OBA now wants optometrists to ‘independently manage’ glaucoma

In its 23 Novber submission, the OBA said to the Australian Health Practitioner Regulation Authority that optometrists should be permitted to initiate and then maintain treatment of glaucoma without co-managent by ophthalmologists.
The OBA said: “When a diagnosis of chronic glaucoma is made, or a patient is at high risk of developing the disease, optometrists who hold an endorsent for scheduled medicines must refer the patient for specialist assessment or develop a managent plan that includes initiation of treatment and monitoring of the patient’s response.
“Instillation of anti-glaucoma eye drops is the preferred primary intervention in chronic glaucoma managent, however, in certain cases; patients will need initial assessment by an ophthalmologist for possible surgical intervention or laser treatment. Optometrists must be able to identify those cases and refer where appropriate.”
The submission went on to say: “Optometrists should familiarise thselves with and refer to the NHMRC Guidelines when setting target intra-ocular pressures and when making decisions about glaucoma managent plans and monitoring cycles.”
Later, in a section headed ‘ergency managent of acute primary open angle closure’, the submission said: “Individuals suffering from an acute angle closure event may present to an optometrist or, rarely, an angle-closure event may be induced through routine pupil dilation.
“The standard managent of such a patient is ergency referral to an ophthalmologist or hospital. However, both the nature of the condition and therapeutic endorsent place the optometrist in a position that he or she can initiate treatment for such patients to stabilise their ocular state before referring th.”
The National Law powers the OBA to develop and approve codes and guidelines to provide guidance to the optometrical profession. It requires the board to ensure there is wide-ranging consultation on the content of any proposed registration standard, code or guideline.
The Royal Australian and New Zealand College of Ophthalmologists, the body responsible for training ophthalmologists and responsible for glaucoma treatment overall, has prepared a submission, but has yet to release it.
The OBA is accepting submissions on its proposal until 4 February 2013.
At the completion of consultation with interested parties, the board will consider the feedback and decide whether or not to approve any or all of the amendments proposed.
The board’s Guidelines for Use of Scheduled Medicines came into effect on 1 July 2010 and have been considered by the board’s Scheduled Medicines Advisory Committee since then. The guidelines were an edited version of guidelines developed more than 10 years ago by the then Optometrists Registration Board of Victoria (now disbanded). The OBA maintains that in the intervening period there have been significant changes in a number of key areas that affect the currency of the current guidelines, including:
– National Health and Medical Research Council of Australia’s 2010 Guidelines for the Screening, Prognosis, Diagnosis, Managent And Prevention Of Glaucoma.
– An increase in the scope of pre-registration training for optometrists, with the scope of education and training of optometry students advanced such that all approved optometry programs in Australia and New Zealand include training in scheduled medicines for managent of eye conditions, and qualify graduates for registration endorsent for scheduled medicines.
– Technological advances and clinical understanding in respect of glaucoma mean there has been a significant increase in the clinical understanding of the diagnosis and managent of the disease and advancents in technology to support that. The proposed significant amendments to the guidelines are:
– A new section that rinds optometrists of the need to report adverse events to the Therapeutic Goods Administration;
– Collaborative care arrangents with ophthalmologists for the care of patients with glaucoma, and;
– Enabling optometrists endorsed for scheduled medicines to initiate and implent managent (in the form of eye drops) of patients diagnosed with chronic glaucoma, or who are at high risk of developing, the disease.
The Royal Australian and New Zealand College of Ophthalmologists, the body responsible for training ophthalmologists and responsible for glaucoma treatment overall, has prepared a submission on the OBA’s proposal, but has not released it yet.
Interested parties are able to comment to the OBA until 4 February.

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