Optometrists and the Use of Theraputic Pharmaceutical Agents

We are pleased to have the opportunity to comment on the consideration to expand the scope of practice for optometrists. We believe it is in the best interest of the public to allow for the optometrists to prescribe and administer appropriate drugs in the treatment of eye disorders.

With an amended Optometry Act, patients who see optometrists and require commonly prescribed TPAs will not necessarily require referral to an ophthalmologist, a family physician or an emergency unit. The public will be better served by seeing one practitioner rather than two, and costly duplication of service will be prevented. By expanding the scope of practice for optometrists, health service for the patient will be immediate, thus preventing further deterioration or complications of the illness, while at the same time improving quality.

An expanded scope for optometrists would benefit the health care system by providing care that is more accessible, affordable and possibly more appropriate for the citizens of Ontario.

Using the HPRAC questions as a guide, we offer the following comments:

Question 1:

Is there an identified unmet need for eye services in Ontario which could be met by allowing optometrists to use TPAs?

In many rural and northern areas when optometrists see patients who require TPA treatment, they must refer these patients to another practitioner, often resulting in significant travel for some patients. The population in Ontario is aging and, for many of our seniors, travelling long distances creates undue hardships. With an expanded scope, optometrists, many of whom are located in northern and rural communities, can treat seniors cost effectively in their own community. Just as nurse practitioners have fulfilled a crucial role in health care promotion and treatment of citizens in Northern Ontario, we foresee optometrists fulfilling a similar role.

Question 2:

Would the public's interest be served by allowing optometrists to use TPAs?

a) How, if at all, would the risk of harm be affected by allowing optometrists to use TPAs?

In terms of risk, there is always an element of risk in any kind of health care. However, optometrists are well educated health professionals who base decisions regarding their patients' care on knowledgeable assessment and diagnosis, part of which includes the necessity to refer to another health care practitioner, where appropriate. They are accountable to a self-regulating college which has clearly defined standards of practice which they must follow. We believe, therefore, that they represent no greater risk than any other regulated health professional.

b) How, if at all, would quality of care be affected by optometrists' use of TPAs?

The optometrist will be able to treat a patient who needs TPAs immediately without having to make another referral. Treatment in a timely manner prevents unnecessary complications and provides relief for patients as soon as is reasonable. Perhaps the most important advantage will be the ready availability of a health professional who specializes in providing primary eye and vision care services to the public.

c) Are optometrists' education and training requirements sufficient to allow them to use TPAs?

The University of Waterloo requires that students who apply to the School of Optometry complete 2 years of university with a grade point average of 85% before they are admitted to the program. The comprehensive 4 year course includes significant clinical as well as theoretical knowledge. All students who enrolled in the program since 1994 are given training in TPAs in the United States. In fact, Ontario is losing many of their trained optometrists to various states in the United States where they have the opportunity to prescribe and administer appropriate drugs in the treatment of eye disorders.

The University of Waterloo is in support of the expanded scope for optometrists as their curriculum already includes 100 hours of training in TPAs. Dr. Anthony P. Cullen, Professor of Optometry at the University of Waterloo, has substantiated the university's support of an expanded scope for the optometrists and the adequacy of the standards for the profession.

d) How, if at all, would optometrists' use of TPAs affect access to appropriate care?

There is no question that optometrists who can prescribe and treat with TPAs will offer another choice to a public which is increasingly demanding choice in health care. Optometrists, as mentioned earlier, can provide increased accessibility, especially in rural and northern Ontario localities, where there are fewer physicians.

In conclusion, ONA believes that the intent of the Regulated Health Professions Act (RHPA) is to encourage professions to practice to their fullest scope, as well as giving consumer choice and increased accessibility to health care. All of these factors will be accomplished by expanding the scope of the optometrists to prescribe and treat with appropriate TPAs. Just as the nurse practitioners have been able to expand their scope of practice to the benefit of all citizens, so we believe the optometrists should be afforded the same opportunity by participating in the promotion and improvement of health care services for the citizens of Ontario.