Missouri Revised Statutes













Chapter 336

Optometrists

←336.210

Section 336.220.1

336.225→

August 28, 2015

Pharmaceuticals, certification for administering required--referral to physician required, when--standard of care--rulemaking authority.

336.220. 1. Notwithstanding the provisions of subsection 1 of section

336.010, any optometrist who is not certified to use either diagnostic or

therapeutic pharmaceutical agents shall continue to be prohibited from

administering, dispensing, or prescribing the respective pharmaceutical

agents unless the optometrist has completed an approved course of study and

has been certified by the board. Such status shall be noted on the license at

each renewal.



2. Any optometrist authorized by the board to administer only diagnostic

pharmaceutical agents shall refer a patient to a physician licensed under

chapter 334 if an examination of the eyes indicates a condition, including

reduced visual acuity, which requires medical treatment, further medical

diagnosis, or further refraction. This referral is not required on known or

previously diagnosed conditions. The record of the referral in the

optometrist's notes shall have the standing of any business record. Any

optometrist violating this section shall be subject to the provisions of

section 336.110.



3. An optometrist's prescriptions for therapeutic pharmaceutical agents

shall be dispensed by a pharmacist licensed under chapter 338. When

therapeutic pharmaceutical agents are dispensed by an optometrist, the

provisions of section 338.059 shall apply.



4. An optometrist certified to use pharmaceutical agents shall be held to

the standard of care in the use of pharmaceutical agents in the optometrist's

diagnosis and treatment as are physicians licensed by the Missouri state board

of registration for the healing arts, who exercise that degree of skill and

learning ordinarily used under the same or similar circumstances by

physicians and surgeons engaged in the practice of medicine.



5. The board may adopt reasonable rules and regulations providing for the

examination and certification of optometrists who apply to the board for

authority to administer and prescribe pharmaceutical agents in the practice of

optometry.



(L. 1981 S.B. 91, A.L. 1986 H.B. 1333, A.L. 1993 S.B. 52, A.L. 1995

S.B. 175, A.L. 2007 H.B. 780 merged with S.B. 308)





1995



1995



336.220. 1. The state board of optometry may adopt reasonable rules

and regulations providing for the examination and certification of

registered optometrists who apply to the board for authority to administer

pharmaceutical agents in the practice of optometry. Such pharmaceutical

agents may be "diagnostic pharmaceutical agents" or "therapeutic

pharmaceutical agents". As used in this section, the term "diagnostic

pharmaceutical agents" means those topically applied pharmaceuticals used

for the purpose of conducting an examination upon the eye or adnexa, and

the term "therapeutic pharmaceutical agents" means those pharmaceuticals,

excluding injectable agents, used for the treatment of conditions or

diseases of the eye or the adnexa.



2. No registered optometrist shall administer diagnostic

pharmaceutical agents or therapeutic pharmaceutical agents in the practice

of optometry unless such person submits to the state board of optometry

evidence of satisfactory completion of: a course of instruction in general

and ocular pharmacology; which includes at least one hundred hours of

approved, supervised, clinical training in the examination, diagnosis and

treatment of conditions of the human eye and adnexa in a program supervised

by a board-certified ophthalmologist; and such other educational

requirements or examination as may be required by the board, and is

certified by the board as qualified to administer diagnostic pharmaceutical

agents and therapeutic pharmaceutical agents in the practice of optometry.

An optometrist may not be certified by the board to administer therapeutic

pharmaceutical agents unless the optometrist is certified to administer

diagnostic pharmaceutical agents. The board shall not approve a course of

instruction in general or ocular pharmacology unless it is taught by an

institution utilizing both the didactic and clinical instruction in

pharmacology and which is accredited by a regional or professional

accrediting organization which is recognized by the United States

Department of Education or its successors and the transcript for the course

of instruction is certified to the board by the institution as being

comparable in content to those courses in general and ocular pharmacology

required by other licensing boards whose licenses or registrants are

permitted the administration of pharmaceutical agents in the course of

their professional practice for either diagnostic or therapeutic purposes

or both.



3. In issuing a certificate of registration or a renewal of a

certificate of registration, the state board of optometry shall:



(1) State upon the certificate of an optometrist certified by the

board to administer diagnostic pharmaceutical agents in the practice of

optometry that the optometrist is so certified; and



(2) State upon the certificate of an optometrist certified by the

board to administer therapeutic pharmaceutical agents in the practice of

optometry that the optometrist is so certified.



4. Any provision of section 336.010 to the contrary notwithstanding,

a registered optometrist who is examined and so certified by the state

board of optometry in the administration of diagnostic pharmaceutical

agents or therapeutic pharmaceutical agents may administer those agents for

which he is certified in the practice of optometry. An optometrist's

prescriptions for therapeutic pharmaceutical agents should be dispensed by

a pharmacist licensed under chapter 338, RSMo. When therapeutic

pharmaceutical agents are dispensed by an optometrist the provisions of

section 338.059, RSMo, shall apply.



5. An optometrist certified in the administration of therapeutic

pharmaceutical agents may:



(1) Administer and prescribe pharmaceutical agents, excluding

injectable agents, for the diagnosis and treatment of conditions or

diseases of the eye or adnexa; and



(2) Perform diagnostic procedures and order laboratory and imaging

tests for the diagnosis of conditions or diseases of the eye or adnexa.



6. Each optometrist certified in the administration of therapeutic

pharmaceutical agents shall, within one year of August 28, 1995, complete a

course of instruction approved by the board that includes at least twenty-

four hours of training in the treatment of glaucoma. The board shall not

approve a course of instruction in the treatment of glaucoma unless it is

taught by an institution that is accredited by a regional or professional

accrediting organization that is recognized by the United States Department

of Education or its successor and the content for the course of instruction

is certified to the board by the institution as being comparable in the

content to those courses in the treatment of glaucoma required by other

licensing boards whose licensees or registrants are permitted to treat

glaucoma in the course of their professional practice; except that, any

optometrist initially licensed in Missouri after December 31, 1990, who had

previously passed the examination of the National Board of Examiners in

Optometry in the year 1990, or anytime after such year, shall be exempt

from the requirement of completing the course of instruction in the

treatment of glaucoma required by this subsection. Until December 31,

1999, as a condition for the annual renewal of the certificate of

registration, each optometrist certified in the administration of

therapeutic pharmaceutical agents shall, as a condition for the annual

renewal of certification through December 31, 1999, complete a continuing

course of instruction of at least six hours in the treatment of glaucoma as

approved by the board; provided that, such six hours may be credited

against the initial course of at least twenty-four hours required by this

section and against the educational optometric program of at least eight

hours required by section 336.080.



7. An optometrist certified by the board in the administration of

therapeutic pharmaceutical agents may remove superficial foreign bodies

from the eye and adnexa. An optometrist may not perform surgery, including

the use of lasers for treatment of any disease or condition or for the

correction of refractive error. An optometrist certified to use

pharmaceutical agents as provided in this section shall be held to the same

standard of care in the use of such agents in the optometrist's diagnosis

and treatment as are physicians, licensed by the Missouri state board of

registration for the healing arts, who exercise that degree of skill and

proficiency commonly exercised by ordinary, skillful, careful and prudent

physicians and surgeons engaged in the practice of medicine.



8. Any optometrist authorized by the board to administer diagnostic

pharmaceutical agents shall refer a patient to a physician licensed under

chapter 334, RSMo, if an examination of the eyes indicates a condition,

including reduced visual acuity, which requires medical treatment, further

medical diagnosis, or further refraction. This referral is not required on

known or previously diagnosed conditions. The record of the referral in

the optometrist's notes shall have the standing of any business record.

Any optometrist violating this section shall be subject to the provisions

of section 336.110.



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