 1996 onwards in various jurisdictions with the last state WA, several years ago,” he said.
“Further, the reforms proposed in the draft Guidelines are for optometrists therapeutically qualified – these optometrists have undergone intensive training in therapeutics and are required to undertake ½ their CPD annually on therapeutic related topics.”
Mr. Harris said optometrists are trained to recognise atypical glaucoma cases that “require urgent attention and to respond appropriately including referral to ophthalmology”.
Genevieve Quilty, CEO of the OAA agreed that optometrists “can play an appropriate and useful role” in treating patients for eye diseases like glaucoma and said their ability to do so will become increasingly valuable as demand for specialist eye care services continues to rise.
“Optometrists Association Australia believes the proposed amendments for optometrists to independently prescribe glaucoma medications recognise the experience and training of optometrists.
“They clearly enable a more flexible, responsive and sustainable eye health workforce in Australia and the care provided by this workforce – a key purpose of the National Registration and Accreditation Scheme.
“In particular they will provide greatly increased flexibility for glaucoma patients in rural and remote Australia where medical specialist services are scarcer,” said Ms. Quilty.
“It is generally accepted that Australia will continue to experience increasing demands on, and challenges for, specialist services in managing chronic eye diseases like glaucoma. The proposed regulatory change seeks to address this within the legislative constraints of the National Registration and Accreditation Scheme ideals including increased access to health services and making effective use of the relevant trained and skilled primary eye health care workforce.
“In this respect, optometry can play an appropriate and useful role to meet the eye health needs of the Australian public.”
Ms. Quilty highlighted the fact that the OBA’s proposal is underpinned by the optometrist being qualified to prescribe the medicine; and the existing regulatory structure that requires an optometrist to recognise and work within their competence and scope of practice, including having the experience to prescribe independently and where necessary, consult and take advice from colleagues.
She and Mr. Harris said the OAA is looking forward to engaging positively with RANZCO and working collaboratively for the benefit of patient care.
“Depending on the outcome of the OBA’s consultation we look forward to working with RANZCO to implement these important reforms should they be agreed,” said Mr. Harris.
Geoff Pollard, National Executive Officer of Glaucoma Australia, also believes optometrists and ophthalmologists can work together to manage glaucoma.
“Glaucoma Australia supports an integrated eye care system, with optometrists, ophthalmologists and other eye health providers working in a collaborative way and less ‘red tape’ would increase the likelihood of eye care providers being able to focus on the need of the patient and to organise for initial and ongoing patient care, for the betterment of those patients,” he said.
At RANZCO, Dr. Best remained firm on his view that glaucoma should continue to be treated by ophthalmologists but acknowledged the need for collaboration. “Initiating treatment and diagnosing glaucoma needs to remain within the realm of the medical field in the interests of patient safety. There is a place for an integrated eye-care system where ophthalmologists and optometrists work together and a model for collaborative care was developed over the years as defined in the NHMRC Guidelines for the Screening, Prognosis, Diagnosis, Management and Prevention of Glaucoma. To help reduce the effects of this terrible disease, still more dialogue is required on how we best continue to collaborate,” he concluded.
