HB 2897

                                 SECOND REGULAR SESSION
                    HOUSE BILL NO. 2897
                           103RD GENERAL ASSEMBLY
                           INTRODUCED BY REPRESENTATIVE FARNAN.
 6557H.01I  JOSEPH ENGLER, Chief Clerk
                                            AN ACT
 To repeal section 336.010, RSMo, and to enact in lieu thereof two new sections relating to the
        practice of optometry.
 Be it enacted by the General Assembly of the state of Missouri, as follows:
         Section A. Section 336.010, RSMo, is repealed and two new sections enacted in lieu
2 thereof, to be known as sections 336.010 and 336.023, to read as follows:
         336.010. 1. The "practice of optometry" is the examination, diagnosis, [treatment,
2 and preventative care] prevention, and treatment, surgical or nonsurgical, of the eye,
3 adnexa, and vision. The practice includes, but is not limited to:
4(1) The examination of the eye, adnexa, and vision to determine the accommodative
5 and refractive states, visual perception, conditions, and diseases;
6(2) The diagnosis and treatment of conditions or diseases of the eye, adnexa, and
7 vision;
8(3) The performance of diagnostic procedures and ordering of laboratory and imaging
9 tests for the diagnosis of vision and conditions and diseases of the eye and adnexa;
10(4) The prescription and administration of pharmaceutical agents[, excluding
11 injectable agents,] for the purpose of examination, diagnosis, and treatment of vision and
12 conditions or diseases of the eye and adnexa;
13(5) The removal of superficial foreign bodies from the eye or adnexa;
14(6) The removal of nonperforating foreign bodies from the cornea, conjunctiva,
15 or eyelids;
16(7) The removal of eyelashes;
17(8) The scraping of the cornea for diagnostic tests, smears, or cultures;
 EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
 intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.
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18(9) The dilation, probing, irrigation, or closure of the tear drainage structure of
19 the eye;
20(10) The expression of conjunctival follicles or cysts;
21(11) The debridement of the corneal epithelium;
22(12) The incision and curettage of a chalazion;
23(13) The removal and biopsy of skin lesions without known malignancy;
24(14) Laser capsulotomy;
25(15) Laser trabeculoplasty;
26(16) Laser peripheral iridotomy;
27(17) Notwithstanding the provisions of any other law to the contrary, including
28 section 334.010, the performance of additional procedures that are not excluded under
29 subsection 2 of this section and that are within the scope of a licensed optometrist's
30 education and training for the treatment of any insufficiencies or abnormal conditions
31 of the human eye and its adnexa as authorized under rules adopted by the board;
32(18) The employment of objective or subjective mechanical means to determine the
33 accommodative or refractive states of the human eye;
34[(7)] (19) The prescription or adaptation of lenses, prisms, devices, or ocular
35 exercises to correct defects or abnormal conditions of the human eye or vision or to adjust the
36 human eye to special conditions;
37[(8)] (20) The prescription and fitting of ophthalmic or contact lenses and devices;
38[(9)] (21) The prescription and administration of vision therapy; and
39[(10)] (22) The prescription and administration of low vision care.
402. The board shall continue to review surgical procedures not listed in this
41 subsection but that shall be excluded from the scope of the practice of optometry. The
42 following procedures are not within the scope of optometry and an optometrist [may]
43 shall not perform [surgery, including the use of lasers for treatment of any disease or
44 condition or for the correction of refractive error] such procedures, except for the
45 preoperative and postoperative care of these procedures:
46(1) Retina laser procedures, laser-assisted in situ keratomileusis (LASIK), and
47 photorefractive keratectomy (PRK);
48(2) Nonlaser surgery related to removal of the eye from a living human being;
49(3) Nonlaser surgery requiring full-thickness incision or excision of the cornea or
50 sclera other than paracentesis in an emergency situation requiring immediate reduction
51 of the pressure inside the eye;
52(4) Penetrating keratoplasty (corneal transplant) or lamellar keratoplasty;
53(5) Nonlaser surgery requiring incision of the iris and ciliary body, including iris
54 diathermy or cryotherapy;
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55(6) Nonlaser surgery requiring incision of the vitreous;
56(7) Nonlaser surgery requiring incision of the retina;
57(8) Nonlaser surgical extraction of the crystalline lens;
58(9) Nonlaser surgical intraocular implants;
59(10) Incisional or excisional nonlaser surgery of the extraocular muscles;
60(11) Nonlaser surgery of the eyelid for eyelid malignancies or for incisional
61 cosmetic or mechanical repair of blepharochalasis, ptosis, and tarsorrhaphy;
62(12) Nonlaser surgery of the bony orbit, including orbital implants;
63(13) Incisional or excisional nonlaser surgery of the lacrimal system other than
64 lacrimal probing or related procedures;
65(14) Nonlaser surgery requiring full-thickness conjunctivoplasty with graft or
66 flap;
67(15) Any nonlaser surgical procedure that does not provide for the correction
68 and relief of ocular abnormalities;
69(16) Laser or nonlaser injection into the posterior chamber of the eye to treat
70 any macular or retinal disease; and
71(17) The administration of general anesthesia.
723. As used in this chapter, except as the context may otherwise require, the following
73 terms mean:
74(1) "Eye", the human eye;
75(2) "Adnexa", all structures adjacent to the eye and the conjunctiva, lids, lashes, and
76 lacrimal system;
77(3) "Board", the Missouri state board of optometry;
78(4) "Diagnostic pharmaceutical agents", topically applied pharmaceuticals used for
79 the purpose of conducting an examination of the eye, adnexa, and vision;
80(5) "Low vision care", the examination, treatment, and management of patients with
81 visual impairments not treatable by conventional eyewear or contact lenses and may include a
82 vision rehabilitation program to enhance remaining vision skills;
83(6) "Pharmaceutical agents", any diagnostic and therapeutic drug or combination of
84 drugs that assist the diagnosis, prevention, treatment, or mitigation of abnormal conditions or
85 symptoms of the human eye, adnexa, and vision;
86(7) "Therapeutic pharmaceutical agents", those pharmaceuticals[, excluding
87 injectable agents,] used for the treatment of conditions or diseases of the eye, adnexa, and
88 vision;
89(8) "Vision therapy", a treatment regiment to improve a patient's diagnosed visual
90 dysfunctions, prevent the development of visual problems, or enhance visual performance to
91 meet the defined needs of the patient.
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        336.023. 1. Notwithstanding section 336.010, a licensed optometrist shall not
2 administer or perform any procedures described in subdivisions (6) to (16) of subsection
3 1 of section 336.010 that require injections or lasers without first successfully completing
4 a thirty-two-hour certification program that includes both didactic and clinical or
5 laboratory experiences approved by the board and presented by a college or school of
6 optometry.
72. Any licensed optometrist who graduated from an accredited college or school
8 of optometry after July 1, 2020, shall be exempt from the requirements of this section.
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