Sponsor Statement for SB 173: Optometrists and Pharmaceuticals

An Act relating to the use of pharmaceutical agents in the practice of optometry; and providing for an effective date.

Last Updated:	January 23, 2002
Contact:	Senator Austerman's office at (907) 465-2487

Optometry is a primary health care profession that examines, diagnoses, and treats disorders of the human eye and its appendages, utilizing diagnostic and therapeutic medications, methods, and procedures in accordance with professional training and competency. Education consists of a Bachelor's Degree followed by a 4-year professional program of didactic and clinical training to receive a Doctor of Optometry degree (O.D.). Many graduates then take an additional one-year residency specialty. This is identical to the training for dentistry.

The courses of instruction in pharmacology and use of medication are equivalent in scope and hours as taught in medical, dental, and podiatry schools, with many more hours of emphasis on treating the eye. Historically, medical doctors have enjoyed unlimited legislative trust in their scope of practice. The methods and procedures used by other limited license health care professions (dentists, podiatrists, nurse practitioners) are determined in regulations by their respective state boards.

Currently, Alaska's optometrists (O.D.) have their scope of practice unduly restricted by old state statutes. For every new advance in technology, optometry has to return to the legislature to update statutes to practice at the highest standard of care. In the U.S., states began authorizing use of drugs by optometrists in 1971, as optometry schools advanced their education.

Alaska's optometrists have been trying to update the statutes for over 25 years. In 1988, after over 12 years of attempts, the statutes were finally updated to allow optometrists to use diagnostic drugs. Alaska was 49th out of 50 states to enact this law. In 1992, the prescribing of therapeutic drugs to treat eye diseases was authorized in Alaska, as the 32nd state to enact. However, due to a compromise in the original bill, only topical medications were allowed at that time. There have been no complaints to the Alaska board concerning drug prescriptions by optometrists since 1988 to the present.

Currently in the U.S., all 50 states authorize optometrists to prescribe drugs, with 37 states allowing oral or systemic drugs, while 13 states, including Alaska, restrict to topical drugs. One other state law and two other state boards have authorized the use of lasers by optometrists. In every state for over 30 years, the medical doctors (M.D.) have opposed these and similar bills of other health professions to provide more accessible, better quality, and cost-effective care for their patients. Optometrists provide primary and secondary eye care, while the ophthalmologists provide secondary and tertiary specialty eye care, the same as family doctors relate to cardiologists or neurosurgeons.

In 1997, a bill (HB 195) was introduced and heard that would have expanded the scope of optometry to include all medications for the eye, as well as the use of lasers and limited minor surgical procedures for qualified optometrists, as are now being taught. Such "As Qualified" statutes, where scope is determined by the board, is how Alaska's advanced nurse practitioners are regulated.

In 1998, SB 78 was introduced, and unlike the previous HB 195, it did not contain the expanded scope of lasers and surgery, but would have only allowed the additional medications to be prescribed by qualified optometrists. There was virtually no opposition to this compromise bill in committee hearings for the two?year session. SB 78 was passed by the legislature, but vetoed by the Governor, citing possible inadequate board oversight of training and testing, and concern regarding eye injections.

For 2001, this current bill is similar to SB 78, but with further limitations and board authority for ensuring competency. It will change the scope of board-endorsed optometrists to prescribe the additional medications beyond topical for treatment related only to the eye. It prohibits injections into the globe of the eye. It further allows the board to require additional education for endorsement, and to apply limitations to a licensee's endorsement.

It would be best to have a full scope of practice statute regulated by the board, as the nurse practitioners currently have, but this small compromise step is the best hope of enactment. Future legislation may further update the statutes.

This bill will allow Alaskan optometrists to practice at the currently accepted standard of care, and once again provide improved access to quality, cost-effective eye care. Alaska has over 90 optometrists in over 20 communities, plus traveling to many isolated villages, providing quality comprehensive eye care.

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