Getting started in therapeutics

D ata from the recent therapeutic practice survey carried out by City University showed that community optometrists routinely managed a range of common non-sight-threatening ocular conditions using therapeutic agents available through the Medicines Act exemptions (Optician, July 27, 2007). Recent changes to medicines legislation have provided opportunities for optometrists to train for extended prescribing roles. For example, additional supply (AS) optometrists are able to use and supply further prescription-only medicines (POMs) from an ‘additional supply’ list that includes the antimicrobial mixture, Polyfax (polymyxin B and bacitracin), anti-allergy drugs, a mucolytic and the non-steroidal anti-inflammatory drug (NSAID) diclofenac sodium. Optometrist supplementary prescribers are theoretically able to prescribe any licensed medicine, provided that the drug is listed in the patient’s clinical management plan. While this prescribing model works for practitioners working in a hospital environment, it has limited scope in community optometric practice as a diagnosis has to be made by an independent prescriber and a clinical management plan has to be drawn up before treatment can begin. This limitation has been recognised by the Department of Health which recently announced that optometrists will soon be able to train as independent prescribers of any licensed medicine for ocular conditions affecting the eye and the surrounding tissues, within their recognised area of expertise and competence. Before prescribing any medication it is important that the prescriber is aware of the licensed indications of the particular drug, its contraindications, dosage and potential side-effects. This article provides an overview of the major classes of therapeutic agent used in ophthalmic practice: ● Antimicrobials ● Corticosteroids and other anti-inflammatories. Emphasis will be placed on those drugs currently available to optometrists (entry level and AS) as well as drugs that can be appropriately used by supplementary prescribers or future independent prescribers.