BILL NUMBER: SB 1406 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 1, 2008
AMENDED IN ASSEMBLY JUNE 19, 2008
AMENDED IN SENATE MAY 27, 2008
AMENDED IN SENATE MAY 23, 2008
AMENDED IN SENATE APRIL 22, 2008
INTRODUCED BY Senators Correa and Aanestad
FEBRUARY 21, 2008
An act to amend Sections 3041 and 3152 of the Business and
Professions Code, relating to optometry.
LEGISLATIVE COUNSEL'S DIGEST
SB 1406, as amended, Correa. Optometry.
Existing law, the Optometry Practice Act, creates the State Board
of Optometry, which licenses optometrists and regulates their
practice. The act defines the practice of optometry as including the
prevention and diagnosis of disorders and dysfunctions of the visual
system, and the treatment and management of certain disorders and
dysfunctions of the visual system. The act also prescribes certain
eye or eye appendage conditions which an optometrist who is certified
to use therapeutic pharmaceutical agents may diagnose and treat, as
specified and subject to certain limitations, and requires additional
certification for the performance of primary open-angle glaucoma and
lacrimal irrigation and dilation procedures, respectively.
This bill would revise and recast those provisions to further
allow an optometrist who is certified to use therapeutic
pharmaceutical agents to, among others, treat glaucoma, as defined,
under specified certification standards, order any test or procedure
necessary for the diagnosis of conditions or diseases of the eye or
adnexa, to perform punctual punctal
occlusion by cautery, to prescribe lenses or devices that incorporate
a medication or therapy the optometrist is certified to prescribe or
provide, to use sharp instruments within the central 3 millimeters
of the cornea , to probe the nasal lacrimal tract in
patients over 12 years of age , and to perform
nonintraorbital injections. The bill would further allow an
optometrist who graduated from an accredited school of optometry on
or after May 1, 2000, to perform lacrimal irrigation and dilation
procedures without additional certification. The bill would also make
other changes with regard to the circumstances under which an
ophthalmologist or an appropriate physician and surgeon or other
health care provider is required to be consulted with, or
patients referred to, and to certain age requirements related to
treatment or diagnosis, as specified. The bill would further make a
conforming change to a related provision , and would make a
statement of legislative intent, as specified .
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 3041 of the Business and Professions Code is
amended to read:
3041. (a) The practice of optometry includes the prevention and
diagnosis of disorders and dysfunctions of the visual system, and the
treatment and management of certain disorders and dysfunctions of
the visual system, as well as the provision of rehabilitative
optometric services, and is the doing of any or all of the following:
(1) The examination of the human eye or eyes, or its or their
appendages, and the analysis of the human vision system, either
subjectively or objectively.
(2) The determination of the powers or range of human vision and
the accommodative and refractive states of the human eye or eyes,
including the scope of its or their functions and general condition.
(3) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, vision
training, or orthoptics.
(4) The prescribing of contact and spectacle lenses for, or the
fitting or adaptation of contact and spectacle lenses to, the human
eye, including lenses that may be classified as drugs or devices by
any law of the United States or of this state.
(5) The use of topical pharmaceutical agents for the
purpose of the examination of the human eye or eyes for any disease
or pathological condition.
(b) (1) An optometrist who is certified to use therapeutic
pharmaceutical agents, pursuant to Section 3041.3, may also diagnose
and treat the human eye or eyes, or any of its appendages, for all of
the following conditions:
(A) 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.
(B) Ocular allergies of the anterior segment and adnexa.
(C) Ocular inflammation, limited to inflammation resulting from
traumatic iritis, peripheral corneal inflammatory keratitis,
episcleritis, and unilateral nonrecurrent nongranulomatous idiopathic
iritis in patients over 12 years of age. Unilateral nongranulomatous
idiopathic iritis recurring within one year of the initial
occurrence shall be referred to an ophthalmologist. An optometrist
shall consult with an ophthalmologist or appropriate health
care provider physician and surgeon if a patient
has a recurrent case of episcleritis within one year of the initial
occurrence. An optometrist shall consult with an ophthalmologist or
appropriate health care provider physician
and surgeon if a patient has a recurrent case of peripheral
corneal inflammatory keratitis within one year of the initial
occurrence.
(D) Traumatic or recurrent conjunctival or corneal abrasions and
erosions.
(E) Corneal surface disease and dry eyes.
(F) Ocular pain associated with conditions optometrists are
authorized to treat.
(G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).
(2) For purposes of this section, "treat" means the use of
therapeutic pharmaceutical agents, as described in subdivision (c),
and the procedures described in subdivision (e).
(c) In diagnosing and treating the conditions listed in
subdivision (b), an optometrist certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3, may use all of the
following therapeutic pharmaceutical agents:
(1) Pharmaceutical agents as described in paragraph (5) of
subdivision (a), as well as topical miotics.
(2) Topical lubricants.
(3) Antiallergy agents.
(4) Topical and oral antiinflammatories. In using steroid
medication for:
(A) Unilateral nonrecurrent nongranulomatous idiopathic iritis or
episcleritis, an optometrist shall consult with an ophthalmologist or
other appropriate health care provider if the patient's condition
worsens 72 hours after the diagnosis, or if the patient's condition
has not resolved three weeks after diagnosis. If the patient is still
receiving medication for these conditions six weeks after diagnosis,
the optometrist shall refer the patient to an ophthalmologist or
other appropriate health care provider.
(B) Peripheral corneal inflammatory keratitis, excluding Moorens
and Terriens diseases, an optometrist shall consult with an
ophthalmologist or other appropriate health care provider if the
patient's condition worsens 72 hours after diagnosis.
(C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or other appropriate health care provider
appropriate physician and surgeon if the patient'
s condition worsens 72 hours after diagnosis and shall refer the
patient to an ophthalmologist or other appropriate health
care provider appropriate physician and surgeon
if the patient's condition has not resolved one week after diagnosis.
(5) Topical antibiotic agents.
(6) Topical hyperosmotics.
(7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in subdivision (f).
(A) The optometrist shall consult with, or refer the
patient to, refer the patient to an
ophthalmologist if requested by the patient or if angle closure
glaucoma develops.
(B) If the glaucoma patient also has diabetes, the optometrist
shall inform, in writing, consult with
the physician treating the patient's diabetes in developing the
glaucoma treatment plan and shall inform the physician in writing of
any changes in the patient's glaucoma medication. The
physician shall provide written confirmation of those consultations
and notifications.
(8) Nonprescription medications used for the rational treatment of
an ocular disorder.
(9) Oral antihistamines.
(10) Prescription oral nonsteroidal antiinflammatory agents.
(11) Oral antibiotics for medical treatment of ocular disease.
(A) If the patient has been diagnosed with a central corneal ulcer
and the central corneal ulcer has not improved 72 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
(B) If the patient has been diagnosed with preseptal cellulitis or
dacryocystitis and the condition has not improved 72 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
(12) Topical and oral antiviral medication for the medical
treatment of the following: herpes simplex viral keratitis, herpes
simplex viral conjunctivitis, and periocular herpes simplex viral
dermatitis; and varicella zoster viral keratitis, varicella zoster
viral conjunctivitis, and periocular varicella zoster viral
dermatitis.
(A) If the patient has been diagnosed with herpes simplex
keratitis or varicella zoster viral keratitis and the patient's
condition has not improved seven days after diagnosis, the
optometrist shall refer the patient to an ophthalmologist. If a
patient's condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
(B) If the patient has been diagnosed with herpes simplex viral
conjunctivitis, herpes simplex viral dermatitis, varicella zoster
viral conjunctivitis, or varicella zoster viral dermatitis, and if
the patient's condition worsens seven days after diagnosis, the
optometrist shall consult with an ophthalmologist. If the patient's
condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
(13) Oral analgesics that are not controlled substances.
(14) Codeine with compounds and hydrocodone with compounds as
listed in the California Uniform Controlled Substances Act (Section
11000 of the Health and Safety Code et seq.) and the United States
Uniform Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The
use of these agents shall be limited to three days, with a referral
to an ophthalmologist if the pain persists.
(d) In any case where this chapter requires that an optometrist
consult with an ophthalmologist, the optometrist shall maintain a
written record in the patient's file of the information provided to
the ophthalmologist, the ophthalmologist's response and any other
relevant information. Upon the consulting ophthalmologist's request
and with the patient's consent, the optometrist shall furnish a copy
of the record to the ophthalmologist.
(e) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may also perform all
of the following:
(1) Procedures necessary for the diagnosis or treatment of a
condition of the eye or visual system, including, but not limited to:
(A) Biopsies not requiring sutures.
(B) Corneal scraping with cultures.
(C) Debridement.
(D) Epilation, including with cryo or electro cautery.
(E) Nonintraoribital injections.
(F) Lacrimal probing, with or without dilation.
(G) Skin lesion removal.
(H)
(F) Removal of skin tags.
(I)
(G) Shaving of epidermal or dermal lesions.
(J)
(H) Stromal micropuncture.
(K)
(I) Suture removal, with prior consultation.
(L)
(J) Treatment or removal of lymphatic or sebaceous
cysts.
(2) Ordering of smears, cultures, sensitivities, complete blood
count, mycobacterial culture, acid fast stain, urinalysis, and other
tests or procedures necessary for the diagnosis of conditions or
diseases of the eye or adnexa.
(3) Punctal occlusion by plugs and cautery, excluding laser,
diathermy, cryotherapy, or other means constituting surgery as
defined in this chapter.
(4) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.
(5) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva. Corneal foreign bodies shall be nonperforating, be no
deeper than the midstroma, and require no surgical repair upon
removal.
(6) For patients over 12 years of age, lacrimal irrigation and
dilation , excluding probing of the nasal lacrimal tract .
The board shall certify any optometrist who graduated from an
accredited school of optometry before May 1, 2000, to perform this
procedure after submitting proof of satisfactory completion of 10
procedures under the supervision of an ophthalmologist as confirmed
by the ophthalmologist. Any optometrist who graduated from an
accredited school of optometry on or after May 1, 2000, shall be
exempt from the certification requirement contained in this
paragraph.
(f) The board shall grant a certificate to an optometrist
certified pursuant to Section 3041.3 for the treatment of glaucoma,
as described in subdivision (j), in patients over 18 years of age
after the optometrist meets the following applicable requirements:
(1) For licensees who graduated from an accredited school of
optometry on or after May 1, 2008, submission of proof of graduation
from that institution.
(2) For licensees who were certified to treat glaucoma under this
chapter prior to January 1, 2009, submission of proof of completion
of that certification program.
(3) For licensees who graduated from an accredited school of
optometry on or after May 1, 2000, submission of proof of
satisfactory completion of not less than 12 hours in case management
of patients diagnosed with glaucoma.
(4) For licensees who have completed a didactic course of not less
than 24 hours in the diagnosis, pharmacological, and other treatment
and management of glaucoma developed by an accredited school of
optometry, submission of proof of satisfactory completion of not less
than 12 hours in case management of patients diagnosed with
glaucoma.
(5) For licensees not described in the preceding paragraphs,
submission of proof of satisfactory completion of a didactic course
of not less than 24 hours in the diagnosis, pharmacological, and
other treatment and management of glaucoma developed by an accredited
school of optometry, and not less than 12 hours in case management
of patients diagnosed with glaucoma.
(g) Any dispensing of a therapeutic pharmaceutical agent by an
optometrist shall be without charge.
(h) 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 in a manner
not specifically authorized by this chapter. Nothing in this section
shall limit an optometrist's authority to utilize diagnostic
and therapeutic laser and ultrasound technology within his
or her scope of practice.
(i) An optometrist licensed under this chapter is subject to the
provisions of Section 2290.5 for purposes of practicing telemedicine.
(j) For purposes of this chapter, "glaucoma" means either of the
following:
(1) All primary open angle open-angle
glaucoma.
(2) All secondary open angle open-angle
glaucoma, excluding irido-corneal endothelial syndrome and
neovascular glaucoma.
(k) For purposes of reversal or stabilization, an optometrist
shall immediately refer any patient who has an acute attack of angle
closure to an ophthalmologist.
SEC. 2. Section 3152 of the Business and Professions Code is
amended to read:
3152. The amount of fees and penalties prescribed by this chapter
shall be established by the board in amounts not greater than those
specified in the following schedule:
(a) The fee for applicants applying for a license shall not exceed
two hundred seventy-five dollars ($275).
(b) The fee for renewal of an optometric license shall not exceed
five hundred dollars ($500).
(c) The annual fee for the renewal of a branch office license
shall not exceed seventy-five dollars ($75).
(d) The fee for a branch office license shall not exceed
seventy-five dollars ($75).
(e) The penalty for failure to pay the annual fee for renewal of a
branch office license shall not exceed twenty-five dollars ($25).
(f) The fee for issuance of a license or upon change of name
authorized by law of a person holding a license under this chapter
shall not exceed twenty-five dollars ($25).
(g) The delinquency fee for renewal of an optometric license shall
not exceed fifty dollars ($50).
(h) The application fee for a certificate to treat lacrimal
irrigation and dilation shall not exceed fifty dollars ($50).
(i) The application fee for a certificate to treat glaucoma shall
not exceed fifty dollars ($50).
(j) The fee for approval of a continuing education course shall
not exceed one hundred dollars ($100).
(k) The fee for issuance of a statement of licensure shall not
exceed forty dollars ($40).
(l) The fee for biennial renewal of a statement of licensure shall
not exceed forty dollars ($40).
(m) The delinquency fee for renewal of a statement of licensure
shall not exceed twenty dollars ($20).
(n) The application fee for a fictitious name permit shall not
exceed fifty dollars ($50).
(o) The renewal fee for a fictitious name permit shall not exceed
fifty dollars ($50).
(p) The delinquency fee for renewal of a fictitious name permit
shall not exceed twenty-five dollars ($25).
SEC. 3. (a) It is the intent of the Legislature
that interested parties come to resolution on the following questions
related to proposed amendments to existing law made by this act:
(1) In paragraph (5) of subdivision (a) of Section 3041 of the
Business and Professions Code, whether it needs to be made clear that
optometrists certified to use only diagnostic pharmaceutical agents
may use only topical pharmaceutical agents for diagnostic purposes.
(2) In subparagraph (C) of paragraph (1) of subdivision (b) of
Section 3041 of the Business and Professions Code, whether it needs
to be made clear that treatment of postsurgical ocular inflammation
in cases comanaged by the operating ophthalmologist and optometrist
is permitted.
(3) In paragraph (7) of subdivision (c) of Section 3041 of the
Business and Professions Code, whether it needs to be made clear that
glaucoma-certified optometrists may use oral glaucoma therapeutic
pharmaceutical agents only for the purpose of reversing or
stabilizing angle-closure glaucoma prior to immediate referral, as
specified in subdivision (k) of Section 3041 of the Business and
Professions Code.
(4) In subparagraph (A) of paragraph (1) of subdivision (e) of
Section 3041 of the Business and Professions Code, whether it needs
to be made clear that optometrists are authorized to perform biopsies
not requiring sutures for testing purposes to confirm diagnoses.
(5) As provided in subparagraph (J) of paragraph (1) of
subdivision (e) of Section 3041 of the Business and Professions Code,
whether optometrists should be authorized to treat or remove
lymphatic or sebaceous cysts.
(b) It is the intent of the Legislature that interested parties
come to resolution on a collaborative process for certification of
optometrists by the State Board of Optometry described in paragraphs
(3), (4), and (5) as added to subdivision (f) of Section 3041 of the
Business and Professions Code by this act, that both ensures that the
public will be protected and that qualified applicants will be
certified on an appropriate and timely basis.