21/11/2024
WHAT IS A THERAPEUTIC OPTOMETRIST??
In New Zealand, optometry has undergone significant changes over the years to expand the scope of practice for optometrists. These changes have involved the introduction of new qualifications and the inclusion of diagnostic tools and therapeutic practices such as the use of diagnostic eye drops and the ability to prescribe medications. Below is an updated look at the development of optometric qualifications in New Zealand, including the role of diagnostic drops and how accreditation was obtained for their use prior to their integration into the BOptom degree.
BOptom (Bachelor of Optometry)
The BOptom is the foundational qualification for optometrists in New Zealand. Historically, the BOptom degree, which is a 4-year undergraduate program, focused primarily on the clinical and theoretical knowledge needed for optometrists to perform standard eye examinations, prescribe corrective lenses (glasses and contact lenses), and assess general eye health. It was sufficient for optometrists to practice as primary eye care providers in New Zealand, but it did not grant permission for prescribing medications or using certain diagnostic tools such as eye drops.
The BOptom has evolved over time to incorporate more advanced skills, but diagnostic eye drops—used to facilitate the examination of the retina, anterior chamber, or to measure intraocular pressure—were not part of the initial training for many optometrists. Accreditation to use diagnostic drops was gained through additional training and certification.
Diagnostic Eye Drops and Accreditation
First Diagnostic Drops Accreditation: Mid-1990s
The introduction of diagnostic eye drops (such as those used for pupil dilation or to measure intraocular pressure) played a key role in expanding optometrists' ability to conduct thorough eye examinations. Historically, optometrists in New Zealand were not initially authorized to use these diagnostic drops. However, as optometry evolved to take on a more comprehensive healthcare role, it became increasingly important for optometrists to be able to use them in their clinical practice.
Accreditation for Diagnostic Drops (Pre-BOptom Changes):
Before diagnostic drops became part of the BOptom degree curriculum, optometrists had to obtain separate accreditation to use these tools. Accreditation was typically granted through a postgraduate certification or clinical training programs overseen by professional bodies such as the Optometrists and Dispensing Opticians Board (ODOB) and the New Zealand Association of Optometrists (NZAO). These programs involved the following components:
Training Courses: Optometrists were required to undergo specific training focused on the safe and effective use of diagnostic drops. This included knowledge of the different types of drops (such as mydriatics for pupil dilation or tonometry drops for intraocular pressure testing), indications for their use, contraindications, and potential side effects.
Competency Assessments: After completing the training, optometrists had to pass practical assessments demonstrating their ability to use the drops correctly and to interpret the results within the context of an eye exam.
Formal Accreditation: Once the training and assessment were completed successfully, optometrists were granted accreditation, allowing them to use diagnostic drops in clinical practice. This was separate from their core BOptom qualification and was often viewed as an additional professional development pathway.
The decision to allow optometrists to use diagnostic drops, as well as prescribing privileges, reflected a shift towards expanding optometrists' role in primary eye care, particularly in detecting conditions like glaucoma, diabetic retinopathy, and age-related macular degeneration, which require specialized testing and evaluation.
Postgraduate Certificate in Ocular Prescribing
Postgraduate Certificate in Ocular Prescribing: Around 2000
The Postgraduate Certificate in Ocular Prescribing allowed optometrists to gain the authority to prescribe medications for certain eye conditions. With the growing demand for optometrists to manage a wider range of ocular diseases, this qualification provided training in the pharmacology of ocular therapeutics and clinical decision-making.
This certificate allowed optometrists to prescribe certain medications for conditions like:
Mild ocular infections (e.g., conjunctivitis)
Dry eye disease
Allergic eye conditions
Although this qualification did not automatically give optometrists the right to use all diagnostic tools or prescribe all ocular medications, it expanded their clinical capabilities significantly.
Postgraduate Certificate in Ocular Therapeutics
Postgraduate Certificate in Ocular Therapeutics: Early 2000s
The Postgraduate Certificate in Ocular Therapeutics further expanded the range of therapeutic practices available to optometrists. This qualification allowed optometrists to prescribe a broader array of medications, including more complex treatments for conditions such as glaucoma, uveitis, and advanced ocular infections. The curriculum of this program also included deeper training in pharmacology, patient safety, and clinical management of ocular diseases, enabling optometrists to more effectively manage serious eye conditions and reduce the reliance on ophthalmologists for these conditions.
BOptom TPA Endorsed (Therapeutic Pharmaceutical Agent Endorsement)
TPA Endorsement: 2003
The BOptom TPA Endorsement granted optometrists the ability to prescribe a full range of therapeutic pharmaceutical agents (TPAs) for treating a broader set of eye conditions. This endorsement was a key development, as it allowed optometrists to prescribe both oral and topical medications, including treatments for conditions like glaucoma, eye infections, and inflammation.
Optometrists with TPA endorsement could now manage a wider scope of ocular conditions autonomously, particularly those related to anterior segment diseases, ocular hypertension, and some retinal disorders.
Integration of Diagnostic Drops into the BOptom Degree
Over time, the increasing complexity of optometry and the recognition of optometrists' roles in the broader healthcare system led to the integration of diagnostic tools, including the use of diagnostic drops, into the BOptom curriculum itself. As of recent years, the use of diagnostic eye drops became a standard part of the BOptom training, so new graduates are now equipped with the knowledge and skills to use them from the outset of their careers.
The BOptom program now includes:
Training on diagnostic drops: Such as mydriatics, cycloplegics, and agents for tonometry, which are essential for examining the posterior segment of the eye, measuring intraocular pressure, and assessing the pupil response.
Skills in patient safety and contraindications: New graduates are trained to use diagnostic drops safely, understanding the potential side effects, risks, and appropriate patient selection.
This integration marks a significant development in the scope of optometric practice, as it allows graduates to be fully prepared to conduct comprehensive eye exams with advanced diagnostic tools, without needing to undergo separate accreditation for diagnostic drops as was required in the past.
In summary, the development of optometry qualifications in New Zealand has involved expanding the scope of practice for optometrists, particularly in the areas of ocular therapeutics and diagnostic tools. The historical accreditation for the use of diagnostic drops was separate from the BOptom degree and required additional training and certification. Over time, however, the inclusion of diagnostic drops within the BOptom curriculum streamlined the process, making it a standard part of optometric education.
Additionally, qualifications such as the Postgraduate Certificate in Ocular Prescribing and the BOptom TPA Endorsement further extended optometrists' clinical capabilities, enabling them to prescribe medications and manage a wider range of ocular conditions. These changes reflect the ongoing evolution of the profession in New Zealand, where optometrists are increasingly able to provide comprehensive, autonomous eye care as part of the broader healthcare system.
