Transforming and Supporting Patient Care - Health Professions ...

326Chapter 13 – Profession of OptometryData collected by the OAO indicates that in the United States, all statesexcept Massachusetts authorize the prescription of topical anti-glaucomadrugs, while a large portion authorized the prescription of both topical andoral anti-glaucoma drugs. 48Further investigation revealed that, in many states, evidence of a tieredcertification structure involving co-management of glaucoma patients withophthalmologists is required prior to certifying optometrists toindependently manage glaucoma. In most states, optometrists are notauthorized to treat acute angle closure glaucoma patients or patients under18-years-old.Some states authorize the prescribing of topical anti-glaucoma agents tocertified optometrists, and oral or topical anti-glaucoma agents for theemergency treatment of acute angle closure glaucoma with immediatereferral to an ophthalmologist (e.g., New Hampshire); in other states, onlycertified glaucoma licensees may prescribe glaucoma drugs, and thetreatment plan must be confirmed by an ophthalmologist (e.g., Kansas).In South Carolina, a therapeutic certified optometrist is one who iseducated and trained for diagnostic and therapeutic purposes. Whenprescribing oral and topically applied medications, an optometrist is limitedto specific pharmaceutical agents. In treating and managing glaucoma anoptometrist must strive to achieve a stable range of intraocular pressuresconsidered unlikely to cause further optic nerve damage in that patient.Once this range of pressures is selected based on conditions presented bythe patient, the optometrist must enter this range in the patient's chart. Ifno measurable progress is achieved in realizing the selected range ofpressures within 60 days of initiating treatment, the optometrist must referthe patient to an ophthalmologist. However, when treating acute angleclosure glaucoma, an optometrist shall immediately initiate treatment, andmust make an appropriate referral to an ophthalmologist. 49In Massachusetts, a TPA certificate authorizes an optometrist to usepharmaceutical agents which are required or used for the diagnosis,prevention, correction, management or treatment of abnormal ocularconditions or diseases, except glaucoma. 50The Delaware Board of Examiners in Optometry authorizes optometristswho are therapeutically certified to use and prescribe anti-glaucoma drugsin topical and oral form. To be certified, newly licensed optometrists arerequired to complete a six-month internship with a therapeutically certifiedoptometrist, physician or optometrist. 5148HPRAC.Prescribing and Use of Drugs by Non-Physician Health Professionals: A JurisdictionalReview of the Profession of Optometry. http://hprac.org/en/projects/resources/hprac-drug-Optometryjurisrevnov08.pdf. 20-21.49Title 40 - Professions and Occupations, Chapter 37. Optometrists.http://www.scstatehouse.gov/code/t40c037.htm.50Board of Registration in Optometry, Division of Professional Licensure Boards 246 CMR 1.00:Purpose, Authority and Definitions.http://www.mass.gov/?pageID=ocasubtopic&L=4&L0=Home&L1=Licensee&L2=Division+of+Professional+Licensure+Boards&L3=Board+of+Registration+in+Optometry&sid=Eoca.51Title 24 Professions and Occupations Chapter 21. Optometry.http://www.dpr.delaware.gov/boards/optometry/newlicense.shtml.HPRAC Critical Links January 2009