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26 Mar 2013

The AMA is calling on all Australian Health Ministers to reverse a decision by the Optometry Board of Australia to allow optometrists to independently manage patients with glaucoma.

AMA President, Dr Steve Hambleton, said today that the decision puts comprehensive quality care of glaucoma patients at risk.

“The Optometry Board decision goes against the advice of the Pharmaceutical Benefits Advisory Committee (PBAC) and against the wishes of the peak glaucoma support group, Glaucoma Australia,” Dr Hambleton said.

“Glaucoma is known as the ‘sneak thief of sight’, and one in 10 Australians over 80 will develop the disease.

“It is a complex disease that comes in many forms, and requires highly specialised care over time.

“The Optometry Board has shown that is out of step with best practice care for patients with glaucoma.

“PBAC recognises the importance of optometrists confirming diagnoses of glaucoma with ophthalmologists, and the need for these two health professions to work together to manage patients with glaucoma, and also recommends the sharing of information with the patient’s GP to complete the clinical team.

“Glaucoma Australia wants the current arrangements for the detection and management of glaucoma to be maintained.

“Yet the Optometry Board has given the green light for optometrists to go it alone in caring for glaucoma patients.

“This is an irresponsible decision by the Board and it must be reversed immediately,” Dr Hambleton said.

Background

On 21 March 2013, the Optometry Board of Australia released revised guidelines for optometrist use of schedule medicines.

The Optometry Board asserts that optometrist “competency standards address differential diagnosis and treatment options …”.

In its submission to the Optometry Board, Glaucoma Australia stated:

Independent and ongoing management of a glaucoma patient by an optometrist alone has the potential to increase the likelihood of missing disease progression on the one hand or to over-treat glaucoma suspects on the other. Glaucoma Australia believes the best option from a patient perspective is the current system where optometry is the logical first port of call for the Australian community to be comprehensively assessed for signs and symptoms of glaucoma, with an ophthalmologist confirming that diagnosis and then discussing and initiating treatment.

In a Fact Sheet, the Optometry Board states that it considered “the practical limitations of the requirement (under the previous guidelines) for participation in a documented shared-care or management plan with an ophthalmologist”.  The AMA asserts that no evidence of the “practical limitations” was provided to the Board in the submissions made to its consultation paper.

The table below shows the anti-glaucoma medicines that the Optometry Board of Australia has listed for optometrists to prescribe independently, compared to other regulatory arrangements and the NHMRC Guidelines:

Medicine

PBS Listing

NHMRC Guidelines

Australian Register of Therapeutic Goods

Apraclonidine

medical practitioners only

2nd line treatment

Listed

Betaxolol

Shared care with, and diagnosis confirmed by, ophthalmologist

1st line treatment

Listed

Bimatoprost

Diagnosis confirmed by, and shared care with, an ophthalmologist

1st line treatment

Listed

Brimonidine

Shared care with, and diagnosis confirmed by, ophthalmologist

2nd line treatment

Listed

Brinzolamide

Shared care with, and diagnosis confirmed by, ophthalmologist

2nd line treatment

Listed

Carbachol

Not listed

3rd line treatment

Listed

Diprivefrin

Not listed

Not listed

Not listed

Dorzolamide

Shared care with, and diagnosis confirmed by, ophthalmologist

2nd Line treatment

Listed

Latanoprost

Shared care with, and diagnosis confirmed by, ophthalmologist

1st line treatment

Listed

Levobunolol

Not listed

1st line treatment

Listed

Pilocarpine

Shared care with, and diagnosis confirmed by, ophthalmologist

3rd line treatment

Listed

Timolol

Shared care with, and diagnosis confirmed by, ophthalmologist

1st line treatment

Listed

Travoprost

Shared care with, and diagnosis confirmed by, ophthalmologist

1st line treatment

Listed

Potential systemic side effects from beta-blocker eye drops (eg Timolol) include bronchospasm, hypotension, bradycardia, heart block, masked hypoglycaemia, adversely affected lipid profile, impotence, fatigue, depression, reduced exercise tolerance, fainting, confusion, and alopecia.


26 March 2013

CONTACT:         John Flannery                       02 6270 5477 / 0419 494 761
                         Kirsty Waterford                    02 6270 5464 / 0427 209 753


Published: 26 Mar 2013