‘Oral prescribing is a natural progression for optometry’

In his busy metropolitan practice, Darrell Baker often sees patients with eye conditions that would benefit positively and immediately from oral prescriptions. However, he is left deeply frustrated when he is unable to provide this service, despite it falling comfortably within his scope of practice.

‘This limitation directly impacts the level of care we can provide to patients. If we were able to offer oral prescriptions, we could provide patients with timely and appropriate treatment, avoiding further complications down the track and minimising the need for unnecessary referrals.’

Darrell served as President of Optometry Australia for three years, spanning from 2018 to 2021. Prior to that, he held the role of President on the Optometry Western Australia board.

For the last 25 years, he has practiced in countries such as Zimbabwe, South Africa, the United Kingdom and Australia. He, along with his wife Christine, own two independent, special interest practices in Perth, where they focus extensively on paediatric care. They are also currently developing a model of care where they employ other allied health professionals, such as occupational therapists and speech therapists, to help compliment the eye health services that optometrists deliver. This collaborative approach allows them to create an integrated care plan for their younger patients.

OA: Do you think optometrists should be allowed to prescribe oral medications in Australia? 

Darrell: Yes, especially as it’s been proven in other countries to be an effective and safe way of delivering primary healthcare. I find it frustrating and, to be honest, somewhat embarrassing that Australia does not have this facility yet.

In our practice, we have four employed optometry graduates from New Zealand who were all accustomed to a highly progressive scope of practice before coming here. They were able to provide oral prescriptions immediately after graduating. However, now that they are practicing in Australia and have this restriction imposed upon them, they understandably feel very frustrated when they come across patients who have relatively common eye conditions that would clearly benefit from an oral prescription.

For myself, as an experienced, therapeutically endorsed optometrist, it’s upsetting to know that I am unable to provide an adjunct service to my topical prescribing capabilities. I’m running two independent practices where I employ optometrists from other countries who have endorsements that they are unable to utilise here. In some ways, this makes me feel inadequate.

Over time, we have seen a national progression in the scope of practice for various allied health professionals, such as nurse practitioners, physiotherapists and occupational therapists. In my opinion, it simply doesn’t make sense that optometry would not follow the same path.

OA: How has this restriction impacted your practice and your patients? 

Darrell: My practices are both located in a metro setting, where we see many dry eye patients. There are some oral medications that would immediately help chronic dry eye sufferers.

At our practice, one of our New Zealand therapeutically endorsed optometrists once had a patient with chronic dry eye who would have benefitted from an oral medication. Because they were unable to prescribe it, our optometrist had to send a referral to a GP recommending that specific medication. However, the GP ended up referring the patient onto an ophthalmologist, who likely ended up prescribing the same medication initially recommended by our optometrist.

There are certain ocular conditions that are better managed by optometrists. But, because we don’t have oral prescribing rights, we inevitably end up with a duplication of services.

OA: How do see this change benefitting patients and the broader health system?

Darrell: By implementing this change, the government and Medicare would undoubtedly experience significant cost savings by allowing us to streamline procedures and eliminate unnecessary referrals and duplication of services.

Once health professionals and the general public become aware of the expanded scope of optometrists, it’s likely that they will proactively seek out optometrists for these services, where they can be attended to efficiently and safely, without the need to go between multiple practitioners.

It greatly concerns me when a patient come to us with an ocular condition that requires an oral prescription, because we are unable to provide it. This situation can often become a turning point for the patient because it’s getting too hard and it’s getting expensive. This is where the true benefit lies; if we were able to offer oral prescriptions, we could provide patients with timely and appropriate treatment, avoiding further complications down the track and minimising the need for unnecessary referrals.

OA: How do you see this affecting the collaboration between optometrists and GPs and ophthalmologists?

Darrell: As we know, there are optometrists out there in other countries already safely prescribing a range of oral medications for ocular conditions.

The GPs that I’ve interacted with really enjoy referring patients to optometrists for ocular conditions that require topical treatment. This is primarily because they sometimes don’t have the instrumentation, knowledge or capacity to manage these conditions as well as an optometrist.

I’m also confident that once ophthalmologists grasp all the potential benefits of this, the vast majority would embrace this change. There will always be challenges, but it’s widely acknowledged that ophthalmologists are much better utilised in surgical procedures, and in the diagnosis and management of sight-threatening conditions. Recognising this means that we can leverage their valuable time for complex conditions that require their care. When it comes to conditions such as dry eye, optometrists are much better suited to provide care and treatment.

I also believe that this change would certainly increase collaboration, particularly with the hospital systems and certainly with ophthalmology. Allowing optometrists to prescribe oral medications is a natural progression for the profession. I am confident that the public would perceive our profession, skills and qualifications in an even more favourable light. This change would only enhance our reputation and capabilities, leading to improved patient trust and patient outcomes.