Transforming and Supporting Patient Care - Health Professions ...

319Chapter 13 – Profession of OptometryThe classes proposed by COO within the anti-glaucoma category are thefollowing:• Beta-blockers• Cholinergics• Alpha-Agonists• Prostaglandins• Carbonic Anhydrase InhibitorsThe OAO has also requested the authority to prescribe anti-glaucomaagents. However, its proposal requested only the approval of topicalcarbonic anhydrase inhibitors and topical prostaglandin analogs for thetreatment of glaucoma. According to the OAO, “limiting the prescription ofanti-glaucoma drugs to those classes of drugs with minimal or no systemicadverse effects, will not only satisfy HPRAC’s concerns with patient safetybut would also provide immediate access to glaucoma care for the patient”. 21Proponents’ RationaleGlaucoma is an eye disease caused by increased pressure within the eye. Itis one of the most common causes of blindness and affects one in everyhundred Canadians over 40 years. 22 Although it often occurs in olderpeople, it can affect anyone at any age.It is suspected that people with glaucoma lose their sight because ofincreased pressure in the eye and other factors, such as poor blood flow.The eye slowly loses nerve function and loss of side (peripheral) vision.This occurs painlessly and may even not be noticed. 23As a result, when an optometrist first diagnoses glaucoma, the disease maybe quite advanced. Proponents note that optometrists outnumberophthalmologists nearly five to one, and are situated in nearly every smallcommunity and large city in Ontario. The increase in qualified professionalsto manage glaucoma will allow patients to access care more easily, possiblywith a provider with whom they already have a professional relationship.According to the proponents, the availability of optometrists who arequalified to treat the disease may prevent delays in care, which couldnegatively affect its management.Updates to a wait time study commissioned by the COO estimate that theaverage wait time for a patient to be seen by an ophthalmologist forglaucoma was 49 days, virtually unchanged from the wait times identified inthe initial 1996 study. 24 According to the study, it is anticipated that patientsrequiring glaucoma treatment will increase by 30 percent over the next20 years while the number of available specialists is expected to decline.Forty-four percent of specialists plan to decrease their clinical load in thenext five years. 2521OAO. Submission to HPRAC. November 2008: 4.22Canadian Ophthamological Society. Glaucoma It Can Take Your Sight Away. 200823Ibid.24Robinson. B. Ontario Glaucoma Wait Times Study – Interim Report, Prepared for the COO. 2008: 7.25Ibid.HPRAC Critical Links January 2009