Use of Medicines by Optometrists Part One Sort Of Intro

Only those medicines designated for use by optometrists, orthoptists and opticians should be used on the public at large.

The MEDICINES ACT determines the use of drugs by optometrists

• Originally prepared in 1968, passed into law 1972, further defined for optometrists in 1978
• Act & its consequences periodically reviewed by drug advisory panel w/optom reps
• Original sections of act relevant to optoms are part III sections 51, 52, 57 & 58.
• Recent revisions of the law (notably SI's 764, 765, 766) mean that a large number of prods for ophthalmic use are now unlicensed and available for unrestricted sale ie not really pharmaceuticals anymore, but CE marked. SO optoms can advise on their use and supply them to the public providing it's in the course of their professional practice ie not food supplements or something we know nowt about. This includes CL related stuff as well as stuff designed for temporary relief for uncomf/irritated eyes + include herbal remedies & natural crap.
• A registered pharmacist can supply an optom w/certain pharms on receipt of an official signed order ie request on optom's letterhead. These are the specified PoMs (Mydriatics, Cyclopentolate, Chloramphenicol, Fusidic Acid) or P Medicines for diagnostic or therapeutic use. Optom must specify the exact quantities & keep accurate records
• Optom is allowed to use these drugs on their patients as part of eye evaluation or to administer them in an 'emergency'. In a similar 'emergency' the optom can supply certain PoMs to their patients if it has a 'use and supply' designation as opposed to 'use only'.
• In 2005 changes involving SIs 764, 765, 766 meant that the 'emergency' bit is only extended to the exempted PoMs. Px can administer any of this stuff themselves and optom can arrange for a personal supply w/a written order similar to a prescription. This includes 'entry level' optoms btw.
• Law changes in 2005 and 2007 meant that access to chloramphenicol was extended to the public at large with its reclassification as a P medicine. So optometrists could actually sell and supply that without it needing to be an emergency.
• One interpretation of 2007 change - optom should be on premises when P meds sold? Only actually _implies_ that. Optom maybe has to know Px as Px. Probably best!
• Sale and supply of prods that aren't the PoMs could be considered as a retail sale and no more but it would be best to keep a record.

The OPTICIANS ACT as relating to optometry and as revised in 2005 also provides indirect guidelines on the use of drugs by optoms

• 'ophthalmic optician' is now 'optometrist' and optom is as of SI.3299 (1999) allowed to diagnose eye diseases rather than simply arranging for referral and to use various drugs to treat the conditions. This implies making note of condition in px's records and noting reasons why not referred.

Three Main Classifications of Drogs:

1. GSL: Avail for public at large, unsupervised use, considered generally safe. Any retailer may sell as long as they have a secure premises (eg locked optom's office). Recently some prods aren't even GSL anymore so are 'non medicinal'. This includes eye vitamin products.

2. P MEDICINES: Generally sold/supp by registered pharmacist under supervision. Some avail from Hosp P for use by professionals. Also known as OTC. Considered generally safe for the public w/out supervision BUT the ingredients/concs/uses indicate that a control step is necessary - practitioner can make assessment of px's suitability - will be expected to ask a few questions relating to the C/I, specific precautions, possible drug interactions and warnings on potential adverse drug reactions. Pharm/optom assumes responsibility for giving appropriate instructions, then it's up to the px. Sold from behind counter w/px's verbal request. Some P classifed prods aren't available to the public but available to optoms for professional use upon production of a signed order. Can be supplied in bulk.

3. PoMs: The restricted access is more to ensure the safety of the general public since PoM listings designate those pharmaceuticals that contain drugs (or higher concs of drugs) which require some supervision. PoMs can be changed to P Meds whenever it can be established that use by the public@large doesn't produce any ADRs. It can go the other way also. Optom can obtain exempted PoMs by way of written order requesting supply & quantity, eg

• 10x 4g tubes of Chloramphenicol Eye Ointment 1%

Some of these are of the type that could be used in an emergency in which case optom can supply px directly or provide pharm w/a written order for a specific patient.