This month, we kick off a four-part series on newer optometric privileges conferred through legislative action and how ODs in those states can position themselves to add any such procedures they feel are a good fit. Throughout the series, you’ll hear directly from optometrists who have already conquered both the clinical and logistical challenges these new procedures pose.
For the first article, we visually depicted the breadth of optometric scope in several key categories of care using a series of maps (see pages 34-35). Encouragingly, the maps show a high degree of uniformity in optometric privileges for at least the most basic medical eyecare rights: use of diagnostic drops and most garden variety pharmaceutical agents, including glaucoma drugs. Every colored-in state on those maps represents untold hours of lobbying effort and hassle that your colleagues and predecessors had to endure to make it happen. We all owe them a debt of gratitude for their chutzpah.
Still, exceptions and caveats abound:
- All US optometrists can finally prescribe glaucoma meds—but three states still withhold oral drugs in this category.
- ODs in 41 states have the right to inject some medical therapies—but almost half can only do so for patients experiencing anaphylaxis.
- Controlled substances can be prescribed in 47 states—but the state-by-state list of approved drugs would turn that nice, uniform map into a checkerboard pattern if we added all the variance by schedule category.
- Naturally, the more hands-on procedures like minor laser surgery and removal of eyelid lumps and bumps are still hotly contested by ophthalmology, as these are the current front lines of the scope battles.
Optometry’s legislative advocates have the wind at their backs right now, as numerous successes over the past few years can attest. Still, the medical lobby remains formidable, recently quashing a bill in Alabama.
Even with momentum going for it, optometry will have to continue to make the same arguments over and over. It’s frustrating and, frankly, embarrassing. The way you practice optometry shouldn’t be subject to how the political winds are blowing in your state capitol.
For the states pursuing expanded scope, it’s encouraging to see the push for “as-taught” laws that would encompass many elements of practice in one shot (those that match the current curricula in optometry colleges). Continued success with this type of bill would obviate the need to go back to the legislature for every new responsibility optometrists seek to be granted. I hope such an approach becomes the new norm in scope expansion efforts. The mantra should be, “If it’s learned, it’s earned.”
The last of the TPA laws (giving ODs basic medication prescribing rights) was passed in 1998—before everyone currently enrolling in optometry college was born. For at least a generation, bright young people have pursued optometry with an understanding that medical care is part and parcel of it. Let’s deliver on that expectation for their sake and the betterment of all.