A recent peer-reviewed paper in Clinical and Experimental Ophthalmology claims that, based on workforce calculations, neither ophthalmologists nor optometrists alone have the capacity now or in the future to independently manage glaucoma patients at the recommended intervals.
In March 2013 Optometry Board Australia (OBA) released revised Guidelines for use of scheduled medicines (the Guidelines), which enabled therapeutically endorsed optometrists to prescribe topical anti-glaucoma medicines for patients diagnosed with chronic glaucoma, or who are at high risk of developing the disease.
Therapeutically endorsed optometrists still have the options of either referring patients with chronic glaucoma to an ophthalmologist for ongoing management or entering into a shared care arrangement.
The OBA stated that the guidelines apply to optometrists with “general registration who use scheduled medicines for diagnostic purposes”, and “optometrists whose registration is endorsed for scheduled medicines, who use scheduled medicines therapeutically to manage eye conditions independently and collaboratively with other healthcare practitioners”.
The guidelines have created uproar among ophthalmologists
The guidelines have created uproar among ophthalmologists, represented by the Royal Australian and New Zealand College of Ophthalmologists (RANZCO).
In their paper entitled ‘Guidelines for the collaborative care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia’, Dr. Andrew White and Professor Ivan Goldberg argue that therapeutically-endorsed optometrists should be able to manage the ongoing care of low-moderate risk glaucoma patients, identified in collaboration with an ophthalmologist, and that, if the guidelines are followed appropriately, patients will get the best management possible.
Although the publication does not address any economic issues, Dr. David Andrews, CEO RANZCO told mivision that it follows that the most effective patient management, (i.e. proper diagnosis, an appropriate management plan with appropriate regular review and testing), will ultimately result in the most efficient cost to the patient and the public purse.
“Good collaboration between an ophthalmologist and optometrist avoids fragmentation of care and provides the checks and balances to ensure best patient outcomes. I think everyone involved in glaucoma management should read the paper, and accompanying editorial, and aim to work by these guidelines,” said Dr. Andrews.
A recent poll by RANZCO of RANZCO Fellows found that suggested issues of patient access to ophthalmologists could be unfounded. Ninety seven and a half per cent of the 350 respondents said they have not received any feedback from referring optometrists or GPs complaining about being able to access glaucoma services in a clinically appropriate timeframe. Additionally, 80 per cent have a waiting time for routine glaucoma appointments of less than one month, and 94 per cent have less than three months.
The poll found that any urgent glaucoma patient referred by an optometrist or GP can be seen by 86 per cent of ophthalmologists the same day, 99 per cent within 48 hours of referral and 100 per cent in less than a week (Dr. Andrews notes, possibly sooner – the survey did not allow for this response).
Dr. Andrews said the “Optometry Board of Australia’s decision to revise guidelines that allow independent management of glaucoma is at odds with everything that has been developed around good medical practice, and everything that is being said by government.
“Whether the OBA guidelines for management of glaucoma are changed or not, all patients should know that collaborative care led by an ophthalmologist is best for their eye health, it is available when they need it and everyone involved should remember to keep the patient’s best interests in mind,” he said.