1ELC1014 Example Final Draft

Should optometrists have a prescribing role?

The term prescribing role can be defined as healthcare professionals

2ability to authorize the use of therapeutic drugs by patients. In recent

3decades, optometrists in the United States, the United Kingdom and some
4parts of Canada and Australia have been given a prescribing role.
5However, prescribing role is not available to Asian and European
6optometrists. Academics and pharmaceutical companies hold two distinct
7views on this topic: while some believe that the prescribing role should be
8given to optometrists in order to facilitate faster drug access for patients
9and relieve the pressure of ophthalmologists, others doubt whether
10optometrists have sufficient training and whether they can dispense drugs
11to patients appropriately. This essay argues that optometrists should be
12able to prescribe drugs independently for the benefits of patients health
13and the healthcare system on the condition that more training should be
14given to optometrists in universities.
15

A major criticism when it comes to giving prescribing rights to

16optometrists

is

optometrists

inappropriate

use

of

pharmaceutical

17samples. Drug manufacturers have been complaining that optometrists

18distribute samples to patients instead of writing prescriptions for
19pharmaceuticals, especially for temporary conditions like eye infections.
20They further argue that optometrists offer samples to patients in order to
21enhance their feelings of satisfaction towards their services and promote
22loyalty (Annunziato & Coble, 2006a). This argument appears to be valid
23because sometimes optometrists may give out samples without writing a
24prescription.
25

However, there are a number of situations in which such practice may

26be justified. Patients with an immediate need for a treatment are a good
27illustration.

This

includes

patients

with

short-term

serious

ocular

28conditions, such as ocular infections, who cannot wait for a prescription.

29Urgent treatments are required to improve these patients vision, relieve
30their pain and prevent progression of serious conditions so optometrists
31may justifiably decide to provide samples to them. Since serious ocular
32conditions could be temporary, prescription of drugs may not be needed
33as eyes may recover after the samples are used. Another example
34involves patients who do not have the financial means to purchase drugs.
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35As patients health is the overriding concern, optometrists may give out
36samples to such patients. With the exception of these cases, optometrists
37generally follow the 1 sample = 1 prescription practice. This is evident in
38the case of sampling of glaucoma drugs, which is usually followed by the
39prescription rate of 90% (Annunziato & Coble, 2006b). To summarise the
40arguments above, the claim that optometrists are misusing drugs samples
41may not be justified.
42

Giving

optometrists

prescribing

rights

should

enhance

the

43accessibility of therapeutic ocular care, which would enable patients to

44have more timely treatments. According to the survey conducted by
45Mason and Mason (2002), the accessibility of therapeutic ocular care was
46increased by between 29% and 50% when optometrists in the United
47Kingdom were authorized to prescribe drugs. Similarly, Needle, Petchey
48and Lawrenson (2008) point out that training optometrists as independent
49prescribers allowed patients to have faster access to therapeutic ocular
50care. The evidence from these studies shows that, since optometrists
51serve as the providers of primary eye-care, patients of optometrists with
52the prescribing role could be given immediate treatment as referral by
53optometrists to ophthalmologists would no longer be required. It is
54possible that increasing the convenience of receiving pharmaceutical
55treatment may also encourage more patients suffering from ocular
56diseases to seek medical assistance.
57

Though giving optometrists prescribing rights has clear advantages,

58some critics believe that optometrists may not have sufficient knowledge
59as, compared to doctors, they do not receive rigorous pharmaceutical
60training at university. This concern is understandable as patients safety is
61the primary concern of any healthcare professional.

To address this

62concern and to ensure the safety of patients, authorities should require

63optometrists to receive training on drugs and obtain a license before
64prescribing. The practice of the authorities in the United Kingdom could be
65used as a reference by countries which wish to extend the prescribing role
66to optometrists. The Department of Health of the United Kingdom trains
67qualified optometrists before allowing them to prescribe. The prerequisites
68include having three years of experience in a clinical field, successful
69completion of a university-based prescribing course and a period of
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7ELC1014 Example Final Draft

70supervised practice, and registration with the relevant regulatory body as

71a prescriber (Department of Health, 2008). In this way, patients safety is
72ensured

without

undermining

the

benefits

that

prescription

by

73optometrists brings.
74

Efficient distribution of health-care resources is another positive

75impact that giving the prescribing role to optometrists could bring.

76Optometrists involvement in prescribing would utilize their skills and
77relieve the workload of ophthalmologists. With respect to the utilization of
78optometrists skills, the health minister of the United Kingdom admits that
79authorizing

optometrists

to

prescribe

would

mean

utilizing

their

80professional skills (The College of Optometrists, 2006). The views of

81Needle, Petchey and Lawrenson (2008) are similar as they concede that
82optometrists could use their skills and develop their role to a larger extent
83if they were given training on prescribing. With regard to relieving
84ophthalmologists workload, optometrists would not need to refer patients
85with therapeutic needs to ophthalmologist, as has been mentioned above.
86This would allow ophthalmologists to focus on other aspects of ocular care,
87such as ocular surgery, and thus the waiting time for patients with ocular
88diseases may be reduced. Recent research has suggested a surge in
89phthalmologists workload because of epidemic diabetes and its related
90eye diseases (e.g., Scanlon, Carter, Foy, Ratiram & Harney, 2005) as well
91as increases prevalence of glaucoma, which is expected to rise to 79.6
92million by 2020 (Quigley & Broman, 2006). With the time saved in meeting
93patients with therapeutic needs, ophthalmologists are expected to have
94more time to treat patients with these and other ocular diseases. This
95would be beneficial to both health-care providers and patients as the best
96service could be provided with the finite resources.
97

This essay has analyzed the potential benefits that authorizing

98optometrists to prescribe drugs may bring to patients health and the

99healthcare system and addressed the major concerns associated with
100optometrists as independent prescribers. Giving optometrist prescribing
101rights may lead to easier access to therapeutic ocular care, enable more
102immediate treatments to relieve patients discomfort, enhance recovery
103and prevent aggravation of ocular diseases. Higher efficiency of allocation
104of healthcare resources could also be achieved as optometrists skills
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105would be more fully utilized and ophthalmologists workload would be

106reduced. As the evidence from several countries shows, optometrists are
107capable of prescribing independently if they are given sufficient training
108on drugs in advance. One possible implication for the above finding is that
109authorities in countries which have not yet given optometrists the
110prescribing role, such as Hong Kong and India, could consider doing so. As
111the demand for therapeutic ocular treatment is expected to rise, there is a
112need for optometrists to prescribe to expedite access to drug treatment
113and reduce ophthalmologists workload. However, findings presented
114above may vary from country to country due to differences in education
115systems. More comprehensive research should be conducted on the views
116of the various stakeholders involved in this issue and on the professional
117standards of optometrists in specific countries before optometrists are
118authorized to prescribe independently.
(Word Count: 1188 words, excluding the title and the reference list)

References
Annunziato, T., & Coble, J. D. (2006a). Appropriate use of pharmaceutical
samples in the optometric practice. Journal of the American
Optometric Association, 77(8), 405-412.
Annunziato, T., & Coble, J. D. (2006b). Toward more accurate prescription
tracking. Journal of the American Optometric Association, 77(9), 459462.
Department of Health, The United Kingdom. (2008). Prescriptions from
Your High Street Opticians. Retrieved from
http://www.gnn.gov.uk/environment/fullDetail.asp?
ReleaselID=310329&NewsArealID=2&NavigatedFromDepartment=Tr
11

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ue.
The College of Optometrists. (2006). Independent prescribing for
optometrists is in sight. Retrieved from http://www.collegeoptometrists.org/en/college/news/index.cfm/indpendentprescribing.
Mason, A., & Mason, J. (2002). Optometrist prescribing of therapeutic
agents: findings of the AESOP survey. Health Policy, 60(2), 185-197.
Needle, J. J., Petchey, R., & Lawrenson, J. G. (2008). A survey of the scope
of therapeutic practice by UK optometrists and their attitudes to an
extended prescribing role. Ophthalmic & Physiological Optics, 28(3),
193-203.
Quigley, H. A., & Broman, A. T. (2006). The number of people with
glaucoma worldwide in 2010 and 2020. The British Journal of
Ophthalmology, 90(3), 262-267.
Scanlon, P. H., Carter, S., Foy, C., Ratiram, D., & Harney, B. (2005). An
evaluation of the change in activity and workload arising from
diabetic ophthalmology referrals following the introduction of a
community based digital retinal photographic screening
programme. British journal of ophthalmology, 89(8), 971-975.

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