2023 Maryland Statutes › Health Occupations › Title 11 - Optometrists › Subtitle 4 - Miscellaneous Provisions › Section 11-404.2 - Therapeutically Certified Optometrists -- Referrals; Administration of Topical Therapeutic and Oral Pharmaceutical Agents; Restrictions

(a)    (1)    Except as provided in this subsection and in subsection (d) of this section for the treatment of open–angle glaucoma, a therapeutically certified optometrist may administer and prescribe therapeutic pharmaceutical agents for the prevention, management, or treatment of conditions and diseases of the eye and ocular adnexa.
(2)    (i)    A therapeutically certified optometrist may not administer or prescribe:
1.    Controlled dangerous substances;
2.    Except as provided in subparagraph (ii) of this paragraph, nontopical systemic immunosuppressive and immunomodulatory agents;
3.    Oral antifungal agents; or
4.    Oral and topical antimetabolite agents.
(ii)    A therapeutically certified optometrist may administer or prescribe oral corticosteroids for not more than 1 month unless the therapeutically certified optometrist consults with a physician.
(3)    A therapeutically certified optometrist may not administer or prescribe pharmaceutical agents that are:
(i)    Delivered intravenously;
(ii)    Given by injection, except a therapeutically certified optometrist may give an injection of epinephrine in the appropriate dose for the treatment of acute anaphylaxis or emergency resuscitation;
(iii)    Given or delivered by a sustained delivery device, except for punctal plugs, contact lenses, or other extraocular devices that release medication into the tear film; or
(iv)    For the treatment of a systemic disease unless specific to the treatment of an ocular condition or disease.
(b)    (1)    Except as provided in paragraph (2) of this subsection, a therapeutically certified optometrist may not administer or prescribe any oral pharmaceutical agent to a patient under the age of 18 years.
(2)    (i)    After a therapeutically certified optometrist consults with a physician, the therapeutically certified optometrist may prescribe and administer oral antibiotics to a minor who is at least 16 years old and under the age of 18 years.
(ii)    A therapeutically certified optometrist shall provide the physician consulted in accordance with subparagraph (i) of this paragraph with a written report.
(c)    (1)    A therapeutically certified optometrist may administer and prescribe topical therapeutic pharmaceutical agents for glaucoma only for a patient who:
(i)    Is at least 18 years old; and
(ii)    Has open–angle glaucoma.
(2)    (i)    A therapeutically certified optometrist who treats a patient with open–angle glaucoma in accordance with this section shall refer the patient to an ophthalmologist for an examination within 3 months after the initial diagnosis or presentation to the therapeutically certified optometrist unless the intraocular pressure has been reduced 20% or more from the initial pressure.
(ii)    A therapeutically certified optometrist who treats a patient with open–angle glaucoma in accordance with this section shall refer the patient to an ophthalmologist for an examination within 12 months after the initial diagnosis or presentation to the therapeutically certified optometrist unless clinical stability has been documented by visual field or imaging of the optic nerve structure.
(3)    For a patient on glaucoma medications at the time of presentation to a therapeutically certified optometrist, if the therapeutically certified optometrist is unable to confirm either the date of initial open–angle glaucoma diagnosis or the intraocular pressure at the time the patient was initially diagnosed, the therapeutically certified optometrist may render treatment to a patient with open–angle glaucoma without referring the patient to an ophthalmologist if:
(i)    The intraocular pressure of the patient remains stable; and
(ii)    Clinical stability is documented by visual field or imaging of the optic nerve structure within 12 months after the patient is first examined by the optometrist.
(4)    (i)    For a patient who is at least 18 years old, a therapeutically certified optometrist may only administer or prescribe oral glaucoma medications for up to 24 hours after the patient presents in the office with uncontrolled intraocular pressure.
(ii)    A therapeutically certified optometrist who administers or prescribes oral glaucoma medications under subparagraph (i) of this paragraph shall immediately consult with an ophthalmologist and refer the patient to an ophthalmologist.
(d)    A therapeutically certified optometrist may remove superficial conjunctival or corneal foreign bodies from the human eye only if:
(1)    The foreign body:
(i)    Has not penetrated beyond the bowman’s membrane of the cornea and is within 2.5 millimeters of the visual axis of the cornea; or
(ii)    Is peripheral and anterior to the mid–stroma; and
(2)    Removal will not require permanent alteration of tissue.
(e)    (1)    Except as provided in paragraphs (2) and (3) of this subsection, a therapeutically certified optometrist may not order any laboratory tests, genetic tests, extraocular imaging, or other testing for a patient.
(2)    (i)    A therapeutically certified optometrist may order:
1.    A conjunctival or corneal culture; or
2.    After consulting with a physician, a nongenetic blood test.
(ii)    A therapeutically certified optometrist who orders nongenetic blood tests shall send the written results to the physician consulted in accordance with subparagraph (i)2 of this paragraph.
(3)    A therapeutically certified optometrist may order and perform in–office, noninvasive, nonradiographic imaging.
(f)    A therapeutically certified optometrist may not provide any therapeutic treatment listed in this section for a child under the age of 1 year.
(g)    Unless the standard of care requires an earlier referral, if a therapeutically certified optometrist diagnoses a corneal ulcer or infiltrate, and the patient does not have the expected response within 48 hours, the optometrist immediately shall refer the patient to an ophthalmologist.
(h)    A therapeutically certified optometrist shall be:
(1)    Held to the same standard of care as an ophthalmologist who is licensed under Title 14 of this article and who is providing similar services; and
(2)    Required to comply with the notice requirement under § 14–508 of this article.