Experience regarding diagnostic drugs – signs form Norway

Experience regarding use of
diagnostic drugs in Norway
Hans Torvald Haugo, optometrist - MSc
Secretary General and Professional Manager
The Norwegian Association of Optometry and Optical Information Council

WCO defines optometry as follows:
“Optometry is a healthcare profession
that is autonomous, educated, and
regulated (licensed/registered), and
optometrists are the primary
healthcare practitioners of the eye and
visual system who provide
comprehensive eye and vision care,
which includes refraction and
dispensing, detection/diagnosis and
management of disease in the eye,
and the rehabilitation of conditions of
the visual system.”

Getting new rights
Education
Legislation
Regulation

Diagnostic drugs in Norway
• First mentioned in our strategy 1998 – 2010
• Education started up 1998 (MSC-course, PCO)
• Optometrists got rights using diagnostic drugs
1.th of May 2004

Optometry - healthcare
• Optometrists in Norway today have a
expanding role within primary eye care.
• The Norwegian health care system have
enormous challenges in the future.
The role of the craftsman is less
important than before.
But remember
– it is not unimportant!

Challenges in the future

Just to your information…
• 5 million people
• 1500 optometrists
• 356 ophthalmologists
• 40 orthoptists
• 5,5 million people
• 2200 optometrists
• 350 ophthalmologists
• 20 orthoptists

Discussion about diagnostic drugs
– always a discussion about safety

Figures in this lecture
• Facts from 3 different studies:
– 2005 (69)
– 2008 (395)
– 2012 (214)

24 %
Age distribution
13 %
3 % 0
Age 2012
32 %
28 %
Below 20
21 - 30
31 - 40
41 - 50
51 - 60
61 - 70

Sex

2005: 93% w/ MSc
2008: 44% w/ MSc
Education – highest level

Use of rights

Use of rights

Type of use

List of diagnostic drugs:
Cycloplegic refraction (childeren)
Atropin øyedråper 10 mg/ml «Ophtha»
Atropin Minims øyedråper 10 mg/ml «Chauvin»
Cyklopentolat
Cyclopentolat Minims øyedråper 10 mg/ml «Chauvin»
Homatropin
Homatropin øyedråper 10 mg/ml «Ophtha»
Miosis (pupil retraction)
Isopto-Carpine øyedråper 20 mg/ml «Alcon»
Pilo øyedråper 20 mg/ml «Novartis»
Pilokarpin øyedråper 20 mg/ml «Ophtha»
Pilokarpin Minims øyedråper 20 mg/ml «Chauvin»
Large pupils (lens, vitreous, fundus)
Tropikamid Minims øyedråper, endosebeholdere
5 mg/ml (0,5%) «Chauvin»
Mydrian øyedråper 0,5% «Novartis»
Lokal anesthesia (different examinations)
Oksybuprokain
Oxibuprokain Minims øyedråper 4 mg/ml «Chauvin»
Proksmetakain
Alcaine øyedråper 5 mg/ml «Alcon»
Tetrakain
Tetrakain Minims øyedråper 10 mg/ml «Chauvin»
Adrenalin
EpiPen Jr injeksjonsvæske i autoinjektor 0.15mg/dose
«ALK-Abello»
(til bruk på barn)
EpiPen injeksjonsvæske i autoinjektor 0.3 mg/dose
«ALK-Abello»
(til bruk på voksne)

Tetracaine
Reversible local
anesthesia
Easy use starter kit:
Cycloplentolate
Mydriatic and cycloplegic
agent
Tropicamid:
Short acting mydriasis
and cycloplegia

Tetracaine
Reversible local
anesthesia
Personal clinical advice:
Change with
Oksybuprokain
-Stains less

Which drugs are in use?
No use of EpiPen!

Side effects or complications

• Safer
Summary 2005:
• Change of respect from other professions
• Referrals from colleges
• Mostly just positive reactions from the
patients
• Side effects: almost 1/3
• Not only for diagnostic purposes – getting a
better view/feeling safer

Summary 2012:
• Use of diagnostic drugs improves the quality
of the examination
• Use of new techniques – development
• Patients feel more safe
• Some tell about less referrals
• Gives the patient the confidence they deserve
• Get more trust from patients
• Better possibilities regarding examination
choices

Put your head on the
chopping block…

Please remember two
things about diagnostic drugs:
Diagnostic drugs is not
a right for optometrists,
it’s for the patients best!
Safety first