DAN MORALES 

.ATT”RSEI GENERAL 

Office of ttp JZUmep Qknerat 

&ate of QCexae 

September 23, 1996 

Bruce A. Levy, M.D., J.D. 

Executive Director 

Texas State Board of Medical Examiners 

P.O. Box 149134 

Austin, Texas 78714-9134 

Dear Dr. Levy: 

Opinion No. DM-4 16 

Re: Whether the Texas Optometry Board 

may adopt a rule authorixing a therapeutic 

optometrist to administer cocaine eye drops 

for diagnostic purposes (RQ-877) 

A therapeutic optometrist may, under V.T.C.S. article 4552-1.03(b), administer a 

topical ocular pharmaceutical agent, other than an antiviral or antiglaucoma agent, “for the 

purpose of diagnosing and treating visual defects, abnormal conditions, and diseases of the 

human eye and adnexa.” The Texas Optometry Board (the “board”) must, by rule, specify 

the topical ocular pharmaceutical agents a therapeutic optometrist may use. You ask 

whether the board may adopt a rule authorixing a therapeutic optometrist to administer 

cocaine eye drops for diagnostic purposest 

Because V.T.C.S. article 4552-1.03(b) explicitly authorizes a therapeutic optometrist to administer a topical ocular pharmaceutical agent for certain diagnostic purposes, 

we believe the board may promulgate a rule permitting a therapeutic optometrist to administer cocaine eye drops for those diagnostic purposes. Cocaine eye drops may not, 

however, be an antiviral or antiglaucoma agent; furthermore, they may be used only for 

the purpose of diagnosing problems of the human eye and adnexa. To the extent the proposed rule authorizes a therapeutic optometrist to use cocaine eye drops to diagnose 

problems other than those of the human eye and adnexa, it is htvalid. 

We begin by briefly discussing pertinent portions of the Texas Optometry Act,2 

which provides for the practice of optometry and therapeutic optometry. Lie an optometrist, a therapeutic optometrist may use “objective or subjective means” to aScertain and 

measure “the powers of vision of the human eye,“3 examine and diagnose “visual defects, 

LBcolusethcpm~ruledocsnot~crtothcuscofcocainc eycdmpsforuwmcntpqoscs, 

we do not consider whaler the board may adopt a mlc authorizing a thaapcutic optonutri.9 to use cocaine drop3 for treaunent purposes. 

‘V.T.C.S. al.% 4552-1.02 - 7.02. 

3&e id an. 4552-1.02(2) (ddining “dning and measuring the powers of vision of the human eye”). 
Bruce A. Levy, M.D., J.D. - Page 2 (DM-416) 

abnormal wnditions, and diseases of the human eye and adnexa,” and prescribe or fit corrective lenses to remedy vision defects.4 By contrast, only a therapeutic optometrist may 

adminkr or prescribe a drug, ifthe therapeutic optometrist does so in compliance with 

the acts Specifically, a therapeutic optometrist may administer a topical ocular pharmaceutical agent.6 among other things, aside from an antiviral or antiglaucoma agent, to 

diagnose and treat “vimal defects, abnormal conditions, and diseases of the human eye and 

hexa.- The “adnexa” are the lids and drainage system of the eye.* 

Under article 4552, the board must specify by rule the pharmaceutical agents a 

thempa& optometrist may use in his or her praotice9 In accordance with this directive, 

the board claims, it has amended title 22 of the Texas Administrative Code, section 280.5 

to include among the list of permksible phammceutical agents “cocaine eye drops for diagnostic purposes.“tc You contend that the proposed amendment impermissibly expands 

the scope of practice of therapeutic optometry. As we understand your argument, cocaine 

eye drops may be used only in the diagnosis of Homer’s syndrome.tl A letter you enclosed with your request describes Homer’s syndrome as “an extremely serious systemic 

disease[] aibting neurologic pathways. “12 Homer’s syndrome is not, according to the 

letter, a disease of the eye or adnexa.t3’ 

'Id. ut. 4552~1.03@);sae Anomcy Gamal Opinion DM-152(1992)u 1;rc also V.T.C.S. art 

4552-1.02(3) (ddiaiq “ftniag latxs or prtsms”). 

‘V.T.C.S. art 4552-1.020; arc koraay Genasl Dpintoa DM-152 (1992) at I-2. 

eAtcpkateadarphannam&catageattsadtuga@tedtetkeyetoatdiaexanGagL Attern9y Gemal opiion Jh4-454 (1986) at 1. 

‘V.T.C.S. art. 4552-1.03(b). 

'Id. at. 4552-1.02(S). 

91d. art. 4552-1.03(d). 

“‘See 21 Ta Reg. 1093.94 (1996) (ccdttied at 22 T.A.C. g 280.5) (Tex Opomeay Ed.). 

~~SarLcElcrfromSamV.~Jr.,~TorTerprOp~ApDdltio4~ 

Loio Ewald, Bxecatk Direaer, Texas opomtry Bcatd (NW. 17.1995). 
Bruce A Levy, M.D., J.D. - Page 3 (DM-416) 

Whether Homer’s syndrome is a disease of the eye or adnexa is a question of fact 

that we cannot resolve in the opinion process.t* Jf it is not such a disease, and if cocaine 

eye drops’ sole use as a diagnostic tool is to detect Homer’s syndrome, then a thempeutic 

optometrist may not administer the eye drops. Moreover, because an administrative 

agency inay not adopt a rule that is inconsistent with statute.ts the board may not adopt a 

rule permitting a therapeutic optometrist to use cocaine eye drops. On the other hand, if 

Homer’s syndrome is a disease of the eye or adnexa, or if cocaine eye drops may be used 

to diagnose conditions, other than Homer’s syndrome, of the eye or adnexa, the board’s 

proposed amendment to title 22 of the Texas Administrative Code, section 280.5 is 

proper.16 The board is authorized to determine these fkct-based questions, subject to judicial review. 

We are unaware of any statute mandating a contrary result. The pomession and 

administration of cocaine by health-care professionals is controlled by the Texas Controlled Substances Act.” Under that act, only a practitioner, as the act detines that term, 

may administer a controlled substance, and only in spechkd circumstances.t* While the 

Controlled Substances Act does not define “practitioner” expressly to include a therapeutic optometrist, the definition encompasses any person who is permitted to administer a 

controkd substance in the course of professional practice. In our opinion, V.T.C.S. article 4552-I .03(b) permits a therapeutic optometrist to administer a controlled substance in 

the course of professional practice ifthe drug is not an antkiml or antiglaucoma agent and 

ifthe purpose of the drug is to diagnose problems of the human eye and adnexa. 

We now wig answer your questions explicitly. You 6rst ask whether the Optometry Act authorizes an optometrist to use cocaine, and if so. to what extent. The statute 

does not authorize an optometrist, as distinguished from a therapeutic optometrist, to use 

any drugs. A therapeutic optometrist may. however, use certain topical ocular pharmaceutical agents, and the topical ocular pharmaceutical agents may include cocaine eye 

drops. Cocaine eye drops may not be an antiviral or antiglaucoma agent, and they must be 

administered for the purpose of diagnosing visual defects, abnormal conditions, and dis- 

“See, e.g.. Atmmey Ckrerol Opiniom DM-98 (1992) a~ 3, H-56 (1973) at 3, M-187 (1968) a 3, 

O-2911 (194O)at2. 

“See State Y. Jackson, 376 S.W.2d 341.344-45 (Tcx. 1964). 

‘%caIth&SafetyCn&ch481. TkTcxas czonmlM-MllIIIcomincaIa~- 

ok ll anrk Id. $481.033(l)@). 
BNIX A Levy, M.D., J.D. - Page 4 (DM-416) 

eases of the human eye or adnexa. Furthermore, a therapeutic optometrist may not adminis&r cocaine eye drops unless the board has adopted a rule authorizing a tkrapeutic 

optometrist to use them. 

Second, you ask whe%he-r the board may promulgate a valid rule allowing optometrists to possess and administer cccaine for diagnostic purposes. Again, an optometrist 

may not administer any drugs, and the board may not promulgate a rule au&king an 

optometrist to do so. On the other hand, the board may promulgate a rule authorizing a 

tbempeutic optometrioi to possess and adminkter a topical ocular pharmaceutics agent if 

the pbaxm~~tical agent is not an antiviral or antiglaucoma agent and ifthe phsrmaceutiad agent is used for the purpose of diagnosing visual defkcts, abnormal conditions, and 

dkases of the human eye and adnexa. The board must, of course, comply with V.T.C.S. 

article 4552-2.14 and other applicable statutes in adopting its nde.19 

SUMMARY 

The Texas Optometry Board may adopt a rule Permitting a 

the-rape&c optometrist to administer cocaine eye drops for diagmmtic purposes, but only if the eye drops are not an antiviral or 

antiglauwma agent and ifthe purpose of the eye drops is to diagnose 

visual defects, abnormal conditions, and dkeases of the human eye 

and adnexa. 

DAN MORALES 

Attorney General of Texas 

JORGE VEGA 

Fii As&ant Attorney General 

SARAH J. SHIRLEY 

Chair, Opiion Committee 

Prepred by Kymberly K. Oltrogge 

Ass&ant Attorney General 

‘9.%e Go-f1 Code ch 551 (Open Mecliogs Act); id. ch. 2001, ntbch B (Mminismtivc F’mccdurI Ad).