Optometrists in the Lone Star State are close to gaining expanded oral medication prescription authority and the ability to manage glaucoma cases independently in most patients, due to an expanded scope of practice bill that’s poised to be signed this month.  

Senate Bill 993 addresses two major areas which have been problems for Texas patients for a long time, according to Texas Optometric Association president Steve Nguyen, OD.

First, Texas optometrists will now be able to prescribe any oral medication used to treat eye conditions, with the exception of Schedule 1 and 2 controlled substances. Second, ODs will be able to diagnose, treat and manage glaucoma independently, without a mandatory comanagement process with an ophthalmologist, Dr. Nguyen explains.  

“This bill is a big win for Texas patients,” Dr. Nguyen says.  “It’s been very inefficient, and in some cases more costly, for patients to get the eye care they need for conditions that require oral medications. Oftentimes, we had to send the patient elsewhere or get a different health care professional to write the needed prescription, which only served to delay the patient’s care or cause them additional inconvenience.”

Additionally, the mandatory glaucoma comanagement process was  inhibiting patient care, hurting treatment plan compliance and adding costs to patients and payers, he adds. “Now, patients will be able to get the eye care services they need at the time they need them, directly from their optometrist,” Dr. Nguyen suggests.

This is the first scope of practice enhancement for Texas ODs in more than two decades. “Texas optometrists have waited 22 long years to have a scope of practice enhancement,” Dr. Nguyen says. 

Prior to the bill, practicing in Texas has been a point of frustration, since ODs could only prescribe oral meds from a limited number of categories and for short time periods that didn’t allow optometrists to fully manage their patients’ ocular issues, he adds.

Considering glaucoma, optometrists were limited to diagnosing and treating the condition with topical eye drop medications only after getting a mandatory “second opinion” from an ophthalmologist, Dr. Nguyen explains.

“With this bill, optometrists in Texas will now be able to help patients without these decades-old regulations that amounted to nothing more than red tape and inefficiency for patients and doctors alike,” Dr. Nguyen says.

The process of building up the support needed to pass the legislation started over 10 years ago. The members of the TOA wanted to fix the issue, and its leadership executed a multi-year plan to achieve success, Dr. Nguyen says.

“We have hundreds of excellent optometrists throughout the state who participate in our grassroots advocacy structure within the TOA. Ultimately, the strength of those doctor relationships to key legislators is what it takes to pass scope of practice legislation. It is always difficult to pass legislation against organized opposition, but with a good plan and a lot of effort, it is possible as proven by Texas and other states,” Dr. Nguyen adds.

The bill passed the state legislature and is currently awaiting the signature of Texas Governor Greg Abbott. The TOA hopes the bill will be signed later this month, and the new law would then go into effect on Sept. 1, 2021.

Texas is the latest state this year to expand its scope of practice for optometrists, joining Mississippi and Wyoming.


1. Texas Senate Bill 993. LegiScan. legiscan.com/TX/text/SB993/2021. Accessed June 2, 2021.