87R5920 KKR-F
 
  By: Hancock S.B. No. 993
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the practice of therapeutic optometry; requiring an
  occupational certificate to perform certain surgical procedures.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 351.002(7), Occupations Code, is amended
  to read as follows:
               (7)  "Practice of therapeutic optometry" means using
  objective or subjective means, [not] including surgery, except as
  prohibited by Section 351.4521 [or laser surgery], to:
                     (A)  determine or measure the powers of vision of
  the human eye as provided by Section 351.355;
                     (B)  examine or diagnose visual defects, abnormal
  conditions, or diseases of the human eye or adnexa;
                     (C)  prescribe or fit lenses or prisms to correct
  or remedy a defect or abnormal condition of vision as provided by
  Section 351.356;
                     (D)  administer or prescribe a drug or physical
  treatment in the manner authorized by this chapter; or
                     (E)  treat the visual system, including the eye or
  adnexa as authorized by this chapter.
         SECTION 2.  The heading to Section 351.151, Occupations
  Code, is amended to read as follows:
         Sec. 351.151.  RULES; INTERPRETATION OF CHAPTER AND RULES.
         SECTION 3.  Section 351.151, Occupations Code, is amended by
  adding Subsection (c) to read as follows:
         (c)  The board may provide an interpretation of a provision
  of this chapter or a rule adopted under this chapter, including by
  issuing an advisory opinion or declaratory ruling.
         SECTION 4.  Subchapter D, Chapter 351, Occupations Code, is
  amended by adding Section 351.170 to read as follows:
         Sec. 351.170.  SOLE AUTHORITY OVER PRACTICE OF OPTOMETRY.
  The board has sole authority to regulate optometrists and
  therapeutic optometrists and to determine the scope of practice of
  an optometrist or therapeutic optometrist.
         SECTION 5.  Section 351.358, Occupations Code, is amended by
  amending Subsections (b) and (c) and adding Subsection (f) to read
  as follows:
         (b)  A therapeutic optometrist may[:
               [(1)]  administer, perform, or prescribe ophthalmic
  devices, procedures, and appropriate medications administered by
  any [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 (e)].
         (c)  A therapeutic optometrist may prescribe not more than 
  [oral 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
  anti-inflammatories;
               [(4)]  one three-day supply of any medication
  classified as a controlled substance under Schedule [analgesic
  identified in Schedules] III, IV, or [and] V of 21 U.S.C. Section
  812; and
               (2)  one three-day supply of hydrocodone or a
  hydrocodone combination medication 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].
         (f)  A therapeutic optometrist may administer, perform,
  prescribe, or order diagnostic studies, analyses, tests, imaging
  studies, or laboratory tests necessary to diagnose or treat visual
  defects, abnormal conditions, or diseases of the human vision
  system, including the eye and adnexa.
         SECTION 6.  The heading to Section 351.3581, Occupations
  Code, is amended to read as follows:
         Sec. 351.3581.  [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.
         SECTION 7.  Section 351.3581(a), 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;
  and
               (2)  pass an examination approved by the board.
         SECTION 8.  Subchapter H, Chapter 351, Occupations Code, is
  amended by adding Section 351.3582 to read as follows:
         Sec. 351.3582.  CERTAIN SURGICAL PROCEDURES: CERTIFICATE
  REQUIRED. A therapeutic optometrist may not perform a surgical
  procedure described by Section 351.4521(b) unless the therapeutic
  optometrist holds a certificate issued by the board. To obtain a
  certificate, a therapeutic optometrist must:
               (1)  complete an instructional clinical review course;
  and
               (2)  pass an examination approved by the board.
         SECTION 9.  Section 351.4521, Occupations Code, is amended
  to read as follows:
         Sec. 351.4521.  PERFORMANCE OF CERTAIN SURGICAL PROCEDURES
  BY THERAPEUTIC OPTOMETRISTS [SURGERY] PROHIBITED. (a) A
  therapeutic optometrist may not perform the following surgical
  procedures:
               (1)  retinal laser procedures;
               (2)  laser-assisted in situ keratomileusis (LASIK),
  photorefractive keratectomy (PRK), or laser epithelial
  keratomileusis (LASEK);
               (3)  penetrating keratoplasty, corneal transplant, or
  lamellar keratoplasty;
               (4)  a surgical procedure that requires the
  administration of general anesthesia;
               (5)  intraocular injection;
               (6)  a surgical procedure relating to the removal of
  the eye from a living person;
               (7)  surgical intraocular implants;
               (8)  surgery of the eyelid for a suspected eyelid
  malignancy;
               (9)  tarsorrhaphy;
               (10)  surgery of the bony orbit, including orbital
  implants; and
               (11)  retrobulbar injection or injection into the
  extraocular orbital space.
         (b)  A therapeutic optometrist may not perform the following
  surgical procedures unless the therapeutic optometrist holds a
  certificate under Section 351.3582 and the procedure is performed
  using laser or any form of ionizing or non-ionizing radiation:
               (1)  a surgical procedure requiring full-thickness
  incision or excision of the cornea or sclera other than
  paracentesis in an emergency situation requiring immediate
  reduction of the pressure inside of the eye;
               (2)  a surgical procedure requiring incision or
  excision of the iris and ciliary body;
               (3)  a surgical procedure requiring incision or
  excision of the vitreous;
               (4)  a surgical procedure requiring incision or
  excision of the retina;
               (5)  a surgical procedure requiring incision or
  excision of the crystalline lens;
               (6)  a surgical procedure requiring incision or
  excision of the extraocular muscles;
               (7)  the incisional or excisional repair of
  blepharochalasis, dermatochalasis, or ptosis;
               (8)  a surgical procedure requiring incision or
  excision of the lacrimal system other than lacrimal probing and
  related procedures;
               (9)  a surgical procedure requiring conjunctivoplasty
  with graft or flap; and
               (10)  a surgical procedure requiring incision or
  excision of pterygium [surgery or laser surgery].
         (c)  This section does not:
               (1)  prevent a therapeutic optometrist from providing
  preoperative or postoperative care relating to a surgical procedure
  listed in Subsection (a) or (b); or
               (2)  limit the use of a diagnostic or therapeutic
  instrument necessary to perform surgical treatments or procedures
  to the eye or adnexa except for those treatments or procedures
  specifically prohibited by this section.
         SECTION 10.  Not later than December 1, 2021, the Texas
  Optometry Board shall adopt rules necessary to implement the
  changes in law made by this Act to Chapter 351, Occupations Code.
         SECTION 11.  The following provisions of the Occupations
  Code are repealed:
               (1)  Section 351.160;
               (2)  Section 351.358(d); and
               (3)  Sections 351.3581(b), (c), (d), (e), (f), (g),
  (h), (i), and (j).
         SECTION 12.  This Act takes effect September 1, 2021.