Therapeutic optometrists need a board-issued certificate to treat glaucoma or prescribe oral or parenteral medication, and they must follow referral, pressure-setting, screening, and reporting rules.
Sec. 351.3581. TREATMENT OF GLAUCOMA. (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 shall be known as an optometric glaucoma specialist. To obtain a certificate, a therapeutic optometrist must: (1) complete an instructional clinical review course; and (2) pass an examination approved by the board. (b) Repealed by Acts 2021, 87th Leg., R.S., Ch. 523 (S.B. 993), Sec. 6, eff. September 1, 2021. (c) Repealed by Acts 2021, 87th Leg., R.S., Ch. 523 (S.B. 993), Sec. 6, eff. September 1, 2021. (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 patient has definite optic disc, retinal nerve fiber layer, or macular imaging abnormalities consistent with glaucoma and visual field abnormalities in both hemifields, or loss within five degrees of fixation in at least one hemifield as tested with standard automated perimetry; or (5) the therapeutic optometrist determines that a patient's glaucoma is not responding to nonsurgical intervention. (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 manner. (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. Added by Acts 2001, 77th Leg., ch. 1420, Sec. 14.152(c), eff. Sept. 1, 2001. Amended by: Acts 2021, 87th Leg., R.S., Ch. 523 (S.B. 993), Sec. 3, eff. September 1, 2021. Acts 2021, 87th Leg., R.S., Ch. 523 (S.B. 993), Sec. 4, eff. September 1, 2021. Acts 2021, 87th Leg., R.S., Ch. 523 (S.B. 993), Sec. 6, eff. September 1, 2021.