In 1580, the French statesman and essayist Michel de Montaigne wrote, “Nothing is more subject to change than the laws.” Indeed, no statute is immutable, and ophthalmologists have learned over the years that this is especially true at our state capitols. As we know, not all of these changes in the law have resulted in improvements to the practice of medicine and the delivery of patient care. Many have had quite the opposite effect.
To the dismay of those of us committed to quality eye care, state legislators have voted again and again to expand the optometric scope of practice. Too often, our experience and expertise have been politely dismissed by lawmakers who have misinterpreted our profound concerns as a self-serving exercise in protecting turf. But this year, something unprecedented happened.
Since 1995, Oregon optometrists had been prescribing topical drugs for the treatment of glaucoma. The law provided that before an optometrist could prescribe antiglaucoma medications, the patient must first undergo an initial examination by a physician. The provision was a precautionary measure for patients who would be prescribed beta blockers by an optometrist. However, no other physician oversight was required.
This year, Oregon Gov. Ted Kulongoski signed legislation that actually added safeguards to existing law to protect glaucoma patients. Oregon now requires optometrists to consult with an ophthalmologist if the patient’s glaucoma continues to progress despite two different glaucoma medications, if more than two medications are required to control the glaucoma, or if a secondary glaucoma develops. With patience and persistence, ophthalmologists of the Oregon Academy of Ophthalmology had persuaded state legislators and the governor that glaucoma patients needed to be carefully monitored during the entire disease process.
This new law represents a turning point for quality eye care in the states. For the first time, a state legislature has limited the optometric scope of practice after having previously expanded the optometric law. State legislators have shown the capacity to revisit an optometric scope of practice issue when further educated on the challenges of treating complex eye disease. Oregon optometrists have lost some independence as a direct result of their expanded scope of practice. Most important, state legislators have begun to realize the significance of our education and training in ensuring quality patient care. Of course, none of this happened by sheer luck.
As ophthalmologists, we’ve had to educate ourselves about the political process. This year, our colleagues in Oregon led the way and turned that education into action. We now know what we need to do: 1) Contribute to our state ophthalmological society PACs, 2) contribute to the Surgical Scope Fund and 3) talk to our state legislators about our concerns.
The Oregon experience demonstrates that inaction, derision and passivity, those well-worn tools of the cynic, will not move state legislators to make bold, intelligent and informed decisions to improve patient care. Legislators do listen when ophthalmologists are fully engaged. But the fluidity of the political and legislative process also means that we must sustain our involvement and be prepared to seize opportunities to improve the lives of our patients. If, as Montaigne asserts, nothing is more subject to change than the law, let’s make sure that the change extends quality eye care for our patients.