Instead of advising patients with glaucoma and other eye diseases to see a physician, California's optometrists soon will be able to treat many conditions themselves.
Their role has been expanded under a new state law that optometrists say will save people time and, possibly, sight, but that ophthalmologists say could endanger patients.
Because they are not medical doctors, optometrists have been limited to treating primarily allergies and bacterial infections. They have been able to prescribe only a limited number of drugs, including just one antibiotic.
For more complex conditions such as glaucoma, viral ulcers and inflammatory diseases, they have had to encourage patients to consult a doctor.
But many patients, optometrists say, don't get the appropriate care, either because they don't know how to find an ophthalmologist or because they don't return for subsequent checkups.
"The issue here is about access," said Bill Mabie, spokesman for state Sen. Richard Polanco (D-Los Angeles), who sponsored the bill.
"Someone with an eye ailment should be treated immediately. . . . To start over with someone new would be a burden," he said. "A lot of people don't know where to find a doctor or where to find an affordable doctor."
Because California has almost twice as many optometrists as ophthalmologists, the new law offers more choices.
"It certainly makes eye care more generally available than it might be now," says Richard Levinson, the associate executive director of the American Public Health Assn. "The major concern is that people in the inner city and rural areas are underserved."
As of Jan. 1, optometrists who have trained with an ophthalmologist for two years will be able to prescribe glaucoma medication, steroids, antiviral drugs and narcotics.
But because some of the drugs can lead to a slowing of the cardiovascular and respiratory systems, many physicians say that optometrists lack the medical training necessary to foresee and treat the potentially dangerous side effects.
"People should be better trained in how to treat trauma," said Dr. Barbara Arnold, a clinical professor of ophthalmology at UC Davis. "Every time you see a patient, you have to review your decision of what to give and how much."
Dr. Michael F. Marmor, a professor of ophthalmology at Stanford University, said that optometrists are not equipped to foresee the complications of the drugs they prescribe. "Virtually all glaucoma medicines have an effect on heart disease and lungs and interact with other medications that patients are taking," he said.
But David Sendrowski, associate professor at the Southern California College of Optometry in Fullerton, said optometrists already learn about the possible complications of these drugs and are trained to work with patients who have eye diseases.
Sendrowski said that allowing optometrists to treat diseases such as glaucoma increases the chance that the condition will be treated.
Nationally, 3 million people suffer from glaucoma, which is caused by damage to the optic nerve due to aging, trauma or disease, said John W. Corwin, the executive director for the Glaucoma Foundation.
Each year, 4,500 of them go blind. In nine out of 10 cases, the blindness could have been prevented, he said.
There are no symptoms of glaucoma, Corwin said. The majority of people who have glaucoma are over age 45. African Americans are four to six times more likely to have glaucoma.
Under the new law, an ophthalmologist must be consulted if the patient's condition does not improve or worsens, or if the patient is still receiving medication after an extended period of time.