N.C. optometrist prescribes to build his practice

Issue: June 1998

AHOSKIE, N.C. - In this small, rural town of about 5,000, solo practitioner Brad Hauser, OD, could not get through the day without a very important practice-building tool - his prescription pad.

"I've been writing prescriptions from day one," said Dr. Hauser, who has been in private practice for 6 years. "I worked with surgeons in a larger referral center before coming to Ahoskie, and here you have to prescribe. Many patients simply cannot get to a practice that's an hour away, so out of necessity we treat."

While enjoying the variety and challenge of a small-town practice, Dr. Hauser believes that prescribing to the full scope of North Carolina's 21-year-old therapeutic pharmaceutical agent (TPA) law is what builds his practice.

Prescribing advantages

"One of the biggest advantages to prescribing is that it's a practice-builder," he said. "By prescribing, treating a referral and following up with the doctor, you establish a lot of confidence with the general practitioner (GP). This increases your referrals."

Dr. Hauser has also taken advantage of North Carolina's recent legislation that requires hospitals to accept applications from optometrists for staff privileges. "I got privileges about a year ago at Roanoke Chowan," Dr. Hauser said, "and being on staff has been very beneficial. It has helped as far as the confidence the GPs and surgeons have in me because a lot of them really did not know what an optometrist could do."

Because he works in a practice and at the local hospital, Dr. Hauser writes three to four prescriptions a day, nearly 20 a week. He is also an optometrist who believes that sampling has its place in the practice. "I feel samples are appropriate in certain instances," he said. "I try to use most of my samples for indigent patients, and I have a few patients who I know will not get a prescription filled, so it's good to have an occasional sample."

Beta-blockers for glaucoma

Glaucoma drugs are among those most commonly prescribed by Dr. Hauser, and beta-blockers are his first choice. "Betagan (levobunolol HCl, Allergan) and Betimol (timolol hemihydrate, Ciba Vision) are my top two choices," he said. After that, he will go to either Xalatan (latanaprost, Pharmacia Upjohn) or Alphagan (brimonidine tartrate, Allergan) for glaucoma therapy.

Combination drugs such as Dexacidin (neomycin and polymyxin B sulfates, dexamethasone, Ciba Vision), Maxitrol (neomycin and polymyxin b sulfates and dexamethasone, Alcon) and TobraDex (tobramycin dexamethasone, Alcon) are other prescriptions Dr. Hauser writes often.

"I see a lot of what I call nonspecific keratoconjunctivitis, when patients have a little bit of redness of the conjunctiva, a little bit of discharge and some discomfort," he said.

His usual regimen with steroid therapy is to use a combination drop. The approach is aggressive initially, with patients instilling drops every 2 hours for 2 days, then tapering down to four times a day. "In a couple of days, patients feel better, things are cleared up and they're happy," he said.

Antibiotics, pain management

Although Dr. Hauser can prescribe oral narcotics under North Carolina TPA law, and he has a Drug Enforcement Administration license, he prefers patients try simple medications at first to control ocular pain. "I also treat corneal abrasions, iritis, the occasional corneal ulcer and perform foreign body removals," he said. "With abrasions, I tend to use a bandage contact lens and Ciloxan (ciprofloxacin HCl, Alcon) - it's the best antibiotic to put on the eye - and I use Voltaren (diclofenac sodium, Ciba) for pain because I feel it really helps patients with corneal pain."

Dr. Hauser steers patients toward over-the-counter pain relievers. "I might go with Tylenol 3 (acetaminophen and codeine phosphate tablets, Ortho-McNeil)," he said, "but rarely do I prescribe Percocet (oxycodone and acetaminophen tablets, Endo Laboratories)."

For Your Information:

Brad Hauser, OD, may be contacted at 500 West Church St., P.O. Box 1185, Ahoskie, NC 27910; (252) 332-5400; fax: (252) 332-8543. Dr. Hauser has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.