DAN MORALES

.ATT”RSEI GENERAL 

# Office ofttp 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 ofthe 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 donotconsiderwhaler theboard mayadopta mlc authorizingathaapcuticoptonutri.9touse cocainedrop3

fortreaunent

purposes.

‘V.T.C.S.al.%

4552-1.02-7.02. 3&e id an. 4552-1.02(2)(ddining “dning andmeasuring thepowersofvisionofthehumaneye”).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 ofthe 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 ofpractice 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

AnomcyGamal Opinion

DM-152(1992)u 1;rc alsoV.T.C.S. art 4552-1.02(3)

(ddiaiq “ftniaglatxs orprtsms”).

‘V.T.C.S. art 4552-1.020; arckoraay Genasl DpintoaDM-152 (1992) at I-2. eAtcpkateadarphannam&catageattsadtuga@tedtetkeyetoatdiaexanGagL Attern9yGemal 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 21Ta Reg.1093.94

(1996) (ccdttied at22T.A.C.g280.5)

(Tex OpomeayEd.). ~~SarLcElcrfromSamV.~Jr.,~TorTerprOp~ApDdltio4~ Loio Ewald, Bxecatk Direaer,Texasopomtry 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 ifcocaine 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 ofthe 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..AtmmeyCkrerolOpiniomDM-98 (1992)a~3,H-56 (1973)at3,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, atherapeutic 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.%eGo-f1Code

ch 551 (Open

Mecliogs Act); id. ch. 2001, ntbchB (Mminismtivc F’mccdurIAd).