‘OM Senate
maf Ollice of the Lorceetacy
SEVENTEENTH CONGRESS OF THE)
REPUBLIC OF THE PHILIPPINES —_)

Second Regular Session ) 18 FER 26 .P7 02
SENATE 7
SENATE BILL NO._1708 /

Introduced by SENATOR LEILA M. DE LIMA

AN ACT
TO STRENGTHEN THE PROFESSION OF OPTOM ETRY, HEREBY
AMENDING REPUBLIC ACT NO. 8050, OTHERWISE KNOWN AS THE
REVISED OPTOMETRY LAW OF 1995, INORDER TO ENHANCE THE
DELIVERY OF VISION CARE IN THE PHILIPPINES AND FOR OTHER
PURPOSES

EXPLANATORY NOTE

The Constitution, Article II, Section 15 provides:

Section 15. The State shall protect and promote the right to health of
the people and instill health consciousness among them.

Article XII, Section 11, likewise provides:

SECTION 11. The State shall adopt an integrated and comprehensive
approach to health development which shall endeavor to make
essential goods, health and other social services available to all the
People at affordable cost. xxx

Unite for Sight, a non-profit organization specializing in healthcare delivery to
communities around the world, and which has reportedly provided eye care services
to more than 2.5 million people worldwide, including more than 99,000 sight-
restoring surgeries,' has stated that “[I]ow vision and blindness have dire effects on
individuals, families, and communities,” which “effects range from a decrease in
quality of life and increased mortality to large-scale economic consequences,”

It likewise shed light on the connection between loss or impairment of eyesight
and poverty, citing sources that indicate that “blindness may be a result of living in
poverty and may also lead an individual or family into poverty,” thus:

| hutp://www.uniteforsight.org/about-us
? http://www uniteforsight.org/community-eye-health-course/module1



The impact of blindness and poor vision on quality of life is particularly alarming
for those living in poverty. Approximately 45 million people in the world are
blind, and 87% of visually impaired people live in developing countries.{°] The
economic consequences of blindness are staggering, as 90% of blind
individuals cannot work.(‘] Thus, “poverty and blindness are believed to be
intimately linked, with poverty predisposing to blindness, and blindness
exacerbating poverty by limiting employment opportunities, or by incurring
treatment cost."[)] impoverished people are more likely to become blind due to
lack of access to health services. They also tend to be more susceptible to eye
infections and diseases, and lack awareness about eye health. ... In addition,
“clear evidence shows that some blinding eye diseases are a direct
consequence of poverty (for example, trachoma).’["] However, the converse is
also true: blindness may also cause people to become poor. For instance, one
study on the consequences of poverty reported:

Although some individuals become disabled because of low
income, a staggering 64 per cent of those with disabilities were
not in poverty prior to onset of the disability. Households
affected by disability, and which were not initially impoverished,
had three times the probability of entering into poverty within
one year of onset of disability compared with unaffected
households. Households affected by disability also had a lower
probability of leaving poverty because of the increased costs
and reduced earnings associated with disability.”[’]

Optometrists are among those who are at the frontline of the nation’s efforts to
protect and enhance the vision health care system of our country, consistent with
Section 2 of Republic Act No. 8050, otherwise known as the Revised Optometry Law
of 1995.

However, the unfortunate reality is that our 10,000-strong corps of professional
optometric healthcare providers is extremely inadequate to service the needs of our
103 million citizens. As a result, the market became ripe for the entry and rampant
proliferation of those who illegally and indirectly engage in the practice of optometry.

Not only does the illegal and indirect practice of optometry undermine the
privilege earned by these licensed optometrists to pursue their profession and earn a
reasonable living therefrom, after having invested valuable resources in order to
become lawfully qualified to practice in said field, but most importantly, such illegal
and indirect practice by unlicensed persons also pose a significant danger to the public,
who rely on the implied credentials and accountability of those who hold themselves

° Ibid. citing “Visual Impairment and Blindness.” WHO. (2009). Accessed 4 January 2011

* Ibid. citing “World Blindness Overview.” Himalayan Cataract Project. www.cureblindness.org. Accessed 7
January 2009.

* Ibid. citing Kuper, H., et. al. “Does Cataract Surgery Alleviate Poverty? Evidence from a Multi-Centre
Intervention Study Conducted in Kenya, the Philippines and Bangladesh.” PloS Medicine. $.11 (2010).
Accessed 3 January 2011

° Ibid. citing Gilbert, C., et. al. “Poverty and blindness in Pakistan: results from the Pakistan national blindness
ual impairment survey.” British Medical Journal. 336.29 (2008). Accessed 3 January 2011

|. citing Holden, B. “Blindness and poverty: a tragic combination.” Clinical and Experimental

Optometry. 90.6 (2007): 401-403. Accessed 4 January 2011.



out to the public as vision care services, thinking that such persons or entities are
subject to professional standards or regulatory control like any other licensed
professionals.

Therefore, there is a need for our government to continue working towards
increasing the number and improving the quality of our corps of professional and
licensed optometric healthcare providers, while, at the same time, taking necessary
steps to protect our countrymen from the dangers posed by persons and entities who
unlawfully hold themselves out as licensed professionals or who otherwise engage in
the illegal or indirect practice of optometry.

There is likewise a need to elevate the level of services that optometrists can
provide, in order to improve the people's access to eye care-related essential goods,
health and other services at affordable cost. For instance, optometrists in developed
countries have recently been allowed to prescribe Therapeutic Pharmaceutical Agents
(TSAs), subject to certification and regulation by appropriate agencies. Subject to the
exercise of regulatory controls by the Department of Health (DOH) and Food and
Drugs Authority (FDA), which shall, in turn, be guided by internationally accepted
practices, there is every reason and opportunity for our optometrists to play an even
greater role in achieving the aspirations laid down in our Constitution, as applied in
the field of vision care.

Finally, in order to promote the growth of the field and the number of
professionals who engage in the practice thereof, it is time to place our optometrists
on a plane that is at par with other professionals, such as medical professionals, by
affording them the opportunity to establish optometry clinics without being subjected
to the payment of local business permits. This is with the understanding that the
exemption applies only to clinics, or portions of the operation thereof, that strictly
involve the direct provision of professional services that are essential and natural
extensions of the practice of the profession of optometry, and not to other income-
generating endeavors, such as sale of products or merchandise like medicine,
ophthalmic products, accessories and implements.

This bill, therefore, aims to address the country's vision care needs by
strengthening the optometric profession, as follows:

1. Prohibiting and penalizing the indirect practice of optometry;

2. Providing guidelines to protect the ethical standards of optometrists
during engagements with commercial eye care and vision adjustment
product providers;

3. Increasing the existing penalties for the illegal practice of optometry;

4. Allowing optometrists to prescribe and administer therapeutic
pharmaceutical agents (TPAs), subject to the exercise of regulatory
controls by the Department of Health (DOH) and Food and Drugs
Authority (FDA), which shall, in turn, be guided by internationally
accepted practices; and



5. Exempting optometry clinics and facilities, or portions of the operation
thereof, that strictly involve the direct provision of professional services
that are essential and natural extensions of the practice of the profession
of optometry, from the payment of national or local tax, fee, including
the Mayor's Permit or business permits; provided that the corresponding
professional tax to the province (or city in the case of Highly Urbanized
Cities) where he practices his profession shall be paid, in addition to
other fees or dues that he may be required to pay under other relevant
laws in order to remain a licensed member of the profession in good
standing.

With these changes, it is hoped that we can enhance the delivery of vision care
services in our country by protecting the legitimate practice of optometry.

4 pr
LEILA M. DE LIMA



© Senate
HF Otiice of tye Secretary
SEVENTEENTH CONGRESS OF THE. )
REPUBLIC OF THE PHILIPPINES )

Second Regular Session ) 18 FEB 26 .P7 02

SY

SENATE
SENATE BILL NO._1708

RECEVIDEY

Introduced by SENATOR LEILA M. DE LIMA

AN ACT
‘TO STRENGTHEN THE PROFESSION OF OPTOMETRY, HEREBY
AMENDING REPUBLIC ACT NO. 8050, OTHERWISE KNOWN AS THE
REVISED OPTOMETRY LAW OF 1995, TO ENHANCE THE DELIVERY OF
VISION CARE IN THE PHILIPPINES AND FOR OTHER PURPOSES

Be it enacted by the Senate and the House of Representatives of the Philippines
in Congress Assembled:
SECTION 1. New Sections 6-A, 6-B and 6-C shall be inserted after Section 6 of
Republic Act. No. 8050, otherwise known as Revised Optometry Law (R.A. No. 8050),

as follows:

Sec. 6-A. Prohibition Against the Indirect Practice of
Optometry. ~
a. No person, whether natural or juridical, shall engage,
employ, hire, form a partnership or corporation with, or
otherwise enter into a contract or arrangement with an
optometrist for the purpose of deriving financial and other
benefit from the practice of said optometrist of the
profession of optometry as defined by law.

b. This prohibition shall not apply:



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1, where a patient-doctor relationship exists between an
individual and an optometrist;

2. when the optometrist is under the employ of the
government or any of its subdivisions, agencies and
instrumentalities, and services the vision care needs of
its public employees;

3. when an optometrist forms a professional partnership
with other optometrists for the purpose of practicing
optometry;

4. when an organization works with optometrists in

undertaking charitable projects to provide vi
services to indigent patients; and
5. on limited commercial optometry practice as provided

in Section 6-B of this Act.

Sec. 6-B. Limited Commercial Optometry Practice. -
Optometrists may enter into contracts or arrangements that
allow them to provide limited optometric services to customers
of establishments that exclusively deal in optical products which:

a. creates a fiduciary relationship that is above and separate

from the contractual relationship between the optometrist
and the establishment, as if it was contracted directly

between them; and

b. shall be regulated by the PRC, in consultation with

recognized optometry associations, to ensure that:



1. All patients are informed in writing, through signages,
and in person by the on-site optometrist of the

following:

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iii.

iv,

v.

The services being offered by the on-site
optometrist are limited only optometric services,
excluding sale of any products and merchandise of
the establishment;

‘That the establishment accepts orders arising from
prescription obtained from different optometrists;
That it is recommended that they consult an
optometrist or ophthalmologist or other medical
professionals, such as pediatricians in the case of
children, for full-scale examination, consultation
and treatment, as vision impairment may be
symptomatic of diseases or conditions that cannot
be detected or treated by the on-site optometrist;
‘That they have no obligation to purchase any item
from the establishment after the consultation, and
that they can obtain a second opinion from another
optometrist if they should so choose; and

That it is best to be examined by a professional,
whether an on-site or off-site optometrist, before
purchasing an unrestricted product, as defined by
the DOH in consultation with an optometrist
association, such as low-risk ones like reading

glasses, or replacement glasses; and if they opt not



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to seek advice or consult with any professional, they
assume the risk of doing so, for which they must
sign a waiver;

c. Optometrists receive no incentive for sales;

d. ensure that optometrists remain liable, administratively,
civilly and even criminally, for malpractice and unethical
behavior for services rendered to patients whom they meet
under these limited commercial optometry practice
arrangements; and that they are aware of such liability.

e. The consultation is done under circumstances that preserve
the doctor-patient confidentiality, and the dignity of the
profession.

f. If the consultation is offered free of service by the
establishment, the on-site optometrist may withhold the
prescription but is required to inform the patient of the
findings, without a written prescription, for purposes of

obtaining and comparing with a second opinion.

Sec. 6-C. Therapeutic Pharmaceutical Agents (TPA’s). -
Optometrists who have obtained their optometry degrees under
a curriculum which contain the requisite subjects, including
pharmacology and pathology, as determined by the Board of
Optometry, shall be allowed to use therapeutic pharmaceutical
agents (TPA's); Provided, that the Board of Optometry shall
implement guidelines for the certification, after undergoing the

appropriate training, of optometrists to use or prescribe TPA's



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who would not otherwise be qualified by reason of not
possessing the above referred qualification; Provided, finally,
that optometrists can only use or prescribe TPA's from a list
approved by the DOH in coordination with the Board of
Optometry and the Food and Drugs Administration (FDA).

The DOH shall follow the internationally acceptable standards
and formularies in establishing the list of TPA’s allowable under
this Act.

Prescription of TPA’s without certification and beyond the list
approved by the DOH shall be considered unauthorized practice
of Optometry, regardless if the offender is a licensed

Optometrist.

SEC. 2. Section 30 of R.A. No. 8050 shall be amended as follows:

SEC. 33. Penal Provisions. — The commission of any of the
prohibited acts listed in the immediately preceding section shall be
punished with imprisonment of not less than one (1) year but not
more than eight (8) years, or a fine of not less than Ten thousand
pesos (P10,000) but not more than Forty—thousand—pesos
{P49,000-00) ONE MILLION PESOS (P1,000,000), or both, at

the discretion of the court.

In addition, the administrative penalties specified in Section 26

hereof shall be imposed whenever applicable.

If the violation is committed by an association, partnership,

corporation or any other institution, the managing officers and other



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persons responsible for its commission shall be liable for the

penalties provided for in this Act.

SEC. 3. A new Section 33-A and 33-B shall be inserted after Section 33 of R.A. No.

8050 as follows:

Sec. 33-A. Penalties for Persons Abetting the Illegal Practice of
Optometry. - Any person, whether natural or juridical, who abets,
assists or facilitates the illegal or indirect practice of optometry as
defined under this law, shall be guilty of the offense of illegally
practicing optometry and be subject to the penalties prescribed in
Section 33 of this Act. In case of juridical entities, the directors,
corporate officers, and/or other offices having control,
management, and direction of said entities shall be held liable for

such violation.

Sec. 33-B. Optometrists Liable for Violating the Law. - An
optometrist who willfully allows himself to be used by persons
who violate the provisions of RA No. 8050 and this law, shall
likewise be guilty of violating said laws, and shalll be subject to the

penalties prescribed in Section 33 of this Act.

SEC. 4. A new Section 40-A shall be inserted before Section 41 under Miscellaneous

Provisions of R.A. No. 8050, as follows:

Sec. 40-A. Exemption of Optometry Clinies from the Payment

of Business Taxes. - Clinics, refraction rooms, offices and other



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places used for conduct of optometric services and procedures are
taken to be established as a direct consequence of the practice of
optometry and are exempt from being subjected to any other
national or local tax, license or fee, including the Mayor's Permit
or business permit provided that concerned medical
professionals pay the corresponding professional tax to the
province where he practices his profession or to the city in case of
Independent Component Cities and Highly Urbanized Cities.

‘The local government, however, may require the Mayor’s Permit
or business permit for clinics which have established shops for
the purpose of generating income and are engaged in the sale of
products such as medicine, ophthalmic products, accessories and

implements are prescribed and dispensed as defined by law.

SEC. 5. Repealing Clause. - All laws, decrees, executive orders, and rules and
regulations, or parts thereof, inconsistent with the provisions of this Act, are hereby

repealed or modified accordingly.

SEC. 6. Separability Clause. - If, for any reason, any section or provision of this Act
is held unconstitutional or invalid, the other sections or provisions hereof shall not be

affected and thereby remain in full force and effect.

SEC. 7.  Effectivity Clause. - This Act shall take effect fifteen (15) days after its

complete publication in at least two (2) national newspapers of general circulation.

Approved,