84R7368 NC-F
  By: Lozano H.B. No. 1420
  relating to the practice of therapeutic optometry.
         SECTION 1.  Sections 351.358(b), (c), (d), and (e),
  Occupations Code, are amended to read as follows:
         (b)  A therapeutic optometrist may:
               (1)  administer, perform, or prescribe ophthalmic
  devices, procedures, and appropriate medications administered by
  topical or oral means[, in accordance with this section and Section
  351.3581,] to diagnose or treat visual defects, abnormal
  conditions, or diseases of the human vision system, including the
  eye and adnexa; or
               (2)  administer medication by parenteral means for a
  purpose and in a manner prescribed by Subsection (d) [(e)].
         (c)  A therapeutic optometrist may administer or prescribe
  oral analgesics [medications] only in the following
  classifications of oral pharmaceuticals:
               (1)  [one 10-day supply of oral antibiotics;
               [(2)  one 72-hour supply of oral antihistamines;
               [(3)     one seven-day supply of oral nonsteroidal
               [(4)]  one three-day supply of any analgesic classified
  as a controlled substance under Schedule [identified in Schedules]
  III, IV, or [and] V of 21 U.S.C. Section 812; and
               (2)  one three-day supply of hydrocodone or of a
  hydrocodone combination product classified as a controlled
  substance under Schedule II of 21 U.S.C. Section 812
         [(5)     any other oral pharmaceutical recommended by the
  Optometric Health Care Advisory Committee and approved by the board
  and the Texas State Board of Medical Examiners].
         (d)  [A therapeutic optometrist may independently administer
  oral carbonic anhydrase inhibitors for emergency purposes only and
  shall immediately refer the patient to an ophthalmologist.
         [(e)]  A therapeutic optometrist may inject appropriate
  medication for a patient who has an anaphylactic reaction to
  counteract the anaphylaxis. The therapeutic optometrist shall
  immediately refer the patient to a physician.
         SECTION 2.  Section 351.3581, Occupations Code, is amended
  to read as follows:
  [(a)] A therapeutic optometrist may not administer or prescribe an
  oral or parenteral medication or treat glaucoma unless the
  therapeutic optometrist holds a certificate issued by the board. A
  therapeutic optometrist certified under this section [subsection]
  shall be known as an optometric glaucoma specialist. To obtain a
  certificate, a therapeutic optometrist must [as required under
  Section 351.165(c)]:
               (1)  complete an instructional clinical review course;
               (2)  pass an examination approved by the board.
         [(b)     Not later than the 30th day after the date of the
  initial diagnosis of glaucoma, a therapeutic optometrist shall
  engage in consultation with an ophthalmologist to develop an
  individual treatment plan that is approved by the therapeutic
  optometrist and ophthalmologist. The parameters of the
  consultation shall be at the discretion of the ophthalmologist but
  must at least include confirmation of the diagnosis and a plan for
  comanagement of the patient, including periodic review of the
  patient's progress.
         [(c)     A therapeutic optometrist required to engage in
  comanagement consultation with an ophthalmologist shall inform the
  patient diagnosed with glaucoma that the therapeutic optometrist is
  required to have the diagnosis confirmed and comanaged with an
  ophthalmologist of the patient's choosing or, if the patient does
  not choose an ophthalmologist, an ophthalmologist practicing in the
  geographic area in which the therapeutic optometrist practices.
         [(d)     A therapeutic optometrist shall refer a patient to an
  ophthalmologist if:
               [(1)     the patient is younger than 16 years of age and
  has been diagnosed as having glaucoma;
               [(2)     the patient has been diagnosed as having acute
  closed angle glaucoma;
               [(3)     the patient has been diagnosed as having
  malignant glaucoma or neovascular glaucoma;
               [(4)     the therapeutic optometrist determines that a
  patient's glaucoma is caused by a diabetic complication and, after
  joint consultation with the physician treating the diabetes and an
  ophthalmologist by telephone, fax, or another method, the physician
  or ophthalmologist determines that the patient should be seen by
  the physician or ophthalmologist; or
               [(5)     the therapeutic optometrist determines that a
  patient's glaucoma is not responding appropriately to a treatment
  specified in Subsection (f) and, after consulting a physician by
  telephone, fax, or another method, the physician determines that
  the patient should be seen by the physician or an appropriate
         [(e)     A therapeutic optometrist who refers a patient to a
  physician or specialist shall inform the patient that the patient
  may go to any physician or specialist the patient chooses. This
  subsection does not prevent a therapeutic optometrist from
  recommending a physician or specialist.
         [(f)     On making an initial diagnosis of glaucoma, a
  therapeutic optometrist shall set a target pressure that is not
  more than 80 percent of the initial intraocular pressure. The
  patient's glaucoma is not considered to be appropriately responding
  to treatment if the patient fails to achieve the target pressure
  within an appropriate time.
         [(g)     Before a therapeutic optometrist may prescribe a beta
  blocker, the therapeutic optometrist must take a complete case
  history of the patient and determine whether the patient has had a
  physical examination within the 180 days preceding the date of
  taking the history. If the patient has not had a physical
  examination or if the patient has a history of congestive heart
  failure, bradycardia, heart block, asthma, or chronic obstructive
  pulmonary disease, the therapeutic optometrist must refer the
  patient to a physician for a physical examination before initiating
  beta blocker therapy.
         [(h)     A therapeutic optometrist who diagnoses acute closed
  angle glaucoma may initiate appropriate emergency treatment for a
  patient but shall refer the patient to a physician in a timely
         [(i)     A physician may charge a reasonable consultation fee
  for a consultation given as provided by this section.
         [(j)     A physician to whom a patient is referred by a
  therapeutic optometrist under this section shall forward to the
  therapeutic optometrist, not later than the 30th day after first
  seeing the patient, a written report on the results of the referral.
  The therapeutic optometrist shall maintain the report in the
  patient's records. A physician who, for a medically appropriate
  reason, does not return a patient to the therapeutic optometrist
  who referred the patient shall state in the physician's report to
  the therapeutic optometrist the specific medical reason for failing
  to return the patient.]
         SECTION 3.  This Act takes effect September 1, 2015.