Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Departments of Internal Medicine.
J Glaucoma. 2018 Mar;27(3):233-238. doi: 10.1097/IJG.0000000000000861.
To describe state laws that govern the optometric practice of glaucoma management in the United States and to correlate those laws with state demographics upto 2015.
We performed a cross-sectional ecological study of the 50 United States and the District of Columbia. Regulations governing optometric scope of practice as written by each state Board of Optometry were reviewed. Specific optometric privileges assessed included: ability to manage glaucoma independently, use of diagnostic pharmaceutical agents, use of therapeutic pharmaceutical agents (including topical and oral steroids and other oral pharmaceutical agents), IV injections, intraocular injections, therapeutic lasers, presence of defined referral, and comanagement guidelines, and hours of yearly continuing education needed for glaucoma management. Optometric privilege was compared with demographic and employment information for each state.
Optometrists in all states, except for Massachusetts, and the District of Columbia are allowed to manage glaucoma; 16 states have defined comanagement guidelines. Therapeutic lasers are allowed in 3 states: Kentucky, Louisiana, and Oklahoma. States with defined comanagement guidelines had a mean of 6.9±1.9 ophthalmologists per 100,000 people, significantly more than the 5.3±1.1 in states without defined comanagement of glaucoma (P<0.01). Binary logistic regression showed that, accounting for population and area, the higher the number of optometrists in a state, the less likely there is to be defined comanagement [β (SE)=-0.008 (0.003), P=0.02] and the greater the number of ophthalmologists in a given state, the more likely a state has defined comanagement [β (SE)=-0.13 (0.006)].
There is a diversity of regulations that govern optometric management of glaucoma in each of the 50 states and the District of Columbia. The number of optometrists and ophthalmologists in a state may influence state regulations governing optometric practice and referral guidelines.
描述美国管理青光眼的视光学实践的州法律，并将这些法律与 2015 年之前的各州人口统计学数据相关联。
我们对 50 个州和哥伦比亚特区进行了横断面生态研究。审查了每个州视光委员会编写的有关视光实践范围的法规。评估的具体视光特权包括：独立管理青光眼的能力、使用诊断药物制剂、使用治疗药物制剂（包括局部和口服类固醇和其他口服药物制剂）、IV 注射、眼内注射、治疗激光、规定转诊和共同管理指南、以及每年进行青光眼管理所需的继续教育小时数。将视光特权与每个州的人口统计学和就业信息进行了比较。
除马萨诸塞州和哥伦比亚特区外，所有州的视光师都被允许管理青光眼；16 个州有明确的共同管理指南。3 个州允许使用治疗激光：肯塔基州、路易斯安那州和俄克拉荷马州。有明确共同管理指南的州每 10 万人中有 6.9±1.9 名眼科医生，明显多于没有明确共同管理青光眼的州（5.3±1.1）（P<0.01）。二元逻辑回归显示，在考虑人口和面积的情况下，一个州的视光师人数越多，就越不可能有明确的共同管理[β（SE）=-0.008（0.003），P=0.02]，而给定州的眼科医生人数越多，该州就越有可能有明确的共同管理[β（SE）=-0.13（0.006）]。
在美国的 50 个州和哥伦比亚特区，管理青光眼的视光实践有各种各样的法规。一个州的视光师和眼科医生人数可能会影响该州的视光实践和转诊指南的管理法规。
