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Texas ODs now authorized to prescribe most glaucoma, oral medications
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HOUSTON – Texas optometrists can now prescribe oral and glaucoma agents, with restrictions, and all topical medications following the therapeutic pharmaceutical agent (TPA) amplification bill being signed into law June 19.
Oral antibiotics may be prescribed for 10 days; oral analgesics (schedules III, IV and V) and antihistamines may be prescribed for 3 days; oral non steroidal anti-inflammatories may be prescribed for 7 days; and oral carbonic anhydrase inhibitors may be used in an emergency. Injectables are permitted for emergency anaphylactic shock. After diagnosing and initiating treatment for glaucoma, an OD must consult with an ophthalmologist within 30 days.
What remains is the push to remove the remaining restrictions. Practitioners will have to be patient, however, said Marc Piccolo, OD, FAAO, immediate past president of the Texas Optometric Association and chair of the Department of Clinical Sciences at the University of Houston, College of Optometry. “We have signed an agreement with the board of medicine that we will not return to the legislature for two sessions,” he explained, “so that will be 6 years from now, in the year 2005, during our sunset review.”
The original TPA law, passed in 1991, included all topical medications with the exclusion of antiglaucoma agents and antivirals, Dr. Piccolo said.
Glaucoma credentialing criteria
To take advantage of the next level of prescribing, Dr. Piccolo said, practitioners in the state will be required to take a review course and pass an associated examination. A committee, called the Optometric Health Advisory Committee — consisting of two ODs, two ophthalmologists and two pharmacists — will be formed to establish the credentialing criteria. “In Texas, the designation for ODs in this next tier will be ‘optometric glaucoma specialist,’ ” he said.
Dr. Piccolo said that outside of the legislative arena, the relationship between optometrists and ophthalmologists is genial and, often, mutually beneficial. “I believe that [TPA legislation] actually strengthened our ability to comanage and took some of the pressure off of ophthalmology because they didn’t have to continue be responsible for delegating the authority to use some of these topical medications,” he noted. “So although politically they felt they had to oppose us, realistically, I think they find that it makes for a better working relationship.”
Although the amplification law does not specifically address the issue of hospital access, the law still may serve to benefit practitioners in that area, Dr. Piccolo stated. “Doctors in the rural areas tend to have a little easier time than doctors in the urban areas in terms of gaining hospital privileges,” he said. “Will this bill make it easier for doctors? I think the answer is yes. But there is no language in the bill that addresses hospital privileges.”
While the association did address the issue of direct access, it was unsuccessful at including it in the new law.
However, the topic will be broached again at a future session, he noted. “We do not have a moratorium on seeking legislation for managed care issues, including direct access,” he said. “In fact, that is something we probably will be pursuing with ophthalmology – they submitted a bill for direct access this year, and it did not pass.”
Of the more than 2,000 optometrists in the state, Dr. Piccolo said that more than 90% are TPA certified under the current therapeutics law.
For Your Information:
Marc Piccolo, OD, FAAO, may be contacted at the University of Houston College of Optometry, 4901 Calhoun, Houston, TX 77204-6052; (713) 743-1971; fax: (713) 743-0730.