MEDIA STATEMENT - Oral Prescribing Rights for Optometrists

The current proposal to expand optometry prescribing rights to include oral medicines is deeply concerning and risks undermining safe patient care.

While the ASO acknowledges there may be scope for limited, carefully considered expansion of topical prescribing, the proposal to allow optometrists to independently prescribe systemic oral medications, including antibiotics, anti-inflammatories, and other systemic agents, presents significant and unacceptable risks.

Unlike topical eye drops, oral medications act throughout the entire body. Their safe use requires a deep understanding of internal medicine, pharmacology, microbiology, drug interactions, systemic disease, and appropriate diagnostic investigations - knowledge gained only through medical training.

A recent survey of ASO members revealed unanimous concern about the proposed changes, with ophthalmologists sharing clear, real-world examples of risk:

“I have treated a patient on the renal ward who developed acute renal failure after oral antivirals. It was unexpected and very serious. The recognition and management of such drug reactions requires medical training. These are not benign medications.”

Another member underscored the knowledge gap: “Prescribing oral antibiotics and antivirals safely requires detailed understanding of microbiology, pharmacology, and resistance patterns - areas not adequately covered in optometry training.”

What appears to be a straightforward eye condition can be early signs of systemic diseases like diabetes, autoimmune disorders, cardiovascular disease, or serious infection. Ophthalmologists undergo more than a decade of medical and surgical training to understand these complex relationships and to recognise when urgent systemic investigation is required.

We note that some of the medications the Optometry Board proposes that optometrists prescribe are associated with serious adverse events including renal failure, electrolyte disturbances, liver injury, cardiac complications, and life-threatening allergic reactions.

Recognising and managing these risks early can be the difference between full recovery and permanent harm.

The proposal also risks fragmenting patient care. Many older patients may not know their full medication history, increasing the likelihood of dangerous drug interactions. Optometrists are not trained to order or interpret renal, liver, electrolyte or cardiac investigations that may be necessary to rule out further serious illnesses.

The Optometry Board’s own example of an optometrist “ruling out orbital cellulitis” without access to imaging highlights the limitations of non-medical training. Orbital cellulitis can be diagnosed or excluded only by CT imaging, a test that optometrists are neither trained nor authorised to order.

The ASO strongly rejects comparisons with New Zealand, the USA or the UK. Australia’s health system consistently ranks among the safest and most equitable in the world, and the scope-fluid prescribing model used in New Zealand is precisely what the OBA is seeking to replicate - a model that risks mission creep, reduced oversight, and increased exposure to patient harm.

The same principle guided ASO and RANZCO’s successful 2014 advocacy to ensure glaucoma care remained under medical oversight. The evidence today remains clear: medical conditions with systemic implications require treatment by medical practitioners.

Rather than expanding oral prescribing rights without adequate safeguards, the ASO calls for:

• Enhanced collaboration between optometrists and ophthalmologists
• Clear, protected referral pathways for timely medical review
• Investment in team-based care models that leverage each profession’s strengths

Optometrists play a vital role in frontline eye care. But prescribing systemic medications requires medical expertise that is not included in current optometry training.

Australia must not jeopardise patient safety by prioritising convenience over clinical risk.

The ASO urges regulators to carefully consider these implications before implementing changes that could expose Australians to unnecessary harm.

ENDS…