Overview

On September 26, 2008 Governor Arnold Schwarzenegger signed Senate Bill 1406 (Chapter 352, Statutes of 2008, Correa). The bill expands the scope of practice for optometrist related to treating patients with glaucoma, treating children, prescribing authority, ordering laboratory tests, and changes the requirements for consultation with ophthalmologists or an appropriate physician or surgeon.

Provided below is a summary of SB 1406; however, you are encouraged to read the bill in its entirety.

Optometrists who have been granted the Glaucoma Certification may treat glaucoma as defined under specified certification standards.

Glaucoma Defined

1. All primary open-angle glaucoma
2. Exfoliation and pigmentary glaucoma
3. In an emergency, an optometrist shall stabilize; if possible, and immediately refer any patient who has an acute attack of angle closure to an ophthalmologist.3. In an emergency, an optometrist shall stabilize; if possible, and immediately refer any patient who has an acute attack of angle closure to an ophthalmologist.

Glaucoma Certification Standards
The Board shall grant a certificate to treat glaucoma in patients over 18 years of age to optometrists who have Therapeutic Pharmaceutical Agents (TPA) Certification and meet the following applicable requirements:

1. Licensees who graduated from an accredited school of optometry on or after May 1, 2008 shall submit proof of graduation from that institution. TPA with Glaucoma Certification (TPG) will be granted with licensure.
   
   Licensees who graduated on or after May 1, 2008 and who wish to obtain a license with TPG Certification may complete a duplicate request form and request a new wall certificate. The fee for the duplicate license is $25. The request form is available on the Board's web site at www.optometry.ca.gov, or with payment of your next renewal your license will be issued to read "TPG Certification".
   
   
2. Licensees who were certified to treat glaucoma under the requirements in SB929 (Chapter 676, Statutes of 2000. Effective January 1, 2001 – December 31, 2008) retain the privilege to treat patients over the age of 18 with glaucoma (Grandparenting provision).
   
   
3. Licensees who have substantially completed the certification requirements pursuant to law in effect between January 1, 2001 and December 31, 2008 shall submit proof of completion of those requirements on or before December 31, 2009. "Substantially completed" means both of the following:
   
   • Satisfactory completion of a didactic course of not less than 24 hours in the diagnosis, pharmacological, and other treatment management of glaucoma, and
   • Treatment of 50 glaucoma patients with a collaborating ophthalmologist for a period of two years for each patient that will conclude on or before December 31, 2009.
4. Any licensee who graduated from an accredited California school of optometry on or after May 1, 2000, shall be exempt from the 24-hour didactic course requirement but would be required to complete the case management requirements for certification established by the Board pursuant to Business and Professions Code section 3041.10.
   
   
5. Licensees who completed a didactic course of not less than 24 hours in the diagnosis, pharmacological, and other treatment and management of glaucoma, are only required to complete the case management requirements for certification established by the Board pursuant to Business and Professions Code section 3041.10.
   
   
6. Licensees who graduated from an accredited school of optometry on or before May 1, 2008, and do not meet the criteria stated above, must submit proof of satisfactory completion of the requirements for certification established by the Board pursuant to Business and Professions Code section 3041.10.
   
   

SB 1406 directs the Board to appoint a Glaucoma Diagnosis and Treatment Advisory Committee (Committee) for the purpose of establishing requirements for glaucoma certification pursuant to Business and Professions Code section 3041.10, (#4, #5, and #6 above). The Committee is charged with recommending (1) an appropriate curriculum for case management of patients diagnosed with glaucoma, and (2) an appropriate combined curriculum of didactic instruction in the diagnostic, pharmacological, and other treatment and management of glaucoma, and case management of patients diagnosed with glaucoma.

The Committee's first meeting is scheduled for Thursday, February 5, 2009. All committee meetings are open to the public. Information regarding the committee meetings is available on the Board's website at www.optometry.ca.gov. The Committee's final recommendation shall be submitted to the Department of Consumer Affairs (DCA), Office of Examination Resources (OER) on or before April 1, 2009. OER is responsible for examining the Committee's recommended curriculum requirements to ensure that they: 1) adequately protect glaucoma patients; 2) that applicant optometrists become certified to treat glaucoma on an appropriate and timely basis; and 3) the requirements are consistent with examination validation requirements and policies of DCA and the Board. OER shall submit its findings to the Board on or before July 1, 2009 and the Board shall adopt the findings of the office and shall implement certification requirements on or before January 1, 2010.

TPA Certified Optometrists May Diagnose, Treat and Perform the Following:

• Removal of foreign bodies from the cornea, eyelid, and conjunctiva with any appropriate instrument other than other than a scalpel or needle. Corneal foreign bodies shall be non-perforating, be no deeper than the midstroma, and require no surgical repair upon removal.
• Venipuncture for testing patients suspected of having diabetes.
• Suture removal, with prior consultation with the treating physician and surgeon.
• Treatment or removal of sebaceous cysts by expression.
• Administration of oral fluorescein to patients suspected as having diabetic retinopathy.
• Ordering of X-rays necessary for the diagnosis of conditions or disease of the eye or adnexa. An optometrist may order other types of images subject to prior consultation with an ophthalmologist or appropriate physician and surgeon.
• Prescribe therapeutic contact lenses, including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
• Through medical treatment, infections of the anterior segment and adnexa, excluding the lacrimal gland, the lacrimal drainage system, and the sclera in patients under 12 years of age.
• Treat a person with AIDS for ocular infections.
• Treat children under one year of age with therapeutic pharmaceutical agents.
• Treat ocular allergies of the anterior segment and adnexa.
• Treat ocular inflammation, nonsurgical in cause except when co managed with the treating physician and surgeon with limitations.
• Prescribe anti-allergy agents
• Prescribe topical and oral anti-inflammatories
• Prescribe topical and oral anti-glaucoma agents
• Prescribe oral antibiotics for medical treatment of ocular disease
• Topical and oral antivirals are authorized without restriction for the treatment of herpes simplex viral keratitis. Herpes simplex viral conjunctivitis, and periocular herpes simplex viral dermatitis, and varicella zoster viral dermatitis.

Limitations or Standards

• See SB 1406 for specified limitations regarding consultation requirements, patient referral and certain limitations to treatment based on the patient's age.
• The practice of optometry does not include performing surgery. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means. Nothing in his section shall limit an optometrist's authority to utilize diagnostic laser and ultrasound technology within his/her scope.

With these new privileges please use your professional judgment in determining your competency to perform newly authorized procedures and to practice safely. There are many resources available to you through continuing education courses and/ or certification classes that can provide you with adequate training. As a reminder, it is vital for you have appropriate storage and disposal for sharps materials and any bio-hazardous waste materials.