Optometrists are expanding the scope of primary care optometry by passing legislation to allow them to treat eye diseases with medications. The scope of the laws governing therapeutic use by optometrists in those states where legislation has been passed was determined by soliciting specific information from each of the state boards. Optometrists in all twenty-five states can prescribe topical anti-microbials and anti-histamines. Corticosteriods can be utilized in twenty-one states, and in ten states anti-glaucoma agents may be administered. Oral drugs to treat eye disease can be prescribed by optometrists in eight states

Kopp, Steven J

Nivala, Jeffrey R.M.

English

CommonKnowledge

Pacific University 
CommonKnowledge 
College of Optometry Theses, Dissertations and Capstone Projects 
5-1991 
A compilation of the laws currently regulating TPA use by 
optometrists 
Jeffrey R.M. Nivala 
Pacific University 
Steven J. Kopp 
Pacific University 
Recommended Citation 
Nivala, Jeffrey R.M. and Kopp, Steven J., "A compilation of the laws currently regulating TPA use by 
optometrists" (1991). College of Optometry. 976. 
https://commons.pacificu.edu/opt/976 
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A compilation of the laws currently regulating TPA use by optometrists 
Abstract 
Optometrists are expanding the scope of primary care optometry by passing legislation to allow them to 
treat eye diseases with medications. The scope of the laws governing therapeutic use by optometrists in 
those states where legislation has been passed was determined by soliciting specific information from 
each of the state boards. Optometrists in all twenty-five states can prescribe topical anti-microbials and 
anti-histamines. Corticosteriods can be utilized in twenty-one states, and in ten states anti-glaucoma 
agents may be administered. Oral drugs to treat eye disease can be prescribed by optometrists in eight 
states. 
Degree Type 
Thesis 
Degree Name 
Master of Science in Vision Science 
Committee Chair 
Diane Yolton 
Subject Categories 
Optometry 
This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/976 
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PACIF!C UN1VERSHY UBRARY 
FOREST GROVE. OREGON 
A COMPILATION OF THE LAWS CURRENTLY REGULATING 
TP A USE BY OPTOMETRISTS. 
JEFFREY R.M. NIV ALA AND STEVEN J. KOPP 
A thesis submitted to the faculty of the 
College of Optometry 
Pacific University Forest Grove, Oregon 
for the degree of 
Doctor of Optometry 
May, 1991 
Advisor: 
Diane Yolton, OD., Ph.D. 
GRADE PAGE 
A COMPILATION OF THE LAWS CURRENTLY REGULATING 
TPA USE BY OPTOMETRISTS 
Jeffrey R.M. Nivala 
Steven J. Kopp 
Diane P. Yolton O.D., Ph.D. 
SIGNATURE PAGE 
ABSTRACT 
Optometrists are expanding the scope of primary care 
optometry by passing legislation to allow them to treat eye diseases 
with medications. The scope of the laws governing therapeutic use 
by optometrists in those states where legislation has been passed 
was determined by soliciting specific information from each of the 
state boards. Optometrists in all twenty-five states can prescribe 
topical anti-microbials and anti-histamines. Corticosteriods can be 
utilized in twenty-one states, and in ten states anti-glaucoma agents 
may be administered. Oral drugs to treat eye disease can be 
prescribed by optometrists in eight states. 
BIOGRAPHY 
JEFFREY R.M. ~TIV ALA 
My undergraduate education was completed at El Camino 
College in Torrance, California and California State University at 
Long Beach where I received an A.A. in social science and a B.A. in 
physical anthropology respectively. I received the anthropology 
department award for academic achievement from El Camino College 
and graduated "with distinction" from CSULB. Upon graduating from 
Pacific University, I plan to sit for the state board examinations m 
Oregon, Minnesota and Wisconsin. Ultimately, I intend to practice 
primary care optometry in the great state of Minnesota. 
STEVEN J. KOPP 
I completed my undergraduate studies at Idaho State 
University in 1987. I recieved a B.S. degree in zoology and one m 
biology. I am currently attending Pacific University and upon 
recieving my degree in optometry, I plan to take state board exams 
in Idaho, Montana, Washington, and Utah. Eventually, I plan to 
practice as a primary eye care practicner in a group setting. 
ACKNOWLEDGEMENT 
We wish to thank Judith E. DuChateau of the American 
Optometric Association and those state board associations for 
providing us with the data necessary to complete this paper. The 
material in this paper was believed to be correct at the time of 
writing, but it should be noted that therapeutic laws and their scope 
are dynamic factors and subject to change. 
INTRODUCTION 
Recently, there has been a concerted effort towards enacting 
legislation to allow optometrists to utilize therapeutic pharmaceutical 
agents (TPA). Many optometrists would like to diagnose and treat 
diseases in their patients. Those states permitting TP A use also 
require that optometrists be certified for their use. Twenty-five 
states now authorize the use of therapeutic agents. Therapeutic bills 
are currently pending in New Jersey, New York, Ohio, Pennsylvania, 
Michigan, and Massachusetts!. Legislation for several of the 
remaining states is presently under consideration or being planned 
for introduction to their respective state legislatures 1. This paper is 
a synopsis of the scope of the TP A use and the certification 
requirements in those states with TP A laws in place. 
METHOD 
A letter was mailed to the optometry boards of those states 
with TP A laws requesting information regarding the scope of their 
laws. The following items were requested: 1) A list of the catagories 
of drugs that can be used to treat ocular diseases/conditions, 2) The 
approved drug formulary (if applicable), 3) The specfic ocular 
diseases/conditions that can be treated, and 4) TP A certification 
requirements for an optometrist in that state (i.e. examinations, 
coursework, etc.). We also contacted the American Optometric 
Association for any pertinent information. Follow-up telephone calls 
were made to those states not initially responding to the letter. We 
also contacted some states for further information or clarification of 
their laws. 
RESULTS 
Twenty-three of the twenty-five states responded to our letter 
with follow-up phone calls made to those states which did not 
initially respond. The primary therapeutic agents available to 
optometrists are topical. The most widely allowed topical agents are 
the anti-microbials (all twenty-five states), anti-histamines (all 
twenty-five states), and corticosteriods (twenty-one states). The use 
of topical anti-glaucoma medications are the most restricted. 
Currently, only ten states allow the use of anti-glaucoma topical 
agents (Arkansas, Idaho, Iowa, Kentucky, New Mexico, North 
Carolina, Oklahoma, Washington, West Virginia, Wyoming). 
Orally administered TPA's are generally not available to 
optometrists in most of the therapeutic states. However, optometrist 
can administered drugs orally in eight states: Colorado, Florida, Iowa, 
Missouri, Montana, North Carolina, North Dakota, Wyoming. The oral 
agents most available to optometrists in these states are anti-
microbials, anti-histamines, and analgesics. The most restricted orals 
are the anti-glaucomas and corticosteriods. 
The parenteral/injectible application of drugs is the most 
restricted for optometry. Only North Carolina and Tennessee are 
allowed to use parenterals. In North Carolina the optometrist must 
first consult with a physician before administering the agent. In 
Tennessee the only available injectibles are Benadryl or epinephrine 
to counteract anaphylactic reactions. 
As table 1 illustrates, there are various provisions and 
conditions for use of certain TPA's. The most restrictive aspect of 
TP A use by optometrists is the method of application. Although 
specific drugs can be used topically, the same class of drugs can not 
be used through oral or parenteral administration in most states. 
However, the scope and extent of the TPA laws is subject to 
modification at any time. 
Most therapeutic states require clinical training, education or a 
combination thereof to certify optometrists for TP A use. A number 
of states require an examination i.e., state administered, Treatment 
and Management of Ocular Disease (TMOD) etc., for TPA certification 
or a combination of coursework, trammg and examination. Only five 
state laws did not specify any cerification requirements in their 
statutes (Indiana, North Carolina, Oklahoma, Rhode Island, West 
Virginia) but the state board has the authority and responsibility to 
promulgate such rules. 
TABLE 1 
TPA LAW PROVISIONS 
MARCH 1991 
TOPICALS AR CD FL GA ID IN IA KS KY ME MO MT NE NM NC ND CK RI SD TN VA WA wv WI WY 
Anti-glaucoma *(1) NP NP NP (4~ p NP p NP NP NP NP (1) p NP p NP NP NP NP p p NS p 
Anti-histamine p p p p p p p p p p p p p p p p p p p p p p NS p 
Corticosteriods p p NP p p p (5) p p p NP p p p p p (8) (9) (10) NP p p NS p 
Anti-infectives 
Anti- biotic s p p p p p p p p p p p p p p p p p p p p p p NS p 
Anti-fungal p p NP p NP p p p p p p p p p p p p p p NP p p NS p 
Anti-microbial p p p p p p p p p p p p p p p p p p p p p p NS p 
Anti-virals NP p NP p NP p p p p p p p p p p p p p p NP p p NS p 
ORALS 
Anti-microbial NP (2) NP NP NP p NP NP NP p NP NP NP (1) p NP NP NP NP NP NP NP NS p 
Anti-histamine NP p NP NP NP p NP NP NP p NP NP NP (1) p NP NP NP NP NP NP NP NS NP 
Anti - glaucoma NP NP NP NP NP p NP NP NP NP NP NP NP (1) NP NP NP NP NP NP NP NP NS NP 
Corticosteriods NP NP NP NP NP NP NP NP NP NP NP NP NP (1) NP NP NP NP NP NP NP NP NS NP 
Analgesics NP p (3) NP NP p NP NP NP (6) (7) NP NP (1) p NP NP NP NP NP NP NP NS NP 
PARENTERAL 
lnjectibles NP NP NP NP NP NP NP NP NP NP NP NP NP (1) NP NP NP NP (11) NP NP NP NS NP 
COMMENTS** 
(A) (B) (C) (D) (E) (F) 
_{GJ (H) (I) (J) (K) 
* See footnotes 
** See Appendix A 
KEY 
P=Permitted NP=Not permitted NS=Not specified 
FOOTNOTES 
( 1) With physician consultation. 
(2) Except oral anti-viral and anti-fungal agents. 
(3) Non-controlled oral analgesics for forty-eight hours; requires 
physician's consultation if for longer period. 
( 4) Beta blockers are not authorized for use except in consultation 
with a physician 
(5) After 2 days of controlled substance use without improvement, 
must consult physician. 
( 6) Limited to fourteen day supply administered topically. 
(7) Codeine, propoxyphene, hydrocodone, dihydrocodeine, alone of 
in combination with non-scheduled or non-regulated drugs. 
( 8) After fourteen days of prescribed topical steriod use, must 
consult physician. 
(9) After seven days of prescribed topical steriod use, must consult 
physician. 
(1 0) Use/prescription limited to seven calendar days from onset of 
treatment. 
( 11) Benadryl or epinephrine may be used to counteract 
anaphylactic reaction. 
APPENDIX A 
(A) Drug formulary established by " Optometric Therapeutic 
Committee." 
(B) A "formulary shall consist of those topical ocular 
pharmaceutical agents which the certified optometrist is qualified 
pursuant to this section to use"; the formulary is currently under 
legal challenge. 
(C) "The Board shall establish by rule a list, which may be modified 
from time to time, of topically applied pharmaceutical agents which 
optometrist shall be allowed to use for treatment purposes." 
(D) Specific "topically applied therapeutic pharmaceutical 
ophthalmic agents" to be "jointly agreed upon by the Board of 
Optometry and either the Board of Medicine or the Board of 
Pharmacy." 
(E) General legislation, favorable attorney general's optmon. 
Legislation which would have prohibited pharmaceutical utilization 
defeated. Appeal from dismissal of litigation which have prohibited 
pharmaceutical utilization denied by state supreme court, February 
27, 1986. 
(F) Only the topical pharmaceutical agents described by the state 
board can be administered, dispensed, or prescribed by certified 
optometrist. 
(G) "In using or prescribing pharmaceutical agents, other than 
topical pharmaceutical agents within the definition herein above set 
out which are used for the purpose of examining the eye, the 
optometrist so using or prescribing shall communicate and 
collaborate with a physican." 
(H) A technical advisory panel "shall recommend..... specific 
conditions, medication, training and testing requirements with 
respect to those ocular conditions that duly qualified and licensed 
optometrists of this state may use." 
(I) Optometrists certified by the Board are approved for 
"treatment (other than by surgery) of patients with infections, 
inflammations, and abrasions of the eye or eyelid with topically 
applied drops, ointments or creams." 
(J) An optometrist may treat certain diseases or abnormal 
conditions of the human eye and its adnexa with certain therapeutic 
pharmaceutical agents if he has successfully completed the 
requirements for certification established by the Board of Medicine. 
These requirements are in the process of being promulgated. 
(K) An optometrist may treat diseases or abnormal conditions of 
the human eye and its adnexa with therapeutic pharmaceutical 
agents and remove superfical foreign bodies if the optometrist has 
successfully completed the education and examination requirements 
for certification and is certified by the Optometry Examining Board. 
The pharmaceutical agents will subsequently be determined by 
administrative rulemaking. 
TABLE 2 
TPA CERTIFICATION REQUIREMENTS 
I MARCH 1991 
STATE CLINICAL TRAINING COURSE REQUIREMENT OTHER REQUIREMENTS EXAMINATION 
ARKANSAS 100 hrs. by a certified State board approved 
ophthalmologist. 
CIX.ORADO 60 hrs. by attendance. 60 hrs. for therapeutics. By state board. 
FLORJDA lyr. internship. 110 hrs. combined State board approved 
clinical/courses. 
GEORGIA Board approved programs. State board 11I']Jroved. 
IDAHO Board approved programs. *IAB(J'MOD. 
INDIANA None specified. IAB(J'MOD. 
IOWA 60 hrs . supervised training. 40 hrs. of didactic training . 44 hrs. of additional ed. prior to IAB{fMOD. 
use of topical/oral agents. 
KANSAS Minuim of 100 hrs. of By state board. 
didactic/clinical training. 
KENTUCKY Minuim of 6 semester Hrs. 
MAINE 25 hrs. supervised training 75 hrs. of ocular therapeutics. IAB{fMOD. 
MISSOURI Minium of 100 hrs. supervised Unspecified hrs. (course includes State board approved. 
training. clinical) 
MONTANA Completion of courses at an lAB/state board approved. 
accredited institution. 
NEBRASKA 100 hrs. of classroom /clinical IAB!fMOD. 
training. 
NEW MEXICO Minium of 105 hrs. classroom By state board. 
/clinical 
NORTH CAROLINA None specified IAB{fMOD 
NORTH DAKOTA 24 hrs. of clinical application 76 hrs. of didactic instruction IAB{fMOD 
OKLAHOMA None specified lAB/state board approved. 
RHODE ISLAND Authority delegated to panel of 2 IAB{fMOD 
OD's, 2 MD's, and 1 
I pharmacologist. 
SOUTH DAKOTA Minium of 40 hrs. of experience 150 hrs. of instruction IAB{fMOD 
TENNESSEE Minium of 40 hrs. of experience 1 SO hrs. of instruction By state therapeutic 
certification panel. 
VIRGINIA Board of Medicine approved By Board of Medicine. 
!programs. 
WASHINGTON Minium of 75 Hrs. of IAB{fMOD 
didactic/clinical instruction. 
WEST VIRGINIA None specificed. IAB{fMOD 
WISCONSIN 100 hrs. At an accredited 
institution . 
WYOMING Board approved course. IAB!fMOD 
--
*International Association of Boards/Treatment and Management of Ocular D1sease 
DISCUSSION 
The advent of therapeutic use by optometrists represents a 
huge step forward in expanding the scope of primary care 
optometry. Some state boards, in conjunction with medical or state 
pharmacy boards, determine the TP A's that can be utilized. These 
states have designed their laws to allow flexibility in response to any 
advances in the clinical or educational training of optometrists m 
disease management. However, most laws limit the use of 
therapeutic drugs by optometrists by either the method of 
application or category of drug. Only when optometrists have no 
restrictions and can use medications commensurate with their 
education and experience can primary care optometry truly succeed. 
In conclusion, this report has attempted to provide a simple 
and concise reference guide for optometrists, optometric institutions, 
and state legislative bodies specifying the scope of current TPA 
legislation in those states permitting their use by optometrists. 
REFERENCES 
1. News Review. Review of Optometry 1991: Vol. 1:7 
2. DuChateau, J. Specific Provisions of State TPA Laws. American 
Optometric Association 1989. pg 2-3. 
3. Arkansas State Board of Examiners. 1990. 
4. Colorado State Board of Examiners in Optometry. 1991. 
5. Floridaa State Board of Optometry. 1991. 
6. Georgia State Board of Examiners in Optometry. 1990. 
7. Idaho State Optometry Board. 1991. 
8. Indiana Optometry Board. 1990. 
9. Iowa Board of Optometry Examiners. 1990. 
10. Kansas Board of Optometry Examiners. 1990. 
11. Kentucky Board of Optometric Examiners. 1991. 
12. Maine Board of Registration and Examiners in Optometry. 1990. 
13. Missouri State Board of Optometry. 1990. 
14. State of Montana, Board of Optometrists. 1990. 
15. Nebraska Board of Examiners in Optometry. 1990. 
16. New Mexico Board of Examiners in Optometry. 1991. 
17. Norht Carolina State Board of Examiners in Optometry. 1990. 
18. North Dakota State Board of Optometry. 1990. 
19. Oklahoma State Board of Examiners in Optometry. 1990. 
20. Rhode Island State Board of Optometry. 1991. 
21. South Dakota Board of Optometry. 1990. 
22. Tennessee State Board of Optometry. 1990. 
23. Virginia Board of Optometry. 1991. 
24. Washington State Optometry Board. 1990. 
25. West Virginia Board of Optometry. 1990. 
26. Wisconsin Optometry Examining Board. 1990. 
27. Wyoming State Board of Optometric Examiners. 1990. 


A compilation of the laws currently regulating TPA use by optometrists

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A compilation of the laws currently regulating TPA use by optometrists

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