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TITLE 22EXAMINING BOARDS
PART 14TEXAS OPTOMETRY BOARD
CHAPTER 280THERAPEUTIC OPTOMETRY
RULE §280.11Treatment of Glaucoma by an Optometric Glaucoma Specialist

(a) An optometric glaucoma specialist may treat glaucoma as directed by this rule.

(b) Consultation with an ophthalmologist after an initial diagnosis of glaucoma.

  (1) Not later than the 30th day after the date of the initial diagnosis of glaucoma, an optometric glaucoma specialist shall engage in consultation with an ophthalmologist to develop an individual treatment plan that is approved by the optometric glaucoma specialist and ophthalmologist.

  (2) The optometric glaucoma specialist shall inform the patient diagnosed with glaucoma that the optometric glaucoma specialist must have the diagnosis confirmed and comanaged by an ophthalmologist of the patient's choosing or, if the patient does not choose an ophthalmologist, an ophthalmologist practicing in the geographic area in which the optometric glaucoma specialist practices.

  (3) 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 comanagement of the patient, including periodic review of the patient's progress.

(c) Setting a target pressure on the initial diagnosis of glaucoma.

  (1) On making an initial diagnosis of glaucoma, an optometric glaucoma specialist shall set a target pressure that is not more than 80 percent of the initial intraocular pressure.

  (2) If the optometric glaucoma specialist determines that a patient's glaucoma is not responding appropriately to treatment, the optometric glaucoma specialist shall consult a physician by telephone, fax, or another method. The patient's glaucoma is considered to not be appropriately responding to treatment if the patient fails to achieve the target pressure within an appropriate time. If the physician determines that the patient should be seen by the physician or an appropriate specialist as a result of the consultation, the optometric glaucoma specialist shall refer the patient to an ophthalmologist.

(d) Prescribing a beta blocker.

  (1) Before an optometric glaucoma specialist may prescribe a beta blocker, the optometric glaucoma specialist must take a complete case history of the patient and determine whether the patient has had a physical examination within the 180 days preceding the date of taking the history.

  (2) If the patient has not had a physical examination or if the patient has a history of congestive heart failure, bradycardia, heart block, asthma, or chronic obstructive pulmonary disease, the optometric glaucoma specialist shall refer the patient to a physician for a physical examination before initiating beta blocker therapy.

(e) Referral to an ophthalmologist.

  (1) An optometric glaucoma specialist shall refer a patient to an ophthalmologist if:

    (A) the patient is under 16 years of age and has been diagnosed as having glaucoma;

    (B) the patient has been diagnosed as having acute closed angle glaucoma;

    (C) the patient has been diagnosed as having malignant glaucoma or neovascular glaucoma;

    (D) the optometric glaucoma specialist determines that a patient's glaucoma is caused by a diabetic complication and, after joint consultation with the physician treating the diabetes and an ophthalmologist by telephone, fax, or another method, the physician or ophthalmologist determines that the patient should be seen by the physician or ophthalmologist; or

    (E) the optometric glaucoma specialist determines that a patient's glaucoma is not responding appropriately to a treatment as specified in this rule.

  (2) The optometric glaucoma specialist may initiate appropriate emergency treatment for a patient diagnosed with acute closed angle glaucoma, but shall refer the patient to a physician in a timely manner.

  (3) An optometric glaucoma specialist who refers a patient to a physician or specialist shall inform the patient that the patient may go to any physician or specialist the patient chooses. This subsection does not prevent an optometric glaucoma specialist from recommending a physician or specialist.

  (4) The optometric glaucoma specialist shall maintain physician reports in the patient's records.


Source Note: The provisions of this §280.11 adopted to be effective August 3, 2000, 25 TexReg 7176

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