Optometry Australia urges the inclusion of oral medications in scope of practice

The peak professional body for optometrists in Australia is calling for the inclusion of oral medications within optometrists’ current prescribing capabilities. This development would enhance patient care, improve accessibility and catch Australia up to the successful practices already in place in New Zealand and the United Kingdom.

The current restriction on prescribing oral medications to treat ocular conditions means that optometry patients must be on-referred to a GP, ophthalmologist or hospital eye service for their oral medications. This causes unnecessary treatment delays and added costs for patients and Medicare.

CEO of Optometry Australia Skye Cappuccio said: ‘The restriction adds pressures to already-overburdened parts of the health system and disadvantages patients in rural and remote areas, who have less access to health professionals. In some cases, the cost, lack of access and inconvenience mean the patient forgoes treatment, putting their eye health at risk.

‘The restriction also prevents optometrists from treating patients in a timely, holistic manner and is contrary to the direction in the Strengthening Medicare Taskforce Report that health professionals should be practising to their full scope in an efficient, multidisciplinary team-based environment,’ Skye added.

Advocating for change

Optometry Australia asserts that therapeutically endorsed optometrists possess the necessary knowledge and training to responsibly prescribe appropriate oral medications for ocular conditions. Their advanced education and clinical experience equip them with a comprehensive understanding of the visual system, ocular diseases and the pharmacological management of eye-related disorders, just like their counterparts in New Zealand and the UK.

The most common oral medications that would be prescribed by optometrists are antibiotics, antihistamines, antivirals, acetazolamide, and analgesics. They are used primarily to treat ocular surface diseases, herpetic eye disease, eye infections, eye injuries, and acute angle glaucoma. A 2021 analysis of the prevalence and incidence of ocular conditions by the QUT School of Optometry and Vision Science found up to 60% of the population may receive oral medications for these conditions.

The clear evidence from countries where optometrists prescribe oral medications is that it has no negative impact on patient safety. This is hardly surprising given that optometrists are focused on detecting ocular conditions using ophthalmic equipment like slit lamp biomicroscopes for accurate diagnosis and treatment.  An independent study of six years of oral prescribing by optometrists in New Zealand found no evidence of out-of-scope prescribing by optometrists or adverse events for patients.  In the UK, studies show no reports of legal cases for therapeutic prescribing by optometrists.

‘Optometrists are ready and motivated to take on the responsibility of prescribing oral medications to their patients,’ said Skye Cappuccio. ‘More than 73% of Australian optometrists are therapeutically endorsed and already able to prescribe scheduled topical medications. Entry-level graduates and therapeutically endorsed optometrists are trained in pharmacology, drug interactions, indications for systemic or oral treatment, lab testing and toxicology, and discussing medications with patients.

‘Younger optometrists see oral prescribing as inevitable and are puzzled why their colleagues in New Zealand – some of whom have studied in Australia – can prescribe oral medications when they cannot,’ she added.

Optometry Australia continues to engage in discussions with regulatory bodies and stakeholders to advocate for this critical update to the scope of practice for optometrists. The organisation remains committed to fostering a collaborative environment that supports the ongoing evolution and advancement of optometry in Australia.