Feature, Research

Optometry’s latest move for expanded scope

In a new push for expanded scope-of-practice, Optometry Australia is calling for change in six areas – including oral medications and intravitreal injections – so the nation’s under-utilised optometric workforce can get to work tackling urgent eye health issues. Insight unpacks the organisation’s key proposals.

The peak professional body for optometrists has seized on the timing of an imminent Federal election and the Aged Care Royal Commission’s damning report to demand concerted action to address the nation’s eye health challenges.

In July, Optometry Australia (OA) released a new policy platform, ‘Working Together for Better Eye Care, offering a stark reality check on Australian eye health and practical methods to tackle some of the biggest issues.

The organisation’s national president Mr Darrell Baker says the skills of Australian optometrists continue to be “seriously under-utilised” compared to their counterparts in similarly developed nations.

This view underpins the organisation’s six key recommendations that will require a substantial – and potentially controversial – expansion of the current optometry scope to implement.

He says there are many reasons for change. For example, public ophthalmology wait times in areas like cataract surgery are disappointingly long. Collaborative eyecare remains in its infancy, and only about 50% of patients with diagnosed diabetes get access to the eye examinations they need.

“Whilst significant progress has been made, we have not closed the gap in Indigenous eye health, with First Nations Peoples three times more likely to be blind or visually impaired; and a tsunami of age-related macular disease is rapidly approaching,” he explains.

Darrell Baker.

“The only way we can get on top of Australia’s looming eye health crisis is for optometrists to be supported to practise to their full scope to enhance patient access and increase the efficiency of Australia’s eye health system.”

Ophthalmology supply 

One area Optometry Australia (OA) believes needs urgent attention is the longstanding problem of public ophthalmology wait times.

The report notes that ophthalmology consistently has one of the longest median and maximum public wait times of the medical specialties. OA states it is not unusual for less urgent patients to wait more than 300 days for their initial ophthalmology outpatient appointments in the public health system, with COVID-19 exacerbating the problem.

Also compounding the issue is the maldistribution and under-supply of ophthalmologists, cited in recent reports. Despite this, OA states it is not unusual for ophthalmologists to spend time undertaking eyecare for which other eye health professionals, such as optometrists, have the training and regulatory authorisation to deliver.

“More efficient referral and triaging practices and a commitment to allowing all eye health professionals to practise to their full scope would have the added benefit of freeing up the limited and specialised time of ophthalmologists,” the organisation argues.

For that reason, OA is recommending collaborative care models between ophthalmologists and optometrists to be integrated into the mainstream health system for patients with stable glaucoma, pre and post-operative cataracts, paediatric eyecare and early-stage diabetic retinopathy.

This concept builds on what OA describes as a “growing number of successful formal and informal collaborations between optometry and ophthalmology around Australia” that “seek to reduce public ophthalmology wait times and enhance access by using optometrists to assess and manage patients who would otherwise be seen by ophthalmologists”.

Oral and intravitreal pathways 

While optometrists have been safely prescribing ocular medications since therapeutic legislation was introduced in Australia (the dates of which vary from state-to-state), in other countries regulations have been extended to allow optometrists to prescribe oral medications, and even administer intravitreal injections.

The indisputable contrast in scope-of-practice has prompted leaders in the profession in Australia to recommend that optometrists be permitted to prescribe oral medications for eye health conditions.

We recently covered this issue in depth, which includes new data on prescribing attitudes in New Zealand, and delves into why ophthalmology doesn’t support such a move.

The sector is divided on whether optometrists should be allowed to administer intravitreal injections in Australia.

Geographic access, especially outside the metropolitan centres, has also been outlined as a significant barrier to patients receiving intravitreal injections, which in Australia, can only be administered by ophthalmologists.

OA is calling for pilot models of care that utilise optometrists to enhance access to intravitreal injections for age-related macular disease and diabetic macular oedema. It points out that given the undersupply and geographic maldistribution of the ophthalmology workforce, the Federal Government’s MBS Taskforce Review recently recommended enabling intravitreal injections be administered by appropriately trained nurse practitioners, optometrists, and GPs.

“In countries like the UK, the US and New Zealand, non-ophthalmologists are playing an enhanced role in enabling access to intravitreal injections, with high levels of patient satisfaction and increased throughput in retinal clinics,” OA states.

The notion of optometrists providing eye injections is controversial in Australia and has been opposed by RANZCO and the Australian Society of Ophthalmologists in recent times. Federal Health Minister Greg Hunt is now considering the proposal as part of the MBS review and will deliver his decision soon.

Digital technology 

OA also cited an overall lack of connectedness within the eye health system as a cause of sight loss from preventable conditions. This has been characterised by siloed approaches, buck passing and last-century IT systems.

It wants to address this problem immediately as the profession is witnessing significant technological advances transforming eyecare and the role of optometry, which OA expects to continue over the next two decades.

It is calling for the implementation of consistent ophthalmology referral guidelines, templates and pathways for common eye health conditions, with a facilitated transition to electronic referrals.

It’s also recommending the government introduce telehealth MBS items for brief optometry consults where face-to-face visits are impractical, and enabling ophthalmology reports and advice to be relayed to patients.

While acknowledging how initiatives such as the KeepSight program – introduced in 2019 – have been developed to support people with diabetes by sending reminders, OA believes more needs to be done in this space.

It says better use of digital systems to emphasise the need for regular eye examinations is necessary to lift the current low levels of compliance, along with a major public awareness raising campaign.

An ultimatum 

Citing an overall lack of focus by government, industry, and health professionals on the fundamental importance of eye health as a public and population health issue, OA is calling for urgent action.

“Australia has a clear choice as a nation. Either we give eye health the
priority it deserves or face a future with increasing numbers of Australians unnecessarily having to live with the personal, social, and economic impacts of blindness and vision loss,” the organisation’s ‘Working Together’ report says.

It concludes: “Their timely implementation will remove bottlenecks, reduce wait times, prevent unnecessary blindness and vision impairment, and enhance the overall efficiency of the eye-health system. At the same time, there must be an increased commitment to investing in public ophthalmology and public optometry, and in closing the gap in Indigenous eye health.”

More reading

Optometrists asked to join national COVID-19 surge workforce

Expanded scope only way to tackle eye health issues, OA says

A hard pill to swallow: oral medication prescribing rights for optometrists