This longstanding legislative fight goes by the apt, but somewhat silly name of the “eyeball wars.”
The dispute, again reigniting in Tallahassee, pits ophthalmologists against optometrists over authority to prescribe certain medications, treat some eye conditions and even the right to call oneself a “physician.”
Most notably for patients, bills this year would expand prescribing authority of oral medications to optometrists — eye specialists patients usually see for routine care — taking them from the exclusive realm of ophthalmologists, who are medical doctors.
State Rep. Matt Caldwell, R-Lehigh Acres, has introduced the House bill to expand prescribing authority to optometrists. State Sen. Garrett Richter, R-Naples, has proposed a similar measure.
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The bills would bar optometrists from prescribing the most powerful, and addictive, painkillers. But, drugs like Vicodin would not necessarily be excluded if they serve a medical purpose.
Optometrists may only provide topical medication, but must refer patients elsewhere if they need those treatments in pill form. For supporters of the measure, it’s an unnecessary burden on patients.
“If I need laser eye surgery I’m going to see an ophthalmologist with a full M.D.,” Caldwell said. “But, if I need a simple eye exam and maybe some minor considerations — an analgesic, for example, for a mild eye irritation —do I need to see a ophthalmologist for that?”
The stakes are particularly big in Florida, whose older population has higher rates of certain visual impairments, including cataracts (26 percent of the state versus 16 percent nationally); and glaucoma (5.4 percent in Florida versus 2 percent nationally), according to the Centers for Disease Control and Prevention.
Supporters of expanding prescribing authority say it would help reduce health care costs and make treatment more available to communities short on ophthalmologists.
Lee County has 45 ophthalmologists, compared with about 100 optometrists, according to state records. Similarly, Collier counts about 25 ophthalmologists and 40 or so licensed optometrists.
“This authority has been granted by 48 states,” reads a statement from the Florida Optometric Association. “It saves money, increases access to eye care, and saves people from losing vision due to treatment delays.”
North Fort Myers optometrist Dr. Terry Tucker, a 30-year practitioner, said he’s more than knowledgeable enough to prescribe most prescription drugs his patients would need. He estimates he refers 1 to 2 patients each week elsewhere to get prescriptions.
He said there restrictions are “pretty stupid.” Allowing optometrists to write drug prescriptions would particularly help patients in rural areas where there are fewer M.D.s, he said.
“Is there a vast need for it here? Not necessarily,” he said. “But when I need it, I need it.”
Florida’s ophthalmologists, who are eye doctors with medical degrees, argue allowing an expansion of prescribing authority is a dangerous move. Their lobbying arm, the Florida Society of Ophthalmology, warns on its website “Passage of these bills would put the patients of Florida in grave danger!”
The organization also claims concerns about ophthalmologist shortages are unfounded. It claims Florida has the nation’s sixth-largest concentration of these eye doctors and ophthalmologists are “within 20 minutes of any Florida patient.”
Ophthalmologists have backing of the Florida Medical Association, the lobbying arm of the state’s medical doctors, which also opposes a similar measure that would expand prescribing authority to the state’s nurse practitioners.
Dr. Charles Slonim, a Tampa-area ophthalmologist who speaks for the society, likened the difference between optometrists and ophthalmologists to that between lawyers and paralegals.
“We know that, for whatever reason, they didn’t go into medical school. They chose to go into a profession surrounded by medical professionals,” Slonim said. “I just want to make sure our patients are safe.”
Optometrists earn doctorates and commonly call themselves “optometric doctors” and “physicians,” terms ophthalmologists consider misleading. A competing measure would prohibit them from calling themselves physicians.
It’s unclear if that will ever pass. But even ophthalmologists believe they are outspent by the optometry lobby.
“I think it’s going to happen eventually,” said Dr. Austin Coleman, a Naples-based ophthalmologist. “They’re just going to keep knocking at it and knocking at it.”
Both measures face committee hearings, so it’s unclear if either will eventually win passage in the Legislature. A deal last year fell through at the last minute.
“This has been going on forever,” Caldwell said. “It’s older, really, than I am, and I’m 32.”