Rules & Requirements for Optometric Glaucoma Specialist

An optometric glaucoma specialist may use all of the drugs that a therapeutic optometrist may prescribe and any additional drugs that are authorized in the OGS law (HB1051).

The Texas Optometry Board (TOB) provides the Texas State Board of Pharmacy a list of oral and glaucoma medications that may be prescribed by a Texas OGS. This list is updated on an annual basis by the Texas Optometry Board.

USE OF ORAL MEDICATIONS:
To prescribe any oral medication, a therapeutic optometrist must first be licensed as an OGS. An OGS can prescribe certain limited oral medications for the diagnosis and treatment of visual defects, abnormal conditions of the visual system, and diseases of the human visual system. This rule includes treatment of the eye and adnexa. However any oral prescription written by an OGS is limited as follows:

1. One 10-day supply of oral antibiotics
2. One 72-hour supply of oral antihistamines
3. One 7-day supply of oral NSAIDs
4. One 3-day supply of analgesics (Pain Meds. of DEA Schedules III, IV, V)

These four guidelines limit the course or length of treatment by the OGS to the specified number of days.

USE OF GLAUCOMA MEDICATIONS:
To prescribe any topical glaucoma medication, the optometrist must first be OGS licensed.

CASES OF ANAPHYLAXIS:
An OGS may administer appropriate medication to treat a patent that has an anaphylactic reaction. This severe type of allergic reaction then needs to be referred to a physician for further management.

RULES FOR PRESCRIBING AND HANDLING CONTROLLED SUBSTANCES:
Oral Analgesics or pain medications – DEA Schedules III, IV, or V

All OGS’s must comply with Federal laws regarding controlled substances such as narcotic pain medications. A DEA number must be obtained for schedules III, IV, and V from the Drug Enforcement Agency.

All OGS must have this DEA number in their possession prior to writing prescriptions for any controlled substances. This DEA number must be included on every prescription for controlled substances that the OGS writes.

The OGS must also obtain a DPS number from the Texas Department of Public Safety. This DPS number needs to be maintained at the OGS’s principle office.

If an OGS possess controlled substances within their office they must; establish adequate security, limit access to authorized agents only, provide locked storage areas, and allow no convicted felons to have access to these controlled substances.

Any breach in these standards of handling controlled substances will be treated as a violation of the Texas Optometry Act.

TREATMENT OF GLAUCOMA BY AN OGS:
Any OGS may treat glaucoma under the rules of this law. OGS’s are required to consult with an ophthalmologist after an initial diagnosis of glaucoma.

This consultation with an ophthalmologist needs to occur within 30 days of the initial diagnosis date.

The OGS and the ophthalmologist shall consult to formulate a treatment plan.

The OGS is required to inform their patient that his/her glaucoma diagnosis will be confirmed and co managed with an ophthalmologist.

The patient must be able to select an ophthalmologist or if they do not have a preference, then the OGS may choose to comanage with any local ophthalmologist.

The parameters of the consultation shall be at the discretion of the ophthalmologist but must at least include confirmation of the diagnosis and a plan for comangement of the patient, including periodic review of the patient’s progress.

Setting a Target Intraocular Pressure
OGS’s must set a target intraocular pressure at the time of the initial diagnosis of glaucoma. This target pressure must represent at least a 20% or greater decrease in intraocular pressure.

If the OGS finds that the patient’s glaucoma does not respond in the appropriate time period, then the OGS shall consult with a physician by telephone, fax, or other means.

The physician can then determine whether or not the patient needs to be seen by a physician.

Prescribing Beta Blockers
Prior to prescribing a Beta Blocker, the OGS needs to take a thorough case history to determine if the patient has had a physical within the last 180 days.

If they have not had a recent physical or if they have a medical history of; congestive heart failure, bradycardia, heart block, asthma, or chronic obstructive pulmonary disease -then the OGS must refer the patient to a physician for a physical exam before prescribing a Beta Blocker.

If the patient does not have any of these contraindications and has had a recent physical, the OGS may prescribe Beta Blockers for glaucoma treatment and management.

Cases that Require Referral to an Ophthalmologist
An OGS shall refer patients to an ophthalmologist right away if:

1. the patient is under 16 years of age and has been diagnosed with glaucoma;
2. the patient has been diagnosed as having acute angle closure glaucoma (an OGS may initiate emergency treatment of angle closure, but a timely referral to an ophthalmologist is required.)
3. the patient has been diagnosed as having malignant glaucoma or neovascular glaucoma;
4. the OGS determined that a patient’s glaucoma is caused by diabetic complications and after joint consultation with the physician treating the diabetes and an ophthalmologist by telephone, fax or other method, the physician or ophthalmologist determines that the patient should be seen by the physician or ophthalmologist; or
5. the OGS determines that a patient’s glaucoma is not responding appropriately to treatment and after consulting with a physician by telephone, fax or other method, the physician determines that the patient should be seen by the physician or an appropriate specialist.

OGS’s must inform all patients that are referred to a physician or specialist that the patient may choose whoever they would like to see. Finally, as with all referrals, OGS’s must maintain copies of the physician’s reports in their patient’s records.