Optometrists in Georgia can now prescribe oral therapeutics, and ODs in Connecticut will enjoy a broader scope of foreign body removal and glaucoma and cornea practice.
John B. Whitlow
On May 29, Republican Gov. Sonny Perdue of Georgia signed SB 17 that allows ODs to prescribe oral pharmaceutical agents for treatment purposes. A week later, on June 5, Republican Gov. Mary Jodi Rell of Connecticut signed HB 7159 into law, expanding optometric scope of practice regarding treatment of glaucoma, iritis and corneal ulcer as well as foreign body removal.
Im excited that we can start treating up to the level of our education by prescribing orals, John B. Whitlow, OD, president of the Georgia Optometric Association (GOA), told Primary Care Optometry News. Being able to prescribe oral antibiotics is the most important change. In particular, eyelid diseases will benefit because sometimes topicals dont work as well as an oral medication. Treating patients with oral antivirals will also be valuable.
The only oral medication that Georgia optometrists will not be able to prescribe is steroids. This was a compromise we made for the legislation to pass, Dr. Whitlow said.
Georgia law specifics
Previously, Georgia ODs could use non-narcotic oral analgesics and Schedule III or Schedule IV controlled substances that are oral analgesics for ocular pain but for no more than 72 hours without consultation with the patients physician.
Now, SB 17 will speed up delivery of care and decrease insurance costs. Patients will no longer need to make an additional visit to an ophthalmologist, which saves patients time and avoids a copayment, continued Dr. Whitlow, who practices in LaGrange, Ga. There are savings all around. In addition, around here, sometimes you cant schedule an ophthalmologist appointment for a few days or longer.
For example, one of Dr. Whitlows patients needed treatment with an oral antibiotic, but the local ophthalmologist was booked for a month. I sent the patient down to Columbus, which is about 45 miles away, Dr. Whitlow said. Some patients cannot afford such a long trip.
Dr. Whitlow believes ODs are already comfortable dispensing the additional agents, saying they have been well trained in the pharmacology of these medications.
In addition, the state association will place greater emphasis on letting members know about existing and new medications within these groups. Some of our upcoming conferences will focus more heavily on continuing education in this area, Dr. Whitlow said.
State board eliminates formulary
On Aug. 8, the state board of optometry adopted a new rule, eliminating a formulary and adopting a list, by category, of drugs as written in SB 17, Georgianne B. Bearden, GOA executive vice president and director, told PCON. As of Aug. 8, all therapeutically licensed doctors of optometry in Georgia can prescribe from this category list, she said.
The list includes:
- topical and oral antibiotics
- topical and oral antivirals
- topical and oral antifungals
- topical and oral antiallergics
- topical and oral antiglaucomas
- topical steroids
- topical and oral nonsteroidal anti-inflammatories
- oral non-narcotic analgesics
- oral narcotic Schedule III or IV analgesics
It will now be much easier for a Georgia OD to prescribe an FDA-approved antibiotic, for example, for the eye or the eyelid, Ms. Bearden said. The OD will not need to wait for the board to list a medication individually. Previously, there may have been a lengthy review process.
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Georgianne B. Bearden
Ms. Bearden noted considerable opposition from ophthalmologists. Weve been working on this specific bill for the past 7 years. It is the balance of the oral medications that we have been asking for, she said. Ophthalmologists have claimed in years past that if optometrists are allowed to prescribe these oral medications, then optometrists will begin to treat such conditions as high blood pressure, diabetes, eating disorders and even erectile dysfunction. But the language has always been written for the eye and the eyelid only.
Dr. Whitlow, who was legislative chair for the bill, was somewhat surprised by the amount of ophthalmologist opposition because, out in the real world, we seem to get along so well. But once you get under the lights of the Capitol, tensions increase, even though Georgia is one of the remaining states that up until now did not allow ODs to administer oral and topical medications. On the senate side of the Georgia General Assembly, the Health and Human Service Committee is chaired by an MD, which definitely delayed passage.
Treating glaucoma in Conn.
The new Connecticut legislation takes effect Oct. 1. Ten years ago, we were granted the right to treat most glaucomas and allowed to use all topicals and all orals (except oral antiglaucoma in non-emergenies), Brian T. Lynch, OD, legislative chair of the Connecticut Association of Optometrists, told PCON in an interview. Prior to this new legislation, however, we were only able to treat pressures with an IOP of less than 35 mm Hg. Now we can treat all pressure levels. Also, in the past, we were not allowed to treat secondary glaucoma. But now we can treat all secondary glaucomas. The only limitation is for pediatric glaucoma and angle closure glaucoma. After initiating treatment for angle closure glaucoma, we need to consult with an ophthalmologist.
In addition to expanding glaucoma services, the new act augments foreign-body removal. The 10-year-old bill restricted which foreign bodies we could remove, said Dr. Lynch, who is in private practice in Branford, Conn. These foreign bodies had to be within the corneal epithelium. Now we can eliminate any superficial corneal foreign body, regardless of the depth.
The legislation permits ODs to perform noninvasive surgical procedures that do not require an incision, such as punctal dilation and occlusion, epilation of eyelashes, corneal débridement and stromal micropuncture.
Moreover, ODs previously had to refer iritis cases that did not show a documented substantial improvement within 72 hours. Now, as long as the patient is improving, we can continue treating, Dr. Lynch said.
Oral antiglaucomas excluded
Brian T. Lynch
As with the Georgia legislation, however, many in ophthalmology opposed parts of the bill. Organized ophthalmology was really adamant about optometrists not using oral antiglaucoma medications, Dr. Lynch said. In Connecticut, we cannot use these medications, except in emergency situations. So the bargaining chip was to exclude oral antiglaucomas, other than in an emergency.
However, I think the push would have been much harder if there were a bevy of oral antiglaucoma medications that were very effective, he continued. But currently there is only one, Diamox (acetazolamide, Lederle). So this is an exclusion we can live with for the time being. Diamox is also used primarily in cases of advanced glaucoma, so we may consult with a glaucoma specialist anyway.
Overall, the new Connecticut legislation allows ODs to continue to provide for their patients the primary care they are trained in, according to Dr. Lynch. It eliminates the need for unnecessary referrals, he said. Whether I am treating a patient who has glaucoma due to pseudoexfoliation or just primary open-angle glaucoma, the treatment is the same. Our members are very excited with the new bill. Over the past few years, there have not been many scope-of-expansion acts. Without a doubt, this is one of the most progressive bills in the country.
For more information
- John B. Whitlow, OD, is president of the Georgia Optometric Association. He can be reached at his private practice at 407 S. Greenwood St., LaGrange, GA 30240; (706) 882-0616; fax: (706) 882-8515; e-mail: email@example.com.
- Georgianne B. Bearden is executive vice president and director of the Georgia Optometric Association. She can be reached at 1000 Corporate Center Dr., Suite 240, Morrow, GA 30260; (770) 961-9866; (800) 949-0060; fax: (770) 961-9965; e-mail: firstname.lastname@example.org; www.goaeyes.com.
- Brian T. Lynch, OD, is legislative chair of the Connecticut Association of Optometrists. He can be reached at 60 Montowese St., Branford, CT 06405; (203) 488-9544; fax (203) 481-2028; e-mail: email@example.com
- The Connecticut Association of Optometrists can be reached at 750 Old Main St., Suite 304, Rocky Hill, CT 06067; (860) 529-1900; fax (860) 529-4411; www.cao .org.