The use of injectable medications is a touchy subject and the source of ongoing dispute and deliberation. Currently, optometrists in 35 states are permitted to administer drugs via injection; yet many well-trained, prominent O.D.s opt not to do so. Their reasons are varied and are of particular interest to many ophthalmologists who wish to retain sole ownership of injectable territory.

While I would never criticize an optometrist for steering clear of a procedure that he or she is not comfortable performing, the hushed debate got me wondering what everyone’s really so afraid of—is it the needle itself, or what’s inside that sparks the quarrel and hesitation?

Much of what you would potentially administer via injection is already part of your frequently-used armamentarium of pharmaceutical agents. But there are some key points to remember when administering an injection. Several years ago, James Fanelli, O.D., pointed out the following in a Review of Optometry article:¹

“Injectable medications have one very important and striking difference compared with both topicals and orals: The body absorbs injectables faster than other routes of administration. Faster absorption means that the desired action of the medication occurs more quickly, but it also means that untoward side effects also occur more rapidly.”

While the lion’s share of an optometrist’s experience is in prescribing topicals, optometrists are trained extensively on the use of a whole spectrum of pharmacologic agents—including systemic and injectable medications. And, to be fair, understanding absorption rates is not rocket science—particularly to trained doctors. So again, I ask, what is everyone so afraid of?

Perhaps the reason why ophthalmologists so fiercely attack optometry’s efforts to gain injection privileges is because placing a needle anywhere near the eye is dangerous business. Certainly, states should take a close look at your training before deciding whether you are qualified to take a sharp object full of medicine or dye and inject it into a patient or consumer. That’s why I was so surprised when I went shopping online for some less irritating eye makeup that wouldn’t leave me rubbing my itchy lids all day. During my quest, I stumbled upon several local businesses that will tattoo permanent eyeliner along my lash line for about $250.

Excuse me? Apparently, the great state of Pennsylvania has placed a higher educational value on its cosmetology schools than on graduates of the esteemed Salus University. That’s right. Don’t inject that chalazion with a steroid, but by all means, take a needle to my lid and pierce my skin while injecting me with unregulated chemicals.

Actually, I take that back, the chemicals are—or should be—regulated. According to the FDA’s website: “FDA considers the inks used in intradermal tattoos, including permanent makeup, to be cosmetics and considers the pigments used in the inks to be color additives requiring premarket approval under the Federal Food, Drug, and Cosmetic Act.”² They go on, however, to say that they don’t traditionally exercise their authority over tattoo inks or the pigments used in them, even though they recognize the fact that “many pigments used in tattoo inks are not approved for skin contact at all” and “some are industrial grade colors that are suitable for printers’ ink or automobile paint.”²

I applaud the optometrist who knows his or her own limits and chooses not to go down the road of gaining injection privileges. That’s not what I’m afraid of. I’m afraid of the system, which obviously ignores the differences between trained health care professionals and unlicensed tradesmen, and focuses instead on amplifying labels, rather than considering the training that’s behind them.

Amy Hellem
Editor-in-Chief

1. Fanelli JL. The use of injections in primary care. Rev Optom. 2002 Nov;139(11):70-81.
2. The U.S. Food & Drug Administration. Tattoos & Permanent Makeup. Available at: www.fda.gov/cosmetics/productandingredientsafety/productinformation/ucm108530.htm (accessed January 4, 2012).