Practice scopes expanded in Vermont, Virginia

Optometric scope of practice took another significant step forward in Vermont and Virginia, where bills were recently passed to expand privileges in each of these states.

Virginia’s HB 856 will broaden the ability of optometrists to prescribe therapeutic pharmaceutical agents, according to Bruce B. Keeney Sr., executive director of the Virginia Optometric Association. The bill will also eliminate a consultation requirement prior to treating glaucoma.

In Vermont, optometrists now are able to treat all forms of glaucoma and have also gained the right to prescribe oral medications.

HB 856

According to Mr. Keeney, Virginia’s HB 856 will allow optometrists more freedom in terms of using diagnostic pharmaceutical agents.

“The previous law listed specific diagnostic drugs that were allowed,” he told Primary Care Optometry News. “This legislation removes the laundry list in the statute and says that optometrists may use any appropriate diagnostic pharmaceutical agent, Schedule VI agents topically applied for the purposes of examining abnormal or disease conditions in the eye and adnexa.”

The bill additionally removed a provision in age restriction that was established 10 years ago, Mr. Keeney said. “This provision would have prohibited optometrists from using diagnostic agents on patients who were 3 years of age and younger,” he said. “And that age restriction was removed.”

The bill also stated that as of July 1, 2004, any newly licensed optometrist must be therapeutic drug certified, Mr. Keeney said. In addition, HB 856 eliminated a requirement that optometrists consult with ophthalmologists prior to treating glaucoma.

Mr. Keeney said the legislation also expanded privileges for the use of Schedule III through VI agents. “That was all broadened so that it’s essentially any Schedule III through VI agent, oral or topical, narcotic and non-narcotic, that is appropriate for treating abnormal or disease conditions of the eye or adnexa,” he said.

According to Mr. Keeney, the aspects of the legislation pertaining to the consultation requirement and age restrictions went into effect July 1. The sections pertaining to orals will be subject to a regulatory process by the Virginia Board of Optometry. “They’ve already started the planning process on that,” he said. “The legislation requires that the new regulations go into effect no later than December.”

Mr. Keeney said the legislation met with a significant amount of opposition from ophthalmology. “They ended up hiring the equivalent of about a dozen extra lobbyists. They started by pointing out the ‘dangerous things’ optometrists would be able to do under this legislation,” he said. “But almost everything they were citing, optometrists had been doing for 10 years with a perfect safety record.”

Mr. Keeney said the Virginia Optometric Association takes pride in the fact that there have been no complaints about patient harm as a result of optometrists performing these procedures. “We touted the fact that since optometrists first obtained use of prescription privileges, including diagnostics back in 1979 but especially with therapeutics, the board of optometry has never received a substantiated complaint of any patient harmed by any of these agents,” he said.

Vermont gains orals and glaucoma

In Vermont, a significant advance has been made with the removal of restrictions on glaucoma treatment. SB 54, which was signed by the governor on May 11, also allows optometrists to prescribe oral medications.

“It is somewhat different from what was originally submitted, as they all are,” said Timothy Johnson, OD, legislative chair of the Vermont Optometric Association, in an interview. “We had to accept a formulary committee that will actually decide which of the orals we will be using.”

“There is a restriction on injectables for treating anaphylaxis,” Dr. Johnson said.

The removal of restrictions on glaucoma treatment is a significant improvement in Vermont’s optometric scope of practice, Dr. Johnson said. “We are now allowed to treat almost all forms of adult open-angle glaucoma,” he said. “We are also permitted to do emergency treatment of closed-angle glaucoma.”

Dr. Johnson said the formulary committee will be revisited at the end of next year, and a determination will be made as to whether it has been successful. “The legislature will either decide that the formulary committee has been working fine, or they will decide to modify it or get rid of it,” he said.

Dr. Johnson said the formulary committee will consist of two optometrists appointed by the state board of optometry, two ophthalmologists appointed by the health commissioner and two doctors of pharmacology appointed by the Office of Professional Regulations.

For Your Information:

• Bruce B. Keeney Sr. is executive director of the Virginia Optometric Association. He can be reached at 118 North Eighth St., Richmond, VA 23219-2305; (804) 643-0309; fax: (804) 643-0311; e-mail: VOAEyeDocs@aol.com.
• Timothy Johnson, OD, is legislative chair of the Vermont Optometric Association. He can be reached at PO Box 517, 231 Rockingham Rd., Bellows Falls, VT 05101-0517; (802) 463-4216; fax: (802) 463-2543.