                                 CODE OF VIRGINIA

TPA CERTIFICATION; CERTIFICATION FOR TREATMENT OF DISEASES OR ABNORMAL
CONDITIONS WITH THERAPEUTIC PHARMACEUTICAL AGENTS (TPAS) (§ 54.1-3222)

TPA certification shall enable an optometrist to prescribe and administer,
within his scope of practice, Schedule II controlled substances consisting of
hydrocodone in combination with acetaminophen and Schedules III through VI
controlled substances and devices as set forth in the Drug Control Act (§
54.1-3400 et seq.) to treat diseases and abnormal conditions of the human eye
and its adnexa as determined by the Board, within the following conditions:

1. Treatment with oral therapeutic pharmaceutical agents shall be limited to (i)
analgesics included on Schedule II controlled substances as defined in &#xA7;
54.1-3448 of the Drug Control Act (&#xA7; 54.1-3400 et seq.) consisting of
hydrocodone in combination with acetaminophen, and analgesics included on
Schedules III through VI, as defined in &#xA7;&#xA7; 54.1-3450 and 54.1-3455 of
the Drug Control Act, which are appropriate to alleviate ocular pain and (ii)
other Schedule VI controlled substances as defined in &#xA7; 54.1-3455 of the
Drug Control Act appropriate to treat diseases and abnormal conditions of the
human eye and its adnexa.

2. Therapeutic pharmaceutical agents shall include topically applied Schedule VI
drugs as defined in &#xA7; 54.1-3455 of the Drug Control Act (&#xA7; 54.1-3400
et seq.).

3. Administration of therapeutic pharmaceutical agents by injection shall be
limited to the treatment of chalazia by means of injection of a steroid included
in Schedule VI controlled substances as set forth in &#xA7; 54.1-3455 of the
Drug Control Act (&#xA7; 54.1-3400 et seq.). A TPA-certified optometrist shall
provide written evidence to the Board that he has completed a didactic and
clinical training course provided by an accredited school or college of
optometry that includes training in administration of TPAs by injection prior to
administering TPAs by injection pursuant to this subdivision.

4. Treatment of angle closure glaucoma shall be limited to initiation of
immediate emergency care.

5. Treatment of infantile or congenital glaucoma shall be prohibited.

6. Treatment through surgery or other invasive modalities shall not be
permitted, except as provided in subdivision 3 or for treatment of emergency
cases of anaphylactic shock with intramuscular epinephrine.

7. Entities permitted or licensed by the Board of Pharmacy to distribute or
dispense drugs, including, but not limited to, wholesale distributors and
pharmacists, shall be authorized to supply TPA-certified optometrists with
therapeutic pharmaceutical agents.

HISTORY: 1996, cc. 152, 158; 2004, c. 744; 2015, c. 355; 2018, c. 280; 2023, c.
268; 2025, cc. 391, 408.