Politics

Optometrists, Ophthalmologists Don't See Eye to Eye

By: Jim Saunders News Service of Florida | Posted: February 8, 2013 3:55 AM

Optometrist

Credit: Shutterstock - StockLite

In one of the Capitol's longest-running industry fights, a House panel Thursday approved a bill that would expand the drug-prescribing powers of optometrists --- an idea that is fiercely opposed by ophthalmologists and other medical doctors.

Dubbed the "eye war," the issue centers on whether optometrists should be able to prescribe oral medications. They now are limited to prescribing what are known as "topical" medications, such as drops or creams, and have to send patients to ophthalmologists for conditions requiring oral drugs.

The House Health Quality Subcommittee voted 10-3 to expand the optometrists' powers, giving them an initial victory in a battle that will play out during the upcoming legislative session.

Bill sponsor Matt Caldwell, R-Lehigh Acres, said optometrists are not currently allowed to practice to the full extent of their training. He also said optometrists are allowed to prescribe oral medications, to varying degrees, in 47 other states.

Opponents, however, contend that optometrists don't have the same type of training as ophthalmologists and say the bill would not do enough to protect patients such as seniors, who might be on numerous medications and could have harmful reactions if drugs are not prescribed properly.

Stephen Schwartz, a Naples ophthalmologist, said doctors in his specialty receive years of hands-on training as they go through medical school and gain experience through such things as residencies and internships.

"You cannot learn this in a classroom,'' Schwartz said.

But Kimberly Reed, an optometrist who is a faculty member at Nova Southeastern University, said optometrists are trained in the proper use of medications, including making sure patients don't have harmful side effects. She disputed that expanded prescribing powers would threaten the quality of care provided to groups such as seniors and children.

"To think that we would treat those patients any differently is, I think, an unfair assumption,'' Reed told the House panel.

Optometrists have not been able to convince lawmakers to approve similar bills in the past, but both sides appear to be preparing for a major fight during the session that starts March 5. Industry groups spent hundreds of thousands of dollars during last year's elections, and they also have hired prominent lobbyists to push their positions.

The bill (HB 239) is slated to go next to the House Health and Human Services Committee. A similar measure (SB 278) has been filed in the Senate but has not gone before a committee.

Under the House proposal, optometrists would be required to complete a course and an exam before they would be allowed to prescribe oral medications. The Florida Optometric Association and the Florida Medical Association -- two foes on the prescribing issue -- would jointly develop and administer the course and exam.

While the House panel overwhelmingly approved the measure, some lawmakers expressed interest in tinkering with it. Rep. Kevin Rader, D-Delray Beach, voted against the bill, saying he didn't think it should move forward without changes.

"I don't really know of a strong public need for this,'' Rader said.

Supporters, however, say giving the expanded powers to optometrists would expand access to care for patients. Caldwell said he would be willing to consider changes sought by the ophthalmologists, but he also noted the years of debate about the issue.

"This bill's been around nearly as long as I've been alive,'' said Caldwell, 31.


Tags: News, Politics

Comments (10)

Jacob
7:41PM FEB 21ST 2013
As an optometrist, I would like Rep. Delray to come follow me around for a month so I can show him the numerous opportunities oral medication would be beneficial to patients.

I can't prescribe it here but if I drive 30 minutes north to Georgia, I can? Did I all of a sudden become more competent when I crossed that state line?
Levi M.
12:14AM FEB 13TH 2013
I understand the MDs point of view. On the other hand, the MDs argument that oral meds prescribed by an OD would be catastrophic due to improper evaluations of a pts other meds causing possible disasters is irrelevant. An MD can just as easily make the same mistake. Ive been in both fields for over 5 years now and it is very easy for a pt to not properly inform or fill out all meds they are taking. Half of them can't even remember all meds, let alone be honest about it. Plus, if ODs were able to prescribe oral meds, their would be a limit obviously. Its not like they would be able to prescribe controlled substances or major systemic disease meds. And even if one radical MD in ophthalmology or OD did, they would be flagged. LET THE ODs help! haha
MPOD
12:43PM FEB 11TH 2013
Florida is always the last to do everything. We as a state should be ashamed this argument is even going on. Ophthalmologists should be embarrassed at saying things like optometrists are not educated enough to prescribe a LIMITED set of oral medications to treat OCULAR disorders? 47 other states have allowed ODs to prescribe oral meds for years. Some states even allow ODs to perform laser procedures including YAG and SLT...why does FL have to be the last to embrace a positive change that would help prevent unnecessary referrals, extra copays and time out of a patient's day to be told by an MD the same thing he/she was told by their OD. It's absurd and FL lawmakers continue to prove why we are one of the most laughed at states in the nation and why I as a former resident of FL will never return.
Linda P
8:09PM FEB 10TH 2013
I'm only in my 2nd year of optometry school and I have to know the dosing, concentration, contraindications, side effects, etc of all of these ocular pharmacological agents that I'm not allowed to prescribe. We go through all conditions and cases. This is after general pharmacology, pathology, ocular anatomy, ocular disease of the anterior and posterior segment, and general anatomy & physiology. NOVA Southeastern University, the only optometry school in Florida is part of a multiple disciplinary system - we take pharmacology with Dental and they prescribe orals and more! We have 8 classes, 2-3 labs all year with 1-2 exams every week. How on earth do ophthalmologists think our education is inadequate when we get 4 years of eyes and they don't even touch eyes until residency?
John K
7:14PM FEB 10TH 2013
Take into consideration the fact that in most states this is not an issue. I would like to thank Dr. Reed for taking the time to be a voice for optometric education and the scope of practice for our legislators. It is far too often the wrong information is disseminated to the public about the education of an optometrist.

How do state lines draw competency? North of our state border, in Georgia, optometrists are prescribing orals right now! Georgia Board of Optometry Board Rule 430-10-.03 was put into effect in 2007 and describes the oral medication rights of optometrists (in GA). This year a handful of ODs will graduate and some will remain in Florida, while others will move elsewhere (like Georgia). Let's say one new graduate moves to Folkston, GA and another moves to Hilliard, FL. They both went to the same college of optometry and got the same degree, but because there is a state line between them, along the 11.5 mile stretch of road that separates them, one can prescribe orals and the other can't because he's a danger to his patient's well being... let's be serious.

Florida optometrists undergo one of the most strenuous and in depth state board certifications in the nation behind North Carolina in regards to OD state licensure. A lot of states only require that the three parts of the National Board of Optometry Examination be passed along with a state law exam. So, before an optometrist can even practice in Florida they are taking twice as many exams as most of their counterparts residing in other states.

Updating the optometry scope of practice to follow suit with most of the country (47/50) will undeniably bring expanded access of eye care to patients. It is a disservice for patients to receive limited treatment from optometrists. The idea of optometrists prescribing oral medications, like antibiotics, has been a struggle for far too long and has hindered the growth of the infrastructure of eye care in Florida. We need to come together as a medical community to give our patient's easily accessible health care and this bill provides that.
John Sharper
1:45PM FEB 10TH 2013
I am somewhat familiar with the diffeence between a opthalmologist and optometrist and I aswell have no issue allowing my optometrist to prescribe oral medications. She does a great job managing my glaucoma and if I needed a oral medication I would not hesitate or think twice about her instructions.
Sara B
10:49AM FEB 10TH 2013
I am a 3rd year optometry student at NOVA Southeastern University and it is very frustrating to me that certain (not all) ophthalmologists continue to lie about how dangerous it would be if we were to prescribe orals. This is the same argument that they had when optometrists were trying to get rights to dilate eyes! Seriously! And to comment on my education-- we see real patients at the very beginning of our 3rd year of optometry school and during our 4th year we are seeing patients 5 (sometimes 6) days a week for the whole year. Medical school students don't get the proper training in the care of the eyes and visual system in medical school because they haven't specialized yet. Ophthalmologists have no idea how to prescribe glasses (let alone orals) while in their first 4 years of school. That's why these residencies and internships are so important-- for them. I know that it takes time for things to get passed in legislation, but THE TIME HAS COME for this bill.
paul barnes
9:12AM FEB 10TH 2013
...optometrists are allowed to prescribe oral medications, to varying degrees, in 47 other states...

way to be progressive FL!!!
karen smiith
9:06AM FEB 10TH 2013
I dont understand all the differences between the two professions, but i know my optometrist very well and im very comfortable in her ability to treat eye conditions. my father has had many eye problems and when we were in north carolina i only had to drive to one place to get his eye care needs handled and now that were in florida i have to drive around town to an ophthalmologist and pay extra exam fees so he can prescribe the same pill my optometrist told me we needed.
Michael P
2:03PM FEB 11TH 2013
The true opposition against ODs being granted the privilege to prescribe oral Rxs comes down not for concern for the patient, but for concern for the pocket book. Many eye care practices have ophthalmologists and optometrists working side by side to provide the best care for a patient’s visual needs. MDs are fully aware that ODs are well educated and trained in prescribing medications; not only oral and topical ophthalmic drugs, but also systemic meds that could interfere with such ocular Rxs or otherwise impact ocular/visual health. As long as MDs have a niche privilege to hold above ODs, they can secure that service and in turn, the fee from the patient that comes with it. Unfortunately there are significantly more MDs than ODs, and they are a powerful lobbying force. What is more unfortunate, is that it is the patient who inevitably suffers in this power struggle. Not due to a lack of education, but due to a road block in accessing proper care. It is shameful that ophthalmologists are perpetuating these untruths for selfish financial gains, and it is time they truly put the best interests of Floridian patients first.

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