IML C.S.H.B. 2091 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.H.B. 2091 By: Coleman 5-5-97 Committee Report (Substituted) BACKGROUND Under Article 4552-1.02(1) of Vernon's Texas Civil Statutes, the practice of optometry is defined as "...the employment of objective or subjective means, with or without the use of topical ocular pharmaceutical agents, for the purpose of ascertaining and measuring the powers of vision of the human eye; examining and diagnosing visual defects, abnormal conditions, and diseases of the human eye and adnexa; and prescribing or fitting lenses or prisms to correct or remedy any defect or abnormal condition of vision." Under current law, unless an optometrist is either a licensed physician, a surgeon, or a therapeutic optometrist, he or she may not treat the eye for any defect, prescribe any drug, or administer any physical treatment. Therapeutic optometrists have the same background as optometrists, except they have some pharmacological training. Therapeutic optometry is similar to the practice of optometry, except that a therapeutic optometrist may administer or prescribe a drug or physical treatment to treat the eye and adnexa, as long as he or she does not perform surgery or laser surgery. In 1991 the Legislature passed SB 774, authorizing therapeutic optometrists who have met certain educational requirements to treat eye diseases and disorders. Prior to this legislation, therapeutic optometrists were prohibited from using certain tools to treat diseases, such as oral medications, anti-glaucoma and anti-viral medications, and most surgical procedures. PURPOSE CSHB 2091 expands the practice of therapeutic optometry, including surgery under narrow circumstances. The bill eliminates the current technical advisory committee to the Texas Board of Optometry on appropriate drug prescriptions. A study is established to determine whether therapeutic optometrists may safely perform laser surgery. RULEMAKING AUTHORITY It is the committee's opinion that this bill amends the rulemaking authority given to the Texas Optometry Board in SECTION 2 (Section 1.03(d), Texas Optometry Act (Article 4552-1.03, Vernon's Texas Civil Statues)). SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 1.02(7) and (8), Texas Optometry Act (Article 4552-1.02, V.T.C.S.), as follows: Subsection (7) amends the definition of "practice of therapeutic optometry" by adding language clarifying that therapeutic optometrists treat the "visual system." Strikes "without the use of surgery or laser surgery," and adds language indicating that the general prohibition against the use of surgery or laser surgery is modified "as specifically authorized by this Act." Subsection (8) amends the definition of "adnexa" by adding "related structures." SECTION 2. Amends Section 1.03, Texas Optometry Act (Article 4552-1.03, V.T.C.S.), by amending Subsections (b) and (d)-(g), and adding Subsections (h)-(l) as follows: Subsection (b) allows therapeutic optometrists to administer, perform or prescribe ophthalmic devices, procedures, and appropriate medications administered by topical, oral, or parenteral means. Additional language is also added to clarify that optometrists may treat the vision system. Prohibitions regarding limitations on the use of steroids, and prohibitions on the treatment of glaucoma and anti-viral disease are deleted, and the limitations set forth in Subsection (f) are referenced. Subsection (d) requires the optometry board to adopt rules setting forth specific "classifications" of drugs which may be used. This amendment conforms to a recent attorney general opinion. Subsection (e) strikes all current language referencing the technical advisory committee, and designates unamended Subsection (g) as Subsection (e). Subsection (f) strikes language regarding the membership of the advisory committee, and adds language allowing a therapeutic optometrist to prescribe only specified classifications of oral pharmaceuticals. Subsection (g) allows a therapeutic optometrist to perform certain treatment procedures if they are performed without the use of lasers. Subsection (h) requires a therapeutic optometrist to be certified by the board as specified before a therapeutic optometrist is allowed to treat glaucoma. Subsection (i) allows a therapeutic optometrist certified to treat glaucoma to independently treat glaucoma with topical medications and administer oral medications for emergency purposes only, and within a specified duration. Requires consultation with a physician under certain specified situations, and requires the physician and therapeutic optometrist to arrive at a comanagement plan. Subsection (j) requires the therapeutic optometrist to refer children under 10 years of age with certain diagnoses to a physician. Subsection (k) prohibits a therapeutic optometrist from treating glaucoma with surgery or laser surgery. Subsection (l) defines "surgery" and "surgical procedure." SECTION 3. Amends Article 1, Texas Optometry Act (Article 4552-1.01 et seq., V.T.C.S.) by adding Sec. 1.04, STUDY REGARDING LASER SURGERY, as follows: Subsection (a) requires the University of Houston and The University of Texas Health Science Center to conduct a study analyzing safety, efficacy and cost effectiveness of laser surgery performed by therapeutic optometrists. Subsection (b) requires the study to be governed by a project steering committee. Requires the project steering committee to be responsible for certain aspects of the study and to be appointed as specified. Subsection (c) requires the deans of both universities to jointly appoint a principal investigator. Requires the principal investigator to appoint personnel, oversee the collection and analysis of data, and act as chair of the project steering committee. Subsection (d) requires the study to be conducted under specific guidelines. Subsection (e) requires the project steering committee to report to the legislature as specified. Subsection (f) requires any report arising from this study to be provided to the appropriate entity if HB 2216 becomes law. Subsection (g) prohibits a therapeutic optometrist from performing laser surgery except under the direct supervision of an ophthalmologist as part of the study conducted under this section. SECTION 4. Emergency clause. This Act is effective upon passage. COMPARISON OF ORIGINAL TO SUBSTITUTE SECTION 2. HB 2091 amended Subsections (f) and (g), and added Subsection (h) dealing with therapeutic optometrists performing certain surgeries, whereas CSHB 2091 amends Subsections (f) and (g), and adds Subsections (h)-(l). The bill as filed allowed optometrists to perform minor surgeries approved by the optometry board. The CSHB prohibits surgery by therapeutic optometrists and defines "surgery" in accordance with a recent Attorney General's opinion. It itemizes certain non-surgical procedures. The bill as filed allowed optometrists to treat glaucoma without restriction. The CSHB requires additional education and testing before treating glaucoma, requires consultation with a physician before prescribing oral glaucoma medications, requires consultation and co-management with a physician if a patient is not responding to glaucoma treatment, and requires referral to a physician for certain types of glaucoma. The bill as filed allowed optometrists to prescribe any appropriate oral medication. The CSHB restricts oral medications to 5 specific classes. SECTION 3. HB 2091 called for a laser study conducted by the University of Houston College of Optometry to determine whether optometrists can safely perform laser procedures. CSHB 2091 requires the study to be jointly conducted by The University of Houston and the University of Texas Health Science Center, and adds Subsections (d)-(f) relating to the study. CSHB 2091 also adds Subsection (g) prohibiting a therapeutic optometrist from performing laser surgery except under direct supervision of an ophthalmologist as part of the study.