Opticians (Amendment) Bill 2002: Second Stage
Dr. Henry: I wish to share time with Senator Quinn.
I welcome the Minister to the House. I also welcome the majority of the Bill's provisions, including the updating of the terminology, fines and the deregulation of ready-readers. While the institute of opticians has naturally been in contact with Members, I have also had contact from the college of ophthamologists. The Minister recognised their concerns about the use of the phrase, "the treatment of eye disease", by stating that an amendment would be tabled by him on Committee Stage. I am glad of that because it saves my trying to fight for it.
I share the concerns about the extension of the use of drugs for the eye. One thing that should cheer the Minister is that I wish fewer people could prescribe less rather that more and that, while these drugs affect the eye only, we must be careful that something that affects the eye does not have a systemic effect or have side-effects within the eye which we did not suspect at the time. For example, Chloramphenicol eye ointment was widely used at one stage until it was found to be capable of causing agranular cytosis. I used it, as did many others, and we thought it was wonderful. While one says these drugs are just being applied to the eye, the sight of the person is terribly important, as is their general health. We know that some of these drugs have side-effects and I am concerned that the local application may mask problems in the general system which, because the person does not have medical training, they will not recognise. I ask the Minister to consider these matters before Committee Stage.
The Minister says this brings matters into line from an EU perspective. However, the only optometrists who can prescribe drugs in the EU are in the UK and the Netherlands. I do not know the situation in the Netherlands, but in the UK optometrists have to do an extra year in a hospital and an examination at the end of that year. We are not introducing that here.
Mr. Martin: I made the EU reference in the context of the deregulation of ready-made readers.
Dr. Henry: The drugs that optometrists want to prescribe are mainly local anaesthetics for the eye, as well as drugs that affect accommodation. The only reason for using drugs that affect accommodation is to examine the fundus of the eye. If one is examining the fundus of the eye, one is surely trying to diagnose the medical condition. Diabetes is one of the most important problems regarding disease of the eye.
I have no doubt that optometrists will refer people to medical practitioners as they have done, but if people visiting optometrists are given the impression they are getting a full examination of the eye, they will have a sense of security that their retina has been looked at and any disease has been picked up. I would like to know more about why it is desirable that opticians should be in a position to examine the fundus and perhaps diagnose retinal diseases.
These practitioners are also putting themselves in a situation where they are far more liable to litigation. Who will be held responsible if, after using drugs that affect accommodation, a disease of the retina is found? Will they be liable? They do not have medical training so they could not be expected to recognise these diseases but, having given the impression they are conducting more than an examination required for glasses, will they be liable under this Act if they miss any diseases present? I would like some guidance on that.
The Minister said we will have to update the Medical Products (Prescription and Control of Supply) Regulations 1996 to allow these drugs to be used and I want to know the view of the Irish Medicines Board and if it has it been consulted.
Optometrists are taking great responsibility upon themselves which I hope has been properly thought through. Even when using local anaesthetics on the eye one must be careful about warning people when they leave the examination not to get dust in their eye because they will not feel it. If they do not give these warnings, will they be liable for any damage done to the cornea? I hope these aspects have been carefully considered.
While it might be a plus to allow people to prescribe for diagnostic purposes, people may think they have had a whole examination of their eye and any diagnosis of disease which may be systemic but which manifest itself in the eye, such as with diabetes, may be overlooked. I hate to sound like a doubting Thomas, but I see problems with patients perceiving they are getting a more extensive examination than they in fact are.
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