Transforming and Supporting Patient Care - Health Professions ...

327Chapter 13 – Profession of OptometryIn Texas, a therapeutic optometrist is licensed and authorized to administerand prescribe a drug, but may independently administer oral carbonicanhydrase inhibitors for emergency purposes only, and must immediatelyrefer the patient to an ophthalmologist. 52 The Texas Optometry Boardrequires therapeutic optometrists to complete educational courses andpass an examination to be certified as “optometric glaucoma specialists” inorder to administer or prescribe an oral or parenteral medication or treatglaucoma. 53Texas laws respecting care of glaucoma patients are prescriptive. No laterthan 30 days after the initial diagnosis of glaucoma, a therapeuticoptometrist must consult with an ophthalmologist to develop a jointlyapproved treatment plan, including a plan for co-management of the patientwith periodic reviews of the patient’s progress. A patient must be referredto an ophthalmologist if the patient is younger than 16 years-of-age and hasbeen diagnosed with glaucoma, if the patient has been diagnosed as havingclosed angle glaucoma, if the patient has been diagnosed as havingmalignant glaucoma or neovascular glaucoma, if the therapeuticoptometrist determines that the glaucoma is caused by a diabeticcomplication and the patient should be referred, or if the therapeuticoptometrist determines that a patient’s glaucoma is not respondingappropriately to a treatment and should be seen by a specialist.On making an initial diagnosis of glaucoma, a therapeutic optometrist mustset a target pressure of not more than 80 percent of the initial IOP, anddetermine when the patient’s glaucoma is responding appropriately totreatment. Before prescribing a beta blocker, a complete history of thepatient must be taken, and if the patient has a history of specificconditions, the optometrist must refer the patient to a physician beforeinitiating beta blocker therapy. 54In addition, Texas has established an Optometric Health Care AdvisoryCommittee, whose mandate is to:• establish requirements for the education and clinical trainingnecessary for certification as an optometric glaucoma specialist;• establish the parameters of care for treatment of ocular diseasesand conditions by optometric glaucoma specialists as health caretechnology advances; and• identify additional classes of pharmaceuticals that are effectivetreatments for ocular diseases and conditions and that may beeffectively used by certified optometric glaucoma specialists. 55In Virginia, the Board of Optometry may provide TPA certification toqualified optometrists to prescribe for and treat diseases or abnormalconditions of the human eye and its adnexa with oral and topical TPAs.Treatment of angle closure glaucoma is limited to initiation of immediateemergency care. Treatment of infantile or congenital glaucoma is prohibited.The training and examination of TPA certified optometrists sets a minimumnumber of hours of clinical training to be supervised by an ophthalmologist. 5652Texas Optometry Board. http://www.tob.state.tx.us/.53The Texas Optometry Act, Sec. 351.3581.54Ibid. Added by Acts 2001, 77th Leg., ch.1420, Sec. 14.152(c), eff. Sept. 1, 2001.55Ibid: Sec. 351.165.56Code of Virginia Optometry. Chapter 32 of Title 54.1: s.54.1-3222, s.54.1-3223.http://www.dhp.virginia.gov/optometry/optometry_laws_regs.htm.HPRAC Critical Links January 2009