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ODs in Hawaii prepare for TPA certification
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HONOLULU - The 48th state to receive therapeutic pharmaceutical agent (TPA) legislation, Hawaii is currently setting up its certification process and formulary so that when the law goes into effect in 1999, ODs here will be trained and ready to prescribe.
That preparation includes completing a 100-hour Therapeutic Manage-ment of Ocular Disease (TMOD) course, passing the TMOD exam and completing 100 hours of preceptorship under the supervision of an ophthalmologist, said Verna Oda, executive officer of the Board of Examiners of Optometry here.
Optometrists will also have to complete 36 hours of therapeutics related to continuing education every 2 years.
Under its TPA law passed in June 1996, certified optometrists in Hawaii will be able to prescribe topical agents to treat ocular allergies, infections and inflammation, as well as perform foreign body removal. TPA exclusions include oral therapeutics, glaucoma medications and controlled substances.
A welcome addition
"The law is definitely a welcome addition," said Bryan Sakka, OD, president of the state optometric association, "because we would like to care for our patients to the fullest extent of our training, which definitely includes the routine red eye, conjunctivitis, infections and iritis. These are fairly common and the primary conditions we see everyday."
Dr. Sakka is in solo, private practice in Kaneohe. As one of nearly 170 licensed ODs in the state, he acknowledges that the certification requirements are stringent and lengthy. "The 100 hours of preceptorship we're required to have is the most of any state, and that is our challenge with TPA," he said.
Delay was a compromise
The delay from Hawaii's passage of TPA law to its implementation in 1999 was, according to Dr. Sakka, "One of the compromises we agreed to in order to pass what is a relatively good law."
In practice, the ability to treat many typical ocular conditions should save time for patients and optometrists, Dr. Sakka said. "Many times people wait until the last minute to see a doctor and then we have to refer, which adds to the time they're uncomfortable. Most of these conditions are easily treated and a lot of them are contact lens-related."
Dr. Sakka estimates that 70% of his practice is made up of contact lens patients, the majority of whom present with conditions that TPA legislation will allow him to treat therapeutically.
"Contact lenses are definitely an optometric specialty and yet we can't handle the complications related to contact lens wear without being able to prescribe therapeutics," he said.
Relationships to improve
Dr. Sakka said optometry's rapport with ophthalmology is probably similar to other states in that there are some very good relationships between ODs and MDs, but there is also room for improvement.
"There are ophthalmologists we refer to because they're in our area, but sometimes the relationships aren't as good as they should be, and we are hoping for better ones," said Dr. Sakka.
The required 100 hours preceptorship with an ophthalmologist is a step in that direction, he said, above and beyond its purpose of credentialing optometrists to prescribe therapeutics.
The formulary committee - made up of optometrists, ophthalmologists and pharmacists (two each) - has been appointed and will meet in the coming months, said Dr. Sakka.
"Patients deserve to have the most current drug of choice, and drugs continue to improve and change, so hopefully a formulary won't limit patient choices or present a roadblock to patient care," he said.
For Your Information:
- Bryan Sakka, OD, may be contacted at 45-600A, Kam Highway, Kaneohe, HI 96744; (808) 236-1029, fax: (808) 247-7888. Dr. Sakka has no direct financial interest in any of the products mentioned in this article nor is he a paid consultant for any company mentioned.
- Verna Oda may be contacted at P.O. Box 3469, Honolulu, HI 96801; (808) 586-2694.