A new eye care bill will allow optometrists to fully prescribe topical or oral medications and independently manage most forms of glaucoma. CSSB 993which North Texas Sen. Kelly Hancock sponsored, sits in Governor Greg Abbott’s office and will become law later this month until he vetoes it.
Original legislation submitted by Texas House Representative Stephanie Klick of Fort Worth would have allowed optometrists to perform minor eye surgery. Optometrists can do this in several neighboring states, but the effort met with resistance and was removed from the unifying House and Senate bill.
Proponents of the bill are excited about the development. “We are pleased with the outcome because patients can now get the care they need when they need it directly from their doctor of optometry,” says Dr. Jenny Terrell, president of advocacy group Focus Texas and co-director of Community eye clinic in Fort Worth. “It’s important when it comes to certain eye conditions that can be significant in the long term if not treated in a timely manner.”
Currently, optometrists are limited to prescribing ten days of medication, even if the diagnosis required 14 days of medication. The patient should return to the optometrist for a second prescription. “It’s not necessarily the best in terms of the burden on the patient to have to go on a second trip and take another day off and pay another co-pay,” Terrell says. Now eye ointment or similar medication can be prescribed for the entire required period.
Additionally, glaucoma management previously had to be overseen by an ophthalmologist, but optometrists can now manage most glaucoma patients independently. Since most patients with an optometrist have eye checkups every year, symptoms of glaucoma are likely to be recognized by the optometrist, who will be able to manage the condition.
But opponents of the bill see it as a uniquely American problem that could lead to problems down the line. Rather than getting the training needed to manage glaucoma, advocacy groups have found that changing the law can be a more effective way to expand their reach.
“In other parts of the world, it’s not a problem because licensing is different and qualifications are taken more seriously,” says Dr. Robert Gross, pediatric ophthalmologist and clinical professor of ophthalmology at UT Southwestern and former president of the ophthalmology section. from the American Academy of Pediatrics. “People have realized that there are different ways to get what they want. In a way, it’s a bit disappointing because the focus should be on education and training rather than what what can be done to change the law.
Another issue for Gross and others is the difference between the Texas Optometry Board and the Texas Medical Board, which have different levels of transparency and standards of care. When the State of Texas renewed the Texas Optometry Board during its review by the Sunset Commission in 2017, the commission said the board was generally well run, but wrote, “In the area of enforcement, the agency has a light touch on practitioners compared to other agencies. The Board of Optometry issues few severe penalties, places a limited amount of information about a licensee’s disciplinary history on the website, and does not report certain formal actions of the board to the National Practitioner Data Bank , as would seem necessary. This trend raises questions about whether council regulation leans more towards the profession than towards the public.
Gross was thrilled to see surgery removed from the bill. While surgeries that would have been allowed are minor and allowed in other states, the extensive surgical training that ophthalmologists undergo helps them understand which cases should be selected for surgery, what to do if there is a problem, and how these surgeries will impact the rest of the body’s symptoms. “Everything seems simple on its surface,” Gross says. “If a case goes well, it may seem simple, and that’s largely because of case selection, knowledge of all other intervention options and differential diagnoses, which are based on years training and skills of the surgeon.”
Glaucoma can be complex, and even an experienced ophthalmologist like Gross refers his patients to glaucoma specialists. “A lot of these cases are difficult, even on the non-surgical side. In most cases, I will get a second opinion from a stock-trained glaucoma specialist,” Gross says. “I have been practicing for 35 years and I am trained in glaucoma, but I think it’s a very difficult area. People go blind from glaucoma.
Ophthalmologists and optometrists work in harmony in most situations and have expertise where others don’t, and just because optometrists are licensed to manage glaucoma doesn’t mean they will. “Of the optometrists I know and talk to week in and week out, I don’t know of any who advocate this,” Gross says. “I think it’s a small group that wants that.”
Still, supporters are optimistic about the bill and its impact on patients. “This is a win for Texas patients and access because patients should be looking to other providers to get their eye conditions treated, and in some parts of some parts of the state, that’s not easy” , says Terrell. “Being able to have their local trusted optometrist to fully take care of the things we are trained to do is a win overall.”