In this section the following words have the meanings indicated. “Governmental unit” means any board, commission, authority, department, or other administrative agency of this State, a county, or a municipality. “Ocular practitioner” means any practitioner who is authorized to provide services within the scope of optometry. Except as provided in this subsection, a governmental unit may not interfere with the complete freedom of the public to choose any ocular practitioner. A governmental unit may make an agreement under which an ocular practitioner is to provide optometric services to the employees of a governmental unit. A governmental unit shall honor and accept any report, statement, or service made or provided by a licensed optometrist within the scope of optometry to the same extent as if the report, statement, or service was made or provided by a physician.

If, while providing optometric services to a patient, an optometrist or diagnostically certified optometrist detects or diagnoses an active eye pathology which the optometrist is not licensed or certified to treat under § 11-404 or § 11-404.2 of this subtitle, the optometrist shall refer the patient to: An ophthalmologist or a therapeutically certified optometrist, as appropriate; The patient’s physician; A physician if required under a managed care contract; or A hospital emergency room or ambulatory surgical center if necessary. If, while providing optometric services to a patient, a therapeutically certified optometrist diagnoses an active eye pathology that the optometrist is not certified to treat under § 11-404.2 of this subtitle, the optometrist shall refer the patient to: An ophthalmologist; The patient’s physician; A physician if required under a managed care contract; or A hospital emergency room if necessary.

A licensed optometrist may: Use the title “optometrist”; If the optometrist holds the degree of doctor of optics or doctor of optometry from a college or university authorized to give the degree, use the title “Doctor” or the abbreviations “Dr.” or “O.D.” with the optometrist’s name; If the optometrist is certified under § 11-404 of this subtitle, use the title “diagnostically certified optometrist”; and If the optometrist is certified under § 11-404.1 of this subtitle, use the title “therapeutically certified optometrist”. Except as otherwise provided in this section, a licensed optometrist may not attach to the optometrist’s name or use as a title: The words or abbreviations “Doctor”, “Dr.”, “M.D.”, “physician”, or “surgeon”, or any other word or abbreviation that suggests that the optometrist practices medicine; or Any word or abbreviation that suggests that the optometrist treats diseases or injuries of the human eye, including the words “eye specialist”, “eyesight specialist”, “oculist”, or “ophthalmologist”.

Unless certified under this section, a licensed optometrist may not administer a topical ocular diagnostic pharmaceutical agent to a patient. The Board shall certify a licensed optometrist as qualified to administer topical ocular diagnostic pharmaceutical agents if the licensed optometrist submits to the Board evidence satisfactory to the Board that the licensed optometrist: Meets the educational requirements that the Board establishes for certification of qualification to administer topical ocular diagnostic pharmaceutical agents; and Has within 7 years before certification completed a course in pharmacology that meets the requirements of subsection (c) of this section. The course in pharmacology required by subsection (b) of this section shall: Be of at least the length that the Board establishes but not less than 70 course hours; Place emphasis on: Topical application of ocular diagnostic pharmaceutical agents for the purpose of examining and analyzing ocular functions; and Allergic reactions to ocular diagnostic pharmaceutical agents; and Be given by an institution that is: Accredited by a regional or professional accrediting organization that is recognized or approved by the United States Commissioner of Education; and Approved by the Board. The Board shall revoke the certification of qualification to administer topical ocular diagnostic pharmaceutical agents of any licensed optometrist who does not annually take a course of study, approved by the Board, that relates to the use of those agents. Certification of qualification under this section authorizes the licensed optometrist who is certified under this section to administer a topical ocular diagnostic pharmaceutical agent to a patient for diagnostic purposes but not for purposes of treatment. Except as expressly authorized under this section for diagnostic purposes or under § 11-404.1 of this subtitle for therapeutic purposes, an optometrist may not administer drugs or medicine to any patient. The Department shall collect and report statistical information on the incidences of negative reactions to the administration by optometrists of topical ocular diagnostic pharmaceutical agents.

This section does not apply to an individual authorized to practice optometry in the State under §§ 10–14A–03 and 10–14B–03 of the State Government Article. Unless certified under this section, a licensed optometrist may not administer or prescribe any therapeutic pharmaceutical agents or remove superficial foreign bodies from a human eye, adnexa, or lacrimal system. Except as provided in paragraph (2) of this subsection, the Board shall certify a licensed optometrist as a therapeutically certified optometrist if the licensed optometrist submits to the Board evidence satisfactory to the Board that the licensed optometrist: Has successfully completed at least 110 hours of a therapeutic pharmaceutical agents course approved by the Board; Has successfully passed a pharmacology examination relating to the treatment and management of ocular disease, which is prepared, administered, and graded by the National Board of Examiners in Optometry or any other nationally recognized optometric organization as approved by the Secretary; Is currently certified by the Board to administer topical ocular diagnostic pharmaceutical agents under § 11–404 of this subtitle; and Has successfully completed an 8–hour course in the management of topical steroids approved by the Board. Except as provided in subparagraph (ii) of this paragraph, an optometrist who has graduated on or after July 1, 2005 from an accredited school of optometry recognized by the Board is not subject to the requirements of paragraph (1) of this subsection. If an optometrist who has graduated on or after July 1, 2005 from an accredited school of optometry recognized by the Board is not certified under this section within 3 years of graduation, the optometrist shall successfully complete a therapeutic pharmaceutical agents course and successfully pass a pharmacology exam under paragraph (1) of this subsection before the Board may certify the optometrist.

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. A therapeutically certified optometrist may not administer or prescribe: Controlled dangerous substances; Except as provided in subparagraph (ii) of this paragraph, nontopical systemic immunosuppressive and immunomodulatory agents; Oral antifungal agents; or Oral and topical antimetabolite agents. 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. A therapeutically certified optometrist may not administer or prescribe pharmaceutical agents that are: Delivered intravenously; 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; 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 For the treatment of a systemic disease unless specific to the treatment of an ocular condition or disease. 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. 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. A therapeutically certified optometrist shall provide the physician consulted in accordance with subparagraph (i) of this paragraph with a written report. A therapeutically certified optometrist may administer and prescribe topical therapeutic pharmaceutical agents for glaucoma only for a patient who: Is at least 18 years old; and Has open–angle glaucoma. 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. 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. 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: The intraocular pressure of the patient remains stable; and 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. 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. 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. A therapeutically certified optometrist may remove superficial conjunctival or corneal foreign bodies from the human eye only if: The foreign body: 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 Is peripheral and anterior to the mid–stroma; and Removal will not require permanent alteration of tissue. 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. A therapeutically certified optometrist may order: A conjunctival or corneal culture; or After consulting with a physician, a nongenetic blood test. 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. A therapeutically certified optometrist may order and perform in–office, noninvasive, nonradiographic imaging. A therapeutically certified optometrist may not provide any therapeutic treatment listed in this section for a child under the age of 1 year. 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. A therapeutically certified optometrist shall be: 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 Required to comply with the notice requirement under § 14–508 of this article.

The Board shall recommend to the Secretary quality assurance guidelines for therapeutically certified optometrists and optometric care. After considering the recommendations of the Board, the Secretary shall adopt regulations that establish standards of quality for therapeutically certified optometrists and optometric care.

In this section the following words have the meanings indicated. “Replacement contact lens prescription” means a prescription prepared by a licensed optometrist containing the information specified in this section and written expressly for the purpose of providing lenses which have already been properly fitted. “Immediate follow-up care” is that period of contact lens fitting time required to reach a contact lens prescription that is appropriate to the documented clinical needs of the patient. A licensed optometrist shall ensure that each replacement contact lens prescription that the licensed optometrist prescribes for contact lenses: Contains all the information necessary for the replacement contact lens prescription to be properly dispensed, including but not limited to the: Lens manufacturer; Type of lens; Power of the lens, including plano or zero-powered contact lenses; Base curve; Lens size; Name of the patient; Date the prescription was given to the patient; Name and office location of the licensed optometrist who writes the replacement contact lens prescription; and Expiration date of the replacement contact lens prescription; and Is reduced to writing and placed in the patient’s permanent file. After a licensed optometrist releases the patient from immediate follow-up care, the patient may request the replacement contact lens prescription from the licensed optometrist. If, after examination, the patient’s prescription has not changed since the last examination, a licensed optometrist shall comply with the provisions of paragraph (2) of this subsection without requiring the patient to purchase contact lenses or to undergo immediate follow-up care. Upon the request of a patient of a licensed optometrist, and without cost to the patient, the licensed optometrist shall provide the patient’s replacement contact lens prescription to the patient or the patient’s designee. In responding to a request under paragraph (1)(i) of this subsection, a licensed optometrist shall transmit the contact lens prescription by mail, telephone, facsimile, e-mail, or any other means of communication that will, under normal circumstances, result in the designee receiving the information within 7 business days after the patient’s request. The replacement contact lens prescription that the licensed optometrist provides the patient under subparagraph (i) of this paragraph: Shall contain the information necessary for the proper duplication of the current prescription of the patient; Shall contain, subject to the provisions of subsection (d) of this section, an expiration date for the replacement contact lens prescription of not more than 24 months from the time the patient was first examined; and May contain wearing guidelines or specific instructions for use of the contact lenses by the patient, or both. The licensed optometrist shall enter into the patient’s medical record the valid clinical reasons for a shorter expiration date and shall provide the patient with a written and oral explanation of the clinical reasons for a shorter expiration date. When a patient’s prescription is dispensed by a person other than the licensed optometrist or a person associated directly or indirectly with the licensed optometrist, the licensed optometrist is not liable for any injury to or condition of a patient caused solely by the negligence of the dispenser. A licensed optometrist who releases a replacement contact lens prescription to a patient may provide the patient with a written statement that wearing improperly fitted contact lenses may cause harm to the patient’s eyes and that the patient should have an eye examination if there are any changes in the patient’s vision, including pain or vision loss. A licensed optometrist who fills or provides a contact lens prescription shall maintain a record of that prescription in accordance with § 4-403 of the Health - General Article. A person other than a licensed optometrist who fills a contact lens prescription shall maintain a record of that prescription for 5 years. The Board may impose a civil fine of no more than $1,000 on a licensed optometrist who fails to provide a replacement contact lens prescription or who knowingly dispenses contact lenses without a valid and unexpired replacement contact lens prescription, or who otherwise fails to comply with this title.

In this section, “optometrist rehabilitation committee” means a committee that: Is defined in subsection (b) of this section; and Performs any of the functions listed in subsection (d) of this section. For purposes of this section, an optometrist rehabilitation committee is a committee of the Board or a committee of the Maryland Optometric Association that: Is recognized by the Board; and Includes but is not limited to optometrists. A rehabilitation committee of the Board or recognized by the Board may function: Solely for the Board; or Jointly with a rehabilitation committee representing another board or boards. For purposes of this section, an optometrist rehabilitation committee evaluates and provides assistance to any optometrist, and any other individual regulated by the Board, in need of treatment and rehabilitation for alcoholism, drug abuse, chemical dependency, or other physical, emotional, or mental condition. Except as otherwise provided in this subsection, the proceedings, records, and files of the optometrist rehabilitation committee are not discoverable and are not admissible in evidence in any civil action arising out of matters that are being or have been reviewed and evaluated by the optometrist rehabilitation committee. Paragraph (1) of this subsection does not apply to any record or document that is considered by the optometrist rehabilitation committee and that otherwise would be subject to discovery or introduction into evidence in any arbitration or civil proceeding. For purposes of this subsection, civil action does not include a proceeding before the Board or judicial review of a proceeding before the Board. A person who acts in good faith and within the scope of jurisdiction of an optometrist rehabilitation committee is not civilly liable for any action as a member of the optometrist rehabilitation committee or for giving information to, participating in, or contributing to the function of the optometrist rehabilitation committee.