The Australian Society of Ophthalmologists (ASO) is urging Australians to have their say on what it calls “a controversial plan to let optometrists prescribe powerful oral medications”, with the public consultation window closing in just days.
The ASO launched a campaign against the Optometry Board of Australia’s (OBA) proposal last month, which proposed allowing optometrists to independently prescribe systemic medications, including antibiotics, antivirals and anti-inflammatory drugs.
At the time it cited “serious concerns” about the plan, saying it put Australians at risk.
In reply, Optometry Australia (OA) said optometrists were “not seeking to become doctors” and the proposal reduced preventable delays, avoided unnecessary out-of-pocket costs for patients and supported continuity of care.
OA said the proposal was “sensible, patient-centred, and supported by strong international experience”.
In its latest statement, ASO said that, unlike eye drops, systemic drugs acted throughout the body and could trigger serious adverse events, including renal failure, liver injury, cardiac complications and life-threatening allergic reactions.
“These cases have been witnessed first-hand by ASO members throughout their day-to-day practices already,” it said.
ASO vice chair Mr Kerry Gallagher said the risks would be higher than the benefits should the OBA’s proposal go through.
“While optometrists can learn pharmacology and therapeutics in the classroom, they do not receive the depth of clinical training that underpins safe decision-making in acute eye disease,” he said.
“Oral medicines are usually prescribed in situations where patients are unwell, where the diagnosis may be uncertain, and where there may be wider medical implications.
“The ability to manage these situations is not gained from theoretical teaching alone. It develops through years of medical education, work in emergency departments, eye clinics, inpatient services and ICUs, and through close collaboration with physicians, surgeons and GPs.
“These environments build the clinical judgment needed to recognise red flags, understand systemic risks and manage complications.”
He said a four-year undergraduate program in optometry, even with therapeutic content, could not provide that level of exposure or responsibility.
“The training pathways are quite different, and this is reflected in the roles each profession holds within the health system.
“Absolutely, this position should reflect that certain treatments require the full medical and acute care background that ophthalmologists receive.
“Keeping the use of oral therapeutics within medicine ensures patient safety and maintains the integrity of care for people with complex or acute eye conditions.”
ASO CEO Ms Katrina Ronne said the stakes could not be higher as the December 24 deadline for public submissions approached.
“This is a defining moment for patient safety in Australia,” Ronne said.
“Once these changes are locked in, they cannot easily be undone. We are calling on every Australian who values safe, high-quality healthcare to make their voice heard before it’s too late.”
The ASO points to real-world cases where patients have suffered serious complications from oral medications used to treat eye conditions – complications that required urgent medical intervention to manage.
The peak body has also questioned the OBA’s own documentation, which includes an example of an optometrist “ruling out orbital cellulitis”, which is a potentially sight- and life-threatening infection that can only be definitively diagnosed through CT imaging, a test optometrists cannot order.
Ronne rejected arguments that Australia should adopt prescribing models from New Zealand, the United States, or the United Kingdom.
“Australia’s health system is regarded as one of the safest in the world precisely because we maintain appropriate boundaries between professions,” she said.
“We didn’t get that reputation by cutting corners on patient safety.”
Ronne said this was reflected in the Mirror Mirror Report published last year, which showed New Zealand and the US ranking last when it came to accessing health care and their experiences when it was accessed.
