Saturday, April 08, 2017
Eye specialists in Massachusetts are split over pending legislation that would allow optometrists to treat glaucoma, rather than requiring attention from medical doctors — a move proponents say could save Medicaid dollars and remove some patient burden.“It’s common sense legislation,” said Dr. Matthew Forgues, president of the Massachusetts Society of Optometrists. “Optometrists see the majority of the patients. We’re the ones diagnosing the glaucoma.”
As it stands, optometrists must refer patients to ophthalmologists — who go through more training and obtain medical degrees — to receive treatment for glaucoma, a disease characterized by high pressure in the eye that can lead to blindness.
The bill would allow optometrists to prescribe treatments for glaucoma and various eye infections, sparing patients an extra appointment and additional co-pay. Massachusetts is the only state that has not already expanded treatment abilities for optometrists.
Forgues said it would also save the state an estimated $20 million annually, given the higher Medicaid rates for specialists.
The state Senate has passed similar legislation six times, but it has yet to be passed by the House.
The new, modified bill may have a better shot — it would no longer allow optometrists to prescribe opioids and administer injections around the eye, provisions included in past versions.
“I’m encouraged it’s got more acknowledgement of patient safety concerns,” said Dr. John Mandeville, president of the Massachusetts Society of Eye Physicians & Surgeons.
But, he said, the cost saving estimates are “dubious.”
Ophthalmologists argue that glaucoma is not just an eye condition, but a complex, neurological disease that is difficult to both diagnose and manage and should be evaluated by someone who has gone to medical school. While optometrists have four years of training outside of college, they do not hold medical degrees. Treatment options go beyond standard eye drops, said Dr. Angela Turalba, associate director of glaucoma service at Massachusetts Eye and Ear Infirmary.
“Surgical options have expanded now,” Turalba said. “It does require a lot of training and continued medical education to know when something else is needed.”
And while optometrists are a valued part of eye care, she said, there should “be a model where ophthalmologists and optometrists can take care of glaucoma patients in a responsible way both medically and fiscally.”