|(a) Purpose. The purpose of this section is to implement
the mandate of the 76th Legislature as it relates to the Optometry
Act, Texas Occupations Code Chapter 351, regarding the minimum standards
for the collaborative management of glaucoma.
(b) Minimum requirements. At a minimum, the treating
ophthalmologist should follow the guidelines outlined in paragraphs
(1) - (10) of this subsection.
(1) The ophthalmologist will confirm the diagnosis
within 30 days of the diagnosis of glaucoma made by the optometrist.
While the ophthalmologist may, in his or her discretion, require that
the patient visit the ophthalmologist for a face-to-face visit, such
a face-to-face visit is not mandated. The ophthalmologist may, at
the ophthalmologist's discretion, rely upon the results of diagnostic
tests performed originally by the optometrist, unless reaffirmation
(2) The ophthalmologist must communicate in written
form the confirmation of the diagnosis within 30 days, as well as
the refinement of the treatment plan as recommended by the optometrist.
(3) A proper medical record must be generated for each
patient by the ophthalmologist and shall include all correspondence
and testing results. The medical record must also include a written
note made in the record by the ophthalmologist or a copy of the written
informed consent demonstrating that the patient understands that he
or she is participating in a co-management of primary open angle glaucoma.
(4) The necessity for follow-up visits will be at the
discretion of the ophthalmologist based on the communication of the
patient's progress by the optometrist.
(5) The ophthalmologist must report any irregular behavior
of the optometrist to the Texas Medical Board for referral to the
Texas Optometry Board.
(6) The ophthalmologist must enter into the patient's
written medical records that the ophthalmologist has elected to enter
into a co-management agreement with an optometrist.
(7) It is at the discretion of the ophthalmologist
to complete a clinical skills assessment with each optometrist in
which a co-management arrangement exists. The ophthalmologist will,
however, receive written confirmation and documentation that the co-managing
optometrist has completed all of the requirements of the Optometric
Health Care Advisory Committee to obtain the designation of "optometric
(8) A physician may charge a reasonable consultation
fee for a consultation given when a patient is referred with a diagnosis
of primary open angle glaucoma.
(9) When a physician examines a patient involved in
a co-management consultation with a therapeutic optometrist for treatment
of primary open angle glaucoma, the physician shall forward to the
therapeutic optometrist, not later than the 30th day following the
examination, a written report on the results of the examination. A
physician who, for a medically appropriate reason, does not return
a patient to the therapeutic optometrist, shall state in the physician's
report to the therapeutic optometrist the specific medical reason
for failing to return the patient.
(10) In order to enter into a co-management agreement
with an optometrist, there must be an agreement between the two professionals
that, following each visit, specified information, previously agreed
upon by both the ophthalmologist and the optometrist, about the patient
examined will be forwarded to the other practitioner.