Quality of eye care in Florida in jeopardy

As an ophthalmologist, I am proud to say that the citizens of Florida have the best eye care of any state in the country. This is undoubtedly due to the thousands of outstanding ophthalmologists and optometrists who have been working side by side and in cooperation with each other for decades. Unfortunately, that quality of eye care is in serious jeopardy.

This year a trade group of well financed optometrists — who are not medical doctors — are rushing the Legislature to pass legislation (SB 278 and HB 239) that for the first time in this State’s history would allow optometrists to prescribe a vast arsenal of potentially dangerous oral medications with absolutely no patient safeguards.

If passed, this legislation would be one of the most liberal prescribing laws in the country, and would have none of the patient safety measures that are in the laws in other states. Simply put, these bills would give the Board of Optometry unbridled power to authorize optometrists to prescribe any drug except Schedule I and II narcotics.

Florida already has the unenviable reputation as a “pill mill” state. So it escapes me why the legislature would give thousands of optometrists in our state new prescription pads to prescribe Vicodin, Lortab, Xanax and other habit-forming drugs that can be abused and cause addiction. Moreover, this legislation further blurs the distinction between medical doctors (ophthalmologists) and optometrists, and leaves patients confused as to who is actually treating their eye problems.

My Florida Society of Ophthalmology (FSO) colleagues have spent the last several weeks working on a reasonable and balanced resolution to this debate. If the Legislature believes it is in the public interest to give optometrists oral drug privileges, then those privileges need to be accompanied by real patient safeguards. The FSO has repeatedly advised the legislature that those safeguards should include at a minimum:

• Medical community involvement in defining which oral drugs an optometrist can safely prescribe, to whom the drug can be prescribed, and how long the drug should be prescribed before the optometrist should refer the patient to a medical doctor (MD).

• A clear definition of surgery based on the Guidelines of the American College of Surgeons. At present, Florida law expressly prohibits optometrists from performing surgery of any kind, but it doesn’t define “surgery.” A clear definition would eliminate the temptations of optometrists to perform surgery in conjunction with any new prescribing authority.

• Adverse incident reporting requirements that will allow anyone to track what impact oral prescribing privileges will have on patients. The requirements would equal those currently placed on physicians but from which optometrists are currently exempt.

• Safeguards that would promote a safe, efficient, and transparent patient referral system. There are legitimate concerns that by allowing optometrists to prescribe drugs it will cause them to delay proper referral of patients for necessary medical care. Measures are needed to ensure that patient referrals among and between ophthalmologists and optometrists are timely, and are based on what is best for the patient and not in the economic interests of either the ophthalmologist or the optometrist.

Thus far, our requests for meaningful patient safeguards have fallen on deaf ears, and the legislature seems intent on hurrying the bills through the process. However, as the Session progresses, rest assured that the FSO will continue to ring the bill for patient safety. Let’s hope the legislature listens before any patients are harmed.

Gary S. Schemmer, MD is a board certified ophthalmologist in Winter Haven.

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