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CHAPTER 327
OPTOMETRY
Examinations and Licenses
Section 327:6-c
327:6-c Treatment of Glaucoma. –
I. (a) Optometrists seeking authorization to treat glaucoma shall
complete at least 40 hours of classroom education, approved by the
board, incorporating: epidemiology of the glaucomas; genetics of the
glaucomas; anatomy, physiology, and mechanics of aqueous inflow and
aqueous outflow; optic nerve anatomy and pathophysiology; neurotoxicity
and neuroprotectants; receptor biology; pharmacology, clinical use and
toxic effects of alpha and beta adrenergic agents, carbonic anhydrase
inhibitors, prostanoids and cholinergic agents.
(b) Optometrists shall pass an examination approved by the board
that covers the educational components listed in subparagraph (a). Upon
passage of such exam, an optometrist shall have prescriptive authority
during the clinical management period pursuant to RSA 327:6-a.
(c) The board shall waive the requirements of this paragraph and
of paragraph II for optometrists who have either graduated after 2002 or
who have proof of 12 months of credentialed privileges to treat glaucoma
by the United States Department of Defense or Department of Veteran
Affairs or the national Indian Health Service, verified by the board.
II. (a) To be authorized to initiate treatment of glaucoma for
patients 18 years of age or older, a therapeutic pharmaceutical agent
certified optometrist shall complete the educational requirements in
paragraph I and provide evidence of written referrals and consultations
with an ophthalmologist. For purposes of this section, ""glaucoma''
means primary open-angle glaucoma; and ""ophthalmologist''; means a
physician licensed under RSA 329 with a specialty in ophthalmology. The
joint pharmaceutical formulary and credentialing committee shall review
evidence of glaucoma co-management submitted pursuant to subparagraph
(b).
(b) Except as provided in subparagraph I(c) or paragraph III,
therapeutic pharmaceutical agent certified optometrists are required to
provide evidence of successful collaborative treatment and co-management
of 25 glaucoma patients, up to 5 of which may be established patients,
during a period of not less than 18 months for each patient, to
ophthalmologists according to the following criteria:
(1) A new or existing glaucoma patient is examined and
diagnosed by the optometrist;
(2) The optometrist develops a proposed treatment plan and
forwards the plan with examination documentation to an ophthalmologist
for consultation;
(3) The ophthalmologist examines the patient and reviews the
optometrist's examination documentation and proposed treatment plan;
(4) The ophthalmologist, optometrist, and patient mutually
agree to and document a treatment plan;
(5) The optometrist shall consult with the co-managing
ophthalmologist when any of the following occurs: the patient's target
pressure is not reached within 90 days; the patient is experiencing
documented progression of optic nerve damage; the patient develops
documented and repeated progression of visual field loss; or the patient
develops angle-closure or other secondary glaucoma; and
(6) For each successfully co-managed glaucoma patient the
optometrist and co-managing ophthalmologist shall complete a glaucoma
credentialing reporting form and submit the form to the joint
pharmaceutical formulary and credentialing committee upon completion of
the 18 months of treatment.
III. The joint pharmaceutical formulary and credentialing committee
may waive or reduce the requirements of RSA 327:6-c, I and II for the
following categories of optometrists:
(a) Optometrists with a license and proof of practice for 12
months treating glaucoma patients in another state that currently
authorizes the treatment of glaucoma by optometrists; or
(b) Optometrists who have proof of successful completion of a
12-month accredited optometric residency program or its equivalent.
IV. Upon certification to treat glaucoma patients:
(a) For a period of 24 months, optometrists shall consult with an
ophthalmologist within 30 days for each new glaucoma patient for
confirmation of diagnosis and review of treatment plan.
(b) An optometrist shall consult with an ophthalmologist within
30 days when any of the following occurs:
(1) The patient is experiencing documented progression of
optic nerve damage or the patient develops documented and repeated
progression of visual field loss on maximum tolerated medical therapy;
or
(2) The patient develops angle-closure or other secondary
glaucoma.
Source.
2002, 274:3, eff. July 17, 2002. 2006, 182:4, eff. July 24, 2006.
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