In Alabama we can prescribe just about any oral that we need to, including steroids. We are well trained in pharmacology. At UAB we take general pharmacology with the dental students and then complete additional specific ocular pharmacology course work. I once heard that we have more lecture hours devoted to pharmacology than the medical students at UAB. We do such things to "prove ourselves" no doubt. Optometry school is 4 fun filled years including the summers at UAB. You can pack in a whole lot of info in what amounts to class from 8am-5pm everyday for 3 years and one full year of clinic. How much we can retain is a another question lol.
To be quite honest though the need to prescribe oral steroids does not occur all that often in primary eye care. Conditions that I can think of that we more commonly Rx oral meds for are oral analgesics for pain, antibiotics for conditions such as preseptal cellulitis or more commonly things like Tetracycline or Doxycycline for ocular rosacia or a chalazia, oral CAIs (diamox) for angle acute angle closure, and maybe some antivirals for things like HSV.
In eyecare topicals, in general, tend to be more effective and targeted therapies. Topicals have the significant benefit of having less systemic side effects. Any of the Glaucoma meds, topical steroids, topical antibiotics, and topical antihistamines are used orders of magnitude more frequently than any oral meds in eyecare, including ophthalmology. Vigamox, Zymar, Pred Forte, Patanol, Restasis and any of the prostaglandin analogs, topical NSAIDs (acular) and maybe atropine/homatropine/cyclo probably account for 9 out of 10 (or more) Rx's written by O.D.s. This of course does not count any of the drugs that are used diagnostically.
Below you will find the law governing optometry in AL.
(4) PRACTICE OF OPTOMETRY. The practice of optometry is a learned profession involving the examination, measurement by objective and subjective means, diagnosis, treatment and prevention of any departure from the normal of the human eyes, their adjacent structures, and visual system. The practice of optometry includes, but is not limited to: The adapting and fitting of all types of lenses or devices, including , contact lenses; the determination of refractive error and shape of the eye and visual, muscular or anatomical anomalies of the eye through the use of any means including the use of self testing device and the use of any computerized or automatic refracting device; the determination and prescribing of spectacle or contact lens parameters; the administering and prescription of pharmaceutical agents rational to the diagnosis and treatment of disease of the human eye and its adjacent structures; the removal of superficial foreign bodies from the human eye and its adjacent structures; the providing of developmental and perceptual therapy for the vision system; the utilization of any method or means to diagnose and treat diseases of the human eye and its adjacent structures as determined and approved by the board, subject to the limitations of this act; the performance of primary eye care procedures or ordering of laboratory tests rational to the diagnosis and treatment of conditions or diseases of the human eye and its adjacent structures as determined and approved by the board, subject to the limitations of this act. The practice of optometry shall include the prescribing and administering of narcotic analgesics pursuant to the Alabama Uniform Controlled Substances Act, except for narcotic analgesics classified under Schedule I and II, and any Schedule III pharmaceutical agents that contain Dihydrocodeinone (Hydrocodone). The prescribing or administering of any other Schedule III pharmaceutical agent shall be limited to a prescription, the duration of which does not exceed 96 hours. Notwithstanding any provision of this act to the contrary, the practice of optometry shall include the prescribing and administering of pharmaceutical agents which are commonly known as steroids. Optometrists are prohibited from performing injections into the eyeball, cataract surgery, muscle surgery, retinal surgery, radial keratotomy, laser surgery, cryosurgery, or any other invasive surgery. The Alabama Board of Optometry shall be a certifying board as defined in Section 20-2-2, except as limited by this act. The practice of optometry shall include the authority to administer benedryl, epinephrine, or other medication to counteract anaphylaxis or anaphylactic reaction. The use and prescribing of pharmaceutical agents for the treatment of the human eye and its adjacent structures shall be limited to those optometrists approved by the board.
