o.d. to o.d.
A Prescription for Prescribing
About 80% of optometrists are licensed to prescribe drugs. But how many really exercise this privilege in their practices?
BY WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor

Graduating from optometry school in 1975, I remember the frustration of practicing without the ability to prescribe ocular medications.

The long road

The road to prescribing privileges was one that involved time out of the office attending post graduate courses in pharmacology, grand rounds in ophthalmological practices, and hours spent reading Jimmy Bartlett's Clinical Ocular Pharmacology and viewing slides from Lou Catania's "Cornea, Cornea, Cornea." In addition, there were the thousands of dollars donated to Political Action Committees and the countless hours spent in legislative offices across the country making legislators aware of how the public would benefit from extending to optometry the privilege of prescribing medication.

Drug makers show support

Among pharmaceutical manufacturers, optometrists continue to be vocal about their desire to be "detailed" and sampled on medications either on the market or coming to the market. As a result, manufacturers supported us regardless of potential reprisals from ophthalmology. They believe in optometry's role in primary care.

Some of the manufacturers of ocular pharmaceuticals have distinguished themselves by providing detailing and sampling and by sponsoring continuing education at various society meetings.

An underused privilege?

Now with all of the efforts made to provide primary eye care to patients in all 50 states, the changes in curriculum in optometry schools, the education of legislators, the hundreds of thousands of dollars and the countless hours invested by optometrists, are we practicing this expanded scope of eye care?

The answer as you may have expected is that some of us are. It seems that the exercising of optometry's prescribing privileges nationwide follows the 80/20 rule. Twenty percent of the optometrist's licensed to prescribe ocular or oral medication do so, while the remaining 80% underuse their skills or privileges.

Now let's be fair about the circumstances that might limit prescribing. A number of the optometrists who are licensed but do not prescribe medications are involved with teaching or research and are not directly involved in patient care. In addition, optometrists who for years based their practices on vision-related care don't have a patient demographic that supports a primary care practice. Still other optometrists find themselves in retail settings where refractions and spectacle sales are encouraged, while primary care is either frowned on or off limits.

Here I'll apply the 80/20 rule again to encourage those not prescribing to go ahead and prescribe.

Of the optometrists who do not exercise their prescribing privileges, 80% probably have no restrictions limiting their delivery of primary care. They just don't, for whatever reason, exercise their privileges.

In many cases, I believe that optometrist new to primary care feel that if they are going to prescribe anything at all, then they must be totally involved with all aspects of primary eye care. Perhaps the confidence to accurately diagnose and prescribe didn't come with their ability. Let me assure you that everyone, including myself, began it all by writing one prescription.

Take the first step

If you find yourself in the 80% of those who have privileges to prescribe and in the 80% of that 80% who don't, take the first step in diagnosing and then write that first prescription. Make it an easy step. Look for an opportunity to serve a portion of the population that presents to your practice regularly -- the allergy sufferers. Some 20% to 25% of the population have systemic allergies and of those, it's estimated that 60% have ocular symptoms. What could be a better toe in the prescribing waters than offering relief to an allergy sufferer and at the same time, taking your first step in prescribing?