As optometrists expand their scope of practice and more people experience age-related eye problems, the profession has vast potential to improve the quality and timeliness of care. The question is: are they? The authors of a recent study set out to measure the effect of scope expansion on glaucoma care, using Ontario—which added glaucoma care to optometry’s purview in 2011—as an example.
This population-based study examined rates of diagnosis and treatment of new glaucoma patients by ophthalmologists and optometrists in Ontario from 2007 to 2018—that is, both before and after scope expansion. Patients with prior glaucoma treatment were excluded from the study, specifically those who had undergone incisional surgery or laser trabeculoplasty in the 10 years before their diagnosis or treatment, or had received glaucoma medications in the year prior to their diagnosis.
Over the 11-year study period, 401,560 patients age 66 and older received initial glaucoma care, of which 75% was provided by ophthalmologists and 25% by optometrists. The rate of therapy initiation increased annually among optometrists after 2011, while the rate remained stable over that period among ophthalmologists. By the final year of the study, 88% of patients initiating therapy and 59% of patients first diagnosed as a glaucoma suspect received that care from ophthalmologists.
While glaucoma therapy initiation by optometrists has increased since the expansion of scope in practice, almost nine out of 10 patients receiving glaucoma therapy continue to be treated by ophthalmologists. By the end of the study, ophthalmologists initiated therapy in 26.5 patients per provider vs. just two per provider for ODs (median values).
“Optometrists outnumber ophthalmologists in Ontario by a factor of three, similar to the relative proportions in the US,” the authors noted in their paper on the study, but lag behind in Rx writing. The study cites two chief culprits. “Although the granting of prescribing privileges for optometrists was well publicized, prescribing privileges require the completion of a rigorous professional education course, and although optometry visits for glaucoma are covered by publicly funded, universal health insurance, remuneration for providing glaucoma care is relatively low in many circumstances.”
In contrast to rates of therapy initiation, the study found that “rates of glaucoma suspect diagnosis were relatively similar between optometrists and ophthalmologists over the study window. This may reflect the fact that screening for and diagnosis of glaucoma has historically been within the scope of both disciplines, unlike therapy.”
Although the scope practice expansion has not resulted in optometrists having a major role in initiating glaucoma therapy, the study suggests optometrists are a resource to improve accessibility to glaucoma care for patients, and barriers to treating glaucoma should be examined.
Quinn MP, Johnson D, Whitehead M, et al. Distribution and predictors of initial glaucoma care among ophthalmologists and optometrists: a population-based study. Journal of Glaucoma. August 28, 2020 [Epub ahead of print].