ADOPTED BOARD RULES
Adopted Board rules or summaries will appear at the conclusion of this newsletter; however, several of the rules require comment because they affect your practice of optometry and address the new Texas Contact Lens Prescription Act. These should be made a part of your permanent records.
CONTACT LENS PRESCRIPTION
Rule 279.1 has been amended to clarify what must be on a fully-written contact lens prescription. Note that new requirements are brand name, number of lenses, prescription date as well as expiration date, recommended lens replacement and substitution language.
CHAPTER 279. INTERPRETATIONS
Rule 279.1 Board Interpretation Number One
A fully written contact lens prescription as referred to in the Texas Optometry Act, Section 1.02(3)(a), concerning the dispensing of contact lenses by ophthalmic dispensers must include the following:
(A) base curve, unless set by manufacturer
(C) diameter, unless set by manufacturer
(D) optical zone, unless set by manufacturer
(E) peripheral curve, unless set by manufacturer
(A) base curve, unless set by manufacturer
CONTACT LENS EXAM AND FITTING FEE
In order to clarify the charging for contact lenses used in the fitting of contact lenses, the Board has adopted the following Rule 279.16:
CHAPTER 279. INTERPRETATIONS
Rule 279.16. Board Interpretation Number Sixteen
Section 3(a) of the Texas Contact Lens Prescription Act (Act), Article 4552-A, Texas Civil Statutes, prohibits an optometrist or therapeutic optometrist from charging the patient a fee in addition to the examination fee and the fitting fee as a condition for giving a contact lens prescription to the patient. The Board does not interpret the Act to prohibit charges in the fitting fee for lenses used to determine a final contact lens prescription.
TX CONTACT LENS PRESCRIPTION ACT
The following are several points of clarification in regard to the Texas Contact Lens
Prescription Act. The Board has received calls that optometrists’ office staff have been stating that the contact lens prescription cannot be written for more than one year. The Act does not prohibit an optometrist from extending an expiration date nor writing a contact lens prescription for more than one year; it would be a professional judgment call on the part of the examining doctor.
Some optometrists are refusing to issue the two-month extension when a prescription is requested. The Act requires that the optometrist authorize at least once a two-month extension of the patient’s contact lens prescription. This can be done under the emergency refill provision, which will allow the telephoning or faxing of the prescription. All prescriptions must be fully-written with the original being issued and cannot be telephoned or faxed (including spectacle prescriptions).
Opticians are required to obtain a permit for contact lens dispensing. If patients wish to know if a certain optician or optical store has a permit to sell or dispense contact lenses, they may contact the Texas Department of Health, Optician’s Registry, 1100 West 49th Street, Austin, TX 78756-3183, telephone 512-834-6661. Violations of dispensing without a permit may also be reported to that agency.
It is important that physicians, optometrists and therapeutic optometrists understand that the intent of the Texas Contact Lens Prescription Act is for the patient to obtain a prescription for contact lenses.
ASSISTANTS TO OPTOMETRISTS
Rule 279.5 was amended to establish those Basic Competence steps (Section 5.12 of the Act) which an optometrist must perform and record, allowing assistants to perform other steps when in the same office as the optometrist. The rule holds the optometrist professionally responsible for proper examination and recording of each finding of Basic Competence.
CHAPTER 279. INTERPRETATIONS
279.5 Board Interpretation Number Five
(a) The optometrist or therapeutic optometrist shall, in the initial examination of the patient for whom ophthalmic lenses are prescribed, personally make and record, if possible, the following findings of the conditions of the patient:
(1) biomicroscopy examination (lids, cornea, sclera, etc.), using a binocular microscope;
(2) internal ophthalmoscopic examination (media, fundus, etc.), using an ophthalmoscope or biomicroscope with fundus condensing lenses; videos and photographs may be used only for documentation and consultation purposes but do not fulfill the internal ophthalmoscopic examination requirement; and
(3) subjective findings, far point and near point;
(b) When it is not possible to make and record the findings in subsection (a) of this section, the optometrist or therapeutic optometrist shall notate in the patient's record the reasons the findings are not possible.
(c) An assistant present in the same office with the optometrist or therapeutic optometrist may make and record other findings required by section 5.12 of the Act, except those required by subsection (a) of this section. When it is not possible to make and record the findings in subsection (a) of this section, the optometrist or therapeutic optometrist shall notate in the patient's record the reasons the findings are not possible. The authorization for assistants to make and record certain Section 5.12 findings does not relieve the optometrist or therapeutic optometrist of professional responsibility for the proper examination and recording of each finding required by Section 5.12 of the Act.
(d) The willful or repeated failure or refusal of an optometrist or therapeutic optometrist to comply with any of the requirements in the Act, Section 5.12(a) and (b), shall be considered by the board to constitute prima facie evidence that the licensee is unfit or incompetent by reason of negligence within the meaning of the Act, Section 4.04(a)(3), and shall be sufficient ground for the filing of charges to cancel, revoke, or suspend the license. The charges shall state the specific instances in which it is alleged that the rule was not complied with. After the board has produced evidence of the omission of a finding required by Section 5.12, the burden shifts to the licensee to establish that the making and recording of the findings was not possible.
BASIC COMPETENCE EXAMS
As you will note from the above, the Board has adopted a rule which will clarify the instrumentation to be used on biomicroscopy and ophthalmoscopy examinations. This rule amendment affected Rules 277.1, 279.5 and 279.7. In summary, the rule requires the following:
Rule 273.8 has been amended to allow for an additional late penalty fee when optometrists fail to timely meet the mandatory continuing education and must obtain the education following the renewal period. In addition to the penalty fee of $150 (amount of the exam fee), a late renewal penalty fee of $75.00 (one-half of exam fee) will also be assessed. In summary, in addition to the renewal fee, two penalty fees totaling $225 will be assessed. All continuing education must be obtained in a calendar year preceding the year of renewal. Sixteen hours of education are required, with six being in diagnostic/therapeutic education. You are reminded that if you practice in Texas, you should submit the original proof of attendance to the Board Office, not a copy. Copies will be returned to you. The amended rule reads:
CHAPTER 273. GENERAL RULES
273.8 Renewal of License
(a) (No Change.)
(b) Mandatory Continuing Education for Renewal of License.
(1) - (3) (No Change.)
(4) The licensee must pay to the board the license renewal fee with a late penalty fee authorized by Section 4.01 of the Act plus a penalty authorized by Section 4.01B in an amount equal to the amount of the license renewal fee.
(5) - (6) (No Change.)
License renewals will be mailed the last week of October. We will indicate the number of continuing education hours recorded for you on the form.
Enclosed is a new consumer information sign or "complaint sign" which you must display in your office. The sign is printed in both English and Spanish. For those of you who display the consumer pamphlet in lieu of the sign, we are enclosing a slick for purposes of reprinting the pamphlet, along with a printed version. The pamphlet is also available in Spanish, upon request. The sign must be posted in a conspicuous and prominent location.
DATABASE ON OPTOMETRY VIOLATIONS
The Health Integrity and Protection Act Database has been established by the Department of Health and Human Services. Under that Act, the Board will be required to report disciplinary actions, along with information from the agency’s master files, including social security numbers. The final rules have not yet been published in the Federal Register, but we will keep you posted from time to time.
The Investigation-Enforcement Committee recently reviewed a complaint regarding the practice of optometry within a school system. After review, it was determined that it would not be a violation of the Texas Optometry Act for an optometrist to go into the schools and perform COMPLETE examinations as required by Section 5.12 of the Act, provided that proper authorization is obtained from the parents or guardians of each student. This is not to be confused with vision screening.
BOARD RULES UPDATE
Chapter 1. Examinations:
271.1- Summary - amended to add housekeeping language to properly cite the Administrative Procedure Act.
271.2 through 271.6 - Summary - establishes the procedures for applicants to follow in seeking licensure in Texas. It requires the National Board Examination, Parts I, II, III and TMOD, as well as the Jurisprudence examination.
Chapter 273. General Rules:
273.1- Summary - amended to add housekeeping change to grammatically correct a sentence.
273.4 - Summary - amended to clarify the fees to be charged for therapeutic certification (one fee of $80.00 rather than two separate fees of $55 and $25.)
273.5 - Summary - amended to clarify the duty of the deans of educational institutions in regard to limited license candidates.
requirements are required for provisional licensure prior to Board licensure.
correct a word left out of the official printing of the rule.
addition to a penalty fee for obtaining continuing education after the license renewal date, a late penalty fee will also be addressed. See article in this newsletter for full wording.
Chapter 271. Practice and Procedures
277.1 -Summary - amended by adding language to clarify the use of instruments in the biomicroscopy and internal ophthalmoscopy examinations under Section 5.12. See article in this newsletter for specific language.
277.2 - Summary - amended to clarify that the Board’s legal counsel may attend informal conferences in lieu of assistant attorney general.
Chapter 279. Interpretations
279.1 - Summary - fully written contact lens text is printed in full within this newsletter.
279.3 - amended to clarify duplicataion of spectacle lenses; text follows:
The Texas Optometry Act, Section 5.07, relates to prescribing without examination. It is the interpretation of this board that nothing in this section would prohibit a licensed optometrist from:
279.5 - See article in this newsletter for full text regarding assistants in optometric offices.
279.7 -amended as follows:
(a) In order to insure an adequate examination of a patient for whom an optometrist or therapeutic optometrist prescribes contact lenses, in the initial examination of the patient, the optometrist or therapeutic optometrist shall make and record, if possible, the following findings of the condition of the patient:
279.14 - clarifies the telephoning or faxing of a contact lens prescription in an emergency situation. Full text follows:
(a) (No Change.)
(b) A prescription for spectacles, contact lenses, or ophthalmic devices is defined as a written order signed by the examining optometrist, therapeutic optometrist or physician. A prescription for medications may be verbal or written. A facsimile (FAX) prescription is not considered a valid prescription. Under the Texas Contact Lens Prescription Act, if the optometrist or therapeutic optometrist determines the patient needs an emergency refill of the contact lens prescription, the prescription may be telephoned or faxed to a person authorized to fill the prescription.
(c) (No Change.)
279.15 - Summary - amends the rule for a housekeeping change to correct words within contagious or infectious diseases; no substance change to the listing of diseases.
279.16 - Summary - the text of the rule is printed in full in an article in this newsletter.
Chapter 280. Therapeutic Optometry
280.1 - text of the rule follows:
(a) - (b) (No Change.)
(c) An application for certification must be completed by the applicant, signed and notarized, and forwarded to the board along with an application fee of $80. Proof of the required education, as set forth in section 280.2 of this title (relating to Required Education) must accompany the application form.
(d) Successful examination results of the Treatment and Management of Ocular Disease (TMOD) Examination must be submitted prior to the issuance of the certificate to practice as a therapeutic optometrist. The certificate must be displayed along with the initial license in a conspicuous place in the principal office where the optometrist practices.
(e) - (g) (No Change.)
280.2 - Summary - changes the name of the committee to Continuing Education Committee.
280.4 - Summary - repealed because the technical advisory committee was abolished through general legislation.
The Board is in the process of reviewing all rules and will from time-to-time update you on those rules. Because many of these were minor changes, we elected to not print the full text in most instances. If you wish a copy of any of the rules, please let us know and a copy will be furnished to you.
BOARD WEB PAGE
The Board has a home page on the Internet at http://www.tob.state.tx.us