UNOFFICIAL COPY OF HOUSE BILL 719
____________________________________________________________________________________ By: Delegates Pendergrass, Weldon, Bobo, Bronrott, DeBoy, Dumais, Frush, Heller, Jones, Kaiser, King, Krysiak, Love, Madaleno, Malone, Mandel, Marriott, Menes, Moe, Montgomery, Petzold, Rosenberg, Rudolph, and F. Turner F. Turner, Goldwater, Hurson, Hammen, Boutin, Bromwell, Kach, Kullen, and McDonough
Introduced and read first time: February 8, 2005Assigned to: Health and Government Operations_____________________________________________________________________________________Committee Report: Favorable with amendmentsHouse action: Adopted with floor amendmentsRead second time: March 17, 2005_____________________________________________________________________________________
Health Occupations - State Board of Examiners in Optometry - Scope of Practice
4 FOR the purpose of requiring certain optometrists to complete a certain course;5
exempting certain optometrists from certain requirements; authorizing certain
optometrists to administer and prescribe certain pharmaceutical agents;
authorizing certain optometrists to remove certain residual particulate matter
with an alger brush; authorizing certain optometrists to order certain laboratory
tests; authorizing certain optometrists to administer or prescribe certain
steroids under certain circumstances; requiring the State Board of Examiners in
Optometry to approve certain continuing education courses by a certain date;
requiring the Board to grant a waiver of certain requirements under this Act to
certain individuals until a certain date; requiring the Board to certify certain
optometrists; requiring the Board to adopt certain regulations a certain practice
protocol in consultation with and subject to the approval of the State Board of
Physicians by a certain date; requiring the Board to report to certain committees
of the General Assembly by a certain date; and generally relating to the State
19 BY repealing and reenacting, with amendments,20
UNOFFICIAL COPY OF HOUSE BILL 719
(2000 Replacement Volume and 2004 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
3 MARYLAND, That the Laws of Maryland read as follows:
Article - Health Occupations
Unless certified under this section, a licensed optometrist may not
7 administer or prescribe any therapeutic pharmaceutical agents or remove superficial8 foreign bodies from a human eye, adnexa, or lacrimal system.
Except as provided in paragraph (2) of this subsection, the Board
10 shall certify a licensed optometrist as a therapeutically certified optometrist if the11 licensed optometrist submits to the Board evidence satisfactory to the Board that the12 licensed optometrist:
Has successfully completed at least 110 hours of a therapeutic
14 pharmaceutical agents course approved by the Board;
Has successfully passed a pharmacology examination relating
16 to the treatment and management of ocular disease, which is prepared, administered,17 and graded by the National Board of Examiners in Optometry or any other nationally18 recognized optometric organization as approved by the Secretary; [and]
Is currently certified by the Board to administer topical ocular
20 diagnostic pharmaceutical agents under § 11-404 of this subtitle; AND
HAS SUCCESSFULLY COMPLETED A 24-HOUR AN 8-HOUR
22 COURSE IN THE MANAGEMENT OF TOPICAL PHARMACEUTICAL AGENTS AND THE23 REMOVAL OF RESIDUAL PARTICULATE MATTER THROUGH THE USE OF AN ALGER24 BRUSH STEROIDS APPROVED BY THE BOARD.
Except as provided in subparagraph (ii) of this paragraph, an
26 optometrist who has graduated on or after July 1, [1992] 2005 from an accredited27 school of optometry recognized by the Board is not subject to the requirements of28 paragraph (1) of this subsection.
If an optometrist who has graduated on or after July 1, [1992]
30 2005 from an accredited school of optometry recognized by the Board is not certified31 under this section within 3 years of graduation, the optometrist shall successfully32 complete a therapeutic pharmaceutical agents course and successfully pass a33 pharmacology exam under paragraph (1) of this subsection before the Board may34 certify the optometrist.
In this section, "refer" means that a therapeutically certified optometrist:
UNOFFICIAL COPY OF HOUSE BILL 719
Informs the patient that the patient should see an ophthalmologist
2 and give the ophthalmologist an opportunity to physically examine the patient; and
Refrains from rendering further treatment for the specific condition
4 that is the basis for the referral until the patient has been physically examined by an5 ophthalmologist.
A therapeutically certified optometrist may administer and prescribe
7 topical therapeutic pharmaceutical agents limited to:
Ocular antihistamines, decongestants, and combinations
Ocular antiallergy pharmaceutical agents;
Ocular antibiotics and combinations of ocular antibiotics,
13 excluding specially formulated or fortified antibiotics;
Anti-inflammatory agents[, excluding steroids];
Nonprescription drugs that are commercially available;
Primary open-angle glaucoma medications, in accordance
21 with subsection (c) of this section.
If EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS SUBSECTION, IF
23 a therapeutically certified optometrist administers or prescribes a topical therapeutic24 pharmaceutical agent listed in paragraph (1)(i) through [(vii)] (VIII) of this25 subsection, and the patient does not have the expected response within 72 hours:
The therapeutically certified optometrist shall consult with an
The ophthalmologist may determine that the ophthalmologist
29 needs to physically examine the patient.
If EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS SUBSECTION, IF
31 a therapeutically certified optometrist administers or prescribes a topical therapeutic32 pharmaceutical agent under paragraph (2) of this subsection, the therapeutically33 certified optometrist shall communicate with the patient to determine the response of34 the patient to the therapeutic pharmaceutical agent as soon as practicable after 7235 hours of the time the agent was administered or prescribed. UNOFFICIAL COPY OF HOUSE BILL 719
A THERAPEUTICALLY CERTIFIED OPTOMETRIST MAY ADMINISTER
2 OR PRESCRIBE TOPICAL STEROIDS IN ACCORDANCE WITH A PRACTICE PROTOCOL3 ESTABLISHED BY THE BOARD.
A therapeutically certified optometrist may not administer or
A therapeutically certified optometrist may dispense a topical
12 therapeutic pharmaceutical agent listed in paragraph (1) of this subsection only if:
No charge is imposed for the therapeutic pharmaceutical agent
The amount dispensed does not exceed a 72-hour supply, except
16 that if the minimum available quantity for dispensing is greater than a 72-hour17 supply, the minimum available quantity may be dispensed.
A therapeutically certified optometrist may administer and prescribe
19 topical therapeutic pharmaceutical agents for glaucoma only:
For patients with primary open-angle glaucoma;
After the optometrist refers the patient to an ophthalmologist;
After the ophthalmologist and optometrist jointly and promptly
24 develop a written individualized treatment plan that is signed by the ophthalmologist25 and optometrist and includes:
All tests and examinations that led to the diagnosis;
An initial schedule of all tests and examinations necessary
Criteria for surgical intervention by the ophthalmologist. UNOFFICIAL COPY OF HOUSE BILL 719
A treatment plan developed under this subsection may be
2 modified only after both the optometrist and the ophthalmologist consult together3 and consent to the modification.
Each modification shall be noted in the optometric record of the
A therapeutically certified optometrist who treats a patient with
7 primary open-angle glaucoma in accordance with this section:
Shall refer the patient to an ophthalmologist at least once a
9 year after the initial mandatory referral under paragraph (1) of this subsection;
May continue to render treatment under the joint treatment
11 plan until the patient is examined by an ophthalmologist;
Shall consult with an ophthalmologist if:
The patient does not have the expected response to
The target intraocular pressure is not reached; or
There is worsening in a patient's visual field or optic nerve
May perform and evaluate visual field tests, nerve fiber layer
19 photos, and optic disc photos. The tests or photos shall be provided to an20 ophthalmologist for review by the ophthalmologist.
Except as provided in paragraphs (2) and (3) of this subsection, a
22 therapeutically certified optometrist may not administer or prescribe any oral23 pharmaceutical agent for any purpose.
A therapeutically certified optometrist may administer and
25 prescribe oral tetracycline and its derivatives only for the diagnosis and treatment of26 meibomitis and seborrheic blepharitis.
If a therapeutically certified optometrist administers or
28 prescribes oral tetracycline or its derivatives to a patient in accordance with29 subparagraph (i) of this paragraph and the patient does not improve within 3 weeks30 of treatment, the optometrist shall refer the patient to an ophthalmologist.
A therapeutically certified optometrist may administer or prescribe
32 nonprescription drugs that are commercially available.
Except as provided in paragraph (2) of this subsection, a
34 therapeutically certified optometrist may not perform any procedure on the eyelid of35 a patient. UNOFFICIAL COPY OF HOUSE BILL 719
A therapeutically certified optometrist may epilate with forceps an
2 eyelash from the eyelid, adnexa, or lacrimal system of a patient.
A therapeutically certified optometrist may remove superficial
4 foreign bodies from the human eye only if:
The foreign body may be removed with a cotton-tipped
The foreign body has not penetrated beyond the bowman's
8 membrane of the cornea and is not within 2.5 millimeters of the visual axis.
A THERAPEUTICALLY CERTIFIED OPTOMETRIST MAY REMOVE
10 RESIDUAL PARTICULATE MATTER FROM THE HUMAN EYE IF THE RESIDUAL11 PARTICULATE MATTER MAY BE REMOVED WITH AN ALGER BRUSH.
[Except as provided in paragraph (2) of this subsection, a] A
13 therapeutically certified optometrist may [not] order laboratory tests for a patient14 THAT ARE NECESSARY TO ADHERE TO THE STANDARDS FOR THE ADMINISTRATION15 OF TOPICAL PHARMACEUTICAL AGENTS PRESCRIBED IN ACCORDANCE WITH THIS16 SECTION.
A therapeutically certified optometrist may order a conjunctival
A therapeutically certified optometrist may not provide any therapeutic
20 treatment listed in this section for a child under the age of 1 year.
Unless the standard of care requires an earlier referral, if a therapeutically
22 certified optometrist diagnoses a corneal ulcer or infiltrate, and the patient does not23 have the expected response within 48 hours, the optometrist immediately shall refer24 the patient to an ophthalmologist.
A therapeutically certified optometrist shall be held to the same standard
26 of care as an ophthalmologist who is licensed under Title 14 of this article and who is27 providing similar services.
SECTION 2. AND BE IT FURTHER ENACTED, That, on or before October 1,
29 2005, the State Board of Examiners in Optometry shall approve at least one30 continuing education course for a therapeutically certified optometrist administered31 by the Maryland Optometric Association in conjunction with the Maryland Eye32 Surgeons and Physicians on the removal of superficial foreign bodies from the human33 eye, adnexa, or lacrimal system that satisfies the requirements of § 11-404.1(b)(1)(iv)34 of the Health Occupations Article as enacted by this Act and qualifies as a continuing35 education course.
SECTION 3. AND BE IT FURTHER ENACTED, That the State Board of
37 Examiners in Optometry shall grant a waiver of the certification requirements of §38 11-404.1 11-404.1(b)(1)(iv) of the Health Occupations Article to any individual who is39 currently a therapeutically certified optometrist until July 1, 2006. UNOFFICIAL COPY OF HOUSE BILL 719
SECTION 4. AND BE IT FURTHER ENACTED, That the State Board of
2 Examiners in Optometry shall certify a licensed optometrist as a therapeutically3 certified optometrist prior to the license renewal date if the optometrist completes the4 requirements of § 11-404.1 of the Health Occupations Article, as enacted by this Act,5 prior to the license renewal date, by November 30, 2005, the State Board of6 Examiners in Optometry, in consultation with and subject to the approval of the State7 Board of Physicians, shall adopt regulations establishing a collaborative practice8 protocol for the administration and prescription of topical steroids by therapeutically9 certified optometrists under § 11-404.2 of the Health Occupations Article as enacted
SECTION 5. AND BE IT FURTHER ENACTED, That the State Board of
12 Examiners in Optometry and the State Board of Physicians shall each report, in13 accordance with § 2-1246 of the State Government Article, to the Senate Education,14 Health, and Environmental Affairs Committee and the House Health and15 Government Operations Committee by June 1, 2008, on issues related to the practice16 of optometry under this Act. Each report shall suggest changes to §§ 11-404.1 and17 11-404.2 of the Health Occupations Article to improve the quality of and access to18 care or to enhance the scope of practice of optometry in the State.
SECTION 5. 6. AND BE IT FURTHER ENACTED, That this Act shall take
RANJAN P. MALHOTRA, M.D., F.A.C.S. Clinical Instructor of Ophthalmology Washington University School of Medicine St. Louis, Missouri Primary Office Address: Secondary Office Address: 965 Mattox Drive Primary Surgical Address : St. Louis Eye Surgery and Laser Center Date of Birth: Place of Birth: EDUCATION: Fellowship 1999 – 2000 Cornea, Refractive Su