Lengthy waiting lists for public health services, high out-of-pocket fees for many private services, and geographical barriers mean that Australians are often deprived of access to much-needed eye care services. While the consequence of this for some may be impaired vision, for others it may be blindness.
On behalf of its members, Optometry Australia is working to expand optometrists’ scope of practice. The hope is that in doing so, optometrists will be enabled to support the timely delivery of quality eye care to communities around the country.
mivision spoke to Dr Margaret Lam, National President of Optometry Australia to find out more.
- What is Optometry Australia’s current stance on expanding optometry’s scope of practice?
Fundamentally, we believe we must use the skills of our health workforce as effectively as possible to meet the needs of our communities. There is opportunity to use optometrists’ skills more effectively in eye care pathways, within their current scope, and through evolution of their scope of practice. We must pursue both, with the focus being on how to most effectively and efficiently support timely access to quality eye care across our communities.
- How do you envisage optometrists’ scope of practice expanding?
Optometrists are not only a highly skilled, but also a well-distributed workforce. By working in collaboration with ophthalmologists, we can help support better access to sight-saving treatment. There are numerous examples of models being implemented that seek to support collaborative arrangements between optometrists and ophthalmologists, and support more timely patient access to care.
With challenges from both a burgeoning future myopia and eye health epidemic for our younger patients, as well as eye and health diseases that cause sight loss challenging our ageing demographic, the opportunity is ripe to seek to scale and localise these across the country.
We also believe action to enable optometrists to prescribe oral therapeutics is overdue – our New Zealand colleagues have demonstrated that optometrists prescribing oral medications within their scope of practice can be safe and effective and support more timely patient access. It makes sense to enable therapeutically endorsed optometrists in Australia to provide this care option to their patients.
- What data exists to support an expanded scope of practice?
There is Australian and international data attesting that well-planned collaborative care models can support more cost-effective care and more timely patient access to care. However, we also need to pilot and evaluate a broader range of collaborative care models to build confidence that they offer greater efficiency, without compromising quality of care.
- What steps have you taken and what steps will you be taking in the coming 12 months to progress expansion of scope of practice?
A key priority for Optometry Australia is supporting optometrists to work to the fullness of their current scope of practice, including through collaborative care arrangements with ophthalmologists. There are lots of areas in which we can support more optometrists to work to their fullness of scope, and hence support more timely access to care for patients who need it. This includes areas such as glaucoma management, paediatric eye care, pre- and post-cataract care, and in pathways to treatment via intravitreal injection.
We continue to prioritise work to support the best possible use of our highly skilled optometry workforce within eye care pathways. This extends from supporting optometrists to understand billing options when managing glaucoma patients in collaboration with an ophthalmologist, to advocating for investments in pilots to support optometrists to play a greater role in patient pathways to intravitreal injections.
- OA often promotes further collaboration with ophthalmologists. Is this something you are working on with the Royal Australian and New Zealand College of Ophthalmology (RANZCO)?
The College’s ‘Vision 2030 and Beyond’ makes clear it recognises the benefits of well-designed collaborative care models, and this is an area we hope to explore further with RANZCO.
OPTOMETRY AND ORAL THERAPEUTICS PRESCRIBING
- Another area often discussed is the prescribing of oral therapeutics. Why is this an important area of opportunity?
The need to consult a second health practitioner for an oral prescription can disadvantage patients – there is the additional cost for the second consult, as well as the loss of convenience and time involved. For some patients – often the most vulnerable – this increases the likelihood that they may not access the additional appointment, and hence miss out on needed care. This can be particularly problematic if urgent care is required. These issues are often compounded in remote, rural and regional areas where travel times, wait times and service availability can make accessing a GP particularly challenging.
- Would this change reduce pressure on general practitioners?
Although it’s difficult to quantify the number of patients who may benefit from being able to access oral medicines for the treatment of their eye condition from an optometrist, international experience suggests that it may reduce some presentations to GPs. The greatest benefit is likely to be felt by patients who can access the care they need with greater ease and timeliness.
- What is stopping optometry from gaining prescribing rights?
Currently, change is required at a regulatory level to enable optometrists to prescribe oral therapeutics. There is a defined and comprehensive process that any profession looking to evolve scope of practice in this way must go through, which is intended to ensure safety and community benefit.
- How long do you think it will be before approval is gained?
The process to obtain oral prescribing rights needs to be led by the Optometry Board of Australia, rather than by us, the professional association. We would support prompt action to enable optometrists to prescribe oral medications relevant to their scope of practice. Notably, optometrists in New Zealand, with the same qualifications, have been safely and effectively prescribing oral medications since 2014. There are no logical reasons to deprive this benefit to patients of Australian optometrists.
OPTOMETRISTS AND ANTI-VEGF
- Anti-VEGF treatment is another opportunity that is often discussed. What proportion of optometrists does OA believe would be interested in injecting?
While we don’t have data on this, we are aware of numerous optometrists who would be keen to be able to administer intravitreal injections (IVI). Most are working in areas where their patients struggle to get timely and affordable access to care from ophthalmologists and recognise that they could play a role in supporting better access to care for their patients. At the moment, we are not actively pursuing a role for optometrists in administering injections. Instead, we are focussed on how better use of optometrists in the pathway to treatment via IVI can support better access to treatment for patients.
- How would optometrists be trained to deliver injections?
While there is not currently a proposal on the table in Australia for optometrists to be able to administer IVI, there are tried and tested training models used internationally that could be readily adapted to the Australian context. Moorfields Hospital in the United Kingdom, for example, combines a short theoretical component with on-the-job observation and supervised administration.
- How do you see injecting working in practice?
Our focus is on supporting existing models for the delivery of IVI treatment. Optometrists, working in collaboration with ophthalmologists (even if the ophthalmologists provide input and oversight remotely) can undertake the majority of the work-up necessary to inform treatment planning by an ophthalmologist. The injection can then be administered by an appropriately trained health professional. This could significantly increase system efficiency and support better patient access, especially in areas with very limited ophthalmology access.
- Can you share any data on the anticipated patient outcomes in terms of access, equity and maintaining vision?
We are advocating for pilot programs to be established and evaluated to ascertain this data. Fundamentally, however, we know there are significant access issues across the country – geographical and/or financial barriers, and lengthy delays associated with public treatment. This shouldn’t be acceptable when there are ready options to do better.
- How has the approval for optometrists to deliver COVID vaccines helped move the dial for this plan?
We now have recognition that optometrists can safely and effectively administer vaccines. While this may not have a direct link to administration of IVI, it has demonstrated that optometrists can be employed effectively beyond their current scope of practice to support better access to needed care, and are adept at integrating across the health system.
OPTOMETRY AND OPHTHALMIC LASER SURGERY
- Optometrists in New Zealand are now allowed to perform ophthalmic laser surgery. Is this something Optometry Australia is trying to achieve for Australian optometrists?
This currently isn’t an expansion of scope we are pursuing as a priority. We are watching developments in New Zealand closely. Their leadership on this issue is expected to provide evidence of the effective use of optometrists to provide laser surgery.
OPTOMETRISTS AND SPECIALISATION
- Why can’t optometrists promote a specialisation and is this likely to change?
Formal establishment of a ‘speciality’ in optometry would require regulatory change. Few allied health professions have been successful in meeting the bar to establish a formal speciality since the move to the national health professional registration system. There are other options to support health practitioners obtain advanced skills and education in particular areas that may be recognised by their peers and patients, and other professions have taken a range of approaches to this.
- It’s my understanding that OA is working towards a program of specialist education that would enable optometrists to gain certification in specific areas through additional training. Where are you at with this and can you provide some details on how this would work?
We are exploring options. We recognise that establishing a system to recognise additional education and skills is a significant undertaking, which requires substantial consideration and planning. Not only do you need to establish a system for recognising additional skills; for that system to add value to the optometry sector, you need to ensure it is valued and esteemed across the profession and, for example, supports intraprofessional referrals. We hope to share details of our plans in the first half of this year.
