Transforming and Supporting Patient Care - Health Professions ...

329Chapter 13 – Profession of Optometryby an optometrist with more than three topically administered agents atany given time.If an oral medication is required to obtain an adequate clinical response,the licensee must consult with a licensed ophthalmologist as soon asclinically prudent following initiation of the oral medication. This does notrequire that care of the patient be transferred to the consultingophthalmologist, but does require that the patient be seen by theconsulting ophthalmologist. 60In California, an optometrist who is certified to use TPAs may also diagnoseand exclusively treat the human eye or eyes, or any of its appendages, forall of the following conditions: a) infections of the anterior segment andadnexa, excluding the lacrimal gland, the lacrimal drainage system and thesclera; b) ocular allergies of the anterior segment and adnexa; c) ocularinflammation, nonsurgical in cause, limited to inflammation resulting fromtraumatic iritis, peripheral corneal inflammatory keratitis, piscleritis, andunilateral nonrecurrent nongranulomatous idiopathic iritis in patients 18years-of-age or older. Unilateral nongranulomatous idiopathic iritisrecurring within one year of the initial occurrence shall be referred to anophthalmologist. An optometrist shall consult with an ophthalmologist if apatient has a recurrent case of episcleritis within one year of the initialoccurrence. An optometrist shall consult with an ophthalmologist if apatient has a recurrent case of peripheral corneal inflammatory keratitiswithin one year of the initial occurrence; d) traumatic or recurrentconjunctival or corneal abrasions and erosions; e) Corneal surface diseaseand dry eyes; f) Ocular pain, not related to surgery, associated withconditions optometrists are authorized to treat; and g) primary open angleglaucoma in patients over the age of 18. Optometrists are not authorized totreat a person with AIDS for ocular infections.California is explicit in the topical anti-glaucoma agents which may be usedby certified optometrists. The optometrist may not use more than twoconcurrent topical medications in treating the patient for primary openangle glaucoma. A single combination medication that contains twopharmacological agents is considered as two medications. The optometristmust refer the patient to an ophthalmologist if requested by the patient, iftreatment goals are not achieved with the use of two topical medications orif indications of narrow angle or secondary glaucoma develop. If theglaucoma patient also has diabetes, the optometrist must consult in writingwith the physician treating the patient’s diabetes in developing theglaucoma treatment plan and notify the physician in writing of any changesin the patient’s glaucoma medication. The physician must provide writtenconfirmation of such consultations and notifications.The State Board of Optometry may grant a certificate to an optometristcertified for the treatment of primary open angle glaucoma in patients overthe age of 18 only after the optometrist meets the following requirements:(1) Satisfactory completion of a didactic course of not less than24 hours in the diagnosis, pharmacological and other treatmentand management of glaucoma. Any applicant who graduated froman accredited California school of optometry on or after May 1,60Ibid:1728d. (Added 2003, No. 108 (Adj. Sess.), 9.HPRAC Critical Links January 2009