PREFACE
With the fortuitous fall of a dart and significant support from my parents, I entered optometry school at the age of 17 years and graduated four years later in 1984. Although the pharmacology and ocular pathology courses taught were of a high standard, the scope of our profession was extremely limited. Optometrists were not allowed to use diagnostic drugs let alone therapeutic drugs, and it was illegal to examine children under the age of eight years. After graduation, I was drafted into compulsory military service and, eventually seconded to the department of ophthalmology in a state-run hospital in a neighbouring country. Here I worked as part of a team that included ophthalmologists and other medical practitioners providing mainly primary, but also secondary eye care services. In this setting, we were allowed to practice a very different style of optometry than what was the norm in the private setting where most optometrists were employed. This experience, more than anything else, was probably the catalyst that started my journey to not only improve my skill set but also to work toward expanding the scope of our profession in order to better serve our patients. The journey has not been without adversity, both from within and outside the profession, but it has resulted in post graduate qualifications from three universities in the United States of America, two universities in the United Kingdom as well as a few very special fellowships and awards. I have been fortunate to have met and been taught by some of the world’s best clinical optometrists, both in the United States, the United Kingdom and South Africa. Therefore the metaphor “Standing on the shoulders of giants”, which means using the understanding gained by major thinkers who have gone before in order to make intellectual and clinical progress, truly applies to me. As those of you who have been on a similar academic journey are aware, the cost of improving your skill sets amounts to thousands of dollars, not to mention time away from your practice and family. However, I believe we need to do whatever it takes, even 600 “observation hours”, to reach the goal of increased scope for our profession.
This fourth edition of the Southern African Guide to Topical Ophthalmic Drugs has benefited from three things. Firstly, I have at least six years of extra hands-on therapeutic experience and a PhD, secondly my co-author, John Leslie, a registered optometrist and medical student’s contribution; and, finally, I have benefited from editorial comments by my former student and colleague for more than 16 years, Gerrie Kruger, one of the most astute clinicians in the business. This Guide is designed for the busy clinician to use in practice and includes clinical pearls gathered through years of experience. Use it wisely and always remember to share your skills and knowledge freely with your colleagues.
Finally, practising ocular therapeutics is like flying a vintage Tiger Moth aircraft. It starts with a proper pre-flight (your clinical examination), the decision to fly or not (treatment plan), this is followed by moments of shear-joy or terror (your follow up), and finally landing safely back on mother earth (final outcome of your treatment plan). If you have the appropriate skills and experience, the outcome is usually always successful.
Dirk J. Booysen 2021
Dip.Optom (SA), TMOD (PCO), CAS (NECO), PGCOT (SUNY), D.Optom (Aston)
Fellow British College of Optometrists
Fellow Scleral Lens Society
Fellow International Society of Contact Lens Specialists
Fellow South African Optometric Association
Having completed my undergraduate degree in optometry, I realized that South African Optometry needs to embrace ocular therapeutics, which requires an in-depth knowledge of ocular pharmacology in order to provide primary eye care services to our citizens. Optometrists’ therapeutic abilities are limited by their knowledge of ocular pharmacology and pathology. Education, experience and knowledge ultimately determine the standard of care we provide. In-depth knowledge of commonly prescribed ophthalmic drugs is incredibly important, especially if one aims to provide the best patient care possible.
It was a privilege to work with my dad on this Guide and to learn from his broad knowledge base in clinical practice. This book serves as an excellent source of information for any clinical optometrist looking to improve on their pharmacological management and care of patients. It is an excellent base to work from if you are beginning your journey into the world of therapeutics, or even as a supplement to further cement the knowledge you have of the field of ocular pharmacology. Wherever you find yourself on this spectrum, this is a must-have “side-kick” that will change the way you think and practice within your field.
John L. Booysen 2021
B. Optometry (UJ), FOA (SA), MBBCh student at the University of the Witwatersrand.
I was lucky enough to meet Dirk Booysen and his family when we were both guests of Bausch & Lomb at a conference in Athens in 2006. With Dirk being such a family man, I also had the privilege of meeting his wife, Sarah, and his children John and Meagan, who had accompanied him on the trip. It was clear to me at the time that Dirk was well known and respected amongst his international counterparts. During our time in Athens, I also discovered that he had a keen interest in Greek mythology. Dirk has become a good friend and a mentor to me over the years. We have attended several conferences together and I was fortunate enough to be his moderator when lecturing the final year students at the University of Johannesburg. His mantra of practising optometry at the limit of where you are comfortable is something that has certainly resonated with me and prompted me to sometimes step out of my own comfort zone in the way that I practice. For this, I will remain forever thankful. His passion for optometry, as well as maintaining and improving the standard of the profession, has always been paramount.
Dirk has published numerous peer-reviewed articles, spoken at countless events, lectured at universities and published his contact lens book In Contact in 2019. He has been involved in expanding the scope of optometry in several southern African countries and championing the cause to extend the scope of optometry in South Africa to include therapeutics. This has now culminated in him writing The Southern African Guide to Topical Ophthalmic Drugs, the fourth edition in the series. It is great to see his son, John being involved in writing this book. This most recent edition is a must-have for every optometrist seeking to further themselves and practice on the limit of where they are comfortable. It is Dirk’s way of sharing the knowledge and experience gained as one of our most respected optometrists during more than 30 years in practice. Along with all the necessary theoretical facts, the reader will also find practical tips and clinical pearls. This book is an essential reference that can be used daily in a practice setting. It will find its rightful place next to In Contact in my consulting room.
I would like to congratulate Dirk on yet another milestone in his illustrious career. As Benjamin Franklin said, “If you would not be forgotten as soon as you are dead and rotten, either write something worth reading or do something worth writing”. I think that you have managed to accomplish both.
SF van Den Berg 2021
B.Optom (RAU), FOA (SA), MBA, PGCOT (SUNY)
The expanded scope of optometry practice in South Africa is a colossal leap for the delivery of professional eye and vision care. Dirk and John Booysen’s Southern African Guide to Topical Ophthalmic Drugs is an excellent ocular therapeutics resource for students and clinicians.
Prof. Paul Ramkissoon 2021
B Optom (UDW) CAS (NECO) PGCOT (SUNY) ACSpVis (RAU) MPhil (RAU) MOptom (UDW) OD (NECO) DPhil (RAU) FAAO (USA)
This text, in its fourth iteration, is the culmination of a career dedicated to the care of ophthalmic patients in Southern Africa through the medium of an increase in the optometric scope of practice. This is a cause I have also spent 40 years espousing because, by demographics, let alone the increasingly technical diagnostic and imaging aspects of ophthalmic care, optometrists are a vital resource for patients to access non-surgical care.
The book comprehensively deals with a breakdown of the common preservatives used in ophthalmic medicines, a source of many confusing and sometimes unsatisfactory outcomes. The subsequent layout leads the reader through the basics and advanced establishment of therapeutic optometric practice. On the other hand, such the student, novice and experienced clinicians can follow the story, refresh what they already know and add to their knowledge or reference base.
Drugs legislation is evidently subject to individual country jurisdiction and so this needs translation into other countries, nevertheless, the layout is easy to understand and can be interpreted in other contexts. As such this is not simply a region or country-specific text, there is something for everyone. Some jurisdictions that have permitted optometric access to therapeutics have not allowed oral medicines and therefore some texts have been limited to topical medicines. Since Dr. Booysen refused to fall into this trap, the book has universal applicability in optometric education internationally.
A large number of texts on “drugs” confuse scientific and trade names and make it difficult for the reader to follow, whereas this book bridges the gap in information and caters to the needs of the readers. There is a clear nomenclature and a demonstration of the understanding of reasons behind the formulation, mechanisms of action and appropriate use.
Ultimately, the chapter breakdown is by medicine and by inference its use. What makes this book different from other books available on the market is that it encompasses important details on ophthalmic exanimation, such as why one might wish to dilate and what one might look for. One other component that makes this book stand out is that it is not a dry, isolated text on medicines alone.
Whilst there is an underlying passion for the discipline of optometry throughout the text this is not partisan and in summary, I think this is an essential text for any optometrist, ophthalmologist or nurse practitioner who is presented with patients needing ophthalmic diagnosis and medical treatment.
Nicholas James Rumney
Honorary Professor Clinical Optometry
University of Manchester, UK
DIRK J. BOOYSEN
JOHN L. BOOYSEN
2022