Maryland Health Occupations Section 11-404.2

      (a)      In this section, "refer" means that a therapeutically certified optometrist:

            (1)      Informs the patient that the patient should see an ophthalmologist and give the ophthalmologist an opportunity to physically examine the patient; and

            (2)      Refrains from rendering further treatment for the specific condition that is the basis for the referral until the patient has been physically examined by an ophthalmologist.

      (b)      (1)      A therapeutically certified optometrist may administer and prescribe topical therapeutic pharmaceutical agents limited to:

                  (i)      Ocular antihistamines, decongestants, and combinations thereof;

                  (ii)      Ocular antiallergy pharmaceutical agents;

                  (iii)      Ocular antibiotics and combinations of ocular antibiotics, excluding specially formulated or fortified antibiotics;

                  (iv)      Anti-inflammatory agents;

                  (v)      Ocular lubricants and artificial tears;

                  (vi)      Tropicamide;

                  (vii)      Homatropine;

                  (viii)      Nonprescription drugs that are commercially available; and

                  (ix)      Primary open-angle glaucoma medications, in accordance with subsection (c) of this section.

            (2)      Except as provided in paragraph (4) of this subsection, if a therapeutically certified optometrist administers or prescribes a topical therapeutic pharmaceutical agent listed in paragraph (1)(i) through (vii) of this subsection, and the patient does not have the expected response within 72 hours:

                  (i)      The therapeutically certified optometrist shall consult with an ophthalmologist; and

                  (ii)      The ophthalmologist may determine that the ophthalmologist needs to physically examine the patient.

            (3)      Except as provided in paragraph (4) of this subsection, if a therapeutically certified optometrist administers or prescribes a topical therapeutic pharmaceutical agent under paragraph (2) of this subsection, the therapeutically certified optometrist shall communicate with the patient to determine the response of the patient to the therapeutic pharmaceutical agent as soon as practicable after 72 hours of the time the agent was administered or prescribed.

            (4)      A therapeutically certified optometrist may administer or prescribe topical steroids in accordance with a practice protocol established by the Board.

            (5)      A therapeutically certified optometrist may not administer or prescribe:

                  (i)      Antiviral agents;

                  (ii)      Antifungal agents;

                  (iii)      Antimetabolite agents; or

                  (iv)      Antiparasitic agents.

            (6)      A therapeutically certified optometrist may dispense a topical therapeutic pharmaceutical agent listed in paragraph (1) of this subsection only if:

                  (i)      No charge is imposed for the therapeutic pharmaceutical agent or for dispensing the agent; and

                  (ii)      The amount dispensed does not exceed a 72-hour supply, except that if the minimum available quantity for dispensing is greater than a 72-hour supply, the minimum available quantity may be dispensed.

      (c)      (1)      A therapeutically certified optometrist may administer and prescribe topical therapeutic pharmaceutical agents for glaucoma only:

                  (i)      For patients with primary open-angle glaucoma;

                  (ii)      After the optometrist refers the patient to an ophthalmologist; and

                  (iii)      After the ophthalmologist and optometrist jointly and promptly develop a written individualized treatment plan that is signed by the ophthalmologist and optometrist and includes:

                        1.      All tests and examinations that led to the diagnosis;

                        2.      An initial schedule of all tests and examinations necessary to treat the patient's condition;

                        3.      A medication plan;

                        4.      A target intraocular pressure; and

                        5.      Criteria for surgical intervention by the ophthalmologist.

            (2)      (i)      A treatment plan developed under this subsection may be modified only after both the optometrist and the ophthalmologist consult together and consent to the modification.

                  (ii)      Each modification shall be noted in the optometric record of the patient.

            (3)      A therapeutically certified optometrist who treats a patient with primary open-angle glaucoma in accordance with this section:

                  (i)      Shall refer the patient to an ophthalmologist at least once a year after the initial mandatory referral under paragraph (1) of this subsection;

                  (ii)      May continue to render treatment under the joint treatment plan until the patient is examined by an ophthalmologist;

                  (iii)      Shall consult with an ophthalmologist if:

                        1.      The patient does not have the expected response to treatment;

                        2.      The target intraocular pressure is not reached; or

                        3.      There is worsening in a patient's visual field or optic nerve head; and

                  (iv)      May perform and evaluate visual field tests, nerve fiber layer photos, and optic disc photos. The tests or photos shall be provided to an ophthalmologist for review by the ophthalmologist.

      (d)      (1)      Except as provided in paragraphs (2) and (3) of this subsection, a therapeutically certified optometrist may not administer or prescribe any oral pharmaceutical agent for any purpose.

            (2)      (i)      A therapeutically certified optometrist may administer and prescribe oral tetracycline and its derivatives only for the diagnosis and treatment of meibomitis and seborrheic blepharitis.

                  (ii)      If a therapeutically certified optometrist administers or prescribes oral tetracycline or its derivatives to a patient in accordance with subparagraph (i) of this paragraph and the patient does not improve within 3 weeks of treatment, the optometrist shall refer the patient to an ophthalmologist.

            (3)      A therapeutically certified optometrist may administer or prescribe nonprescription drugs that are commercially available.

      (e)      (1)      Except as provided in paragraph (2) of this subsection, a therapeutically certified optometrist may not perform any procedure on the eyelid of a patient.

            (2)      A therapeutically certified optometrist may epilate with forceps an eyelash from the eyelid, adnexa, or lacrimal system of a patient.

      (f)      A therapeutically certified optometrist may remove superficial foreign bodies from the human eye only if:

            (1)      The foreign body may be removed with a cotton-tipped applicator or blunt spatula; and

            (2)      The foreign body has not penetrated beyond the bowman's membrane of the cornea and is not within 2.5 millimeters of the visual axis.

      (g)      (1)      Except as provided in paragraph (2) of this subsection, a therapeutically certified optometrist may not order laboratory tests for a patient.

            (2)      A therapeutically certified optometrist may order a conjunctival culture.

      (h)      A therapeutically certified optometrist may not provide any therapeutic treatment listed in this section for a child under the age of 1 year.

      (i)      Unless the standard of care requires an earlier referral, if a therapeutically certified optometrist diagnoses a corneal ulcer or infiltrate, and the patient does not have the expected response within 48 hours, the optometrist immediately shall refer the patient to an ophthalmologist.

      (j)      A therapeutically certified optometrist shall be held to the same standard of care as an ophthalmologist who is licensed under Title 14 of this article and who is providing similar services.