Nigerian Optometry and the Role of Medication in Eye Care!

Optom
The scope of Optometry practice in Nigeria did not mention using medications to manage what it refers to 'minor ocular infection which does not pose a threat to integrity of the ocular or visual system'. But "manage" and "diagnosis" indirectly gives us access to using both diagnostics (drugs that help in diagnosis) and therapeutics (drugs that help in treating/managing disease conditions) without making us breakers of the law!
But come to think of this, what does this law refer to as, "minor" ocular infection that does not pose a threat to ocular or visual integrity?  A patient of mine who I diagnose to have Angle closure Glaucoma viz positive family history of sudden and painful loss of sight, associated congestive cilliary injection around the corneo-limbal region, with a fixed & dilated pupil, whose intra-ocular pressure is way up the tonometric chart (@least 40 mm Hg on the affected eye!), with a reduced visual acuity of sudden onset and with so many other markers pointed at the culprit secondary Glaucoma, what do I do?
 Of course we all know that the best thing to do is to find medical means to suppress the intra-ocular pressure at the same time providing him a referral service to a Glaucoma surgeon. In some cases, I give IV Mannitol or IV Diamox to facilitate reduction in IOP. I have been able to save many such eyes, subsequently send them to a Glaucoma surgeon to create filtration orifices in the eyes to ease the congestive tension ipsilaterally. Hypoxia is removed, patients sensory retina is preserved by the intervention I proffered, since asphyxiation of the sensory retina even for seconds could have apoptosis consequence on the neuro-retinal fibres.
This law sure needs to be reviewed as soon as possible! Yes the Cap 09 laws of the Federation!
Day to day practicing Optometrists are confronted by challenging eye conditions that require them, not only to diagnose but, to give urgent attention to the underlying cause of that eye conditions with the intention of removing the cause. Most of this attention given could be in form of medications or a combination of medication and glasses! It is therefore very important that basic knowledge of drugs especially those for diagnosing eye care conditions, those for managing eye conditions and those that might have visual side-effects.
Baring in mind that some systemic conditions presents ocular complications, it is not unwise to have basic knowledge of the disease pathology, identify medications that treat/manage these conditions, know the side-effects of these drugs both systemically and visually at the same time ensuring that the integrity of the eye is not compromised! Colleagues you will agree with me that such conditions like Diabetes and Hypertension are very chronic systemic conditions with obvious and sight threatening visual complications... Imagine an Optometrist managing the visual complications of these conditions without basic knowledge of the underlying conditions or the effect  medications used for managing them may have on the entire visual apparatus. I see such systemic conditions with ocular complications almost on daily basis and I have to answer all their eye questions including those related to the systemic drugs used for managing those conditions, I have no other choice. What excuse would I give such patients if my knowledge of the diseases and the drugs are poor? I know that is not what they want to hear from their doctor! I have therefore fortified myself in anticipation of the inevitable.
Why should an Optometrist have a sound knowledge of drugs with visual consequence? As rhetorical as the question might sound, it sure presents the present crop of Optometrist practicing in Nigeria with a moralistic dilemma! If my above patient was referred to the nearest Ophthalmologist (who probably stay thousands of kilometres away), it will take him another two (2) to three (3) weeks before getting prepared enough to go see the Doctor & imagine the snail pace of being able to see the Ophthalmologist! The eye would probably be gone before the Ophthalmologist in Nigeria, who is busy fighting its eye care colleague (the Optometrist) over futile issues.
To become an eye care medical professional in this country and in the African continent & in the world, Optometry in Nigeria had better develop its place in ocular pharmacology. We need to press for more legislation to change the status quo of our scope of practice. There is no legislation on drug use in Optometry, we need to advance on that course. We need to start from the ABC of pharmacology and that is what this blog is all about. What is our intellectual hold on what drugs are made of, how drug pass the obvious ocular barriers to reach the targeted ocular spaces? What are the components of the drugs? What are the pharmacodynamics, pharmacokinetics of those drugs and how do they interact in their target site of actions? Knowing all these does it profit the patient or are we just struggling to out-compete the Ophthalmologists in providing comphehensive eye care services for the growing number of visually challenged persons?
 Without doubt, Optometrists in Nigeria constitute the bulk of eye care providers in Nigeria. As primary eye care providers, we treat with glasses and other medications that protect eyesight... Subsequent blog will elaborate on some pointers that will educate us on the necessity for fully legislated drugs prescription right by practicing Optometrists.
Thanks!