Read below to see what local ODs have to say:

While training at the University of Houston College of Optometry (UHCO), I encountered a patient with an infection on and around the eye that was threatening his health and vision. Even as a student, I was already prepared to handle the treatment of this condition, as was my supervising attending, an optometrist, who had spent over a decade practicing in another state. However, Texas law prohibits optometrists from prescribing certain medications and performing non-invasive laser procedures, often delaying patients from getting the care they need when they need it. Ultimately, we had little choice but to send the patient elsewhere for treatment, despite being trained and qualified to manage such conditions ourselves.

Unfortunately, situations like this are all-too-common due to outdated, restrictive state laws that tie the hands of highly qualified eye care professionals. In fact, Texas ranks 49th out of 50 states in accessing optometric eye care. This means patients are traveling further, waiting longer, and even delaying important eye care services altogether. COVID-19 has only magnified the barriers many Texans face in accessing the healthcare system and why we must take steps to address these disparities.

Two Dallas-Fort Worth legislators have recognized the need to modernize our eye care laws and provide better access for patients across Texas. Representative Stephanie Klick (R-Fort Worth) and Senator Kelly Hancock (R-Fort Worth) filed companion bills (HB 2340/SB 993, respectively) that include commonsense changes to our state eye care laws.

The three changes included in the bills would allow optometrists to 1) prescribe medications to treat diseases of the eye, 2) independently manage glaucoma, and 3) perform a larger number of safe in-office procedures. An increasing number of states across the country allow optometrists to perform these functions, and all available data shows these changes would improve eye care access and with no evidence of negative health outcomes for patients.

Apart from the direct impact these laws would have on eye care in Texas, they would also solve another problem that continues to plague the state: Texas-trained Doctors of Optometry leaving the state upon graduation. Throughout my education at UHCO, professors’ lectures were littered with asterisks marking concepts we were responsible for knowing but legally barred from practicing in Texas. To learn skills we are not allowed to practice in Texas, UHCO students had to travel across state lines to legally complete our training. Upon my own graduation, I chose to stay and use my skills to care for Texans, but with such restrictive laws, it is no surprise that one in four Texas-trained Doctors of Optometry choose to practice elsewhere.

Leaving our eye care laws stuck in the 1990s, which is the last time they were updated, means leaving Texas patients behind too. Some eye conditions require frequent appointments, long-term management, and expensive medications. Many Texans struggle because they can’t afford to see a specialist or don’t have access to one nearby, but also can’t afford to suffer with worsening eye disease as they try to work, drive, and care for their families.

Modernizing our eye care laws will take the pressure off by allowing patients to receive care from their primary eye care provider: optometrists. HB 2340/SB 993 will finally put patients first in Texas and give everyone access to quality eye care.

Megan Collins, OD
Megan Collins, OD
Kerrville, Texas | New Grad (2020)

I’ve practiced Optometry in Cooke County for over 20 years. We are the only eye care open on Saturdays in the entire county. We see lots of Emergency patients. If I have patients that require certain oral medications, I have to stop to call their PCP to tell them to call the medication into the pharmacy for me because our drug laws are antiquated. It is very frustrating and the PCP always comments back and says, “I can’t believe you can’t prescribe that.” I have over 41,000 patient accounts. I have so many patients that prefer to see me over an ophthalmologist because they trust that I will do everything I can to heal their eye before rushing them into major surgery. I’m in close contact with several ophthalmology specialists, from the DFW Metroplex that trust me to manage my patients’ glaucoma completely and that I only need to send them over to them if I feel that they need to proceed with major surgery. I specialize in Low Vision as well and many ophthalmologists refer their patients to me for care. These patients can come from all over, even from other surrounding counties which is usually the case. These patients have been seeing only a retinal specialist ophthalmologist for years and when they come to me their cornea is completely neglected and are suffering from severe dry eye issues. I would love to be able to put them on oral medications for dry eye but again because of the antiquated laws, I’m unable to. As my patients age, the drive to the Metroplex becomes impossible. They trust me to take care of all their eye care needs. Texas needs to modernize its laws, so I can properly take care of my patients.

Cynthia Fleitman, OD
Cynthia Fleitman, OD
Gainesville, Texas | Practicing 25 years

I frequently see patients who have chronic blepharitis and Texas currently limits my ability to prescribe oral medications necessary for that condition. To treat these patients, I must either have them present to their primary care provider who is not an eye care professional or attend additional eye care visits. Both options increase the cost of treatment and create an unnecessary burden on the healthcare system. Another example of being limited by outdated Texas laws involves in-office procedures. Sometimes our patients can develop painful eyelid styes when a gland in their eyelid becomes clogged and subsequently infected. Typically, therapeutic optometrists will treat these with warm compresses and oral antibiotics, however many of them must be lanced to remove the excess material. I frequently have to refer these patients to an eye surgeon (ophthalmologist) to perform this simple in-office procedure. Most ophthalmologists, prefer to focus on more advanced surgical care performed in a surgical center such as cataract or strabismus surgery than performing minor in-office procedures. Because Texas has limited my scope of practice, these patients frequently go for weeks or months before the painful lesion on their eyelids can be treated. If Texas were to modernize our laws to keep up with our bordering states, Texans would be able to seek eye care without the additional burdens and costs associated with the current laws. As Texas’ population increases and ages the need for eye care services will increase and we must work to deliver efficient, cost-effective care by highly trained healthcare providers. Even in my suburban practice, the supply of tertiary providers that are willing to treat patients who need minor in-office procedures is extremely limited. During this pandemic, we’ve seen how critical it is to maintain and protect our healthcare system’s ability to serve the community. Numerous allied health professionals were called upon to prevent, treat and vaccinate against COVID. We are honored to have two schools of optometry within Texas that are training the next generation of optometrists. Sadly, many of these students are leaving Texas to go to other states with a broader scope of practice. Now is the time for the Texas Legislators to be proactive in protecting the vision of Texas by allowing Texas Therapeutic optometrists to practice eye care to the scope that they are trained. Please help preserve the vision of Texas by passing SB 993.

Johnathan Cargo, OD
Johnathan Cargo, OD
Irving, Texas | Practicing 18 years

My patient was seen on a Friday afternoon with acute pain and blurred vision in her left eye. I diagnosed her with an eye infection affecting the cornea. The eye drop needed was not covered by her insurance so her out-of-pocket would be $350. Texas law meant I could not prescribe the appropriate oral medication, and we were not able to refer her to an ophthalmologist until the next Monday. I called her primary care physician to get them to prescribe the medication, but she was unwilling at first to prescribe it. I was able to convince her that the patient could potentially lose vision if left untreated until Monday. Reluctantly, she agreed to prescribe the medication. When I saw the patient Monday, her eye was healing well. I was able to diagnose the problem but unable to treat it. Another patient of mine was having flashes of light and floaters while in central Texas and was unable to come to Dallas to be checked. She called the ophthalmologists in Kerrville, and the soonest she could see one was 3 weeks. In the meantime, I called an optometrist in the area, where she was seen that day. She was able to be referred to a retinal specialist to get her retinal tear treated, preventing a possible retinal detachment. Her lack of access to care could have led to vision loss if not for the optometrist. Would other patients have to wait equally as long to acquire care? I think patients in rural areas would benefit the most from increased access to care. Small towns are much more likely to have an optometrist than an ophthalmologist, and the ability to treat patients in their town would enable people without transportation to access care. It would enable family members to be present with their loved one at the eye doctor and therefore know more about treatment and prognosis. Access to healthcare is vastly different in different parts of the states. Updating optometry laws will increase Texans’ ability to seek and receive care. Updating optometry laws to the level currently being taught will keep the best and brightest optometrists here in Texas rather than moving to another state. Luckily, Texas is growing, with new residents every day. If we don’t increase the number of practitioners, and their ability to treat their patients, the quality of care and Texans’ access to care will continue to decrease.

Karen Allen, OD
Karen Allen, OD
Addison, Texas | Practicing 20 years in the Dallas Area

I have a patient at our clinic who underwent successful cataract surgery in 2018 at a charitable clinic with whom we partner. She began to notice a gradual decline in her vision since early 2020 and was evaluated in our office in the fall of 2020. It was determined that she has a clouding of the posterior capsule which resulted in a level of vision where she no longer meets the legal limit to drive a car in Texas. Though I was trained to perform this quick, in-office procedure, I am disallowed to do so in Texas. The charitable clinic owns the necessary laser instrument and it sits unused in the corner of an exam room. This patient has now been waiting over 6 months for a YAG capsulotomy (and is waiting still) because of the limited availability of any ophthalmologist to operate the laser. Had I been allowed to do as I was trained, this patient’s visual issue would have been resolved months ago.

Jenny Terrell, OD
Jenny Terrell, OD
Fort Worth, Texas | Practicing 17 years in the Fort Worth Area

At least once a month, I have a patient in my chair complaining of blurry vision. They need an in-office laser procedure to clear up their vision after cataract surgery. It is a very quick and easy procedure I learned how to do over 20 years ago but because of our antiquated law, I am not allowed to do it in Texas. My patients now have to make an appointment with the cataract surgeon who is booked out for weeks, sit in a crowded lobby, and usually wait for an hour or more before being seen. If I had the authority to perform this basic procedure in Texas, we would have walked into the next room and the procedure would have been done in minutes. The patient would have walked out seeing well that same day.

Laurie Sorrenson, OD
Laurie Sorrenson, OD
Cedar Park, Texas | Practicing 35 years
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