1. 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. 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. 3. In issuing a certificate of registration or a renewal of a certificate of registration, the state board of optometry shall:

   1. (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. (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. 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. 5. An optometrist certified in the administration of therapeutic pharmaceutical agents may:

   1. (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. (2) Perform diagnostic procedures and order laboratory and imaging tests for the diagnosis of conditions or diseases of the eye or adnexa.
6. 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. 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. 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.

(L. 1981 S.B. 91, A.L. 1986 H.B. 1333, A.L. 1993 S.B. 52, A.L. 1995 S.B. 175)