Legislative Update from the TOA President
by Mark L. Mazow, MD
May 13, 2021

Good afternoon TOA members,

I have a significant legislative update for you regarding HB2340/SB993 related to optometric scope of practice in Texas. Thank you for your patience while we have navigated this challenging legislative session.

As you know, these two bills as filed back in February would have allowed optometrists to practice laser, scalpel, and needle surgery, treat all levels of glaucoma with no required collaboration with an ophthalmologist, prescribe hydrocodone-combination medications, prescribe systemic medications, and order a wide range of tests and studies. The bills also would have given the Texas Optometry Board (TOB) sole authority over its licensees’ scope of practice in the future, giving that agency unprecedented powers.

We have seen the erosion of patient safety this year with optometric surgery bills passed in Mississippi and Wyoming. Each of Texas’ bordering states allows optometric surgery. Texas is the only state that mandates glaucoma co-management for optometrists. 

These bills gained momentum early in the legislative session with their sponsors in each chamber serving as chairs of the committees hearing the bills. HB2340 gained 30 co-authors in the House of Representatives. Several high-profile lawmakers supported the bills in their original form. 

Your TOA leadership has come to a successful agreement with leaders of organized optometry, an agreement that keeps patient care at the forefront. 

Please know that the TOA executive council has never wavered on its stance against the most dangerous aspects of HB2340/SB993. Thanks to your support and advocacy, we have been successful in removing these patient safety threats from Committee Substitute SB993:

  • Surgery in any form.
  • Authority to prescribe narcotics.
  • Authority to prescribe medications beyond treatment for the eye.
  • Unfettered power given to the Texas Optometry Board.
  • Completely independent glaucoma management.

Texas’ strong definition of surgery has not been breached. It remains a model statute for the country. 

CSSB993 does the following:

  • Expands optometrists’ use of only topical and oral medications to treat the eye.
  • Allows optometrists to medically manage mild and moderate glaucoma without mandatory co-management with an ophthalmologist.*
  • Creates a peer review process for glaucoma complaints brought to the TOB. Each complaint must be initially reviewed by an ophthalmologist, and then brought to a panel of an equal number of ophthalmologists and optometrists which will recommend the disciplinary action to be taken. The optometrist will be held to the same standard of care applicable to an ophthalmologist. Additionally, the TOB must notify the Texas Medical Board of the receipt and disposition of complaints and must have a searchable list of therapeutic optometrists whose certificate was suspended or revoked by the board and must maintain publicly available online information about the number of complaints filed with the board regarding the treatment of glaucoma by optometrists. 

The peer review process as described above is unprecedented in Texas and will provide our patients with protections they have not had in over 20 years. This will be the strongest glaucoma law in the country. Organized optometry has agreed to these provisions, showing their commitment to patient care. 

*I want to point out that there is no allowance for laser treatment of glaucoma – Texas’ prohibition of surgery by non-physicians remains unchanged. Any non-physician performing laser, scalpel or needle surgery in Texas would be subject to discipline, as they are today, by the Attorney General for practicing medicine without a medical license.

Given the climate and the unique challenges we faced this year, I am proud of our Executive Council for coming to the table and finding a solution that has mitigated the original bill while simultaneously improving guardrails for glaucoma patients.

This afternoon, the Texas Senate passed CSSB993. Please take some time to watch this 14 minute video (scroll to 1:25:30) where TOA past president Sen. Dawn Buckingham asks bill sponsor Sen. Kelly Hancock specific questions about the goals of the bill. This is called legislative intent and the transcription of that will be used to help guide the rulemaking process. 

A member has asked: Does the medical management of glaucoma mean that optometrists could use injectable medications?

Answer: No. Texas law prohibits injections by optometrists. This bill only amends the current statute, it does not replace it.

The Texas Legislature adjourns on May 31. Your TOA Executive Council will spend the next 18 days watching for any changes to this bill and will not compromise one inch when it comes to patient safety threats, including surgery. 

Thank you for your ongoing advocacy and support of patient safety in Texas.

May 23, 2021 Update

CSSB993, our agreed-to substitute legislation regarding optometric scope of practice, passed on the House floor’s second reading last night.  This new act will take effect September 1, 2021. TOA will be involved in the rule making process later this year. 

During our negotiations with organized optometry, both sides agreed to a moratorium on any optometric scope of practice expansion until 2029. This moratorium is significant because it will allow time for the peer review process regarding glaucoma complaints to work and for all interested parties to review the outcomes of complaints. 

The moratorium will allow us eight years to focus our efforts on other advocacy efforts such as Medicaid reimbursement or an early eyedrop refill law, for example. It will also give us eight years to continue to educate lawmakers on the importance of laser, needle, and scalpel surgery being performed only by those who have completed medical school and an ophthalmology residency. 

These negotiations were complicated, but I do believe that the Executive Council did an excellent job finding a solution that mitigated the original bill while simultaneously improving guardrails for glaucoma patients.