Optometrists say they’ll be watching to see “how the dust settles” as new glaucoma management guidelines start to roll out this year.
Associate Professor and practising optometrist Daryl Guest, has told mivision that revised guidelines for use of scheduled medicines in relation to glaucoma management meant he was now free to explore changes in practice having been in a holding pattern for some 12 months.
The revised guidelines were agreed and implemented by Optometry Board Australia (OBA), the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Australian Society of Ophthalmologists (ASO) in December 2014.
The revised guidelines enable optometrists to assess patients for glaucoma, make an initial diagnosis and start treatment when that is in the patient’s best interests. Optometrists must also provide a referral to an ophthalmologist about glaucoma treatment within four months of initiating treatment or earlier if indicated by a change in the patient’s condition.
“Settlement of this case will allow the evolution of optometry and eye care services to occur – yes, it’s a decision that means we need to refer on for diagnosis of glaucoma, but not necessarily ongoing patient management… and because we no long need to enter into complex patient management contracts, the amount of paperwork will be reduced dramatically,” said A/Prof. Guest.
Sydney optometrist Jim Kokkinakis said the requirement to refer patients on within four months may mean ophthalmologists become burdened with glaucoma patients they wouldn’t otherwise need to see.
He said although the decision would not greatly impact his practice, he was concerned that it adds more unnecessary cost and time for the patient. “The reality is that many glaucoma patients are prescribed drops by their GP and they haven’t seen an eye health professional in years. It would be far better to use the skill level of the optometrist, who is comfortable managing garden variety glaucoma and is far more accessible (than an ophthalmologist). More complex cases obviously will then be referred, which will translate into great patient outcomes.
“Politics being what they are, this decision adds an extra layer of activity into the system, which might or might not be taken away in the future,” said Mr. Kokkinakis.
In the meantime, A/Prof Guest said he was looking forward to getting back to building stronger relationships with ophthalmologists, however, he cautioned that correct procedures and protocols will have to be in place. He will be watching with interest to see how the new guidelines are handled in a variety of practice settings. “Different locations, practitioners and levels of access will all drive local solutions” he said, which he is excited about. “As eye health professionals, our interest is in building a better health system, building better eye health education and achieving better patient outcomes. We are watching and waiting to see how the dust finally settles.”