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• W2511358534 abstract "The optometric associations of Ontario and Canada took note of this article and, although perplexed by the title and several conclusions, thank the authors for providing a number of important insights supporting the competency and need for ongoing scope expansion for the profession of optometry. Notwithstanding the broader title, the objective of “reporting on optometry prescribing and adherence to regulations” attempts to draw statistically significant conclusions from an extremely underpowered sample size of 9, representing 0.4% of the study cohort (n = 1965), during a time of significant regulatory change to the legislated scope of optometric practice. Interestingly, the authors do observe that “most of the non-regulation prescribing observed seemed reasonable.” In fact, there was nearly 70% agreement between optometrists and ophthalmologists in the management decisions of all cases referred, an extremely positive finding given that Ontario optometrists received prescribing privileges1Ontario Regulation 112/11. Designated drugs and standards of practice. 2011. Accessed June 27, 2016. URL: https://www.ontario.ca/laws/regulation/110112Google Scholar only 90 days before the start of the study. Knowing the incidence and prevalence of bacterial conjunctivitis and keratitis, it could be inferred that optometrists provided more appropriate management for these conditions than nonophthalmological physicians in primary care or emergency room settings.2Azari A.A. Barney N.P. Conjunctivitis: a systematic review of diagnosis and treatment.JAMA. 2013; 310: 1721-1729Crossref PubMed Scopus (298) Google Scholar The Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) study highlights the need to be judicious when prescribing topical antibiotics to avoid further issues with antibiotic resistance.3Haas W. Pillar C.M. Torres M. Morris T.W. Sahm D.F. Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) 2009 surveillance study.Am J Ophthalmol. 2011; 152: 567-574Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar Results from Johnson et al. indicate that topical antibiotics were by far the most frequently prescribed therapeutic by nonophthalmologist physicians. This supports our view that optometrists are better suited as first-line providers when treating patients presenting with acute red eye, to avoid overprescribing antibiotics when not clinically necessary. Additionally, the authors make reference to the lack of restrictions in place with regard to optometry regulations for prescribing therapeutic agents across Canada for the “treatment of serious and potentially blinding conditions, including infectious keratitis.” This observation would seem to lend support to extending to optometry the privilege of ordering diagnostic laboratory tests, which Alberta and Manitoba optometrists were recently granted, when appropriate. Johnson et al are to be commended for recognizing that “consideration could be given to amending regulations to allow for prescription of glaucoma medications in a wider number of settings.” The data indicating that only 1 in 9 optometrists adhered to the glaucoma prescribing “guidelines” were irrefutably underpowered, but they demonstrate the recommendation for amending regulations. The other 8 out of 9 optometrists undoubtedly made an appropriate referral and provided the patient with treatment more quickly in their care. Given that optometrists across North America and Europe have long demonstrated the knowledge, skill, and judgement necessary to independently and competently medically manage patients with glaucoma, we agree that the regulations should be amended.4Fingeret M. The optometrist’s role in glaucoma care.Glaucoma Today. 2014; : 30-31Google Scholar, 5Azuara-Blanco A. Burr J. Thomas R. et al.The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma.Br J Ophthalmol. 2007; 91: 1639-1643Crossref PubMed Scopus (48) Google Scholar, 6Ho S. Vernon S.A. Decision making in chronic glaucoma—optometrists vs ophthalmologists in a shared care service.Ophthalmic Physiol Opt. 2011; 31: 168-173Crossref PubMed Scopus (29) Google Scholar, 7Cheng J. Beltran-Agullo L. Trope G. Assessment of the quality of glaucoma referral letters based on a survey of glaucoma specialists and a glaucoma guideline.Ophthalmology. 2014; 121: 126-133Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 8Banes M.J. Viswanathan A. Garway-Heath D. Agreement between optometrists and ophthalmologists on clinical management decisions for patients with glaucoma.Br J Ophthalmol. 2006; 90: 579-585Crossref PubMed Scopus (51) Google Scholar Although most provincial regulations, such as Ontario Regulation 112/11, allow for independent management of open-angle glaucoma, optometrists maintain steadfast support for principles of patient-centred collaborative care, such as those outlined by the Eye Health Council of Ontario (EHCO) in their guidelines for the care of patients with glaucoma, diabetes, and age-related macular degeneration (AMD), while recognizing each profession’s autonomy, including the privilege of self-regulation and the responsibility of self-education.9Eye Health Council of Ontario Writing CommitteeEye Health Council of Ontario guidelines for the care of patients with glaucoma.Can J Optom. 2013; 75: 35-40Google Scholar, 10Eye Health Council of Ontario Writing CommitteeGuidelines for the collaborative management of persons with diabetes mellitus by eye care professionals.Can J Optom. 2011; 73: 16-25Google Scholar, 11Eye Health Council of Ontario Writing CommitteeGuidelines for the collaborative management of persons with age-related macular degeneration by health- and eye-care professionals.Can J Optom. 2015; 75: 2-11Google Scholar Canadian optometrists remain committed to continued partnership with ophthalmologists and family physicians in providing accessible, quality eye care to the population by ensuring the most effective use of the continuum of eye care professionals in the interests of patient safety, quality of care, and cost-effective delivery. This commitment is formally set out in EHCO’s mandate12Eye Health Council of Ontario: Mandate. 〈http://ehco.ca/wp-content/uploads/2015/11/EHCO-Terms-of-Reference.pdf〉. Accessed June 22, 2016.Google Scholar and in the principles established through the working group of the Canadian Association of Optometrists and Canadian Ophthalmological Society. Indeed, patient and provider demographics (an aging and increasing population of patients being cared for by an aging and decreasing population of ophthalmologists) dictate that exactly this type of collaboration must not only continue, but also increase. The Canadian Ophthalmological Society has acknowledged as much, saying “in glaucoma care … we have reached a crisis in resources … the status quo is no longer acceptable.”13Buys Y.M. Nicolele M. Interprofessional care and collaboration: are ophthalmologists and optometrists ready?.Can J Ophthalmol. 2015; 50: 422-428Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar We agree that it is becoming apparent that “ophthalmology may … have to collaborate more with optometry to meet the public’s needs.”14Bellan L. Future trends in ophthalmology health human resources in Canada..Can J Ophthalmol. 2016; 51: 136-141Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Rest assured that optometrists share the vision of Drs. Budning and El-Defrawy to work together to “better clarify and define shared care paradigms … so that the patient receives the correct care, delivered by the appropriate provider.”15Budning A. El-Defrawy S. Interprofessional collaboration in eye health care.Can J Ophthalmol. 2016; 51: 130-132Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Only in an environment that recognizes competence and allows and encourages all professionals to practice to the full scope of their training and abilities can this vision be realized. Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, OntarioCanadian Journal of OphthalmologyVol. 51Issue 3PreviewTo report on patterns of optometry prescribing and adherence to prescribing regulations at a tertiary care ophthalmology centre. Full-Text PDF" @default.
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• W2511358534 title "Re: Johnson et al. Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario (Can J Ophthalmol 2016;51:168–73)" @default.
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