Optometry; Use of Pharmaceuticals
Allows therapeutically certified optometrists to prescribe and use, under certain restrictions, pharmaceuticals approved by the optometry board; prohibits use of injectable agents, except for anaphylaxis.
TWENTY-SECOND LEGISLATURE, 2004
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO OPTOMETRY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The profession of optometry has changed markedly in recent years and is currently defined by the American Optometric Association as follows: "Doctors of optometry are independent health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures, as well as diagnose
related systemic conditions."
Although the education and training are standardized in all schools and colleges of optometry in the United States under this definition, the scope of practice and utilization of therapeutic pharmaceutical agents by optometrists in different states vary considerably. Currently Hawaii ranks forty-sixth among states in the permitted use of pharmaceuticals. Hawaii's optometrists are profoundly limited in providing quality eye care to their patients. The legislature finds that Hawaii should be brought more into the mainstream of optometry pharmaceutical practices in order to provide greater access to quality eye care for the citizens of Hawaii.
The purpose of this Act is to allow licensed optometrists to prescribe and use pharmaceutical agents and steroidal agents.
SECTION 2. Section 459-1, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) The practice of optometry, for the purpose of this chapter, is defined to be:
(1) The examination, diagnosis, treatment, and management of diseases and disorders of the human visual system, the eye, and the eyelids;
(2) The employment of trial frame or trial lenses, and any objective or subjective means or methods, other than the use of surgery, including refractive or therapeutic laser surgery, but including the use and prescription of [
topically applied] pharmaceutical agents, as established by the board, and the performance of non-invasive diagnostic procedures or ordering of laboratory tests related to the use of [ topically applied] pharmaceutical agents for the purpose of examining, diagnosing, treating, and managing visual, muscular, or other diseases and disorders of the human visual system, the eye, and the eyelids; or
(3) The prescribing, fitting, or adaptation of any ophthalmic lenses, contact lenses, prisms, frames, mountings, or orthoptic exercises for the correction or relief of the visual or muscular anomalies of the human eye.
Superficial foreign bodies may be removed from the human eye and eyelids, including the removal of corneal superficial foreign bodies above Bowman's Layer.
(b) Any person who engages in the prescribing of visual training, with or without the use of scientific instruments to train the visual system or other abnormal condition of the eyes, or claims to be able to do so, shall be deemed to be engaged in the practice of optometry and shall first secure and hold an unrevoked and unsuspended license as provided in this chapter; provided that an orthoptist may give visual training, including exercises, under the supervision of a physician or optometrist. The use and prescription of [
topically applied] pharmaceutical agents and the removal of superficial foreign bodies from the human eye and eyelid shall be granted to an optometrist licensed under this chapter who has met the requirements under sections 459-7 and 459-7.4."
SECTION 3. Section 459-7.4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) The use and prescription of [
topical] therapeutic pharmaceutical agents as established by the board for the treatment and management of conditions of the anterior segment of the human eye, eyelids, and lacrimal system and the non-invasive surface removal of superficial foreign bodies from the anterior segment of the human eye and eyelids is authorized only for an optometrist licensed under this chapter who meets the requirements of a therapeutically certified optometrist as authorized in this section. The therapeutically certified optometrist may use or prescribe steroidal agents. The therapeutically certified optometrist shall not [ prescribe, dispense, or] administer [ oral pharmaceutical agents except those available without prescription. Treatment of glaucoma, use of prescription anti-fungal,] injectable[ , or oral] agents except for anaphylaxis [ ,and performing]. Performing any invasive surgery shall not be allowed. [ Therapeutic pharmaceutical agents shall not include any of the controlled substances enumerated in sections 329-14, 329-16, 329-18, 329-20, and 329-22.]"
SECTION 4. Section 459-7.45, Hawaii Revised Statutes, is repealed.
§459-7.45 Restrictions on the use of topical steroidal agents and topical anti-viral agents. (a) A therapeutically certified optometrist may prescribe topical steroidal agents with the following restrictions: (1) An ophthalmologist shall be consulted: (A) If the patient's condition worsens or does not improve seventy-two hours after initiating treatment with a topical steroid; or (B) If the inflammation is still present two weeks after diagnosis; and (C) When treating a corneal ulcer or peripheral inflammatory keratitis with a topical steroid; provided that children under the age of fifteen may be treated with a topical steroid only after consultation with an ophthalmologist; (2) The patient shall be referred to an ophthalmologist if a topical steroid is still indicated three weeks after diagnosis; and (3) The only type of anterior uveitis to be treated under this section is traumatic iritis. (b) A therapeutically certified optometrist may prescribe topical anti-viral agents for corneal epithelial lesions; provided that if the patient's condition does not improve seventy-two hours after initiating treatment with a topical anti-viral agent, the patient shall be immediately referred to an ophthalmologist."]
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect on July 1, 2004.