‘Eyeball wars’ winding down, thanks to legislation

After years of blind discord, optometrists and ophthalmologists may finally see eye-to-eye on a bill set to become law on July 1.

For decades, optometrists have been fighting to prescribe limited oral medications, such as antibiotics, to treat certain eye conditions. But under Florida law, they are limited to writing scripts only for topical medications. Ophthalmologists, who are medical doctors, have long argued that allowing optometrists new prescription powers could harm patients.

“It takes a long time before you become familiar with medications and conditions that affect the eye,” said West Palm Beach ophthalmologist Dr. Nunzio Sossi. “Optometrists may not realize that something else in the body is really affecting the eye. From a patient perspective, it’s much safer if a medical doctor prescribes systemic medications.”

Miami optometrist Adam Clarin said changing the law would help, not harm, patients.  If, for example, a patient has herpes in the eye, all Clarin can prescribe are eye drops that need to be administered nine times a day. Clarin has to refer the patient to an ophthalmologist – a visit that costs more and can take weeks to schedule – or send him to a walk-in clinic, where a physician’s assistant, with less schooling than an optometrist, can write the prescription.

eye dropsIf the law passes, the optometrist can prescribe an antiviral pill taken once a day.

While optometrists are not medical doctors, they attend four years of optometry school, which includes a year of pharmacology, Clarin said.

“I was in the same exact same class with dentists who can prescribe scheduled narcotics,” he said. “I took every test they took. The irony is that we send [ophthalmologists] most of their patients on a referral basis.”

The long-standing fight between the two groups — dubbed the Eyeball Wars by politicians and the media — looks like it’s winding down. The bill has passed the House of Representatives and is scheduled to go before the state Senate on Wednesday (March 27).

Sen. Joe Negron, R-Stuart, is chairman of the appropriations committee, where the bill passed unanimously on March 21. After years of wrangling on both sides, he said the two groups of eye experts finally found common ground.

“You only have two eyes, and the rules surrounding the medical treatment of eyes is a very important and significant issue,” Negron said.

The Florida Medical Association has long invested its political capital to back the ophthalmologists’ position. But doing so has handicapped the organization’s legislative support on other issues, Florida Medical Association President Dr. Miguel Machado said in a letter to colleagues last year. Many ophthalmologists side with optometrists on the issue, Machado added, and nearly every other state already allows optometrists to write scripts for oral medications.

The law would prohibit optometrists from prescribing addictive painkillers in most cases and would also require them to complete a board-approved course and exam on general and ocular pharmaceuticals.


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