The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Referral Pathway for Glaucoma Management “fails to reflect the diversity of optometry expertise and clinical circumstances and optometrists’ scope of practice, and diverges from current guidelines,” according to a statement published by Optometry Australia on its website.
Guidelines for the Referral Pathway for Glaucoma Management were released by RANZCO in August. Further guidelines, for diabetic retinopathy and age-related macular degeneration are currently being finalised. RANZCO has requested feedback on the guidelines from optometrists, other health care professionals, as well as from organisations such as Optometry Australia.
Optometry Australia National President Kate Gifford wrote to members of Optometry Australia and released a statement following consultation with key members of the profession including the Optometry Board of Australia (OBA), Optometry Australia’s Glaucoma Expert Working Group and the State organisations.
In the statement, Ms. Gifford said, “The RANZCO referral pathway was developed without advice from Optometry Australia, the professional organisation which represents the optometry profession in Australia, yet it seeks to advise our profession on patient care… Though RANZCO has every right to release referral pathways to its own members, it does not have authority to instruct the optometry profession on how patients should be managed or referred.
“It fails to reflect the diversity of optometry expertise in Australia and the diversity of clinical circumstances. The RANZCO referral pathway also does not take into consideration the circumstances of the patient, including location or ability to access services. The referral pathway seems ophthalmology-centric rather than patient-centric,” said Ms. Gifford.
“It fails to recognise the scope of practice of optometrists to diagnose, manage and treat glaucoma. This scope is recognised by the OBA as the regulatory body for our profession. The RANZCO referral pathway instead encourages potentially unnecessary referrals and an increased burden on Medicare, as well as unnecessary financial burden for patients in clinical, travel and time-related costs.”
The statement claimed that the RANZCO referral pathway diverged from current guidelines which optometrists were compelled to follow, specifically OBA and NHMRC guidelines.
“The pathway appears to be more compatible with practice in the United Kingdom, and omits gonioscopy from the standard baseline examination which is an entry-level competency in Australia. The OBA and NHMRC guidelines remain as the standards against which any complaint or notification received about a practitioner in this area will be judged.
“Optometry Australia will communicate with RANZCO in relation to these concerns and encourage RANZCO to work in a collaborative manner with Optometry Australia prior to publication of its future referral pathways, to ensure they fully reflect the context of optometry clinical management in Australia.”
In a statement, RANZCO CEO David Andrews said he looked forward to receiving direct feedback from Optometry Australia. “RANZCO launched the RANZCO Referral Pathway for Glaucoma Management, and announced the upcoming launch of guidelines for referral of diabetic retinopathy and AMD, with the intention of ensuring that patient pathways to RANZCO Fellows are appropriate, effective and safe and to encourage a transparent and collaborative approach to eye health care by all eye health care professionals,” said Dr. Andrews.
“RANZCO has been very clear from the start that we hope to receive feedback from all optometrists and other health care professionals, as well as from organisations such as Optometry Australia, so that we can build on the pathways and ensure they are as effective and usable as possible. We have received positive and constructive feedback from a number of eye health professionals, including optometrists, about the glaucoma pathway, with some suggestions already having been incorporated into the pathway. We are pleased that Optometry Australia are keen to feed in to this process and we look forward to hearing from them directly.”
Dr. Andrews said, “All optometrists, GPs and ophthalmologists, are invited to provide feedback on their experience of using the pathways and can email their thoughts to pathways@ranzco.edu”
