HBA-MPM H.B. 1051 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1051 By: Brimer Public Health 2/16/1999 Introduced BACKGROUND AND PURPOSE More than 200,000 Texans have untreated glaucoma, a disease which, if left untreated, will lead to blindness. There are 73 counties in Texas with resident ophthalmologists and 142 counties with optometrists. Forty-two states, excluding Texas, have authorized these certified therapeutic optometrists to treat patients with glaucoma. Therapeutic optometrists must pass a nationally certified exam that tests their knowledge of the diagnosis and treatment of glaucoma. Attorney General Opinion DM-152 states that the use of certain drug classifications to regulate practice by therapeutic optometrists is appropriate. H.B. 1051 allows therapeutic optometrists to treat glaucoma with eye drops and oral prescriptions, and specifies 18 medical procedures which may be performed (aside from surgery or laser surgery). It requires therapeutic optometrists to meet additional education, examination, and certification requirements in order to treat glaucoma. Furthermore, it calls for a joint study between the University of Houston and The University of Texas Health Science Center to analyze the safety, efficacy, and cost-effectiveness of laser surgery performed by therapeutic optometrists. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority previously delegated to the Texas Department of Health is modified in SECTION 2 (Section 1.03) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Sections 1.02(7) and (8), Texas Optometry Act (Article 4552-1.02, V.T.C.S.), as follows: (7) Includes treating the visual system, including the eye and adnexa, under the definition of the "practice of therapeutic optometry." Specifies that the practice of therapeutic optometry does not include the use of surgery or laser surgery except as specifically authorized by this Act. Makes a conforming change. (8) Expands the definition of "adnexa" to mean the lids and drainage system of the eye and related structures. SECTION 2. Amends Sections 1.03(b) and (d)-(g), Texas Optometry Act (Article 4552-1.03, V.T.C.S.), as follows: (b) Authorizes a therapeutic optometrist to perform, as well as administer or prescribe, ophthalmic procedures and appropriate medications, in addition to ophthalmic devices. Deletes over-the-counter oral medications and ocular pharmaceutical agents other than antiviral agents and antiglaucoma agents from a list of medications a therapeutic optometrist is allowed to prescribe. Authorizes a therapeutic optometrist to administer such devices, procedures, and appropriate medications by oral or parenteral means, in addition to topical means, for the purpose of diagnosing and treating visual defects, abnormal conditions, and diseases of the human vision system. Deletes existing language authorizing a therapeutic optometrist to remove superficial foreign matter and eyelashes from the external eye or adnexa. Deletes existing language relating to the conditions of use of a topical steroid. Makes a conforming change. (d) Requires the Texas Board of Health (board) to adopt rules setting forth the specific classifications of pharmaceutical agents, rather than the pharmaceutical agents, that may be used in the practice of therapeutic optometry. (e) Redesignated from Subsection (g). Deletes existing text regarding the creation of a fivemember advisory committee created to assist the board in determining the specific pharmaceutical agents which may be used by therapeutic optometrists, as well as matters regarding committee appointments. (f) Authorizes an optometrist to perform certain enumerated treatment procedures, if the procedures are performed without the use of lasers. Deletes existing text regarding the specific composition of the advisory committee. (g) Requires a therapeutic optometrist to be certified by the board before being allowed to treat glaucoma. Requires a therapeutic optometrist, to be certified to treat glaucoma, to complete a 24-hour, board-approved clinical review course on the diagnosis, treatment, and management of glaucoma, and to pass a board-approved examination covering these topics. SECTION 3. Amends Article 1, Texas Optometry Act (Article 4552-1.01, et. seq., V.T.C.S.), by adding Section 1.04, as follows: Section 1.04. STUDY REGARDING LASER SURGERY. (a) Requires the University of Houston and the University of Texas Health Science Center to conduct a joint study analyzing the safety, efficacy, and cost-effectiveness of laser surgery performed by therapeutic optometrists. (b) Specifies that the study shall be governed by a project steering committee (committee) that shall be responsible for the experimental design, safety, and data analysis of the study. Provides that the committee shall be jointly appointed by the dean of the University of Houston College of Optometry and the dean of The University of Texas Health Science Center and shall consist of equal representation among therapeutic optometrists, physicians, and persons trained in the field of public health. (c) Requires the respective deans of the participating university departments to jointly appoint a principal investigator (investigator). Requires the investigator to appoint personnel, oversee the collection and analysis of data, and act as the committee's chair. (d) Provides that the study shall be conducted under specific guidelines regarding the performance of laser surgery, staffing, and patient selection. (e) Requires the committee to submit a written report consisting of certain evaluative information to the presiding officer of each house of the legislature no later than January 1 of each year. (f) Provides that any report arising from this study, if required by law, shall be provided to the Health Professions Council or any other entity responsible for reviewing and approving impact reports regarding bills that may change the scope of practice of licensed or registered health care providers. (g) Prohibits a therapeutic optometrist from performing laser surgery except under the direct supervision of an ophthalmologist as part of the study. SECTION 4. Emergency clause. Effective date: upon passage.