British Columbia's optometrists are angling for glaucoma privileges

Vancouver, BC-Optometrists here took a major step toward obtaining glaucoma-treatment privileges when the provincial Ministry of Health posted for comment proposed regulatory amendments that would allow precisely that, as well as permit ODs to perform A-scan ultrasound.

The emerging privileges for optometrists in British Columbia are the most recent gains in optometric practice above the 49th parallel (table). All provinces and the Yukon Territory have some level of prescription writing authority, with the exception of Manitoba, where the provincial optometric association is still writing regulations under legislation adopted in 2008.

In British Columbia, the final decision rests with the Minister of Health now that the comment period has closed. The British Columbia Association of Optometrists (BCAO) weighed in with compelling arguments, including that ODs have been educated and trained to diagnose and treat glaucoma.

A BCAO briefing from last September further noted that collaborative glaucoma management, which entails an ophthalmologic consult as set out in specified guidelines, and having optometrists initiate treatment for low- and moderate-risk glaucoma patients is a viable way to meet expanding demand for eye care. Timely access to care is a particular concern for rural patients.

Limits of legislation

The scope of the proposed British Columbia glaucoma amendment has limits. "We would only treat primary glaucoma; we wouldn't treat secondary glaucomas," said Surjinder Sahota, OD, BCAO president. Glaucoma patients younger than 30 would also be off limits.

Another provision of the proposed glaucoma amendment would authorize ODs-in the absence of a readily available ophthalmologist-to prescribe the oral carbonic anhydrase inhibitor acetazolamide (Diamox, Duramed Pharms Barr) in an angle-closure emergency. Once the immediate crisis passes, however, the optometrist must refer the patient to an ophthalmologist. Likewise, progression to moderate glaucoma calls for referral to an ophthalmologist.

An unmet need

Population figures spell out the case for an unmet need. British Columbia has a population of 4.57 million-and about 560 optometrists and 220 ophthalmologists..

"In British Columbia in general, we have a lot of rural areas," Dr. Sahota said. "Sometimes, the closest ophthalmologist is a 2½- or 3-hour drive, and even then, a lot of them are very full or not taking new patients."

She noted that one third of Canadian ophthalmologists are expected to retire within the decade, and that 15% of optometrists are past age 55 compared with 33% of ophthalmologists. "It's really about meeting the demand for vision care in British Columbia," Dr. Sahota said. "Prompt treatment is key in preserving our patients' vision."

UPDATE: New amendment allows BC optometrists treat glaucoma

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