PURPOSE: This rule sets out the requirements and procedures for the certification of optometrists to use pharmaceutical agents.

1. (1) No optometrist licensed in this state may use pharmaceutical agents in the practice of optometry unless that optometrist has been certified by the board as qualified to use those pharmaceutical agents in the practice of optometry.
2. (2) All applications for pharmaceutical certification must be made on forms provided by the board and must be accompanied by the pharmaceutical certification fee. The application must be accompanied by proof that the applicant has passed an examination approved by the board.

3. (3) The board will certify optometrists currently licensed in this state as qualified to use pharmaceutical agents in the practice of optometry in accordance with the following guidelines:

   1. (A) All applicants for certification must present official documentation and/or transcripts showing successful completion of at least one hundred (100) 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. The board cannot approve any credit hours unless they were taught by an institution having facilities for both the didactic and clinical instruction in pharmacology, which is approved by the board and which is accredited by a regional or professional accrediting organization which is recognized by the Council on Postsecondary Accredita tion or the United States Department of Edu cation or its successors; and
   2. (B) All applicants for certification must pass a written examination in pharmacology administered or approved by the board.
4. (4) The board may not accept any documentation required by subsection (3)(A) of this rule unless the course of studies it reflects is certified by the institution as being comparable in content to those courses in general and ocular pharmacology required by other licensing boards whose licensees or registrants are permitted the use of pharmaceutical agents in the course of their professional practice.
5. (5) Applicants certified to use pharmaceutical agents in another state whose requirements for certification are substantially equivalent as those required in this state may be granted a certification to use pharmaceutical agents in Missouri without examination.

6. (6) Use of oral analgesic agents shall be limited to those specific uses as follows:

   1. (A) Prior to the administration of oral analgesic therapy, a complete and careful history of current medications and past drug allergies and sensitivities must be documented in the record, with particular attention to interaction of analgesics with other systemic medications. Optometrists using these agents must be thoroughly familiar with the interactions of these drugs with other systemic medications;
   2. (B) Prescription strength oral analgesic agents and particularly controlled substances are rarely required for the relief of pain in ocular conditions. Therefore, they may be used only for pain of which the etiology can be clearly demonstrated and in which, in the judgment of the optometrist, sufficient relief would not be obtained with noncontrolled substances;
   3. (C) Ocular pain may not be treated with controlled substances over forty-eight (48) hours without referral or consultation with a physician skilled in the treatment of the eye unless marked improvement in the underlying condition can be demonstrated;
   4. (D) When prescribing oral analgesic agents which are categorized as controlled substances, only scheduled oral agents that have been shown to be effective for ocular pain may be prescribed;
   5. (E) Prescriptions for controlled substances may not exceed in number the recommended analgesic dosage for the duration of the prescription;
   6. (F) Prescriptions for controlled substances may not be refilled without further examination and follow-up care; and
   7. (G) Optometrists may not maintain inventories of controlled substances for dispensing or administering.

AUTHORITY: sections 336.160 and 336.200, RSMo 2000.* This rule originally filed as 4 CSR 210-2.080. Original rule filed Oct. 14, 1981, effective Jan. 14, 1982. Amended: Filed March 14, 1982, effective June 11, 1982. Amended: Filed Aug. 4, 1986, effective Nov. 13, 1986. Amended: Filed Nov. 15, 1989, effective March 11, 1990. Amended: Filed Aug. 15, 1991, effective Jan. 13, 1992. Amended: Filed Oct. 15, 1996, effective April 30, 1997. Amended: Filed March 15, 2004, effective Sept. 30, 2004. Moved to 20 CSR 2210-2.080, effective Aug. 28, 2006. *Original authority: 336.160, RSMo 1939, amended 1947, 1963, 1981 and 336.200, RSMo 1939, amended 1981.