Texas optometrists saw efforts to expand their TPA legislation fall short this year

Issue: September 1997

ByScott Warnock

According to a formulary, Texas optometrists are able to prescribe all topical ocular therapeutic pharmaceutical agents (TPAs) and any over-the-counter oral drugs, said Bj Avery, legislative director of the Texas Optometric Association (TOA). They are restricted from prescribing anti-glaucoma, antiviral and oral drugs. The optometric TPA law was put in place in 1991.

Optometrists can use 1% steroids, but if the condition does not improve within 7 days they must consult an ophthalmologist, Ms. Avery said. When using steroid formulations of less than 1%, they must see patient improvement within 14 days or seek a consultation.

Texas optometrists saw a recent bid to broaden their optometric privileges fall short during this past year’s legislative session.

"As taught" bill fell short

"We tried to expand the scope of optometric practice and to put Texas optometry more in the mainstream of what optometry is in this country today," said Dennis Golden, OD, president of the TOA. "We feel that Texas is about 10 years behind in terms of what other states are doing regarding therapeutics."

Dr. Golden said the TOA wanted glaucoma treatment privileges and originally was promoting an "as taught" bill. "It would have allowed us to do the things we're taught to do," he said. "Optometry should not be unlike other medical professions in that we should be able to practice to the extent of our training."

Despite the fact that the TOA raised more money and had broader support, Dr. Golden said, they fell short because of the strong, organized medical opposition in the state. "Also, we lacked the support of key people in leadership roles in the legislature," he said.

However, the battle is not over. "We'll be back in 2 years," he said. "This is something we'll eventually get. It will just take some time. This is in the best interest of the people in this state."

Working with ophthalmology

Texas optometrists have been attempting to build a better relationship with their ophthalmology colleagues. "There is an ongoing conversation and relationship with ophthalmology," Ms. Avery said. "Comanagement networks have been established, although relations, for economic reasons, often remain adversarial."

According to Dr. Golden, optometrists in Texas, particularly those in the rural areas that dominate the state, are using their TPA privileges "to the maximum." Also, many small-town optometrists have hospital staff privileges.

"We're the only [eye care providers] in some of these small areas," he said, "and we have no problem working side-by-side with local family doctors and primary care providers. Where ophthalmology comes along, that's where we have problems."

Sampling still an issue

Ms. Avery said she believes many optometrists still give samples to patients. She said the TOA "encourages everyone to use the tools that are in their arsenal. It appears that some optometrists are still choosing to give out drugs and treat in the office rather than prescribing, but I think that's changing."

Agreeing with Dr. Golden, she pointed out that "usually the doctors out in the rural counties are prescribing more, because there's no one else around to treat [the patients]."

Optometrists in Texas can obtain Drug Enforcement Administration numbers that designate them as mid-level providers. Texas has 2,785 licenses, 1,941 of which have addresses in Texas. Of those in Texas, 1,426 are therapeutic.

To receive therapeutic certification in Texas, optometrists who graduated before 1991 must complete 90 hours of formal education, of which a minimum of 20 hours must be in applied clinical skills. They also must also pass the Treatment and Management of Ocular Diseases examination.

For Your Information:

The Texas Optometric Association can be contacted at 1503 S. I-35, Austin, TX 78741; (512) 707-2020; fax: (512) 326-8504. Dennis Golden, OD, can be reached at (903) 693-7745; fax: (903) 693-8971.