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Focused on the fix

Proposal to streamline treatment of glaucoma has eye care professionals at odds

By Kaitlin Milliken

Boston University Statehouse Program

BOSTON – When Worcesterbased optometrist Dr. Matthew Forgues performs regular eye checkups, he tests for glaucoma – a collection of diseases affecting the optic nerve, which connects the eye to the brain. However, if he finds a patient has the disease, he cannot prescribe treatment.

“We provide all of the testing,” said Mr. Forgues, president of the Massachusetts Society of See GLAUCOMA, A10

Dr. Matthew Forgues demonstrates how he uses a slit lamp microscope to examine eyes at his optometrist office in Shrewsbury Friday. [T&G STAFF/RICK CINCLAIR]

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Optometrists. “Instead of providing them a prescription, we have to refer them to an (ophthalmologist).”

A bill proposed in the Massachusetts Legislature could streamline treatment for the eye disorders. But it has created a point of contention for eye care professionals, with optometrists like Mr. Forgues and ophthalmologists on opposing sides.

Optometrists are health care professionals who receive a doctor of optometry (O.D.) degree after four years of optometry school. Ophthalmologists receive an M.D. degree after four years of medical school, often followed by specialty training.

The proposal sponsored by Rep. Bradley Jones, R-North Reading, would allow optometrists to write prescriptions for eye drops to treat glaucoma. They would also be able to prescribe antibiotics to heal sties and other conditions.

According to the American Optometric Association, 5,800 people in Massachusetts are affected by glaucoma, the second leading cause of blindness in the state. “The required referral to an ophthalmologist creates unnecessary delays and prevents patients who are at risk of permanent vision loss from receiving immediate treatment,” Mr. Jones said. “We know that this disease can have devastating effects on a patient, so it is imperative that we provide the best opportunity for the early detection and treatment of glaucoma.”

According to Mr. Jones, the current system that requires a referral creates additional costs for both patients and insurers. Two appointments equals two co-payments and two charges to insurance providers. Further, a study conducted by Tom Dehner of the Health Management Associates found that the legislation could save MassHealth $20 million annually.

Optometrists, who are trained to perform vision exams and prescribe glasses, argue that the change is long overdue. Massachusetts is the only state in the country that does not allow optometrists to provide treatment for glaucoma.

“Not only have 49 states allowed optometrists to do this, the last state to (pass legislation) did so in 2004,” Mr. Forgues said. “We are 13 years behind on this.”

Currently, hospitals in Massachusetts run by the U.S. Department of Veterans Affairs follow national guidelines, which allow optometrists to write prescriptions for drugs to treat glaucoma.

“If I was seeing someone in (the) VA system, I can write a prescription, but I go across the street to my office in Worcester, and I can’t,” Mr. Forgues said. “My qualifications haven’t changed. It’s ridiculous.”

However, organizations representing ophthalmologists, specialized physicians trained to diagnose and treat eye diseases, have opposed the proposed change. Dr. Deanna Ricker, president of the Massachusetts Society of Eye Physicians and Surgeons, said the language of the bill is too vague and much broader than legislation in the other 49 states.

She worries that the proposal goes beyond just prescribing eye drops for glaucoma, saying the wording of the bill could allow optometrists to prescribe other drugs that could cause harm to patients when not properly used.

“Quite frankly, the education and training are very different for ophthalmologists and optometrists,” Ms. Ricker said. “(Optometrists’) training doesn’t give them the level of sophistication that someone would want a (person who) prescribes these medications to have.”

While the bill also requires that optometrists undergo 60 hours of additional training to treat eye disorders, Ms. Ricker said that does not compare to the thousands of hours of education ophthalmologists receive.

“The education is clearly provided in every optometry institution,” said optometrist Morris Berman. “Traditional ophthalmologists are quick to point out that we are not educated (on glaucoma care) but that’s really a myth.”

Mr. Berman is the dean of the Massachusetts College of PharmacyandHealthSciences’ School of Optometry – one of two facilities in the state that train future optometrists. Faculty prepare students to provide care anywhere in the country. As 49 other states allow optometrist to treat glaucoma, the curriculum includes this care.

When asked if the Massachusetts Society of Eye Physicians and Surgeons would be willing to work on a compromise version of the bill, Ms. Ricker said her organization would “value the opportunity to work with the Joint Committee on Public Health to ensure access to quality eye care.”

Similar bills have been passed

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