In 49 states, patients who require eye care will receive excellent treatment and a full range of services from their hometown optometrist. Standing alone is Massachusetts, where outdated laws forbid fully trained and educated optometrists from directly treating their patients diagnosed with glaucoma or from prescribing oral medications to treat eye infections.
Health care professionals are motivated by the opportunity to care for patients, ideally with the greatest efficiency and for the lowest possible cost. So why are Massachusetts legislators prohibiting optometrists from treating the patients they diagnose? This inaction leaves many patients in an undesirable and dangerous position.
Consider this common scenario; a single Mom brings her child into a community health center in Boston for treatment of a swelling of his upper eyelid. The optometrist correctly diagnoses pre-septal cellulitis; inflammation and infection of the eyelid and skin around the eye. The common treatment for this malady is an oral antibiotic. In every other state optometrists prescribe these routinely and would have treated the infection immediately, but in Massachusetts the patient must be referred to an ophthalmologist. Now this mom is faced with excessive inconvenience, duplicate visits, more expense in terms of co-pays, deductibles and co-insurance, time off work, and a delay in treatment to her child. The child is in pain longer and it puts him/her at risk should the infection spread.
Another common scenario is an elderly glaucoma patient seen at a his/her local Boston community health center who delays their treatment by months because he/she ran out of glaucoma drops and was unable to or didn’t want to go through the hassle and expense of setting up an ophthalmology appointment at a downtown location.
These patient experiences are common but they represent preventable barriers to access and care. In fact, delays in treatment are daily, but unnecessary; they often lead to adverse outcomes and patient anxiety.
These types of healthcare delivery and access problems should not exist in Massachusetts, which rightly enjoys a reputation as a nationwide leader in medicine and treatment of patients. These are problems with an easy solution; legislation is currently pending that will allow optometrists to provide glaucoma care and administer oral anti-infectives as is done successfully in every other state in the USA.
This legislation will ensure excellent care which increases access, is timely, cost effective and what 86% of the people of Massachusetts desire. It eliminates unnecessary reliance on expensive surgical specialists. It saves time and money for patients and for the state’s Medicaid program. A 2017 study by Health Management Associates placed annual savings at $20 million for Medicaid and $53 million to the health care system overall. This is wasted money for the people of Massachusetts.
This legislation is the right thing to do, and provides the people of Massachusetts with the most timely and effective treatment. Glaucoma is the second leading cause of blindness worldwide and affects more than 3 million Americans. The disease is best treated through early diagnosis and consistent, managed treatment. With only about 325 practicing ophthalmologists in Massachusetts compared to more than 1,500 optometrists, patients would no longer have to wait weeks before they receive initial treatment and critically important follow up care following diagnosis. This is especially true in rural areas, nursing homes, and community health centers, where access to ophthalmologists is particularly limited and difficult.
A testament to how archaic our eye care laws in Massachusetts are is demonstrated by a 2016 analysis by the Department of Justice’s Antitrust Division and the Federal Trade Commission. The agencies took the unusual step of sending a letter encouraging Massachusetts “legislators to avoid restrictions that are not necessary to address well-founded patient safety concerns” further they urged increased access to glaucoma care, stating that increased availability of glaucoma treatment “has the potential to bring the benefits of competition to Massachusetts health care consumers.”
The time has come for Massachusetts to align itself with every other state in the country by allowing optometrists to directly treat glaucoma and prescribe oral anti-infectives, lowering expenses for patients and insurers while increasing our standard of, and access to, the vital eye care they need.
Dr. Wayne Zahka, OD, is an optometrist in Westwood and past president of the Massachusetts Society of Optometrists.