By Brimer H.B. No. 1051
76R5015 JMM-F
A BILL TO BE ENTITLED
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. Sections 1.02(7) and (8), Texas Optometry Act
1-6 (Article 4552-1.02, Vernon's Texas Civil Statutes), are amended to
1-7 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 except as specifically authorized by this Act.
1-20 (8) "Adnexa" means the lids and drainage system of the
1-21 eye and related structures.
1-22 SECTION 2. Sections 1.03(b) and (d)-(g), Texas Optometry Act
1-23 (Article 4552-1.03, Vernon's Texas Civil Statutes), are amended to
1-24 read as follows:
2-1 (b) A therapeutic optometrist may administer, perform, or
2-2 [and] prescribe ophthalmic devices, procedures, and appropriate
2-3 medications administered by [over-the-counter oral medications,
2-4 and] topical, oral, or parenteral means [ocular pharmaceutical
2-5 agents, other than antiviral agents and antiglaucoma agents,] for
2-6 the purpose of diagnosing and treating visual defects, abnormal
2-7 conditions, and diseases of the human vision system, including the
2-8 eye and adnexa [and may remove superficial foreign matter and
2-9 eyelashes from the external eye or adnexa. If a therapeutic
2-10 optometrist utilizes topical steroids of a strength of one percent
2-11 concentration to treat a condition and the condition has not
2-12 substantially improved within seven days of the initial topical
2-13 steroid application, the therapeutic optometrist shall consult with
2-14 an ophthalmologist and the ophthalmologist shall then establish the
2-15 treatment regimen. If a therapeutic optometrist utilizes topical
2-16 steroids of a strength of less than one percent concentration to
2-17 treat a condition and the condition has not substantially improved
2-18 within 14 days of the initial topical steroid application, the
2-19 therapeutic optometrist shall consult with an ophthalmologist and
2-20 the ophthalmologist shall then establish the treatment regimen.
2-21 This subsection does not authorize an optometrist to treat glaucoma
2-22 in a manner that was not permitted by law on August 31, 1991].
2-23 (d) The board shall adopt rules setting forth the specific
2-24 classifications of pharmaceutical agents therapeutic optometrists
2-25 may use in the practice of therapeutic optometry. Use by a
2-26 therapeutic optometrist of pharmaceutical agents not authorized by
2-27 the board or otherwise authorized by law shall constitute a
3-1 violation of this Act.
3-2 (e) [A five-member technical advisory committee is created
3-3 to assist the board in determining the specific pharmaceutical
3-4 agents which may be used in the practice of therapeutic optometry.
3-5 Appointments to the committee shall be for two-year terms, and no
3-6 member may serve more than two consecutive terms.]
3-7 [(f) The members of the technical advisory committee shall
3-8 be appointed as follows: one must be an optometrist or therapeutic
3-9 optometrist licensed and practicing in this state, appointed by the
3-10 Texas Optometry Board; one must be a physician licensed and
3-11 practicing in this state whose practice is limited to
3-12 ophthalmology, appointed by the Texas State Board of Medical
3-13 Examiners; one must be a pharmacist licensed and practicing
3-14 pharmacy in this state, appointed by the Texas State Board of
3-15 Pharmacy; one must be a faculty member at a state medical
3-16 institution of higher education with expertise in pharmacology,
3-17 appointed by the Texas State Board of Medical Examiners; and one
3-18 must be a faculty member of a college of optometry at a state
3-19 institution of higher education, appointed by the Texas Optometry
3-20 Board.]
3-21 [(g)] A therapeutic optometrist is subject to the same
3-22 standard of professional care and judgment as a person practicing
3-23 as an ophthalmologist under the Medical Practice Act (Article
3-24 4495b, Vernon's Texas Civil Statutes).
3-25 (f) A therapeutic optometrist may perform the following
3-26 treatment procedures if the procedures are performed without the
3-27 use of lasers:
4-1 (1) removal of foreign body, external eye,
4-2 conjunctival superficial;
4-3 (2) removal of foreign body, external eye,
4-4 conjunctival embedded;
4-5 (3) removal of foreign body, external eye, corneal
4-6 without slit lamp;
4-7 (4) removal of foreign body, external eye, with slit
4-8 lamp;
4-9 (5) removal of embedded foreign body, eyelid;
4-10 (6) application of tissue glue, wounds of cornea or
4-11 sclera;
4-12 (7) destruction of lesion of lid margin;
4-13 (8) correction of trichiasis, epilation, by forceps;
4-14 (9) closure of the lacrimal punctum;
4-15 (10) closure of the lacrimal punctum by plug;
4-16 (11) dilation of lacrimal punctum, with or without
4-17 irrigation;
4-18 (12) probing of nasolacrimal duct, with or without
4-19 irrigation;
4-20 (13) probing of lacrimal canaliculi, with or without
4-21 irrigation;
4-22 (14) removal of corneal epithelium;
4-23 (15) excision of chalazion;
4-24 (16) incision of conjunctiva, drainage of cyst;
4-25 (17) drainage of an abcess, eyelid; and
4-26 (18) other non-cutting procedures used to treat visual
4-27 defects, abnormal conditions, and diseases of the human vision
5-1 system, including the eye and adnexa.
5-2 (g) Before a therapeutic optometrist may treat glaucoma, the
5-3 therapeutic optometrist must be certified by the board as
5-4 authorized to treat glaucoma. To be certified to treat glaucoma,
5-5 the therapeutic optometrist must:
5-6 (1) complete a 24-hour clinical review course approved
5-7 by the board on the diagnosis, treatment, and management of
5-8 glaucoma; and
5-9 (2) pass an examination approved by the board covering
5-10 the diagnosis, management, and treatment of glaucoma.
5-11 SECTION 3. Article 1, Texas Optometry Act (Article 4552-1.01
5-12 et seq., Vernon's Texas Civil Statutes), is amended by adding
5-13 Section 1.04 to read as follows:
5-14 Sec. 1.04. STUDY REGARDING LASER SURGERY. (a) The
5-15 University of Houston and The University of Texas Health Science
5-16 Center shall jointly conduct a study analyzing the safety,
5-17 efficacy, and cost-effectiveness of laser surgery performed by
5-18 therapeutic optometrists.
5-19 (b) The study shall be governed by a project steering
5-20 committee that shall be responsible for the experimental design,
5-21 safety, and data analysis of the study. The project steering
5-22 committee shall be jointly appointed by the dean of the University
5-23 of Houston College of Optometry and the dean of The University of
5-24 Texas Health Science Center and shall consist of equal
5-25 representation among therapeutic optometrists, physicians, and
5-26 persons trained in the field of public health.
5-27 (c) The dean of the University of Houston College of
6-1 Optometry and the dean of The University of Texas Health Science
6-2 Center shall jointly appoint a principal investigator. The
6-3 principal investigator shall appoint personnel, oversee the
6-4 collection and analysis of data, and act as the chair of the
6-5 project steering committee.
6-6 (d) The study shall be conducted under the following
6-7 guidelines:
6-8 (1) laser surgery may be performed only by therapeutic
6-9 optometrists and ophthalmologists at the University of Houston
6-10 College of Optometry, one of the college's affiliated clinical
6-11 facilities, The University of Texas Health Science Center, or one
6-12 of the center's clinical facilities;
6-13 (2) each site in which surgery is performed shall be
6-14 staffed by a laser-trained therapeutic optometrist and
6-15 ophthalmologist; and
6-16 (3) a patient participating in the study shall be
6-17 randomly selected to have the procedure performed by the
6-18 therapeutic optometrist or the opthalmologist, both of whom shall
6-19 be on site during all procedures.
6-20 (e) The project steering committee shall submit to the
6-21 presiding officer of each house of the legislature not later than
6-22 January 1 of each year a written report that evaluates the safety,
6-23 efficacy, and cost-effectiveness of laser surgery performed by
6-24 therapeutic optometrists.
6-25 (f) If required by other law, any report arising from this
6-26 study shall be provided to the Health Professions Council or any
6-27 other entity charged with the responsibility of reviewing and
7-1 approving impact reports regarding bills that may change the scope
7-2 of practice of licensed or registered health care providers.
7-3 (g) A therapeutic optometrist may not perform laser surgery
7-4 except under the direct supervision of an ophthalmologist as part
7-5 of the study conducted under this section.
7-6 SECTION 4. The importance of this legislation and the
7-7 crowded condition of the calendars in both houses create an
7-8 emergency and an imperative public necessity that the
7-9 constitutional rule requiring bills to be read on three several
7-10 days in each house be suspended, and this rule is hereby suspended,
7-11 and that this Act take effect and be in force from and after its
7-12 passage, and it is so enacted.