1-1 AN ACT
1-2 relating to the regulation of the practice of therapeutic
1-3 optometry.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 1.02, Texas Optometry Act (Article
1-6 4552-1.02, Vernon's Texas Civil Statutes), is amended by amending
1-7 Subdivision (7) and adding Subdivision (11) to read as follows:
1-8 (7) The "practice of therapeutic optometry" means the
1-9 employment of objective or subjective means for the purpose of
1-10 ascertaining and measuring the powers of vision of the human eye,
1-11 examining and diagnosing visual defects, abnormal conditions, and
1-12 diseases of the human eye and adnexa, prescribing or fitting lenses
1-13 or prisms to correct or remedy a defect or abnormal condition of
1-14 vision, administering or prescribing a drug or physical treatment
1-15 in the manner authorized by this Act, and treating the visual
1-16 system, including the eye and adnexa as authorized by this Act
1-17 [without the use of surgery or laser surgery]. The practice of
1-18 therapeutic optometry does not include the use of surgery or laser
1-19 surgery.
1-20 (11) "Surgery" means any procedure using instruments,
1-21 including lasers, scalpels, or needles, in which human tissue is
1-22 cut, burned, vaporized, or otherwise altered by any mechanical
1-23 means, laser, or ionizing radiation. The term includes procedures
1-24 using instruments that require closure by suturing, clamping, or
2-1 another device. The term does not include a noninvasive procedure
2-2 to remove a superficial foreign body in the conjunctiva, eyelid, or
2-3 corneal epithelium that has not perforated the Bowman's membrane.
2-4 SECTION 2. Section 1.03, Texas Optometry Act (Article
2-5 4552-1.03, Vernon's Texas Civil Statutes), is amended by amending
2-6 Subsections (b) and (d)-(g) and adding Subsections (h)-(r) to read
2-7 as follows:
2-8 (b) A therapeutic optometrist may administer, perform, or
2-9 [and] prescribe ophthalmic devices, procedures, and appropriate
2-10 medications administered by [over-the-counter oral medications,
2-11 and] topical or oral means, in accordance with this section,
2-12 [ocular pharmaceutical agents, other than antiviral agents and
2-13 antiglaucoma agents,] for the purpose of diagnosing and treating
2-14 visual defects, abnormal conditions, and diseases of the human
2-15 vision system, including the eye and adnexa. In addition, a
2-16 therapeutic optometrist may administer medication by parenteral
2-17 means for the purposes and in the manner set out in Subsection (h)
2-18 of this section. A therapeutic optometrist is prohibited from
2-19 performing surgery or laser surgery [and may remove superficial
2-20 foreign matter and eyelashes from the external eye or adnexa. If a
2-21 therapeutic optometrist utilizes topical steroids of a strength of
2-22 one percent concentration to treat a condition and the condition
2-23 has not substantially improved within seven days of the initial
2-24 topical steroid application, the therapeutic optometrist shall
2-25 consult with an ophthalmologist and the ophthalmologist shall then
2-26 establish the treatment regimen. If a therapeutic optometrist
2-27 utilizes topical steroids of a strength of less than one percent
3-1 concentration to treat a condition and the condition has not
3-2 substantially improved within 14 days of the initial topical
3-3 steroid application, the therapeutic optometrist shall consult with
3-4 an ophthalmologist and the ophthalmologist shall then establish the
3-5 treatment regimen. This subsection does not authorize an
3-6 optometrist to treat glaucoma in a manner that was not permitted by
3-7 law on August 31, 1991].
3-8 (d) The board shall adopt rules setting forth the
3-9 classifications of [specific] pharmaceutical agents therapeutic
3-10 optometrists may use in the practice of therapeutic optometry as
3-11 authorized by this Act. Additional classifications of medications
3-12 as authorized by Section 1.03A(c)(3) may only be approved as
3-13 provided in Section 1.03A. Use by a therapeutic optometrist of
3-14 pharmaceutical agents not authorized by the board or otherwise
3-15 authorized by law shall constitute a violation of this Act.
3-16 (e) [A five-member technical advisory committee is created
3-17 to assist the board in determining the specific pharmaceutical
3-18 agents which may be used in the practice of therapeutic optometry.
3-19 Appointments to the committee shall be for two-year terms, and no
3-20 member may serve more than two consecutive terms.]
3-21 [(f) The members of the technical advisory committee shall
3-22 be appointed as follows: one must be an optometrist or therapeutic
3-23 optometrist licensed and practicing in this state, appointed by the
3-24 Texas Optometry Board; one must be a physician licensed and
3-25 practicing in this state whose practice is limited to
3-26 ophthalmology, appointed by the Texas State Board of Medical
3-27 Examiners; one must be a pharmacist licensed and practicing
4-1 pharmacy in this state, appointed by the Texas State Board of
4-2 Pharmacy; one must be a faculty member at a state medical
4-3 institution of higher education with expertise in pharmacology,
4-4 appointed by the Texas State Board of Medical Examiners; and one
4-5 must be a faculty member of a college of optometry at a state
4-6 institution of higher education, appointed by the Texas Optometry
4-7 Board.]
4-8 [(g)] A therapeutic optometrist, including an optometric
4-9 glaucoma specialist, is subject to the same standard of
4-10 professional care and judgment as a person practicing as an
4-11 ophthalmologist under the Medical Practice Act (Article 4495b,
4-12 Vernon's Texas Civil Statutes).
4-13 (f) A therapeutic optometrist may prescribe oral medications
4-14 only in the following classifications of oral pharmaceuticals:
4-15 (1) one 10-day supply of oral antibiotics;
4-16 (2) one 72-hour supply of oral antihistamines;
4-17 (3) one seven-day supply of oral nonsteroidal
4-18 anti-inflammatories;
4-19 (4) one three-day supply of any analgesic identified
4-20 in Schedules III, IV, and V of 21 U.S.C. Section 812; and
4-21 (5) any other oral pharmaceutical recommended by the
4-22 optometric health care advisory committee and approved by the board
4-23 and the Texas State Board of Medical Examiners.
4-24 (g) A therapeutic optometrist may independently administer
4-25 oral carbonic anhydrase inhibitors for emergency purposes only and
4-26 shall immediately refer the patient to an ophthalmologist.
4-27 (h) A therapeutic optometrist may inject appropriate
5-1 medication for a patient who has an anaphylactic reaction to
5-2 counteract the anaphylaxis. The therapeutic optometrist shall
5-3 immediately refer the patient to a physician.
5-4 (i) Not later than the 30th day after the date of the
5-5 initial diagnosis of glaucoma, a therapeutic optometrist shall
5-6 engage in consultation with an ophthalmologist to develop an
5-7 individual treatment plan that is approved by the therapeutic
5-8 optometrist and ophthalmologist. The parameters of the
5-9 consultation shall be at the discretion of the ophthalmologist but
5-10 must at least include confirmation of the diagnosis and a plan for
5-11 comanagement of the patient, including periodic review of the
5-12 patient's progress.
5-13 (j) A therapeutic optometrist required to engage in
5-14 comanagement consultation with an ophthalmologist shall inform the
5-15 patient diagnosed with glaucoma that the therapeutic optometrist
5-16 shall have the diagnosis confirmed and comanaged with an
5-17 ophthalmologist of the patient's choosing or, if the patient does
5-18 not choose an ophthalmologist, an ophthalmologist practicing in the
5-19 geographic area in which the therapeutic optometrist practices.
5-20 (k) A therapeutic optometrist shall refer a patient to an
5-21 ophthalmologist if:
5-22 (1) the patient is under 16 years of age and has been
5-23 diagnosed as having glaucoma;
5-24 (2) the patient has been diagnosed as having acute
5-25 closed angle glaucoma;
5-26 (3) the patient has been diagnosed as having malignant
5-27 glaucoma or neovascular glaucoma;
6-1 (4) the therapeutic optometrist determines that a
6-2 patient's glaucoma is caused by a diabetic complication and, after
6-3 joint consultation with the physician treating the diabetes and an
6-4 ophthalmologist by telephone, fax, or another method, the physician
6-5 or ophthalmologist determines that the patient should be seen by
6-6 the physician or ophthalmologist; or
6-7 (5) the therapeutic optometrist determines that a
6-8 patient's glaucoma is not responding appropriately to a treatment
6-9 specified in Subsection (m) of this section and, after consulting a
6-10 physician by telephone, fax, or another method, the physician
6-11 determines that the patient should be seen by the physician or an
6-12 appropriate specialist.
6-13 (l) A therapeutic optometrist who refers a patient to a
6-14 physician or specialist shall inform the patient that the patient
6-15 may go to any physician or specialist the patient chooses. This
6-16 subsection does not prevent a therapeutic optometrist from
6-17 recommending a physician or specialist.
6-18 (m) On making an initial diagnosis of glaucoma, a
6-19 therapeutic optometrist shall set a target pressure that is not
6-20 more than 80 percent of the initial intraocular pressure. The
6-21 patient's glaucoma is considered to not be appropriately responding
6-22 to treatment if the patient fails to achieve the target pressure
6-23 within an appropriate time.
6-24 (n) Before a therapeutic optometrist may prescribe a beta
6-25 blocker, the therapeutic optometrist must take a complete case
6-26 history of the patient and determine whether the patient has had a
6-27 physical examination within the 180 days preceding the date of
7-1 taking the history. If the patient has not had a physical
7-2 examination or if the patient has a history of congestive heart
7-3 failure, bradycardia, heart block, asthma, or chronic obstructive
7-4 pulmonary disease, the therapeutic optometrist shall refer the
7-5 patient to a physician for a physical examination before initiating
7-6 beta blocker therapy.
7-7 (o) A therapeutic optometrist who diagnoses acute closed
7-8 angle glaucoma may initiate appropriate emergency treatment for a
7-9 patient but shall refer the patient to a physician in a timely
7-10 manner.
7-11 (p) A physician may charge a reasonable consultation fee for
7-12 a consultation given as provided by this section.
7-13 (q) A physician to whom a patient is referred by a
7-14 therapeutic optometrist under this section shall forward to the
7-15 therapeutic optometrist, not later than the 30th day after first
7-16 seeing the patient, a written report on the results of the
7-17 referral. The therapeutic optometrist shall maintain the report in
7-18 the patient's records. A physician who, for a medically
7-19 appropriate reason, does not return a patient to the therapeutic
7-20 optometrist who referred the patient, shall state in the
7-21 physician's report to the therapeutic optometrist the specific
7-22 medical reason for failing to return the patient.
7-23 (r) A therapeutic optometrist may not administer or
7-24 prescribe an oral or parenteral medication or treat glaucoma
7-25 without holding a certificate issued by the board. A therapeutic
7-26 optometrist certified under this subsection shall be known as an
7-27 optometric glaucoma specialist. To obtain a certificate, a
8-1 therapeutic optometrist must as required under Section 1.03A(c) of
8-2 this Act:
8-3 (1) complete an instructional clinical review course;
8-4 and
8-5 (2) pass an examination approved by the board.
8-6 SECTION 3. Article 1, Texas Optometry Act (Article 4552-1.01
8-7 et seq.), is amended by adding Section 1.03A to read as follows:
8-8 Sec. 1.03A. OPTOMETRIC HEALTH CARE ADVISORY COMMITTEE. (a)
8-9 The Optometric Health Care Advisory Committee consists of six
8-10 members appointed as follows:
8-11 (1) two members who are therapeutic optometrists,
8-12 appointed by the board;
8-13 (2) two members who are board certified
8-14 ophthalmologists, appointed by the Texas State Board of Medical
8-15 Examiners; and
8-16 (3) two members who are pharmacologists, appointed by
8-17 the Texas State Board of Pharmacy.
8-18 (b) Members of the committee serve staggered two-year terms
8-19 with the terms of half of the members expiring September 1 each
8-20 year.
8-21 (c) The committee shall make recommendations that:
8-22 (1) establish requirements for the education and
8-23 clinical training necessary for certification as an optometric
8-24 glaucoma specialist;
8-25 (2) establish the parameters of care for treatment of
8-26 ocular diseases and conditions by optometric glaucoma specialists
8-27 as health care technology advances; and
9-1 (3) identify additional classes of pharmaceuticals
9-2 under Section 1.03(f) of this Act that are effective treatments for
9-3 ocular diseases and conditions and that may be effectively used by
9-4 certified optometric glaucoma specialists.
9-5 (d) A person is not eligible for appointment as a
9-6 pharmacologist member of the committee if the person is licensed as
9-7 a therapeutic optometrist or ophthalmologist or is related within
9-8 the second degree by affinity or consanguinity, as determined under
9-9 Chapter 573, Government Code, to a person who is licensed as a
9-10 therapeutic optometrist or ophthalmologist.
9-11 (e) In making any recommendation, the committee shall
9-12 consider patient safety, patient costs, the effect on a patient's
9-13 access to health care, patient convenience, and any added
9-14 efficiencies to the health care delivery system the decision may
9-15 involve.
9-16 (f) Before a recommendation made by the committee may become
9-17 law, the board and the Texas State Board of Medical Examiners must
9-18 adopt the recommendation. If either board fails to adopt a
9-19 recommendation of the committee, that board must articulate a sound
9-20 scientific reason for the failure to adopt.
9-21 (g) Unless continued in existence by act of the legislature,
9-22 the Optometric Health Care Advisory Committee is abolished, and
9-23 this section expires September 1, 2005.
9-24 SECTION 4. (a) This Act takes effect September 1, 1999.
9-25 (b) The initial members of the Optometric Health Care
9-26 Advisory Committee shall be appointed not later than October 1,
9-27 1999, as follows:
10-1 (1) one therapeutic optometrist member, one
10-2 ophthalmologist member, and one pharmacologist member for terms
10-3 expiring September 1, 2000; and
10-4 (2) one therapeutic optometrist member, one
10-5 ophthalmologist member, and one pharmacologist member for terms
10-6 expiring September 1, 2001.
10-7 SECTION 5. The importance of this legislation and the
10-8 crowded condition of the calendars in both houses create an
10-9 emergency and an imperative public necessity that the
10-10 constitutional rule requiring bills to be read on three several
10-11 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1051 was passed by the House on April
30, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 1051 on May 20, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1051 was passed by the Senate, with
amendments, on May 18, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor