Transforming and Supporting Patient Care - Health Professions ...

323Chapter 13 – Profession of Optometryin some persons and not others or why the same side effect of the samedrug is severe in one person and mild in another are poorly understood. 36The COO indicates that if optometrists are given authority to prescribeanti-glaucoma drugs, the rigour of its professional misconduct rules andstandards of practice will be increased to be at least equivalent to those ofmedicine. This is a common requirement in American jurisdictions.Patients with glaucoma can be managed in stages through collaborativearrangements. The COO said that glaucoma care should be recognized as acontinuum of treatment from simple to advanced. Initial treatment by anoptometrist could commence for simple glaucoma, with continuingassessments to determine any increasing complexity of the disease. If theinitial disease management therapy does not proceed well or fails, then thepatient should be referred to an ophthalmologist for treatment of theincreasing complexity. The need for immediate complex treatmentrequirements is rare. The COO indicates that additional standards andguidelines with respect to the continuum are needed.As is required in many jurisdictions, the COO said that any patient under 18years diagnosed with glaucoma would automatically and immediately betransferred to a specialist, as this would indicate a highly complex diseasestate.COO also spoke of concerns regarding the availability of clinical placementsfor Ontario optometric students seeking to qualify in glaucoma care. Theseplacements are not available in the province, and because student visas tothe United States have been reduced, placements are increasingly difficultto obtain in the United States. HPRAC was told that the University ofWaterloo School of Optometry has made arrangements for clinicalplacements in Oklahoma for Ontario students to address this issue.HPRAC was told by both physicians and optometrists that there is somesupport for a team approach, including staggered visits between optometristsand ophthalmologists in a collaborative model, such as exists in Kingstonand Ottawa. This could have particular value in rural and remote regions,such as Northern Ontario, but would likely benefit patients in urban areasas well.HPRAC carefully reviewed the proposal of the OAO that a selection of twoof five anti-glaucoma drugs would “not only satisfy HPRAC’s concerns withpatient safety but would also provide immediate access to glaucoma carefor the patient”. 37 HPRAC’s review of issues associated with the prescribingof anti-glaucoma drugs indicates that a full regimen of drugs to meetspecific patient care needs based on a range of conditions is necessary.Some anti-glaucoma medications are contraindicated in patients withcertain conditions, including liver disease and heart conditions. Thisproposal does not meet the tests of good pharmacotherapeutic care.36NY Glaucoma Research Institute. http://www.glaucoma.net.37OAO. Submission to HPRAC. November 2008: 4.HPRAC Critical Links January 2009