"Eyeball Wars" Fight Could Soon Be Drawing To A Close

Mar 6, 2013

A decades-long fight between optometrists and ophthalmologists could be resolved this year. The legislature is considering a bill that would allow optometrists to prescribe oral medications.  The debate has been dubbed, “the Eyeball Wars” but ophthalmologists say the fight isn’t over turf, it’s about patient safety.

Optometrists have wanted to be able to prescribe oral medications for years, says former state Republican Senator Durrell Peaden.

“When I came to the legislature, the optometrists wanted to do laser surgery...you know, I had the opportunity to do rotations and I’ve been in a lot of surgeries, but some folks just aren’t trained to do that level of care.”

Peaden is a retired doctor from the Panhandle. Optometrists are the people who do eye exams and prescribe glasses and they want to be able to prescribe medications taken by mouth. In Florida that task is left to ophthalmologists—the people who do eye surgery. That prescription power is at the center of a long-running fight between the two sides.  Last year a compromise proposal that could have brought an end to the battle died in the Senate, and John Thrasher, who serves on the Senate Health Committee, helped craft that deal.  

“In that bill, there was a list of about 14 oral medications that optometrists would have been allowed to prescribe. There was an adverse incident reporting provision for prescription mishaps. There was a specific definition of surgery," he said Wednesday.

But those provisions aren’t in this year’s bill. And that’s a big problem for ophthalmologists, who say the issue isn’t one of turf, but of patient safety. Chuck Sloan is the President of the Florida Society of Ophthalmology.

“Not a single dollar will be lost by any of my ophthalmology colleagues should this bill passed. Our concerns focus exclusively on the fact that this bill doesn’t have any of the patient safeguards which currently exist in the laws of other states that do allow permit optometrists to prescribe...such as limited formularies from which to prescribe, limits on how many pills may need to be prescribed, or time limits to refer patients to a medical doctor," Sloan said.

Sloan says he’s concerned if those things aren’t clearly outlined, the bill, if passed could lead to more demands, like letting optometrists do eye surgery, which he says is happening in other states with similar laws. Opponents to letting optometrists prescribe medications have cited their lack of training. Ophthalmologists have attended medical school and are doctors who specialize in eyes. Optometrists fit people for glasses and do eye exams. Democratic Senator Audrey Gibson says optometrists and opthalmologists are professionals in their field. However, “We have to look at where we draw the line when professions cross over each other if they don’t have exactly the same training and experiences.”  

Optometrists in more than 40 other states can prescribe oral medications. And Joni Scott Wideman, an optometrist in Tallahassee with the VA, says she doesn’t understand why they can’t do it in Florida.

“I have a Georgia and a Florida license. I can prescribe orals 16 miles away in Georgia. I can prescribe it on VA property in Tallahassee. But I can’t practice across the street. The citizens of Florida aren’t benefitting from my abilities, unless of course, you’re a veteran," she said.

Supporters of letting optometrists expand their scope say it will help increase access to care. The bill’s sponsor, Republican Garrett Richter of Naples says it’s time to bring the long-running argument to a close:

“My number one concern was to provide a framework for safety and access. Can it be better? We’ll find out. I’ll continue to keep an open mind.”   

Richter says he’ll revisit the additional safety issues proposed by the ophthalmologists and Senator Thrasher. The proposal cleared the Senate committee and still has one more stop before it hits the floor. The optometrists have lobbied hard for the bill and say they’re confident it will go through this year. A companion measure in the House is scheduled to be heard Thursday in its final committee stop.

For more news updates, follow Lynn Hatter on twitter @HatterLynn