|(a) An optometric glaucoma specialist may treat glaucoma as
directed by this rule.
(b) Consultation with an ophthalmologist after an initial diagnosis
(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
(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
(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
(4) The optometric glaucoma specialist shall maintain
physician reports in the patient's records.