Experience regarding use of diagnostic drugs in Norway

Hans Torvald Haugo, optometrist - MSc

Secretary General and Professional Manager

The Norwegian Association of Optometry and Optical Information Council

WCO defines optometry as follows:

“Optometry is a healthcare profession

that is autonomous, educated, and

regulated (licensed/registered), and

optometrists are the primary

healthcare practitioners of the eye and

visual system who provide

comprehensive eye and vision care,

which includes refraction and

dispensing, detection/diagnosis and

management of disease in the eye,

and the rehabilitation of conditions of

the visual system.”

Getting new rights

Education

Legislation

Regulation

Diagnostic drugs in Norway

• First mentioned in our strategy 1998 – 2010

• Education started up 1998 (MSC-course, PCO)

• Optometrists got rights using diagnostic drugs 1.th of May 2004

Optometry - healthcare

• Optometrists in Norway today have a expanding role within primary eye care.

• The Norwegian health care system have enormous challenges in the future.

The role of the craftsman is less

important than before.

But remember

– it is not unimportant!

Challenges in the future

Just to your information…

• 5 million people • 1500 optometrists • 356 ophthalmologists • 40 orthoptists

• 5,5 million people • 2200 optometrists • 350 ophthalmologists • 20 orthoptists

Discussion about diagnostic drugs – always a discussion about safety

Figures in this lecture

• Facts from 3 different studies:

– 2005 (69)

– 2008 (395)

– 2012 (214)

Age distribution

0

28 %

32 %

24 %

13 %

3 %

Age 2012

Below 20

21 - 30

31 - 40

41 - 50

51 - 60

61 - 70

Sex

Education – highest level

2005: 93% w/ MSc

2008: 44% w/ MSc

Use of rights

Use of rights

Type of use

List of diagnostic drugs: Cycloplegic refraction (childeren) Atropin øyedråper 10 mg/ml «Ophtha» Atropin Minims øyedråper 10 mg/ml «Chauvin»

Cyklopentolat Cyclopentolat Minims øyedråper 10 mg/ml «Chauvin» Homatropin Homatropin øyedråper 10 mg/ml «Ophtha» Miosis (pupil retraction) Isopto-Carpine øyedråper 20 mg/ml «Alcon» Pilo øyedråper 20 mg/ml «Novartis» Pilokarpin øyedråper 20 mg/ml «Ophtha» Pilokarpin Minims øyedråper 20 mg/ml «Chauvin» Large pupils (lens, vitreous, fundus) Tropikamid Minims øyedråper, endosebeholdere 5 mg/ml (0,5%) «Chauvin» Mydrian øyedråper 0,5% «Novartis»

Lokal anesthesia (different examinations) Oksybuprokain Oxibuprokain Minims øyedråper 4 mg/ml «Chauvin» Proksmetakain Alcaine øyedråper 5 mg/ml «Alcon» Tetrakain Tetrakain Minims øyedråper 10 mg/ml «Chauvin» Adrenalin EpiPen Jr injeksjonsvæske i autoinjektor 0.15mg/dose

«ALK-Abello» (til bruk på barn)

EpiPen injeksjonsvæske i autoinjektor 0.3 mg/dose «ALK-Abello» (til bruk på voksne)

Easy use starter kit:

Tetracaine Reversible local anesthesia

Cycloplentolate Mydriatic and cycloplegic agent

Tropicamid: Short acting mydriasis and cycloplegia

Personal clinical advice:

Tetracaine Reversible local anesthesia

Change with Oksybuprokain -Stains less

Which drugs are in use?

No use of EpiPen!

Side effects or complications

Summary 2005:

• Safer

• Change of respect from other professions

• Referrals from colleges

• Mostly just positive reactions from the patients

• Side effects: almost 1/3

• Not only for diagnostic purposes – getting a better view/feeling safer

Summary 2012:

• Use of diagnostic drugs improves the quality of the examination

• Use of new techniques – development

• Patients feel more safe

• Some tell about less referrals

• Gives the patient the confidence they deserve

• Get more trust from patients

• Better possibilities regarding examination choices

Put your head on the

chopping block…

Please remember two things about diagnostic drugs:

Diagnostic drugs is not

a right for optometrists,

it’s for the patients best!

Safety first