LINCOLN — Optometrists in Nebraska want the state's OK to perform more procedures, a move opposed by ophthalmologists.
Optometrists disagree and say it's partly a matter of improving Nebraskans' access to health care. About 400 optometrists practice across the state, while 109 ophthalmologists practice mostly in Nebraska's largest population centers. Some ophthalmologists also have satellite clinics across the state that are open a number of days each month.
Nebraska optometrists want to:
» Prescribe oral steroids, oral anti-glaucoma medications and oral immunosuppressants.
» Use epinephrine or “epi” pens when necessary and inject medications into the eyelid for the treatment of cysts or infected or inflamed glands of the eyelid.
» Perform surgical procedures to allow for the treatment of cysts or infected or inflamed eyelid glands.
The optometrists say their peers in a majority of states already are allowed to prescribe the medications and use epi pens; fewer than 20 states allow optometrists to inject medications into the eyelid and perform the minor surgical procedures.
“We don't see that this increased scope of practice would benefit the public,” said Dr. Millicent Palmer, an Omaha ophthalmologist who is president of the Nebraska Academy of Eye Physicians and Surgeons. “There are patient safety issues or new dangers that could occur.
“We feel that any surgery should be performed by surgeons who are medical doctors who have the training, and (optometrists) should not be prescribing medications that have significant side-effect profiles, and that may include death, even.”
The conditions that optometrists are seeking to treat, Palmer said, are either “non-emergent or non-sight-threatening.”
Dr. Christopher Wolfe, an Omaha optometrist who is legislative chairman of the Nebraska Optometric Association, said multiple office visits to see more than one doctor inconvenience people and take time away from their jobs and family.
“If they have to wait a week to a month or travel a long distance to get the care, that can play a part in their quality of life,” Wolfe said, adding, “The differences between an emergency and urgency are always in the eye of the beholder.”
Representatives from both groups have made presentations to and answered questions from members of a technical review committee of the Nebraska Board of Health formed specifically to review the optometrists' proposal.
Optometrists have successfully sought to broaden their scope of practice before. In the early 1980s, they received approval from the Nebraska Legislature to use diagnostic eyedrops. In the late 1980s, they got the OK to use topical therapeutic medications, such as eyedrops or creams.
In the early 1990s, they received approval to administer oral medications to treat some eye diseases. Later that decade, they were allowed to provide care for glaucoma, a disease that damages the optic nerve.
A 2009 attempt to expand optometrists' scope of practice failed. Among other reasons, state officials told them that proposal was too broad.
Iowan optometrists can do more than their Nebraska counterparts. Iowa optometrists can treat glaucoma with topical and oral drugs; Nebraska optometrists can use only topical drugs.
Iowa optometrists can prescribe oral steroids; Nebraska optometrists can't. Iowa optometrists can use an epi pen if a patient has an allergic reaction to a medication in the office or clinic; Nebraska optometrists can't.
Iowa optometrists can perform surgical procedures to treat cysts on the eyelid; Nebraskans can't.
Wolfe said optometry schools are training students to provide the care that the optometrists are seeking to offer in Nebraska.
“The knowledge, education and training of optometrists has been such where it has expanded to include all these things,” Wolfe said. Permitting the expanded scope of practice, he said, is “a logical step.”
Ophthalmologists counter that the preparation optometrists receive falls far short of what an ophthalmologist gets.
The American Academy of Ophthalmology notes that in addition to completing college and medical school, ophthalmologists typically receive one or more years of general clinical training and three or more years in a hospital-based eye residency program, often followed by one or more years of a subspecialty fellowship.
Administering the medications also requires knowledge of the effects of the drugs on the entire body, ophthalmologists said. Optometrists say they are trained to identify the systemic effects of drugs.
The technical review committee will meet at 1 p.m. Aug. 9 at the State Office Building in Lincoln to conduct a preliminary vote on the proposal, then in September to conduct a public hearing. It will take a final vote in October.
The matter then will go to the Board of Health and to Dr. Joseph Acierno, the director of the Division of Public Health and the state's chief medical officer. All three will write recommendations for the Legislature's consideration.