Prescribing medicines

18 February 2015
Optometrists prescribing medicines
 
Some optometrists can prescribe medicines in the same way a medical doctor can. At our practice we have 3 optometrists who can do this.
 
So if your eye is red or sore you can come to one of our optometrists for treatment. We have the necessary equipment and after 5 years studying the eye we are in a great position to help you.
 
Having optometrists prescribe medicines enables New Zealand optometrists to provide a very high standard of care to their patients but it has been a long time coming. Optometrists in the USA have been prescribing medicines for over 30 years.
 
Twenty five percent of practising optometrists in New Zealand are able to prescribe prescription medicines. This percentage is increasing quite rapidly.
 
 
The technical bits…
 
Medicines prescribed by an optometrist prescriber attract the same government subsidies for the patient as if the medicine was prescribed by a medical practitioner.
 
The formulary for designated optometry prescribers includes all topical eye preparations excluding those for glaucoma.
 
The Bachelor of Optometry program at the University of Auckland became a 5 year degree in 2006 in order to accommodate the therapeutic component of the new degree. Graduates from that year onward are able to register immediately in the optometry prescriber scope of practice. Post graduates have needed to complete a 280 hour bridging course.
 
Regulations under the Medicines Act 1981to permit optometrists prescribing medicines came into effect late 2005.
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Optical Coherence Tomography (OCT)

18 February 2015

Optical Coherence Tomography (OCT) is one of the two major advances in ophthalmology over the past 10 years

 

The other is the discovery of Avastin (or Lucentis) – an injection into the eye that prevents the proliferation of destructive new blood vessels within the eye e.g. in macula degeneration or diabetic retinopathy

 

The OCT permits high resolution 2-D and 3-D views of the retina allowing all of the retinal layers to be easily identified. This makes the OCT an invaluable machine in identifying abnormality in these layers and makes the non invasive diagnosis of most retinal diseases much easier. 

This patient presented after noticing small ring in the centre of their right eye vision. Using our regular examination techniques the eye looked normal 

 

Only when we used the OCT could we see this abnormality – it shows all of the retinal layers but especially it shows a hole that shouldn’t be there (compare to the picture of the normal left eye below) (For the expert this is an obvious pseudo lamella hole at the macula caused by traction of a small epi-retinal membrane)

  

OCT also allows us to image and quantify the optic nerve head (ONH) and the retinal nerve fiber layer (RNFL) around the optic nerve head. Detected abnormality in the ONH or the RNFL can be the earliest sign of damage caused by glaucoma – but perhaps even more importantly – it can show more sensitively, change over time i.e. between visits

The cornea iris interface (the drainage angle of the eye) can also be imaged by OCT. This is relevant to the diagnosis of narrow angles that can lead to an acute form of glaucoma (sudden onset, very painful, red eye). Being able to identify these narrow angles before an acute angle closure attack means that preemptive (and simple) treatment to open the angle can be done by a medical eye specialist.

The first image below shows a wide open angle between the cornea and the iris and second shows a very narrow - but not closed angle

All our patients, here at McClellan Grimmer Optometrists will be offered an OCT exam when it is clinically indicated but especially where there is suspicion of glaucoma or where there is a strong family history of glaucoma, where there is unexplained central vision loss or where we need to further assess the macula or other retinal areas