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States make legislative progress toward oral, laser privileges
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States on opposite sides of the country are making strides toward expanding optometry’s scope of practice.
The New Jersey Assembly Health Committee has approved a bill that would empower the state board of optometry to develop educational criteria for incorporating new technologies for the state’s optometrists, including laser procedures. Washington State’s orals legislation would allow the use of nearly all oral medications, as well as injectables for anaphylaxis.
N.J. bill: aimed at education
New Jersey Assembly Bill 3364 “empowers the state board of optometry to develop specific educational criteria,” Christopher Quinn, OD, immediate past president of the New Jersey Society of Optometric Physicians, told Primary Care Optometry News. “And if optometrists were to successfully complete those defined criteria, it would allow them to incorporate new technologies into their practices, possibly including lasers.”
The bill, which was sponsored by Assemblyman Jeff Van Drew (D-Cape May), was approved 5-1 by the health committee on March 10.
The State Board of Optometry, which operates under the direction of the Division of Consumer Affairs and the Department of Law and Public Safety, consists of optometrists, members of the public and a government official. “It is important to recognize that the board of optometry is accountable to the consumer, and not just an extension of the profession,” Dr. Quinn said.
Currently in New Jersey, Dr. Quinn said, optometrists have unlimited prescriptive authority for topically applied medications. They are also specifically authorized to administer injections for anaphylaxis, he said. However, New Jersey optometrists — unlike ODs in 36 other states — are not permitted to prescribe oral therapeutic agents nor oral narcotics, he said.
This bill would allow ODs to prescribe oral agents, including controlled dangerous substances, after completion of board-defined educational criteria. “This is a regulatory mechanism that would offer safety and oversight,” he said. “The optometrists would need to go back to an accredited educational institution and meet whatever criteria have been established.”
The bill also specifically would allow optometrists in New Jersey to provide “the delivery of care reasonable to the diagnosis and treatment of conditions or diseases of the eye and adnexae, including, but not limited to, diagnostic and therapeutic applications of ophthalmic ultrasound and laser technology, as determined by the board; except that these applications shall not include invasive intraocular surgery and LASIK surgery, which, for the purposes of this subsection, means the use of a mechanical microkeratome and blade to create a corneal incision …”
“This specifically refers to LASIK as it is now, with the use of a microkeratome to cut the flap,” Dr. Quinn said. “But in the future, if a technology is developed in which a flap does not need to be cut, optometrists would be able to receive accreditation for that if the board considered it appropriate.”
The purpose and function of this bill have been “distorted” through statements by ophthalmology in the lay press, according to Dr. Quinn. “There has been a lot of misinformation spewn about by ophthalmology, and they have done a good job of distorting in the press what this bill is about,” Dr. Quinn said. “Of course, the first claim that they have made is that this will allow optometrists to perform surgery. That is categorically incorrect.”
Washington’s oral/injectable privileges
Washington’s long-awaited oral medication legislation recently passed both the house and the senate and will most likely become law soon, said Brett Bence, OD, president of Optometric Physicians of Washington (OPW).
“This is something we’ve worked towards for several years,” he said. “The final wording of the bill was a compromise between optometry and ophthalmology.”
Substitute Senate Bill 5226 will allow optometric physicians to prescribe all oral medications with the exception of oral corticosteroids and schedule I and II oral narcotics. The bill permits the prescription of schedule III and V medications for a 7-day limit per episode of ocular pain. Current optometry law in Washington State includes use of all topical medications.
In addition, the bill allows injections in situations of anaphylactic shock, Dr. Bence told Primary Care Optometry News.
To have the legislation passed, the OPW met with ophthalmology and addressed medicine’s concern regarding ophthalmic surgery. Optometry agreed to include prohibition of ophthalmic surgery in the bill as long as they could continue providing external ocular procedures.
Subsequently, optometric physicians in Washington are permitted to remove superficial ocular foreign bodies, perform epilation of misaligned eyelashes, place lacrimal or punctal plugs and perform diagnostic dilation and irrigation of the lacrimal system, or any similar procedure within the scope of practice of optometry.
Dr. Bence said although including the surgery prohibition language in the bill was unanticipated at the start of the legislative session, it was necessary in order to pass the legislation.
“We had to compromise on that issue,” he said. “But that is something we will revisit as our education and training broadens. We believe this bill is good for our patients, allowing optometry to prescribe nearly all legend oral drugs to treat eye disease”
For Your Information:
- Christopher Quinn, OD, is immediate past president of the New Jersey Optometric Association. He can be reached at Omni Eye Services, 485 Route 1, Suite A, Iselin, NJ 08830; (732) 750-0400; fax: (732) 750-1507.
- Brett Bence, OD, is president of the Optometric Physicians of Washington. He can be reached at Northwest Eye Surgeons, 10330 Meridian Ave. N., Suite 370, Seattle, WA 98133-9463; (206) 528-6000; fax: (206) 522-1479.