Section 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.