New legislation allows ODs in British Columbia to treat glaucoma

Amendments to the Optometrists Regulation recently took effect in British Columbia, allowing optometrists in the province to prescribe, dispense and administer anti-glaucoma medications, according to a British Columbia Association of Optometrists press release.

“By allowing doctors of optometry to prescribe anti-glaucoma medications, British Columbian patients will have greater access to timely and appropriate eye care in all areas of the province,” Surjinder Sahota, OD, president of the British Columbia Association of Optometrists, said in an interview with Primary Care Optometry News. “The ability to initiate care and manage patients collaboratively with ophthalmologists is a great benefit to our rural ODs, where access to care is a huge issue.”

About 27% of the 600 optometrists in British Columbia practice in rural or remote areas, where access to an ophthalmologist can be severely limited, Sahota told PCON.

“It’s not uncommon for rural patients to wait over a year or travel hundreds of kilometers to receive treatment,” Sahota said.

Also, expanding the scope of practice for B.C. optometrists will result in an overall reduction in health care costs, according to Sahota.

Under the new amendments, B.C. optometrists can initiate treatment on glaucoma suspects and early glaucoma, Sahota told PCON; however, the patient must be older than 30 years of age, must not use more than two drops or one combination drop to reach target IOPs and must reach target pressure within 6 weeks. Also, only primary glaucoma can be treated, and the patient must always be given the option to be treated by an ophthalmologist. 

The definitions, stages and standards are based on the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of glaucoma in the adult eye, Sahota said.

“Oral medications can be used to treat angle closure glaucoma only when an ophthalmologist is not readily available,” Sahota added. “And once pressure is under control, the patient is to be referred to an ophthalmologist.”

According to Sahota, there were official submissions during the amendments’ posting periods from both provincial and national ophthalmological societies challenging these amendments and raising concerns about optometrists’ education and training.

“There is always opposition when one profession expands scope that overlaps another, even though ODs in most jurisdictions in North America and Canadian provinces with the same training have been treating glaucoma for years, and even though ophthalmology is underserving patients, especially in rural B.C.,” Sahota said.

“Fortunately for optometry and B.C. glaucoma patients, the Ministry of Health sided with optometrists, and the amendments were signed,” Sahota added. – by Daniel R. Morgan