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Ophthalmologists see red over bill to expand optometrists’ Rx authority

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Ophthalmologists see red over bill to expand optometrists’ Rx authority

Ophthalmologists are seeing red over a bill that would expand the ability of Arizona optometrists, who aren’t medical doctors, to prescribe medications.

Joined by three Republican lawmakers, they held a news conference Wednesday to say the change would undermine the safety of patients while failing to achieve what supporters say is a key goal: increasing access to eye care in rural areas.

“An optometrist isn’t an ophthalmologist-lite,” said Rep. Heather Carter, R-Cave Creek, chairwoman of the House Health Committee. “They are two distinct and important practices, and one should not be confused for the other.”

Among other provisions, HB 2380 would allow optometrists to prescribe oral anti-infectives, carbonic anhydrase inhibitors and steroids to those ages 6 and older. Opponents said those drugs pose severe health risks to patients if administered incorrectly.

Optometrists in the state are currently able to prescribe and administer antihistamines, nonsteroidal anti-inflammatory agents, antibiotics and over-the-counter and topical pharmaceuticals.

Contained in a bill by Rep. Justin Olson, R-Mesa, that originally dealt with tax liens and had won House approval, the new provisions resulted from a strike-everything amendment offered by Sen. Nancy Barto, R-Phoenix, chairwoman of the Health and Human Services Committee.

The Senate voted 20-7 to approve the bill Wednesday. That sent it back to the House, which can vote to accept the changes or send it to a conference committee to resolve the differences.

Sen. Kelli Ward, R-Lake Havasu City, a family physician, said though optometrists know eyes it’s ophthalmologists who have clinical experience from residency and fellowship programs. She said an understanding of the eye and whole body are needed to grasp the potential side effects of drugs.

“This bill seeks to remove that, and I think that’s a very dangerous precedent,” she said.

The bill has support from the Arizona Optometric Association.

Michael Kozlowsi, an optometrist who spoke in favor of the measure before the Senate Health and Human Services Committee, said in a phone interview that failing to pass HB 2380 would leave Arizona behind states where optometrists are licensed to prescribe not just topical steroids but oral medications covered by the bill.

“I think in the current health climate, where optometrists are performing more primary eye care in Arizona, we need to give them the tools to do a good job. That’s really what it all comes down to,” he said. “With any drug there are dangers, but we don’t intend to begin using drugs without training.”

Don Isaacson, a lobbyist representing the Arizona Optometric Association, said optometrists hold four-year doctoral degrees and pass national board exams. Because there are three times as many optometrists as ophthalmologists in Arizona, he said, expanding their ability to prescribe medications would enhance eye care throughout Arizona.

“Optometrists are everywhere, and ophthalmologists tend to be in the cities because they’re surgeons,” he said. “This is so these doctors can fully use the training they have and the tested competence they’ve shown and bring a broader range of care to all communities.”

Barto’s office said she was on the floor all day Wednesday and unavailable to comment.

At the news conference, Carter said that Arizona’s robust system of mobile clinics means that access to ophthalmologists in rural areas isn’t as difficult as the bill’s supporters contend.

“We should be looking at innovative ways to continue to deliver that care by an ophthalmologist,” she said.

Dr. Sara Bode, a Valley pediatrician representing the American Academy of Pediatrics, said that providing eye care across the state is an admirable goal but that expanding the scope of practice may not necessarily translate to better health care for children.

“Kids are not little adults; they have specific needs,” she said. “This bill in particular allows optometrists to give fairly dangerous oral medications to kids that can often have serious enough side effects that they can result in hospitalization or even death if they’re not recognized early.”

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