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Profession of optometry marks 40 years of expansion into medical eye care

March 2, 2012

Optometry last year celebrated the 40th anniversary of the beginning of a landmark effort that ultimately established optometric practices – already America’s most important source of vision correction – as the nation’s leading source of primary medical eye care.

With the July 16, 1971, enactment of Rhode Island legislation authorizing use of diagnostic pharmaceuticals by optometrists, the profession saw the first in a series of state laws giving optometrists additional tools to diagnose eye health conditions.

Just five years later, on March 4, 1976, West Virginia granted optometrists authority to prescribe therapeutic pharmaceuticals, meaning optometrists, for the first time, would be allowed to provide treatment for such conditions.

By April 22, 1998, when the District of Columbia granted optometrists therapeutic pharmaceutical authority, optometrists across the nation had gained authority to use diagnostic drugs and prescribe drugs to treat health conditions of the eye.

The effort changed the American health care landscape by opening new access to critical primary eye care services – from diagnosis and treatment of eye disease to emergency care and surgical co-management – for millions of people across the nation, noted AOA Associate Director of State Government Relations Sherry L. Cooper, the author of “1971 – 2011: Forty-Year History of Scope Expansion Into Medical Eye Care” in the February edition of Optometry: Journal of the American Optometric Association.

In the new Optometry paper, Cooper calls for a continuing grassroots movement by optometrists to achieve uniform scope of practice over the coming years.

“There have been four basic interconnected legislative components related to scope of practice expansion into medical eye care over the past 40 years,” Cooper noted.

  • Use of diagnostic pharmaceutical agents (DPAs) — the ability to use anesthetic, dilation, and other topical drugs.
  • Diagnosis of disease— authorization to diagnose diseases or conditions of the eye. (This component specifically established the legal responsibility of optometrists to “diagnose” diseases or conditions of the eye and vision system and was generally tied to diagnostic, or more frequently, therapeutic prescriptive authority expansion efforts.)
  • Prescription of therapeutic pharmaceutical agents (TPAs)—the prescription of medication to treat diseases or conditions of the eye and related structures.
  • Performance of surgical procedures—the authority to perform nonsurgical and surgical procedures.

In all, more than 180 expansion and amplification laws have been enacted over the past 40 years in the various states and the District of Columbia to expand optometry’s authority to diagnose and treat eye conditions.

However, “there are many areas in which optometry laws must still be amended to achieve more uniformity from one state to the other, regarding prescriptive authority and the ability to perform primary care procedures,” Cooper observed.

Toward uniform scope of practice

“A uniform prescriptive authority law for optometry is a realistic, achievable concept,” Cooper said. “Quite simply, an optometry license, as authorized by the state legislature, should allow licensees to examine, diagnose, treat, and manage diseases or conditions of the vision system, eye, and related structures with any appropriate means. This includes every facet of the practice of modern optometry, from the use of lenses and prisms; to the provision or prescription of ocular exercises, vision therapy, and vision rehabilitation; to the prescription, fitting, dispensing, and sale of corrective eyewear and contact lenses, including plano or cosmetic lenses; to the ordering or performing of appropriate diagnostic or imaging tests; to the use or prescription of appropriate drugs, including controlled narcotic substances; to the performance of non-surgical and surgical procedures.”

“While there is no model language there is a model result; it is the effect of a state’s practice act, not the precise language of the law,” Cooper continued.
“The statutory language establishing uniform prescriptive authority can be written in as many ways as there are practice acts. The goal is for the optometry law to authorize the use and prescription of all appropriate or necessary legend (prescription) and over-the-counter drugs, including controlled narcotic substances, via any route of administration for the diagnosis, treatment, and management of conditions of the vision system, eye, and related structures. As with other classes of independent doctoral-level prescribing professions (e.g., allopathic or osteopathic medical physicians, dentists, and podiatrists) an optometry license issued or renewed today should automatically include full prescriptive authority. And importantly, there should be no statutorily defined conditions, restrictions, limitations, or other standard of care-type language codified into the practice act by the state legislature,” according to Cooper.

The AOA State Government Relations Center encourages AOA members to read “1971-2011: Forty-Year History of Scope Expansion Into Medical Eye Care” in this month’s edition of Optometry online.

AOA members can conveniently access the latest electronic edition of Optometry online through the AOA Web site (www.aoa.org). Members can select “Journal of the AOA” and enter their member number and password when prompted.

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