Transforming and Supporting Patient Care - Health Professions ...

320Chapter 13 – Profession of OptometryProponents also say that higher risk drugs used to treat glaucoma are beingovertaken by newer generation drugs that provide lower risk to patients.Coupled with proper prescribing procedures and training, these new drugswill provide significantly safer care. According to the OAO, topical carbonicanhydrase inhibitors and topical prostaglandin analogs are classes of drugswith minimal or no systemic adverse effects. The COO agreed that “someolder drugs used to treat glaucoma have a potential effect on thecardiovascular system in some at risk patients; however, recent professionalliterature indicates this risk is minimal. Appropriate training and properprescribing techniques mitigate against the risk of harm”. 26The COO commissioned a report on anti-glaucoma drugs, prepared by Dr.William Black. 27 This report responds to several points raised in a studycommissioned by HPRAC from Dr. Denis Grant in 2006, which concludedthat glaucoma medications carry a significantly higher level of risk beyondother agents used for eye disorders such as infections.Dr. Black states that risks associated with prescribing drugs can bemitigated by good prescribing practices, which should eliminate all but therarest of adverse reactions. He underlines that a careful history must betaken of a patient to ensure that medication will not lead to serious adversereactions; if a drug can potentially lead to a worsened situation, the patientshould be referred to a specialist for evaluation before a prescription isgiven. Dr. Black notes that a collaborative working model betweenoptometrists and ophthalmologists jointly dealing with glaucoma couldgreatly improve services and reduce wait times to initiate treatment.Proponents state that if optometrists are authorized to manage glaucomaand intraocular pressure, opportunities for greater collaboration betweenoptometrists, physicians and ophthalmologists will emerge in medical andsurgical management. As optometrists manage glaucoma in primary carecases, ophthalmologists will be able to focus on more serious secondaryand tertiary care. 28In Ontario, optometrists frequently work with ophthalmologists, familyphysicians and other health professionals in providing patient care.Optometrists are often called upon to refer patients to, or consult with,other regulated professionals in order to achieve desirable outcomes fortheir patients. Examples of situations where optometrists currentlycollaborate with ophthalmologists include co-management of cataractsurgery and refractive surgery patients, ophthalmologists working inoptometrists’ offices and vice-versa, optometrists in community healthcenters and nursing homes. 29With collaboration on protocols for referrals, records maintenance andother matters, it would be relatively simple to establish working26COO. Submission to HPRAC. November 2008: 715.27Black, W. Report to the Ontario College of Optometrists – Comments on the Grant Report,College of Optometrists of Ontario. 2008.28COO. Submission to HPRAC. November 2008: 10.29Ibid: 13.HPRAC Critical Links January 2009