A systematic evaluation of state laws across the U.S. showed that optometrists are permitted to manage glaucoma in most states, except Massachusetts, but only 16 states have defined regulations for comanagement.
State laws and regulations governing optometric scope of practice, guidelines for referral to ophthalmology as well as the number of hours of continuing education required for glaucoma management were reviewed by two trained reviewers in each of the 50 states and the District of Columbia.
In the U.S., optometric scope has expanded over the last 40 years to allow use of diagnostic pharmaceutical agents (DPA) and therapeutic pharmaceutical agents (TPA), including steroids. Glaucoma laser procedures are allowed in Louisiana, Kentucky and Oklahoma.
Optometric management and comanagement of glaucoma is part of optometric training, but only 16 states have specific guidelines for comanagement. Interestingly, comanagement guidelines are more often in place within states with a lower ratio of optometrists to ophthalmologists.
Some of the states, including Pennsylvania, Georgia and Nevada, specify that following diagnosis of glaucoma, patients should be referred in all cases to an ophthalmologist, Other states, such as Arkansas, Florida, Maryland, New Hampshire and New York, advocate cooperation between optometrists and ophthalmologists for comanagement plans, including goals of care and guidelines for the escalation of therapy.
According to the authors, “the patchwork of regulations makes the move toward a national referral guideline challenging.”
They concluded: “As the number of patients with glaucoma continues to increase, such comanagement schemes may become increasingly necessary.”
“This article was meant to describe the varied patterns of optometric management of glaucoma and compare optometric privileges in larger and smaller states and those with more or [fewer] optometrists or ophthalmologists. It highlights the large variation in ability to manage glaucoma and what influences these privileges. Ultimately, one would hope that these privileges were made more on objective measures focusing on patient safety and provider ability as opposed to other factors. The challenge is to know when to refer, and national referral guidelines are hindered by the patchwork of regulations nationwide,” study author, Osamah Saeedi, MD, told Primary Care Optometry News. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.