BILL NUMBER: SB 1406 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 29, 2008
PASSED THE ASSEMBLY AUGUST 21, 2008
AMENDED IN ASSEMBLY AUGUST 20, 2008
AMENDED IN ASSEMBLY AUGUST 11, 2008
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, and to add and repeal
Section 3041.10 of, the Business and Professions Code, relating to
optometry.
LEGISLATIVE COUNSEL'S DIGEST
SB 1406, 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 X-rays necessary for
the diagnosis of conditions or diseases of the eye or adnexa, perform
venipuncture for testing patients suspected of having diabetes,
administer oral fluorescein to patients suspected of having diabetic
retinopathy, prescribe lenses or devices that incorporate a
medication or therapy the optometrist is certified to prescribe or
provide, and use specified instruments within the central 3
millimeters of the cornea. 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 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.
Until January 1, 2010, this bill would also provide for a Glaucoma
Diagnosis and Treatment Advisory Committee to consist of 6 members
appointed by the State Board of Optometry for purposes of
establishing certain requirements for glaucoma certification. The
bill would require the committee to submit its final recommendations
to the Office of Examination Resources of the Department of Consumer
Affairs by April 1, 2009, would require the office to present its
findings and any modifications thereof to the board by July 1, 2009,
and require the board to adopt the office's findings by January 1,
2010.
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, nonsurgical in cause except when
comanaged with the treating physician and surgeon, limited to
inflammation resulting from traumatic iritis, peripheral corneal
inflammatory keratitis, episcleritis, and unilateral nonrecurrent
nongranulomatous idiopathic iritis in patients over 18 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 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
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, nonsurgical in cause except when comanaged with
the treating physician and surgeon, 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. In using topical steroid medication for
the treatment of ocular allergies, an optometrist shall consult with
an ophthalmologist if the patient's condition worsens 21 days after
diagnosis.
(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
appropriate physician and surgeon 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
appropriate physician and surgeon.
(B) Peripheral corneal inflammatory keratitis, excluding Moorens
and Terriens diseases, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis.
(C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis and shall refer the
patient to an ophthalmologist or 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 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 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.
(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 48 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 48 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) Corneal scraping with cultures.
(2) Debridement of corneal epithelia.
(3) Mechanical epilation.
(4) Venipuncture for testing patients suspected of having
diabetes.
(5) Suture removal, with prior consultation with the treating
physician and surgeon.
(6) Treatment or removal of sebaceous cysts by expression.
(7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.
(8) Use of an auto-injector to counter anaphylaxis.
(9) Ordering of smears, cultures, sensitivities, complete blood
count, mycobacterial culture, acid fast stain, urinalysis, and X-rays
necessary for the diagnosis of conditions or diseases 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.
(10) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.
(11) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.
(12) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel or
needle. Corneal foreign bodies shall be nonperforating, be no deeper
than the midstroma, and require no surgical repair upon removal.
(13) 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
section prior to January 1, 2009, submission of proof of completion
of that certification program.
(3) For licensees who have substantially completed the
certification requirements pursuant to this section in effect between
January 1, 2001, and December 31, 2008, submission of proof of
completion of those requirements on or before December 31, 2009.
"Substantially completed" means both of the following:
(A) Satisfactory completion of a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma.
(B) 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) For licensees who completed a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma, submission of proof of satisfactory
completion of the case management requirements for certification
established by the board pursuant to Section 3014.10.
(5) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and not described in paragraph
(2), (3), or (4), submission of proof of satisfactory completion of
the requirements for certification established by the board pursuant
to Section 3014.10.
(g) Other than for prescription ophthalmic devices described in
subdivision (b) of Section 2541, 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. "Surgery"
does not include those procedures specified in subdivision (e).
Nothing in this section shall limit an optometrist's authority to
utilize diagnostic 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 glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(k) 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.
SEC. 2. Section 3041.10 is added to the Business and Professions
Code, to read:
3041.10. (a) The Legislature hereby finds and declares that it is
necessary to ensure that the public is adequately protected during
the transition to full certification for all licensed optometrists
who desire to treat and manage glaucoma patients.
(b) The board shall appoint a Glaucoma Diagnosis and Treatment
Advisory Committee as soon as practicable after January 1, 2009. The
committee shall consist of six members currently licensed and in
active practice in their professions in California, with the
following qualifications:
(1) Two members shall be optometrists who were certified by the
board to treat glaucoma pursuant to the provisions of subdivision (f)
of Section 3041, as that provision read on January 1, 2001, and who
are actively managing glaucoma patients in full-time practice.
(2) One member shall be a glaucoma-certified optometrist currently
active in educating optometric students in glaucoma.
(3) One member shall be a physician and surgeon board-certified in
ophthalmology with a specialty or subspecialty in glaucoma who is
currently active in educating optometric students in glaucoma.
(4) Two members shall be physicians and surgeons board-certified
in ophthalmology who treat glaucoma patients.
(c) The board shall appoint the members of the committee from a
list provided by the following organizations:
(1) For the optometrists' appointments, the California Optometric
Association.
(2) For the physician and surgeons' appointments, the California
Medical Association and the California Academy of Eye Physicians and
Surgeons.
(d) The committee shall establish requirements for glaucoma
certification, as authorized by Section 3041, by recommending both of
the following:
(1) An appropriate curriculum for case management of patients
diagnosed with glaucoma for applicants for certification described in
paragraph (4) of subdivision (f) of Section 3041.
(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,
for certification described in paragraph (5) of subdivision (f) of
Section 3041.
In developing its findings, the committee shall presume that
licensees who apply for glaucoma certification and who graduated from
an accredited school of optometry on or after May 1, 2008, possess
sufficient didactic and case management training in the treatment and
management of patients diagnosed with glaucoma to be certified.
After reviewing training programs for representative graduates, the
committee in its discretion may recommend additional glaucoma
training to the Office of Examination Resources pursuant to
subdivision (f) to be completed before a license renewal application
from any licensee described in this subdivision is approved.
(e) The committee shall meet at such times and places as
determined by the board and shall not meet initially until all six
members are appointed. Committee meetings shall be public and a
quorum shall consist of four members in attendance at any properly
noticed meeting.
(f) (1) The committee shall submit its final recommendations to
the Office of Examination Resources of the department on or before
April 1, 2009. The office shall examine the committee's recommended
curriculum requirements to determine whether they will do the
following:
(A) Adequately protect glaucoma patients.
(B) Ensure that defined applicant optometrists will be certified
to treat glaucoma on an appropriate and timely basis.
(C) Be consistent with the department's and board's examination
validation for licensure and occupational analyses policies adopted
pursuant to subdivision (b) of Section 139.
(2) The office shall present its findings and any modifications
necessary to meet the requirements of paragraph (1) to the board on
or before July 1, 2009. The board shall adopt the findings of the
office and shall implement certification requirements pursuant to
this section on or before January 1, 2010.
(g) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 3. 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).