Section 7101-A. Certification to use therapeutic drugs

1. Definitions. As
  used in this section, the  following  terms  shall  have  the  following
  meanings:
    (a)  Clinical  training.  Clinical  training shall mean the diagnosis,
  treatment and management of patients with ocular disease  and  shall  be
  comparable  to  that  acquired  by  a  current  graduate  of  the  State
  University College of Optometry.
    (b) Consultation.  Consultation  shall  mean  a  confirmation  of  the
  diagnosis, a plan of co-management of the patient, and a periodic review
  of the patient's progress.
    (c)  Education review committee. Education review committee shall mean
  the committee established pursuant to subdivision nine of this section.
    (d) Diagnostic pharmaceuticals. Diagnostic pharmaceuticals shall  mean
  those  drugs  which  shall  be  limited  to  topical applications to the
  surface of the eye for the purpose of diagnostic examination of the  eye
  and shall be limited to:
    (i) Anesthetic agents;
    (ii) Mydriatics;
    (iii) Cycloplegics;
    (iv) Miotics;
    (v)  Disclosing  agents  and other substances used in conjunction with
  these drugs as part of a diagnostic procedure.
    (e)  Phase  one   therapeutic   pharmaceutical   agents.   Phase   one
  pharmaceutical  agents  shall mean those drugs which shall be limited to
  topical application to the surface of the eye for  therapeutic  purposes
  and shall be limited to:
    (i) antibiotic/antimicrobials;
    (ii) decongestants/anti-allergenics;
    (iii) non-steroidal anti-inflammatory agents;
    (iv) steroidal anti-inflammatory agents;
    (v) antiviral agents;
    (vi) hyperosmotic/hypertonic agents;
    (vii) cycloplegics;
    (viii) artificial tears and lubricants.
    (f)   Phase   two   therapeutic   pharmaceutical   agents.  Phase  two
  pharmaceutical agents shall mean those drugs which shall be  limited  to
  topical application to the surface of the eye and shall be limited to:
    (i) beta blockers;
    (ii) alpha agonists;
    (iii) direct acting cholinergic agents.
    2.  Standard  of care. An optometrist authorized to use pharmaceutical
  agents for use in the  diagnosis,  treatment  or  prevention  of  ocular
  disease  shall be held to the same standard of care in diagnosis, use of
  such agents, and treatment as  that  degree  of  skill  and  proficiency
  commonly exercised by a physician in the same community.
    3.  Certificate. The commissioner shall issue appropriate certificates
  to  use  therapeutic  pharmaceutical  agents  in  accordance  with   the
  provisions of this section to those optometrists who have satisfactorily
  completed  a  curriculum in general and ocular pharmacology at a college
  of optometry with didactic and supervised clinical programs approved  by
  the department are eligible to apply for the certificate issued pursuant
  to this section.
    4.  Phase  one  therapeutic pharmaceutical agents. (a) Before using or
  prescribing  phase   one   therapeutic   pharmaceutical   agents,   each
  optometrist  shall  have  completed  at  least  three  hundred  hours of
  clinical training in the diagnosis, treatment and management of patients
  with ocular disease other than glaucoma  and  ocular  hypertension,  not
  fewer  than twenty-five hours of such training shall have been completed

  subsequent  to  June  thirtieth,  nineteen  hundred   ninety-three   and
  additionally  shall  either  have  taken  and  successfully  passed  the
  treatment and management of ocular  diseases  portion  of  the  National
  Board  of  Examiners  in  Optometry  test or have taken and successfully
  passed an examination acceptable to the board.
    (b) Before using or prescribing phase two  therapeutic  pharmaceutical
  agents,  an  optometrist  must be certified for diagnostic and phase one
  therapeutic agents and have completed an additional one hundred hours of
  clinical training in the diagnosis, treatment and management of patients
  with glaucoma and ocular hypertension, not fewer than twenty-five  hours
  of  such  training  shall  have been completed subsequent to July first,
  nineteen hundred ninety-four, and  shall  have  taken  and  successfully
  passed an oral or written examination acceptable by the board.
    (c)  The  clinical  training  required  by  this section may have been
  acquired prior to the enactment of this section  not  inconsistent  with
  paragraphs (a) and (b) of this subdivision. Approval of the pre-acquired
  clinical training shall be in accordance with subdivision nine-a of this
  section.
    (d) The provisions of paragraphs (a) and (b) of this subdivision shall
  not  apply  to  (i)  graduates of an appropriate program approved by the
  department who have successfully passed the examination on  the  use  of
  diagnostic and therapeutic drugs and who graduated subsequent to January
  first, nineteen hundred ninety-three; or (ii) optometrists who have been
  certified  for  at least five years to use phase one and phase two drugs
  in another jurisdiction, have demonstrated  such  use  in  independently
  managed  patients,  and  have  been  licensed in accordance with section
  seventy-one  hundred  four  of  this  chapter.  Provided,  however,   no
  optometrist  exempt under this paragraph shall be permitted to use phase
  one  therapeutic  pharmaceutical  agents  or   phase   two   therapeutic
  pharmaceutical  agents  prior  to  the general authorization provided to
  optometrists licensed in this state.
    5. Suspension of  certification.  The  department  shall  suspend  the
  certification  for  the  use  and  prescribing  of phase one therapeutic
  agents of any optometrist who fails to receive certification  for  phase
  two  therapeutic pharmaceutical agents within three years of having been
  certified for phase one therapeutic pharmaceutical agents.
    6. Consultation. (a) After the initial diagnosis of glaucoma or ocular
  hypertension  and  before  initiating  treatment  of  any  patient,   an
  optometrist  shall  engage  in  a  written  consultation with a licensed
  physician specializing in diseases of the eye.
    (b) A consultation shall be required for a period of  three  years  or
  until  the  optometrist has examined and diagnosed seventy-five patients
  having glaucoma or ocular  hypertension  which  examinations  require  a
  written   consultation   in   accordance  with  paragraph  (a)  of  this
  subdivision, whichever occurs later.
    (c) The consultation provisions shall not apply to a  graduate  of  an
  appropriate  program  approved by the department who successfully passed
  an examination in the use of diagnostic and  therapeutic  pharmaceutical
  agents  approved  by the department and graduated such school subsequent
  to January first, nineteen hundred ninety-nine and who has had at  least
  seventy-five  documented  examinations  and  diagnosis  of patients with
  glaucoma or ocular hypertension which examinations were  part  of  their
  training and were under physician supervision.
    7.  Continuing  education. Each optometrist certified to use phase one
  or phase two therapeutic pharmaceutical agents shall complete a  minimum
  of  thirty-six  hours of continuing education per triennial registration
  period. The education shall  be  in  the  area  of  ocular  disease  and
  pharmacology and may include both didactic and clinical components. Such

  educational  programs shall be approved in advance by the department and
  evidence of the completion of this requirement shall be  submitted  with
  each  application  for license renewal as required by section sixty-five
  hundred two of this chapter.
    8.  Notice  to patient. (a) (i) An optometrist prescribing steroids or
  antiviral medication shall inform each patient that  in  the  event  the
  condition  does  not  improve  within  five  days,  a  physician  of the
  patient's choice will be notified.
    (ii)  An  optometrist  engaged  in  a  written  consultation  with  an
  ophthalmologist  shall inform a patient diagnosed with glaucoma that the
  optometrist will have the diagnosis confirmed  and  co-managed  with  an
  ophthalmologist  of  the  patient's  choice,  or  one  selected  by  the
  optometrist.
    (b) In addition, each  optometrist  certified  to  prescribe  and  use
  therapeutic   drugs  shall  have  posted  conspicuously  in  the  office
  reception area the following notice:
    "Dr. (Name), O.D. is certified by New  York  State  to  use  drugs  to
  diagnose  and  treat  diseases  of  the eye. In the event your condition
  requires the use of steroids or antiviral medication and your  condition
  does  not  improve  within five days, a physician of your choice will be
  notified.
    In the event you are diagnosed with  glaucoma,  the  optometrist  will
  have   your   diagnosis  confirmed  and  treatment  co-managed  with  an
  ophthalmologist (MD) of your choice, or if you wish, one selected by Dr.
  (Name)."
    The second paragraph of such notice  shall  only  be  required  to  be
  included  during the period when the optometrist is engaged in a written
  consultation pursuant to subdivision six of this section.
    9. Education review committee. An education review committee is hereby
  created to advise and assist the commissioner in evaluating pre-acquired
  clinical training. The members of the committee shall  be  appointed  by
  the  commissioner  in  consultation  with  the  chancellor  of the state
  university of New York. The committee shall consist of five members, two
  of whom shall be optometrists on the faculty  of  the  SUNY  college  of
  optometry,  two  of  whom  shall be ophthalmologists who, in addition to
  being members of the faculty of any  approved  medical  school  in  this
  state  and  not  also faculty members of SUNY college of optometry, have
  surgical privileges at a New York state hospital. The fifth  member  who
  shall  be  designated as chair shall be an expert in the field of public
  health and shall be neither an ophthalmologist nor an optometrist.
    The commissioner shall submit each application to  the  committee  for
  its  review  and  recommendation.  In  making  such  recommendation, the
  committee shall advise  as  to  the  number  of  hours  of  pre-acquired
  clinical  training,  if  any, to be approved, based upon the information
  submitted  with  the  application.  In  evaluating  such  training,  the
  committee  shall  be  authorized  to  require  the  submission  of  such
  reasonable documentation needed to facilitate the committee's review  of
  the adequacy and relevance of such training.
    9-a.  Pre-acquired  clinical training. (a) Each optometrist requesting
  approval of  pre-acquired  clinical  training  shall  submit  a  written
  application  to  the  department. The commissioner, in consultation with
  the education review committee may provide credit for the following:
    (i) clinical training acquired  at  an  institution  accredited  by  a
  regional  or professional accreditation organization which is recognized
  or approved by the United States Department of Education, the department
  and the Board of Regents of the University of the state of New York;
    (ii) clinical training acquired at a facility licensed by the state of
  New York in accordance with article twenty-eight of  the  public  health

  law  or  at  a  comparable  facility located in another state or country
  provided the licensing requirements  or  accreditation  requirements  of
  such institution are comparable to those of New York state;
    (iii)  hospital  affiliations, including rounds and patient management
  for applicants having staff privileges at such facility;
    (iv) consultation and co-management with ophthalmologists of  patients
  with ocular disease and post-surgery recovery;
    (v) postdoctoral accredited residency or fellowship programs;
    (vi)  experience at an accredited educational institution as a faculty
  instructor  in  clinical  practice,  ocular   disease   management   and
  pharmacology;
    (vii)  experience  in  other  states  in  which the applicant has been
  certified to use therapeutic pharmaceutical agents.
    (b)  Any  optometrist  disagreeing  with  the  recommendation  of  the
  education  review  committee  shall have a right to appeal in writing to
  the commissioner. The decision of the commissioner shall  be  final  and
  binding on all parties.
    10.  Pharmaceutical  agents.  Optometrists  who have been approved and
  certified by the department shall be  permitted  to  use  the  following
  drugs:
    (a) Diagnostic pharmaceuticals.
    (b) Those optometrists having been certified for phase one therapeutic
  pharmaceutical  agents  shall be authorized (i) to use and recommend all
  nonprescription  medications  appropriate  for  ocular  disease  whether
  intended  for  topical  or  oral  use; and (ii) to use and prescribe all
  phase one therapeutic pharmaceutical agents which are FDA  approved  and
  commercially available.
    In the event an optometrist treats a patient with topical antiviral or
  steroidal  drugs  and the patient's condition either fails to improve or
  worsens within five days,  the  optometrist  shall  notify  a  physician
  designated by the patient or, if none, by the treating optometrist.
    (c) Those optometrists having been certified for phase two therapeutic
  pharmaceutical agents shall be authorized to use and prescribe phase two
  therapeutic   pharmaceutical   agents   which   are   FDA  approved  and
  commercially available.
    11. Responsibilities of the commissioner. The commissioner shall adopt
  regulations (a) providing for  the  certification  of  graduates  of  an
  appropriate  program  approved  by  the department who have successfully
  passed  the  examination  on  the  use  of  diagnostic  and  therapeutic
  pharmaceutical  agents  and  who  have  graduated  subsequent to January
  first,  nineteen  hundred  ninety-three;  and  (b)  providing  for   the
  certification  of  optometrists who have graduated from other accredited
  colleges  of  optometry  or  who  are  licensed  to  practice  in  other
  jurisdictions,  have  demonstrated  such  use  in  independently managed
  patients and are seeking licensure and certification in New York.
    12. Responsibilities of the commissioner of health.  The  commissioner
  of  health  may  recommend to the commissioner additions or deletions to
  the department's regulations relating to optometric use of drugs  except
  that  such recommendations shall be limited only to additions which have
  been determined to be equivalent to those drugs  already  authorized  or
  deletions  based upon a finding that the drugs are no longer appropriate
  for their current use or for other similar reasons.