Transforming and Supporting Patient Care - Health Professions ...

331Chapter 13 – Profession of Optometryglaucoma. That proof shall include corroborating information from thecollaborating ophthalmologist. After an optometrist has treated a total of 50patients for a period of two years each and has received certification fromthe State Board of Optometry, the optometrist may treat the original 50patients independently, with the written consent of the patient. However,any glaucoma patients seen by the optometrist before the two-year periodhas expired for each of the 50 patients shall be treated under thecollaboration protocols described. 61A review of a cross-section of Canadian and United States jurisdictionsindicates that there are trends to authorizing optometrists to treat openangle glaucoma with the topical administration of TPAs, with immediatereferral to an ophthalmologist for cases of acute angle closure, glaucomadiagnosed in patients under 18, glaucoma in patients with diabetes orpatients with a history of conditions that would likely create adverse drugreactions. As well, many jurisdictions require clinical experience prior tocertification, with co-management of patients under either the supervisionof an ophthalmologist or an optometrist who is a specialist in glaucoma.Competency-Based Performance StandardsThe Competency-Based Performance Standards (CBPS) were developed bythe Canadian Examiners in Optometry (CEO) Competence Committee andthe CBPS Working Group, a group of practicing optometrists from acrossCanada. The mandate of the Working Group was to develop the minimumquality of practice required to provide safe and effective optometric care inCanada and revising the standards for the CSAO.The standards require that optometrists meet patients’ eye and vision careneeds by possessing the functional knowledge to manage patient care, toconsult with other health professionals when managing patients’ complexneeds, and to refer patients to other optometrists, ophthalmologists orfamily physicians for eye care needs that require specialized managementor are beyond the scope of practice of the optometrist.Optometrists are required to complete a full patient history includingcritical information such as relevant ocular and vision, medical and socialhistory and risk factors. They must use their knowledge of epidemiological,ocular and medical risk factors to determine the patient’s risk and obtainthe patient’s consent to contact others to obtain relevant information.The accurate identification of tests that may be appropriate or may becontraindicated in patients with specific conditions, along with applicationof professional knowledge to determine more detailed examinations that arerequired, is a key skill. Performance of visual field testing for glaucomafollowing elevated tonometry readings is an example. As well, theoptometrist must recognize when special testing or equipment needs meanthat a referral to another optometrist or ophthalmologist is needed, orwhen the patient’s condition requires management by another healthprofessional.6iActs constituting practice of optometry. S.3041. http://www.optometry.ca.gov/lawsregs/index.shtml.HPRAC Critical Links January 2009