Let’s broaden the role of optometrists

Bill would make the change – and save state money

IN EVERY OTHER STATE, optometrists prescribe oral antibiotics to treat ocular infections as well as treat and manage glaucoma. Massachusetts is the only state where this is not permitted. If a patient with one of these conditions presents at an optometrist’s office in the Commonwealth, the most he or she can do is make a referral to an ophthalmologist, and this often leads to a long wait and added costs for the uncomfortable patient.

There is no rationale for this since optometrists are experts on the eye and trained to provide care in these situations. Ophthalmologists are surgeons and they should be providing the most advanced care.

As dean at a school of optometry, I can testify with certainty that optometrists today have the education, training, and background to safely use the modalities included in a bill before the Massachusetts Legislature. Moreover, the Commonwealth would realize $20 million in MassHealth (Medicaid) savings by making the change, at a time when MassHealth faces a huge funding deficit.

Medical school curriculum is very rigorous and thorough, but because of the volume of material that must be covered for conditions such as heart attacks, strokes, and cancer, there is very little time devoted to many specialty areas such as the eye during the four-year medical school education. Ophthalmologists learn what they need to know about the eye after medical school graduation.

On the other hand, the four-year, post-baccalaureate optometry school curriculum is devoted almost entirely to the eye.  Of course, there are optometry courses in general anatomy, pathology, general internal medicine, and pharmacology, which parallel the same courses taught in medical and dental schools.  Consequently, optometrists are well educated and trained within their programs to properly examine, diagnose, and treat these eye conditions, and to consult with, and refer to, ophthalmology or other medical specialties when appropriate.

Many systemic diseases such as hypertension, diabetes, and immune mediated diseases are evident during a routine eye examination.  Optometrists are also educated and trained to identify and diagnose these manifestations and then refer to the appropriate medical practitioner.

The privileges sought regarding application of oral antibiotics for ocular conditions and the treatment of glaucoma in the care of their patients is consistent with standards in all other states. The public can be assured that any optometrist awarded such privileges is appropriately educated and trained.  The Massachusetts Board of Registration in Optometry will provide the correct level of oversight of optometrists through a strict credentialing process in keeping with the board’s role and responsibility for public protection and patient safety.

Some ophthalmologists in Massachusetts who actively oppose the bill appear to be out of step with reality, especially when they cite concerns for “patient safety.” They appear unaware that the education of optometrists has changed dramatically over the past 45 years. With these changes, the scope of practice has legally expanded through state legislative action in every other state.

The comprehensive four-year post baccalaureate education and clinical training at the two accredited optometry schools in the Commonwealth parallels that at the other 20 colleges of optometry nationwide.

Why are some ophthalmologists opposing the bill? Is it to protect their turf? Is it to secure their own economic interests? Or is it, as I believe, because of misconceptions or lack of knowledge about the education and training of optometrists today?

As eye care professionals, doctors of optometry enjoy close working relationships with many area ophthalmologists.  They are on our campus, they teach our students and they understand how the profession of optometry has advanced.  They are respectful and supportive of our program.

Meet the Author

Morris Berman

Dean, MCPHS University School of Optometry, Worcester
Broadening the scope of practice for optometrists is long overdue and will bring Massachusetts in line with every other state in the nation.  It will also ensure that patients throughout the Commonwealth will have access to the eye care that they need.

Enabling optometrists to practice as they have been trained is a vision that we should all share.

Morris Berman is dean of the MCPHS University School of Optometry in Worcester.