SENATE BILL 1406 – CHANGES TO CURRENT LAW

Thanks to a united COA team, the California Legislature and Gov. Arnold Schwarzenegger have made it possible for California's licensed Doctors of Optometry to provide more and better primary eye care services to you, their patients, which will save you time and money – and might even save your life.

Senate Bill 1406, co-authored by Sens. Lou Correa (D – Santa Ana) and Sam Aanestad (R – Grass Valley), was signed by the Governor on September 26. Its provisions take effect on January 1, 2009. (They were capably assisted by Assemblyman Ed Hernandez, O.D. (D – Baldwin Park), who's featured in two videos you can see on the Home page.) To see a full copy of the chaptered bill, click here.

Following is a table that summarizes how SB 1406 changes existing law. Just click on the area or subject you’re interested in below to learn how SB 1406 changes existing law.

Questions? Comments? Contact Us.

GLAUCOMA:
THERAPEUTIC PHARMACEUTICAL AGENTS (TPAs):
PROCEDURES
OTHER PROVISIONS:

GLAUCOMA:

	CURRENT LAW	SB 1406
DEFINITION	Restricted to primary open-angle glaucoma (POAG) in patients over 18 years	Expanded to exfoliation and pigmentary glaucoma; may use orals to stabilize acute angle closure attack in emergency.
CERTIFICATION	Certification to treat requires first completing 24 hours of didactic instruction offered by accredited school of optometry, unless optometrist graduated after January 1, 2000. Collaboration with ophthalmologist for 50 patients required; each patient must be newly-diagnosed by the optometrist and followed over two years by same ophthalmologist only.	Post 5/1/08 graduates automatically certified SB 929 certified ODs "grandfathered" ODs who are halfway through SB 929 certification by 1/1/09 can choose to finish by 12/31/09 ODs who’ve taken SB 929 24-hr. didactic course don’t have to retake – just complete case mgmt. requirements Others will be certified by State Board based on didactic & case mgmt. curricula recommendations of appointed Advisory Committee (3 ODs, 3 OMDs) reviewed by Ofc. Examination Resources/DCA. (Entire process must be completed in 1 yr.)
	Optometrist must make initial diagnosis, not after referral of potential patient from following ophthalmologist.	ELIMINATED
	More than one optometrist may not take credit for the same patient.	ELIMINATED
	Patients counted in the first 50 required must not have had a previous diagnosis of glaucoma or ocular tension.	ELIMINATED
	Ophthalmologist must heed Medical Board of California's recommendations requiring only one optometrist per patient and only newly-diagnosed glaucoma patients in preceptored first 50.	ELIMINATED
	Collaborating ophthalmologist must be geographically accessible to patient and must examine each patient.	ELIMINATED
	Collaborating ophthalmologist must initially confirm diagnosis and approve treatment plan presented in writing by optometrist.	ELIMINATED
	After confirmation of diagnosis and approval of treatment plan by ophthalmologist, optometrist may begin treatment with any topical glaucoma medication.	ELIMINATED
	Any change in medication must be communicated to ophthalmologist in writing.	ELIMINATED
	Annual written report of treatment results to ophthalmologist required, which must be acknowledged in writing by ophthalmologist within 10 days of receipt.	ELIMINATED
	Treatment limited to two topical medications – components of each medication are counted separately.	ELIMINATED
	Patient must be re-referred to ophthalmologist if requested by patient, if treatment goals are not met with two medications, or if secondary glaucoma develops.	ELIMINATED
	Ophthalmologist may choose to examine the patient at any time.	ELIMINATED
	Optometrist must provide to patient in writing: the nature of the working or suspected diagnosis; the need for consultation with collaborating ophthalmologists; treatment plan goals; expected follow-up care; and a description of referral requirements. Both optometrist and ophthalmologist must sign the document and both must keep it in each patient's chart.	ELIMINATED
	Upon completion of diagnosis and treatment of 50 newly-diagnosed and preceptored patients with POAG, optometrist must apply to Board of Optometry for certification. Collaborating ophthalmologists will be asked to verify patients diagnosed and treated. If ophthalmologist does not respond within 60 days, the Board may act on available information.	ELIMINATED
POST-CERTIFICATION	After certification, optometrist may treat only POAG and must refer patients requiring more than two medications for all further treatment.	ELIMINATED
POST-CERTIFICATION	After certification, optometrist may treat only POAG and must refer patients requiring more than two medications for all further treatment.	ELIMINATED

THERAPEUTIC PHARMACEUTICAL AGENTS:

	CURRENT LAW	SB 1406
ADNEXAL INFECTIONS	Oral antibiotics in adnexal infections are limited to: tetracycline; dicloxacillin; amoxicillin; amoxicillin with clavulamate; erythromycin; clarythromycine; cephalexin; cephadoxil; cefaclor; trimethoprim with sulfamethocazole; ciprofloxacin; and azithromycin.	NO RESTRICTIONS
	Azithromycin limited to eyelid infections and chlamydial ocular disease.	ELIMINATED
	Referral required if condition not improved 72 hours after diagnosis, or if still receiving oral antibiotics 10 days after diagnosis.	Referral required 48 hours after diagnosis if no improvement. 10-day oral antibiotic restriction ELIMINATED
ALLERGY	Oral, non-steroidal anti-inflammatory medication restricted to three days’ use, and referral required if not resolved.	ELIMINATED
ALLERGY	Consultation required if not improved within 24 hours of diagnosis.	ELIMINATED
BLEPHARITIS	May not treat any surgically-related inflammation or pain.	Topical AND Rx oral anti-inflammatories authorized; may treat post-surgically if comanaged w/surgeon.
CENTRAL CORNEAL ULCER	Referral required if not improved within 48 hours of diagnosis, or if treatment does not result in improvement 10 days after diagnosis.	Referral required if not improved within 48 hours of diagnosis.
CENTRAL CORNEAL ULCER	Oral acyclovir limited to 10 days; topical antivirals limited to three weeks.	Topical and oral antivirals authorized w/o restriction.
HERPES SIMPLEX, ZOSTER	Consultation required if condition worsens seven days after diagnosis.	ELIMINATED
HERPES SIMPLEX, ZOSTER	Referral required if not resolved three weeks after diagnosis.	Same
IRITIS, IDIOPATHIC	Consultation required if worsens 72 hours after diagnosis, if not resolved within three weeks of diagnosis.	Same, but consultation w/"appropriate" MD permitted.
	Referral required if medication necessary after six weeks.	Same, but consultation w/"appropriate" MD permitted.
	Morrien's or Terrien's excluded.	Same
IRITIS, TRAUMATIC	Referral required if not resolved in one week.	Same, but consultation w/"appropriate" MD permitted.
IRITIS, TRAUMATIC	Recurrent, granulomatous, bilateral, or non-idiopathic iritis excluded.	Same
PAIN	Codeine/Tylenol and hydrocodone limited to three days; referral required if pain persists.	Same
PERIPHERAL KERITITIS	Consultation required if condition worsens 48 hours after diagnosis.	Same, but consultation w/"appropriate" MD permitted.
	Referral required if medication necessary two weeks after diagnosis.	ELIMINATED.
	Referral required if allergic symptoms treated with oral antihistamines not resolved within two weeks.	Oral AND topicals authorized w/o restriction

PROCEDURES:

	CURRENT LAW	SB 1406
PERMITTED	Mechanical epilation Punctal occlusion w/plugs, excluding laser, cautery, diathermy, cryotherapy, or other means constituting "surgery" as defined. Foreign body removal from cornea, eyelid & conjunctiva. "Corneal bodies shall be nonperforating, be no deeper than the anterior stroma, and require no surgical repair on removal. Within three millimeters of the cornea, the use of sharp instruments is prohibited."	Same. Same. Foreign body removal from cornea, eyelid & conjunctiva with any appropriate instrument other than a scalpel or needle. "Corneal bodies shall be nonperforating, be no deeper than the mid-stroma, and require no surgical repair on removal. Within three millimeters of the cornea, the use of sharp instruments is prohibited." Corneal scraping with cultures. Debridement of corneal ephithelia. Venipuncture for testing patients suspected of having diabetes. Suture removal with prior consultation w/treating MD. Treatment or removal of sebaceous cysts by expression. Admin. of oral fluorescein for diabetic retinopathy.

OTHER PROVISIONS:

	CURRENT LAW	SB 1406
AIDS/PEDIATRIC PATIENTS	Patients with AIDS; children under one year w/TPAs; nasolacrimal probing under 12 years of age; glaucoma under 18 years.	TPA Tx of children under one year and AIDS patient restrictions ELIMINATED
CONSULTATIONS	Consultations may involve examining the patient, or consulting in person, by telephone, or through other media.	ELIMINATED
CONTINUING CARE	Referrals require examination of the patient and assumption of continuing patient care.	ELIMINATED
"GEOGRAPHICALLY ACCESSIBLE" OMD	All ophthalmologists serving in consultation, referral, or collaborative roles must be geographically accessible to patient.	ELIMINATED
INJECTIONS	Restricted to use of auto-pen for anaphylaxis.	Same
LAB TESTS	Order smears, cultures, sensitivities, complete blood count, mycobacterial culture, acid fast stain, and urinalysis.	Order smears, cultures, sensitivities, complete blood count, mycobacterial culture, acid fast stain, urinalysis, & X-rays "necessary for the diagnosis of conditions of diseases of the eye & adnexa." OD may order other images w/MD consult.
LACRIMAL IRRIGATION/DILATION	Children under 12 years excluded.	Same
	All probing prohibited.	Same
	If graduated before 5/1/2000, must have certificate issued by Board of Optometry, after provided proof of 10 procedures preceptored by ophthalmologist; otherwise, exempt.	Same
LASERS	Surgical use prohibited by definition of "surgery"(see below). Diagnostic use "frozen" in time by surgery definition	Prospective use of diagnostic lasers and ultrasound authorized.
LENSES	Rx of therapeutic contact lenses	Rx & sale of therapeutic contact lenses "including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide."
PATIENT RECORD REQUIREMENTS	All consultations require a written report by the optometrist of the information provided to the ophthalmologist, the ophthalmologist's responses, and any other relevant information. The consulting ophthalmologist may request a copy of these records at any time.	OD maintains record, provides to patient or OMD on request with patient's consent.
POST-SURGICAL INFLAMMATION & PAIN	Consultation required if worsens 72 hours after diagnosis.	Same, but consultation w/”appropriate” MD permitted.
PRESEPTAL CELLULITIS/DAYCROCYSTITIS	Consultation required if patient does not improve after six weeks of therapy.	ELIMINATED
SURGERY DEFINED	"Notwithstanding any other provision of law, the practice of optometry does not include surgery. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means in a manner not specifically authorized by this act. Nothing in this act amending this section shall limit an optometrist’s authority, as it existed prior to the effective date of the act amending this section, to utilize diagnostic laser and ultrasound technology."	"The practice of optometry does not include performing surgery. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means. 'Surgery' does not include those procedures specified in subdivision (e). Nothing in this act shall limit an optometrist's authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice."
TELEMEDICINE	Excluded from coverage or reimbursement	Included for coverage and reimbursement (w/ AB 1224 & elimination of "geographically appropriate" OMD requirement).