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Nevada ODs authorized to treat glaucoma
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RENO, Nev. — An amplification law passed earlier this year provides expanded therapeutic pharmaceutical agent (TPA) legislation for Nevada optometrists, permitting them to prescribe topical glaucoma medications, said Al Dufur, OD, Nevada Optometric Association (NOA) president. Oral glaucoma medications are permitted in emergency situations, which “include traumatic situations where a patient has an angle closure or gets hit in the eye and the pressure is high due to that injury,” Dr. Dufur said.
He said that, under the new legislation, ODs also have the ability to order lab tests and prescribe narcotics, such as Tylenol with codeine (acetaminophen and codeine, McNeil), for up to 72 hours. Optometrists are not allowed to treat patients younger than 16 for glaucoma or to treat malignant-type glaucomas, he said.
“Secondary to trauma, we would have to refer out, but we could give patients oral medications until they get to the hospital or to an ophthalmologist,” said Dr. Dufur.
He noted that a Drug Enforcement Administration license is required to prescribe narcotics.
Seeking direct access
Dr. Dufur said that, while he is happy with the amplified bill passed in May, direct access still eludes state optometrists. “We still want to seek this privilege,” he said. “We have a pretty good bill now; the only other issues we could amplify would be oral steroids and direct access, and direct access is more of an issue.”
He said that ODs in the state currently do not have hospital privileges, but if that were ever to be achieved, they would likely face opposition from ophthalmologists. “Some states, especially in rural areas, are a little bit more accepting of that, but in more populated areas you would get more of a fight to stop those privileges,” he said.
Nevada optometrists also face the obstacle of many insurance companies refusing to cover prescriptions written by ODs. This is an issue the NOA is trying to address, Dr. Dufur said.
TPA benefits practice, OD/MD relations
Of the approximately 150 practicing optometrists in the state of Nevada, Dr. Dufur estimated that about 75% of those use their prescribing privileges. In his own practice, Dr. Dufur said the legislation has benefited him. “It has reduced the cost for many patients,” he stated. “It has also established confidence with my patients, and they feel a little bit more comfortable staying here vs. being referred out.”
The relationship between ODs and MDs may be somewhat strained, he said, but he hopes that working together with the new TPA law will serve to strengthen it. “There’s always going to be some conflict,” he said. “I think it’s more of a turf-related issue, so you’re going to feel some kind of hesitancy to allow certain things to happen or bills to pass. In the long term, it should bring optometry and ophthalmology a little closer together — at least that’s what I hope.”
Future issues
Now that the TPA amplification law has passed, Dr. Dufur said that, in addition to direct access, the NOA’s primary concern for the upcoming year is refracting opticians, something the NOA does not support. “The public is already a little bit misled by what constitutes an eye exam,” he said. “I think that’s going to create a lot of problems in certain situations, for instance, with glaucoma being missed, because opticians are not looking for health-related issues.”
Nevada optometrists first received TPA privileges in July 1995.
For Your Information:
- Al Dufur, OD, is the president of the Nevada Optometric Association and has been in private solo practice for 6 years. He may be reached at 1825 Kirman Ave., Reno, NV 89502; (775) 323-4391; fax: (775) 323-2086.