Proposed Expansion Of Optometrist Prescribing

The Australian Society of Ophthalmologists (ASO) has voiced serious concern regarding the Optometry Board of Australia’s proposal to expand optometrists’ prescribing rights to include oral and topical medicines.

Public consultation was opened on 27 Oct, 2025 with little notice. Consultation ends on Christmas Eve.

While the ASO acknowledges that limited topical prescribing, when supported by appropriate training, can enhance patient access, the current proposal exceeds what is safely achievable within an optometrist’s scope of practice. Several of the drugs listed are systemic in nature, requiring a deep understanding of internal medicine, pharmacology, and multi-organ interactions that form the foundation of a medical degree.

“Prescribing oral antibiotics, antivirals, and anti-inflammatory drugs is not simply a matter of treating the eye,” one ASO member said in a survey conducted by the ASO.

“These medications can affect the entire body, interact with other medicines, and mask or exacerbate underlying conditions. Without full medical training, there is a real risk of harm.”

"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 is the role of a medical doctor. These are not benign medications,” another member said.

Ophthalmologists undergo more than a decade of medical and surgical training, encompassing not only eye health but systemic diseases such as diabetes, autoimmune disorders, and infections that can manifest through ocular symptoms. ASO members have raised concerns that expanding prescribing rights without matching educational requirements may fragment care, create diagnostic blind spots, and delay proper treatment.

Another member noted, “We’ve seen what happens when shortcuts are taken in patient care. Convenience should never outweigh safety. The priority must be protecting patients, not expanding professional boundaries.”

The ASO emphasises that ophthalmologists and optometrists work best in collaboration, where each profession’s expertise is respected and utilised to deliver holistic care. However, any regulatory change must be evidence-based, safety-driven, and patient-centred.

“We are not opposed to collaboration,” said ASO CEO Katrina Ronne. “We are opposed to changes that put Australians at risk. The focus should be on strengthening existing partnerships, not weakening safeguards.”

The ASO will participate in ongoing consultation between the Optometry Board, medical specialists, and the public to ensure prescribing regulations maintain Australia’s world-class standards of eye health and patient safety.

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READ WHAT OUR MEMBERS SAY BELOW:

“The ability to safely and appropriately prescribe oral antibiotics and antivirals requires extensive knowledge of microbiology, pharmacology, pharmacodynamics and kinetics, as well as current patterns of antibiotic resistance, none of which are adequately covered in any of the current optometry curricula.”

“I feel that optometrists don't have the training and understanding to prescribe anti-infectives as a group. Will likely lead to poor prescribing practices and increase the risk of resistance developing. The rest of the drugs I feel are ok.”

“There are no significant benefits to practitioners without formal medical training, providing unsupervised prescribing (especially for oral medicines) in this era of telemedicine, but the potential disadvantages are substantial.”

“A lot of these oral medications can put patients into renal failure, and some can disturb electrolyte levels, which can result in cardiac death. Unless the prescriber knows medicine, including an understanding of the spectrum of renal diseases and all the individual drugs (that they may not be prescribing) that can increase the risk of renal failure, and unless the prescriber is also able to order and interpret renal function tests and electrolyte tests and liver function tests, it is not safe for the prescriber to be prescribing these oral medications. It’s not possible to teach, in an isolated optometry prescribing course, the spectrum of renal, liver, and cardiac diseases that could affect the safety of prescribing these medications. Suppose the patients develop side effects from these medications. How would the prescriber know whether it’s a benign side effect or a sinister systemic concurrent disease if they are not trained to understand how a spectrum of medical diseases can present?

“The scope of prescribing is very wide. It is my understanding, based on the Optometry Board's report, that all medications may be prescribed. I do not think it is limited to a few glaucoma drugs or antibiotics.
I feel that if it is going ahead, there should be limitations put on what drugs can be prescribed.”

“Not safe. If patients require higher-level treatment, such as oral medications, they should be seen by a practicing ophthalmologist with more experience in the management of these disorders.”

“A registered medical practitioner must supervise the use of oral antibiotics and antivirals; the longer a patient is under, or overtreated, the more likely it is to lead to difficulties in subsequent management.
Acetazolamide is a very toxic drug; fatalities have been recorded in Australia. This list includes potentially life-threatening conditions being managed by practitioners with questionable competence and a high level of confidence; this is a problem under the current prescribing guidelines.
The pub test is likely to fail!”

“(Optometrists) should have a complete understanding of complex systemic interactions with all physiological diseases the patient could have and all other medications the patient is already taking before prescribing any medicines with serious potential side effects. When treating patients, first do no harm.”

“I don't believe they should be prescribing any medication. They are not medically trained. This should be strongly opposed. I fear we are fighting a losing battle. If they want to be ophthalmologists, then they should do a medical degree and try to get into ophthalmology.”

“I have treated a patient on the renal ward who developed acute renal failure after oral antivirals. It was unexpected and severe. The recognition and management of such drug reactions is the role of a medical doctor. These are not benign medications"

“I feel that if a patient requires acetazolamide or systemic antiviral therapy, then they should be seen by an Ophthalmologist, or at the very least discussed with an Ophthalmologist. Maybe this could be restricted to repeat prescriptions or only in conjunction with an Ophthalmologist. I think there is a risk of systemic adverse events and inappropriate prescribing. I do not think Optometrists have the experience to use these medications safely or appropriately.”

“I feel it is entirely inappropriate that an optometrist with minimal medical training is allowed to prescribe medications after only limited instruction. They have little knowledge of the bigger picture, such as side effects, drug interactions, antimicrobial resistance or effectiveness. While they may claim they only want to prescribe for Ophthalmologic conditions, these drugs have a much broader general application.
This applies especially to S4 medications, as the others are freely available anyway. As for the argument that it would give better access and save money for patients, this is false, at least in urban areas, as most GPs and Ophthalmologists see urgent cases promptly. The lack of PBS access will be a financial burden for many, especially pensioners and concession card holders.”

“I think this list must be a direct copy of a list from somewhere overseas, e.g. a state in the USA. Not all of these drugs (e.g. topical tetracycline) are available in Australia. Somebody from the PBS and antimicrobial guidelines should be consulted before this list is even considered.
I would support optometrists being able to prescribe the following topical antimicrobials: Chloramphenicol, tobramicin and ofloxacin/ciprofloxacin.
Better antimicrobial stewardship education is needed as optometrists are currently using fluoroquinolones inappropriately for prophylaxis, e.g. in marginal keratitis. These patients get recurrent disease and are at risk for being colonised by fluoroquinolone-resistant organisms because of recurrent prescribing. Most of these things have never been prescribed by me before or after my ophthalmic training, so I do not agree that an optometrist should be prescribing them. Prescribing needs to be kept simple and safe.
I would support optometrists being able to prescribe the following systemic antimicrobials: doxycycline (for rosacea/meibomitis only), valacyclovir for VZV. Optometrists do not have the medical background to prescribe antimicrobials with serious potential side effects, e.g., minocycline/azithromycin (arrhythmia) and clindamycin (pseudomembranous colitis). They should have no need to prescribe any other systemic antibiotic. I hardly use any of these except on the basis of a +ve culture result/microbiologist advice, and optometrists should not either. They should be deferring to medical care in the case of an infection requiring antibiotics.
I do not support optometrists prescribing diclofenac. They should be allowed to prescribe the lowest cardiovascular, GIT and liver toxicity risk NSAIDS.

“Medical training is inadequate for prescribing these dangerous medications. Patients will suffer from a lack of medical knowledge and insight into serious side effects from these medications.”

“There is not enough medical skill/knowledge. In optometry training to understand indications, prescription dosage requirements and monitoring of effectiveness and side effects of these drugs
Additionally, limited prescribing rights promote overuse of these particular drugs when diagnostic uncertainty prevails. There are still many issues with the uncertainty of unsupervised topical medication prescriptions.”

“I feel that many of the proposed medicines should only be prescribed by someone who has a medical degree and has studied the relevant pharmacology and general medicine, as these drugs act systemically with an added effect on the eye rather than a drop, which acts on the eye with an added effect on the body.”

“Not medically trained
Many of these oral medications have significant side effects.
We have to draw the line and act in our patients' interests.
No evidence that patient care will be improved with enhanced prescribing rights.”

“I think it will lead to more complications and multiple treatments. There will be an increase in microbial resistance, particularly as fluoroquinolones will be used more (see the USA, where resistance to these is much higher as they are used routinely, and they can't use Chloramphenicol(!)), and management with anti-inflammatories can be quite complex and react with other medical issues. I think GPs should be canvassed as to their thoughts, as they will take away from collaborative care, as the optoms will think they can manage it all themselves. Unfortunately, ophthalmology teaching has a low priority in training, although it is a significant issue for many specialties. GPs see an eye problem and send it to the local optometrist, as they can get in quickly, and some ophthalmic practices don't see anything except procedural cases. We will end up with half or over-treated problems with perhaps interactions, and it will be more difficult to sort out.”

How can we stop this proposal?

We encourage our members to submit and say NO to OBA's proposal.

What do I say in my submission?

See our suggested responses here:

Below is the list of medications OBA has proposed optometrists be allowed to prescribe, and their side effects.

Medication	Drug Class	Primary Uses		Common Negative Side Effects	Rare but potentially life-threatening / serious adverse effects (red flags)
Acetazolamide	Carbonic anhydrase inhibitor		Glaucoma, altitude sickness, epilepsy, edema	Tingling in extremities, frequent urination, drowsiness, confusion, kidney stones	Severe metabolic acidosis, aplastic anemia, agranulocytosis, Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), severe hypersensitivity reactions, significant electrolyte disturbances causing arrhythmia.
Aciclovir (Acyclovir)	Antiviral		Herpes simplex, herpes zoster (shingles), varicella	Headache, dizziness, nausea, vomiting; neurotoxicity (rare)	IV-related crystalluria/acute kidney injury (nephrotoxicity), neurotoxicity (confusion, seizures) in renal impairment, severe hypersensitivity, rare blood dyscrasias.
Amoxicillin	Penicillin antibiotic		Ear infections, pneumonia, throat infections, UTIs	Nausea, vomiting, diarrhea, black/hairy tongue, rash	Anaphylaxis, severe cutaneous adverse reactions (SJS/TEN), drug-induced liver injury (cholestatic hepatitis), severe hypersensitivity vasculitis.
Amoxicillin + Clavulanic acid	Penicillin/Beta-lactamase inhibitor		Resistant bacterial infections, sinusitis, pneumonia	Similar to amoxicillin plus increased diarrhea risk	Cholestatic hepatitis (can be prolonged), anaphylaxis, severe skin reactions (SJS/TEN), severe liver injury (rare but reported).
Azithromycin	Macrolide antibiotic		Sinus infections, pneumonia, sexually transmitted diseases	Diarrhea, nausea, abdominal pain; cardiovascular risks	QT prolongation / torsades de pointes (especially with other QT drugs), severe hepatic injury, anaphylaxis, very rare arrhythmias.
Beclometasone (Beclomethasone)	Inhaled corticosteroid		Asthma, COPD, allergic rhinitis	Oral candidiasis, dysphonia (hoarseness), cough, throat irritation	Rare systemic corticosteroid effects at high/long-term doses: adrenal suppression, growth suppression (children), opportunistic infections (e.g., TB), severe systemic hypersensitivity (rare).
Budesonide	Inhaled corticosteroid		Asthma, COPD, allergic rhinitis, Crohn's disease	Local throat irritation, oral candidiasis, dysphonia; less systemic effects than other steroids	As above: adrenal suppression with high systemic exposure, growth suppression (children), severe infection risk if immunosuppressed; rare severe hypersensitivity.
Cefalexin (Cephalexin)	Cephalosporin antibiotic		Skin infections, UTIs, respiratory infections	Diarrhea, nausea, vomiting, abdominal pain, rash	Anaphylaxis, severe allergic skin reactions (SJS/TEN), C. difficile colitis (can be life-threatening), rare blood dyscrasias.
Cetirizine	Second-generation antihistamine		Allergic rhinitis, urticaria, allergies	Drowsiness (more than other 2nd gen antihistamines), headache, dry mouth	Rare severe hypersensitivity/anaphylaxis; very rarely severe hepatic dysfunction or seizures in predisposed patients.
Ciclesonide	Inhaled corticosteroid		Asthma, allergic rhinitis	Lower incidence of oral side effects, minimal systemic absorption	Rare systemic steroid effects (adrenal suppression) with high doses, paradoxical bronchospasm, severe hypersensitivity (rare).
Ciprofloxacin	Fluoroquinolone antibiotic		UTIs, respiratory infections, GI infections	Diarrhea, nausea; tendon damage (especially in elderly), dizziness, confusion	Tendon rupture (may be bilateral), peripheral neuropathy (possibly permanent), QT prolongation, aortic aneurysm/dissection risk (rare association), severe hepatotoxicity, CNS toxicity.
Clindamycin	Lincosamide antibiotic		Skin/soft tissue infections, bone infections	Diarrhea (including C. difficile colitis), nausea, rash, abdominal pain	Clostridioides difficile colitis (can be severe/fatal), severe hypersensitivity, agranulocytosis or other blood dyscrasias (rare).
Desloratadine	Second-generation antihistamine		Allergic rhinitis, chronic urticaria	Less sedating than cetirizine, headache, dry mouth	Rare severe hypersensitivity reactions, very rare hepatic dysfunction, anaphylaxis.
Dexchlorpheniramine	First-generation antihistamine		Allergies, cold symptoms	Drowsiness, dizziness, dry mouth, blurred vision, constipation	Severe anticholinergic toxicity in overdose, rare arrhythmias, severe hypersensitivity, seizures (rare).
Diclofenac	NSAID		Pain, inflammation, arthritis	GI bleeding/ulcers, cardiovascular events (highest risk among NSAIDs), liver effects	Serious GI bleeding/perforation, acute kidney injury, severe hepatic injury, increased risk of thrombotic cardiovascular events (MI/stroke), severe hypersensitivity (angioedema/anaphylaxis).
Dicloxacillin	Penicillin antibiotic		Staphylococcal infections	Nausea, vomiting, diarrhea, abdominal pain, rash	Severe allergic reactions including anaphylaxis, cholestatic hepatitis/hepatic injury (rare), neutropenia (rare).
Doxycycline	Tetracycline antibiotic		Respiratory infections, acne, Lyme disease	Nausea, photosensitivity, esophageal irritation, tooth discoloration (children)	Intracranial hypertension (pseudotumor cerebri), severe photosensitivity burns, esophageal ulceration with improper dosing, hepatic toxicity (rare), severe hypersensitivity.
Erythromycin	Macrolide antibiotic		Respiratory infections, skin infections	Nausea, vomiting, diarrhea, abdominal cramping	QT prolongation / torsades, severe cholestatic hepatitis, ototoxicity at high doses, severe hypersensitivity.
Esomeprazole	Proton pump inhibitor		GERD, erosive esophagitis, peptic ulcers	Headache, diarrhea, nausea; long-term: fractures, kidney disease, infections	Acute interstitial nephritis (rare but serious), hypomagnesaemia (prolonged use), increased risk of C. difficile infection, rare severe hepatic injury.
Famciclovir	Antiviral		Herpes simplex, herpes zoster	Headache, nausea, diarrhea, fatigue	Rare neurotoxicity in renal impairment, severe hypersensitivity reactions, rare blood dyscrasias.
Fexofenadine	Second-generation antihistamine		Allergic rhinitis, chronic urticaria	Minimal sedation, headache, back pain	Very rare severe hypersensitivity/anaphylaxis; rare cardiac effects in predisposed patients.
Flucloxacillin	Penicillin antibiotic		Staphylococcal infections	Nausea, diarrhea, rash, rare hepatotoxicity	Severe cholestatic hepatitis (can be prolonged and severe), anaphylaxis, rare blood dyscrasias.
Fluticasone	Inhaled corticosteroid		Asthma, COPD, and allergic rhinitis	Oral candidiasis, dysphonia, throat irritation; higher systemic absorption than budesonide	Rare systemic steroid effects (adrenal suppression) with high doses, increased risk of systemic infection in immunosuppressed patients, severe hypersensitivity.
Ibuprofen	NSAID		Pain, inflammation, fever	GI upset, bleeding risk, cardiovascular risk with long-term use	Serious GI bleeding/perforation, acute kidney injury/renal failure, increased cardiovascular thrombotic risk, severe hypersensitivity (angioedema, anaphylaxis).
Indometacin (Indomethacin)	NSAID		Arthritis, gout, patent ductus arteriosus	GI upset, headache, dizziness, increased bleeding risk	Severe GI bleeding/ulceration, acute renal failure, severe CNS effects (confusion, seizures), increased CV risk, rare severe hepatic injury.
Loratadine	Second-generation antihistamine		Allergic rhinitis, chronic urticaria	Minimal sedation, headache, dry mouth	Rare severe hypersensitivity/anaphylaxis, very uncommon hepatic injury.
Mometasone	Inhaled corticosteroid		Asthma, allergic rhinitis	Local irritation, oral candidiasis; most lipophilic steroid	Rare systemic corticosteroid effects with high/long-term exposure: adrenal suppression, growth suppression, severe hypersensitivity (rare).
Naproxen	NSAID		Pain, inflammation, arthritis	GI side effects (higher than ibuprofen), increased bleeding risk, and cardiovascular risk.	Serious GI bleeding/perforation, acute renal failure, increased CV risk, severe hypersensitivity (angioedema/anaphylaxis).
Nepafenac	Ophthalmic NSAID		Post-cataract surgery inflammation	Eye irritation, blurred vision, headache	Rare corneal adverse events including corneal melt/perforation (particularly post-surgery or with predisposing conditions), vision-threatening infections, severe hypersensitivity.
Omeprazole	Proton pump inhibitor		GERD, peptic ulcers, erosive esophagitis	Headache, diarrhea, abdominal pain; long-term risks similar to other PPIs	Acute interstitial nephritis (rare), hypomagnesaemia (prolonged use), increased risk of C. difficile infection, rare severe hepatic injury and severe allergic reactions.
Pantoprazole	Proton pump inhibitor		GERD, erosive esophagitis, Zollinger-Ellison syndrome	Headache, diarrhea, nausea; hypomagnesemia with long-term use	Same class risks as omeprazole: acute interstitial nephritis, hypomagnesaemia, C. difficile risk, rare severe hepatic injury.
Paracetamol (Acetaminophen)	Analgesic/Antipyretic		Pain, fever	Generally well-tolerated; liver damage with overdose	Liver failure/hepatic necrosis in overdose (can be fatal), rare severe hypersensitivity including SJS/TEN, rare blood dyscrasias.
Valaciclovir (Valacyclovir)	Antiviral (Prodrug of aciclovir)		Herpes simplex, herpes zoster, and CMV prevention	Headache, nausea, vomiting; rare neurotoxicity, kidney problems	Acute kidney injury (crystalluria/renal failure) if not dose-adjusted in renal impairment, neurotoxicity (confusion, hallucinations) particularly in elderly/renal impairment, rarer reports of thrombotic microangiopathy/TTP-HUS in immunocompromised; severe hypersensitivity (rare).

How can we stop this proposal?

We encourage our members to submit and say NO to OBA's proposal.