Article Date: 11/1/2008

California Scope of Practice Bill Becomes Law

California Scope of Practice Bill Becomes Law


■ The "California Access to Vision Bill," (SB 1406), which takes effect January 1, 2009, expands the scope of practice for California optometrists by both eliminating most current restrictions on glaucoma treatment certification and broadening previous legislation regarding the use of therapeutic pharmaceutical agents (TPA), ophthalmic procedures and other provisions, such as continuing care.

"Current law prevents us from providing the best care to our patients, and it's cost prohibitive for our patients, too, because it requires them to see both an optometrist and ophthalmologist for several appointments," says David Redman, O.D., president of the California Optometric Association (COA) and one of the chief negotiators of the bill. "In most routine cases, that's simply not necessary."

The bulk of SB 1406 concerns glaucoma treatment certification. To start, it will provide automatic certification to O.D.s who graduate from an accredited optometry school on or after May 1, 2008.

The current certification law (California Business & Professions Code Section 3041 [f]) requires O.D.s who graduated before January 1, 2000 to complete 24 hours of didactic instruction offered by an accredited optometry school and to comanage 50 newly diagnosed glaucoma patients with the same ophthalmologist within two years. Those who graduated after this date are deemed to have satisfied the didactic requirement but must meet the patient comanagement requirements. (As we go to press, only 162 California O.D.s out of 6,000 in active practice have obtained glaucoma certification, according to the COA.)

Under the new bill, currently certified O.D.s will be able to carry over their certifications. In addition, those halfway through existing requirements by January 1, 2009 can choose to finish them by December 31, 2009, and those who've already taken the didactic course just have to complete the case management requirements, once the State Board of Optometry has established them (see below). Those and all other practitioners can obtain certification via the State Board once a Board-appointed Glaucoma Diagnosis and Treatment Advisory Committee (comprised of three O.D.s and three M.D.s) makes its curricular recommendations to the Office of Examination Resources in the California Department of Consumer Affairs. The Office will issue final findings that the State Board must adapt into its final certification regulations. By law, this process must be completed by January 1, 2010.

SB 1406 also expands glaucoma care, as O.D.s will be able to treat primary open angle glaucoma (POAG), exfoliation and pigmentary glaucoma in patients older than age 18, and in an emergency, use oral drugs to stabilize an acute angle closure attack. Under the current law, O.D.s are only permitted to treat POAG patients older than age 18.

Finally, the bill will free O.D.s from the shackles of mandatory collaborations with M.D.s for glaucoma treatment plans and referrals.

For information concerning TPA, ophthalmic procedures and other provisions, visit


Vision Council Report Offers Compelling Statistics

Vision Care: Focusing on The Workplace Benefit, a new report issued by The Vision Council, reveals:
■ A total of two-thirds of Americans say they would be more willing to obtain an eye exam if they had some coverage, yet only 17% of employers report offering vision insurance.
■ Nearly 40% of Americans fear they can't afford adequate treatment for vision-related problems, yet 63% say, if given the opportunity, they'd sign up for vision care coverage even if it required them to pay a small amount each month.
■ Major adult vision disorders cost America more than $35 billion annually, including an estimated $8 billion in lost productivity.
So, does The Vision Council have any plans to use these facts to prompt action by U.S. employers?
"We are planning on conducting outreach to employers and HR [human resources] managers in the coming months to encourage them to offer vision benefits to their employees, says Susan Martonik, spokesperson for The Vision Council. "For now, our focus is on getting this information out to the different media outlets to educate all those involved with vision coverage."

Marco and M&S Technologies have announced the integration of the Marco TRS-5100 refraction system and the M&S Smart System 2020 visual acuity system. With the integration, the refraction system can be controlled by — and displayed on — the TRS control panel. The integrated system allows complete access to other systems, including contrast sensitivity systems, Eyemaginations, LEA symbols, pediatric testing as well as the ability to participate in clinical trials.

Alcon provided nearly $750,000 in product and cash donations to the victims of the recent cyclone in Myanmar and the massive earthquake in China. In addition, Alcon has contributed more than $167 million in donations globally through the past four years.

■ CooperVision's online customer service center,, now accounts for nearly 25% of the company's annual direct revenue. One of the most popular features of the practitioner-only site is the online ordering and fulfillment program, CooperDirect, where contact lenses are shipped directly to patients.

Transitions Optical has broadened its healthcare initiative to reach human resource professionals, brokers, vision plan providers and employees. The initiative's Web site,, explores how comprehensive eye exams provide vision correction and early detection of disease, which can lead to significant cost savings.

• Thyroid disorders may increase the risk of glaucoma, following adjustment for differences in age, gender, race and smoking status, according to an Oct. 16 online version of the British Journal of Ophthalmology.

• The q.i.d. dosing of difluprednate ophthalmic emulsion 0.05% (Durezol, Sirion Therapeutics) is more effective in decreasing cell grades, pain, signs (i.e. posterior synechiae, hypopyon, limbal injection, etc.) and symptoms (i.e. photophobia, blurred vision, etc.) of anterior uveitis than a leading steroid that requires an eight-times-a-day daily dosing regimen, according to the preliminary results of a Sirion Therapeutics' trial on the condition. The company plans on using these results as part of its eventual Food and Drug Administration (FDA) New Drug Application for anterior uveitis.

• Inspire Pharmaceuticals has announced it hopes to begin clinical testing of INS117548 ophthalmic solution — a rho kinase inhibitor designed to decrease intraocular pressure (IOP) in early stage glaucoma or ocular hypertension patients via disrupting the actin cytoskeleton of the trabecular meshwork — by the end of this year.

• Eating oily fish, such as salmon and mackerel, at least once per week vs. less than once per week may decrease the risk of developing neovascular, or "wet" AMD, by half, says a study in August's The American Journal of Clinical Nutrition.

Optometry Assists Hurricane Ike's Victims


■ Optometry's Fund for Disaster Relief (OFDR) is providing assistance to optometrists whose practices and homes were affected by Hurricane Ike.

More than 100 optometrists have applied for grants through OFDR, which is administered by the American Optometric Association (AOA) Foundation. Although several natural disasters have occurred in the past three years, "nothing like the magnitude of Ike has caused such a drain on the Fund's resources," reads an AOA statement.

The AOA Foundation established OFDR after Hurricane Katrina and provided assistance to more than 100 affected optometrists. The Fund provides immediate assistance in the aftermath of natural disasters.

AOA encourages all optometrists, industry and other groups to make a tax-deductible contribution to OFDR at Contact Dr. Catherine Amos, at (205) 982-5000, or Ms. Shannon Torbett, at (314)-983-4138 for more information.

Optometric Management, Issue: November 2008