Prescriptions by Optometrists

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Shnurek

Shnurek

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I'm not sure how aware other professionals are of the prescription privileges of Optometrists outside the corrective lenses categories but I was just wondering about the extent to which you see ODs write out prescriptions for topical drugs (authority in 50/50 states), oral drugs (authority in 47/50 states) and narcotic drugs (authority in 43/50 states).

I am wondering because I want to get an idea of how many Optometrists out there practice medical eye care and use their scope of practice to the fullest extent.

Thank you for any of your insights 🙂
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Mostly eye drops. I did see one rx for a steroid cream from an optometrist.
 
What states are all of you in? In NY, yes no oral/narc authority. FL and MA also no orals authority.

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Controlled-Substance.gif
 
All4MyDaughter said:
KY. The point is that whether state law allows it or not, people won't go to ODs for medical eye care if they can't use their medical insurance.
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Ya, I was just curious how many ODs actually use/can use their Rx authority. Thanks.

Everyone tells me to move to a place where I'll be able to get on medical insurance panels so that I can practice to the full scope of my license. Most of my local ODs are on medical panels so I thought its pretty popular, but maybe not in other parts of the country.
 
Can you get an NPI number? I think that is required for your prescriptions to be billed to insurance.

I guess optometrists would prescribe drugs for infections and glaucoma. But if they try to prescribe Viagra for their friends I would have to turn them away.
 
pezdispenser said:
Can you get an NPI number? I think that is required for your prescriptions to be billed to insurance.

I guess optometrists would prescribe drugs for infections and glaucoma. But if they try to prescribe Viagra for their friends I would have to turn them away.
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It's not that OD RXs can't be billed to insurance. Not the issue. Issue is many ODs are providers for vision insurance plans, not health insurance plans. So patients have to pay out of pocket for medical eye care.
 
As others have said, 99% of prescriptions written by an OD that I've seen are for eye drops. I believe I've only seen one time where an OD had written Valium for a patient before a procedure.
 
Digsbe said:
As others have said, 99% of prescriptions written by an OD that I've seen are for eye drops. I believe I've only seen one time where an OD had written Valium for a patient before a procedure.
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Ya, ophthalmologists don't really prescribe too many oral drugs either. I was just wondering what the percentages were and this is interesting to me since of course topical drugs are isolated to the ocular system while oral drugs may cause the patient to deal with systemic side effects. Also its not surprising since OD malpractice liability rates are extremely low at around $800 a year.

All4MyDaughter said:
It's not that OD RXs can't be billed to insurance. Not the issue. Issue is many ODs are providers for vision insurance plans, not health insurance plans. So patients have to pay out of pocket for medical eye care.
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This is where it gets iffy. Some Vision Plans cover treatment and diagnosis of ocular disease while others don't. I'm not too knowledgeable about this but what I do know is that people should get comprehensive care when they go see their local eye doctor.
http://www.optometricmanagement.com/articleviewer.aspx?articleid=103472
 
Shnurek said:
Ya, ophthalmologists don't really prescribe too many oral drugs either. I was just wondering what the percentages were and this is interesting to me since of course topical drugs are isolated to the ocular system while oral drugs may cause the patient to deal with systemic side effects. Also its not surprising since OD malpractice liability rates are extremely low at around $800 a year.
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In my pharmacy eye related RXs are probably 90/10 OMD/OD. And we are next food to an OD. I just think they mainly do vision in my area.
 
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All4MyDaughter said:
In my pharmacy eye related RXs are probably 90/10 OMD/OD. And we are next food to an OD. I just think they mainly do vision in my area.
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Ya the older ODs mostly do vision care. They don't want to step into the fray of medical eye care especially since OD training was vastly different 20-30 years ago.

I think the ratio will slowly shift towards ODs in Kentucky since they just passed that laser surgery and self-governing of the profession law. The public should catch on eventually.
 
"Of course I can prescribe Toprol XL! It's opth related. If the person has a heart attack and dies due to their cardiological problems, their eyes won't work!"
 
ODs cannot prescribe any controlled substances, and like other practitioners, can only write within the scope of their practice. It's mostly eye drops, and one time I did fill a prescription for PO acetazolamide for a person whose eye infection caused IOP and was quite painful for this reason.
 
rph3664 said:
ODs cannot prescribe any controlled substances, and like other practitioners, can only write within the scope of their practice. It's mostly eye drops, and one time I did fill a prescription for PO acetazolamide for a person whose eye infection caused IOP and was quite painful for this reason.
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In most states they can. In Ohio, ODs can prescribe codeine and hydrocodone products w/ no more than 60 mg codeine and 7.5 mg hydrocodone per dosage unit and they have to be a combo product w/ a non-narcotic analgesic. Limited to pain only and no more than 4 days.
 
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rph3664 said:
ODs cannot prescribe any controlled substances, and like other practitioners, can only write within the scope of their practice. It's mostly eye drops, and one time I did fill a prescription for PO acetazolamide for a person whose eye infection caused IOP and was quite painful for this reason.
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Did you not see the map I posted previously in this thread? They can in 43 states.


npage148 said:
I can prescribe metformin to prevent DM associated retinopathy.

Ny is nice because it's only ocular medication period for ODs
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NY is backwards and stupid. NY was also the/one of the last states to pass the privilege to allow pharmacists to do certain injections. You should know better.
 
How much pharmacology/pharmacotherapy training to you get in school. Suny opt gives 2 semesters, hardly enough to provide training required to safely use oral agents
 
npage148 said:
How much pharmacology/pharmacotherapy training to you get in school. Suny opt gives 2 semesters, hardly enough to provide training required to safely use oral agents
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Same as MDs/DOs. But thanks for your biased opinion. 47/50 state governments would disagree with you.
 
Honestly, other than concern for peoples' health with the hypothetical dentist prescribing metformin, I'm mostly concerned about reimbursement. We've got this dentist that always tries to get his wife's birth control filled with his own script pad. And I always tell him to pound sand. He accuses me of just being a loser that wants to be difficult. Dude doesn't seem to understand that insurance companies know who practices what. If they decide to audit our electronic submissions and they see an NPI number submitted attached to a guy who's a dentist, do you think they might try to get out of reimbursement? Not to mention its...you know...illegal.

But how I'm I supposed to know if letting someone that's a non-generalist (MD, PA, etc) write for a systemic medication - even if it IS for a legitimate medical purpose prescribed within the usual course of professional practice - won't give me a headache down the road with third parties?

Guess I don't. We're always getting squeezed by everyone.
 
We have a dentist who always writes for PO drugs for himself - lisinopril, etc. He probably takes 5 PO drugs that he writes for himself, sometimes more (abx if he gets sick, etc). If it were me, I wouldn't fill a single one, but I'm not the pharmacist, so I let the RPh know what's up and then fill it when he lets it go. Every time.
 
Carboxide said:
We have a dentist who always writes for PO drugs for himself - lisinopril, etc. He probably takes 5 PO drugs that he writes for himself, sometimes more (abx if he gets sick, etc). If it were me, I wouldn't fill a single one, but I'm not the pharmacist, so I let the RPh know what's up and then fill it when he lets it go. Every time.
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I turned down an MD who was trying to write for her cat. Her husband asked if we could just cross off the cats name and fill in his. Ummmm how bout NO?
 
All4MyDaughter said:
I turned down an MD who was trying to write for her cat. Her husband asked if we could just cross off the cats name and fill in his. Ummmm how bout NO?
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HAHAHAHAH. That is hilarious. It's amazing how they think their scope of practice is so much larger than it is....NO, you cannot write for stuff that you've NEVER STUDIED!
 
Carboxide said:
HAHAHAHAH. That is hilarious. It's amazing how they think their scope of practice is so much larger than it is....NO, you cannot write for stuff that you've NEVER STUDIED!
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The worst is when they come back 5 min later with a new script in their name like they think you'll buy it

Once a resident asked what the best benzo was for sleep in the phone and then walked in 3 minutes later with a script for it written by another resident, his friend sitting in the car.
 
I find it amusing that we're dealing with a so-called narcotic crisis but yet just about every state lets everyone and their dog write for narcotics.
 
Socrates25 said:
I find it amusing that we're dealing with a so-called narcotic crisis but yet just about every state lets everyone and their dog write for narcotics.
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I've heard that they are actually running out of DEA numbers too.

Shnurek said:
Ya, ophthalmologists don't really prescribe too many oral drugs either. I was just wondering what the percentages were and this is interesting to me since of course topical drugs are isolated to the ocular system while oral drugs may cause the patient to deal with systemic side effects. Also its not surprising since OD malpractice liability rates are extremely low at around $800 a year.
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Just out of curiosity, do you support expanding an OD's scope of practice to include regularly prescribing more oral drugs or preform more office procedures? What would you say separates an OD from an MD that has done residency in ophthalmology? I'm genuinely curious since I don't know much about either field. If you feel it might derail the thread or isn't the intent of your OP to discuss that PM me (or not).
 
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Socrates25 said:
I find it amusing that we're dealing with a so-called narcotic crisis but yet just about every state lets everyone and their dog write for narcotics.
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Well, the "crisis" is relatively limited, IMO, to the Florida area. However, I do think we regularly overprescribe and overfill narcotics. Here is a summary of my experiences on why this happens:

1. Physicians see them as first-line pain medication. They almost never start with Motrin 600 or Motrin 800 - instead, they write a script for oxycodone 5 mg 1-2t q 4-6h prn. Oxycodone is NOT a first line pain medication. Hydrocodone should not be used for mild pain.

2. They are either suckers or do not care enough to monitor drug usage. I regularly have physicians calling me authorizing an early fill of oxycodone/methadone/morphine FOR THE SAME STRENGTH AND DIRECTIONS. I can think of several individual patients just off the top of my head who regularly pay cash for these drugs because they "spill their liquid/lose the bottle/were shorted" EVERY MONTH. Yeah right. You have got to be kidding me! When I see the same physician authorizing 3 early fills by WEEKS each time for the same patient in a 3 month time span, I can't hep but get really angry. THIS IS THE PROBLEM. I would not be filling this if it were not for you, and if I were the RPh, I still wouldn't fill it.

3. Some pharmacists do not believe that we are responsible for refusing to dispense prescriptions that we believe are being diverted or misused. This is evident in another recent thread - "Call the pill mill doc, once they authorize it just go ahead." I don't think this is morally, ethically or legally right. If you have good reason to believe that patient is diverting or abusing, it is your JOB to refuse to dispense.

4. Patients have been given the idea that they can and should expect a pain-free life. If you have chronic back pain, you cannot expect to have no pain ever. Your goal should be to increase functionality and allow ADLs to be accomplished without excessive pain, NOT to be pain free. Patients (and family members of mine) frequently do stuff like take multiple pain medications so that they can do things that they should NOT be doing with chronic back pain, such as: planting trees, doing extensive house repairs including ladder work and heavy carrying, and things of that nature.


End story: physicians need to STOP prescribing these medications for the average patient. In my PERSONAL experience, they are pushed on you. Last time I visited the ER, I rated my pain at a 5 of 10 when asked and was offered oxycodone THREE TIMES, despite saying no each time. Seriously, that is out of control.
 
Digsbe said:
Just out of curiosity, do you support expanding an OD's scope of practice to include regularly prescribing more oral drugs or preform more office procedures? What would you say separates an OD from an MD that has done residency in ophthalmology? I'm genuinely curious since I don't know much about either field. If you feel it might derail the thread or isn't the intent of your OP to discuss that PM me (or not).
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I don't mind at all. My primary reason for being on these forums is to educate people about what contemporary Optometrists do.

Yes, I fully support the 40 year on-going expansion of the OD scope of practice. (http://newsfromaoa.org/2012/03/23/1...ory-of-scope-expansion-into-medical-eye-care/)

ODs can already perform minor surgical procedures in almost every state such as epilation, foreign body removal, tear duct irrigation and dilation, corneal tissue debridement and others which I do not remember off the top of my head.

Now some people might say, oh you just didn't get into medical school so you are doing the best what you could do. Wrong. I chose Optometry because I researched the laws and the legislative trends. I chose it because I could have a healthy income living in a rural location since not many jobs allow this. I chose it because of the early and specialized training.

Ophthalmologists go through 4 years of medical school but they barely learn anything about the eye. Talk to any ophthalmology resident/attending. They will tell you that jumping into ophthalmology you are completely lost. And the residency is only 3 years where they not only learn optical and medical eye care but also surgical eye care. While Optometrists spend 4 years learning optical, medical and minor surgical eye care along with associated systemic conditions. Basically what separates optometrists from ophthalmologists is that ophthalmology currently has a monopoly in major eye surgery such as cataract surgery.

Now there is a huge gray area in what Optometrists can do. In Massachussetts for example Optometrists cannot even treat Glaucoma. While in Oklahoma Optometrists can do laser and scalpel eye surgery along with performing injections and prescribing orals/narcotics.

Socrates25 said:
I find it amusing that we're dealing with a so-called narcotic crisis but yet just about every state lets everyone and their dog write for narcotics.
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Sounds like a typical ignorant MD hyperbole, maybe even DO. The only ones who can are: MD, DO, DDS/DMD, OD and DPM.

tl;dr - Optometrists are Eye Doctors, Ophthalmologists are Eye Surgeons.
 
Farmercyst said:
They can in CA under protocol with a prescriber, so can NDs. I had to scour CA business & professions code Fri because an ND was writing xanax.
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Under supervision of another provider doesn't count. I'm talking about independent prescribing here.
 
In KY nurse practitioners can write, with certain conditions, for schedules II through IV. PA's cannot. I am also licensed in Indiana where I believe they both have some controlled Rx privs. I would have to check the laws though. OD scheduled prescribing is more limited in KY and not allowed at all in IN.
 
Shnurek said:
link
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sorry, I didn't come to this with an agenda and the pretty color coded maps, but the truth is that in my state, NPs rx CIIs legally (she sent a copy of her license certifying that she is allowed to rx CIIs).
 
I really don't understand why dentists, optometrists, and podiatrists exist to be honest. Why aren't they just folded into medicine nowadays? I understand that they are relics of the past and all that jazz, but I really don't understand why three arbitrary body parts/orifices get people who don't have to get a generalists' training before specializing. Then we wouldn't have this argument.
 
WVUPharm2007 said:
I really don't understand why dentists, optometrists, and podiatrists exist to be honest. Why aren't they just folded into medicine nowadays? I understand that they are relics of the past and all that jazz, but I really don't understand why three arbitrary body parts/orifices get people who don't have to get a generalists' training before specializing. Then we wouldn't have this argument.
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I will give dentists/oral surgeons a pass since they actually get substantial training and optometrists can take the load of eyeglass fitting away from ophthalmologists so they can do real stuff.

But podiatrists, WTF are they useful for? I mean I'm sure ortho would love to handle foot surgery and an LPN/RN can do diabetic foot checks.
 
All4MyDaughter said:
In KY nurse practitioners can write, with certain conditions, for schedules II through IV. PA's cannot. I am also licensed in Indiana where I believe they both have some controlled Rx privs. I would have to check the laws though. OD scheduled prescribing is more limited in KY and not allowed at all in IN.
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True, only CIII - CV in KY:

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and none in Indiana.

WVUPharm2007 said:
I really don't understand why dentists, optometrists, and podiatrists exist to be honest. Why aren't they just folded into medicine nowadays? I understand that they are relics of the past and all that jazz, but I really don't understand why three arbitrary body parts/orifices get people who don't have to get a generalists' training before specializing. Then we wouldn't have this argument.
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I agree, its a bit ridiculous too but it is what it is and I chose the best opportunity that presented itself before me. If it were up to me there would only be MDs and nurses but that would create a monopoly and professional competition is good 🙂 Professions are very dynamic nowadays.

npage148 said:
I will give dentists/oral surgeons a pass since they actually get substantial training and optometrists can take the load of eyeglass fitting away from ophthalmologists so they can do real stuff.

But podiatrists, WTF are they useful for? I mean I'm sure ortho would love to handle foot surgery and an LPN/RN can do diabetic foot checks.
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Ehhh, we do a lot more than just glasses. When you come in for an eye exam your pupils get dilated and the retina is the only place in the whole body where you can see neural tissue and vascular tissue through a clear medium without any tampering. So we can detect diseases such as hyperlipidemia, hypertension, diabetes, tumors, hightened intra-cranial pressure, multiple sclerosis, even alzheimers: http://www.sciencedaily.com/releases/2010/06/100624092520.htm and many many more.

Here's almost a full list, knock yourself out: http://en.wikipedia.org/wiki/List_of_systemic_diseases_with_ocular_manifestations
 
Shnurek said:
So we can detect diseases such as hyperlipidemia, hypertension, diabetes, tumors, hightened intra-cranial pressure, multiple sclerosis, even alzheimers: http://www.sciencedaily.com/releases/2010/06/100624092520.htm and many many more.
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Seriously? you detect diabetes, HTN and high cholesterol with a dilated eye exam? Why are doctors still taking blood pressures via cuff and doing lipid/metabolic blood panels? At best you're monitoring retinal complications due to these diseases, at worst you're dilating people unnecessary to bill for a couple more dollars.
 
npage148 said:
Seriously? you detect diabetes, HTN and high cholesterol with a dilated eye exam? Why are doctors still taking blood pressures via cuff and doing lipid/metabolic blood panels?
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Well, they do it their way, we do it our way 🙂 If we detect any signs of these systemic diseases we immediately refer to the primary care Doctor because we aren't specialized in treating systemic diseases, but only detection.

2455_2472_3.jpg


img-diabetic-retinopathy.jpg


graph-vsp-early-detection-553x420.gif

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Also check this out: http://www.diabetespharmacist.com/2...rneal-arcus-eye-condition-linked-to-diabetes/
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npage148 said:
What is the typical time between the onset of disease and the time at which complications become detectable by retinal exam?
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Not really sure, I just finished the first year out of four in my school. Also I plan on doing an ocular disease residency. However, I found this using google at least when it comes to diabetes. I'm sure its different for the other diseases: http://www.ophthobook.com/chapters/retina

"After 10 years, more than half of patients will show signs of retinopathy, and after 15 years this number increases to nearly 90%"

This is assuming uncontrolled sugar levels.
 
Shnurek said:
Not really sure, I just finished the first year out of four in my school. Also I plan on doing an ocular disease residency. However, I found this using google at least when it comes to diabetes. I'm sure its different for the other diseases: http://www.ophthobook.com/chapters/retina

"After 10 years, more than half of patients will show signs of retinopathy, and after 15 years this number increases to nearly 90%"

This is assuming uncontrolled sugar levels.
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See that's too late. Optometrists may detect these things, but only after signs of damage have occurred. Yearly checkup would pick it up before you could.
 
People who have DM that is SO uncontrolled that they have have retinal changes probably don't go to their physicians very often (if at all). Therefore, I feel that it is unlikely that these patients would make regular visits to the optometrist, thus allowing the OD to "find" their disease. I'd say the role of optometrists in screening for systemic disease is pretty low. They have a much greater role in monitoring, assuming patients will come in for eye exams, pay for dilation, etc.
 
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