(a) Red eye.
(b) Painful eye.
(c) Decrease in vision.
(d) Pale or red swelling of the periocular or periorbital tissues.
(e) Nausea.
(f) Vomiting.
(g) Fainting.
(h) Mental confusion.
(i) Cessation of respiration.
Section 5. Opt 6.02 (1m) is repealed.
Section 6. Opt 6.02 (1e), (1n), and (1s) are created to read:
(1e) “Approved institution” means an institution approved by the board and accredited by a regional or professional accrediting organization which is recognized by the Council for Higher Education Accreditation or its successor or the federal department of education, in accordance with ss. 449.17 (1m) (b) and 449.18 (2) (a) 2., Stats. (1n) “Classroom hour" means a minimum of 50 minutes of lecture, group discussion, or laboratory. “Classroom hour” does not include time spent working in a clinic other than as part of a laboratory directly associated with a course in pharmacology.
(1s) “Course of study in pharmacology" means a course of study completed in an approved institution after 1973 in general and clinical pharmacology as it relates to optometry with the characteristics described in s. 449.17 (1m) (b), Stats. For a course, such as a continuing education course, that does not lead to a degree in optometry to qualify as part of a course of study in pharmacology, the course must include at least one examination on course content. Section 7. Opt 6.02 (3) is amended to read:
(3) “DPA" or “diagnostical diagnostic pharmaceutical agent" has the meaning given under s. SPS 10.01. means an agent authorized under s. SPS 10.02. Section 8. Opt 6.02 (4) is repealed.
Section 9. Opt 6.02 (6) is amended to read:
(6) “TPA" or “therapeutic pharmaceutical agent" has the meaning given under s. SPS 10.01. means an agent authorized under s. SPS 10.03. Section 10. Opt 6.025 and Opt 6.025 (Note) are created to read:
Opt 6.025 Adverse drug reaction referral plan. (1) An optometrist who wants to use diagnostic pharmaceutical agents authorized under s. SPS 10.02 or therapeutic pharmaceutical agents authorized under s. SPS 10.03 shall submit an adverse drug reaction referral plan prior to providing pharmaceutical agents. The plan shall be submitted to the department on an approved form in which the optometrist agrees to do all of the following: (a) Refer any patient who notifies the optometrist of an adverse drug reaction to appropriate medical specialists or facilities.
(b) Routinely advise all patients to immediately contact the optometrist if the patient experiences adverse reactions.
(c) Place in a patient's permanent record information describing any adverse drug reactions experienced by the patient and the date and time that any referral was made.
(2) The plan shall include the names of at least 3 physicians, physician clinics, or hospitals to whom the optometrist agrees to refer patients who experience an adverse drug reaction. At least one of these physicians shall be skilled in the diagnosis and treatment of diseases of the eye.
(3) An optometrist authorized to use diagnostic or therapeutic pharmaceutical agents shall file a revised adverse drug reaction referral plan with the department within 10 working days after the optometrist designates a new physician, physician clinic, or hospital to which the optometrist agrees to refer patients who experience adverse drug reactions.
(4) An optometrist authorized to use therapeutic pharmaceutical agents shall file with the department within 10 working days of its occurrence a report on any adverse drug reaction resulting from the optometrist's administration of the agents. This report shall include all of the following:
(a) The optometrist's name, address, and license number.
(b) The patient's name, address, and age.
(c) The patient's presenting problem, the diagnosis, the agent administered and the method of administration, the reaction, and the subsequent action taken.
Note: The TPA Adverse Reaction Report (Form #1728) and DPA/TPA Certification Application are available on the department’s website at dsps.wi.gov, or by request from the Department of Safety and Professional Services, P.O. Box 8935, Madison, Wisconsin 53708, or call (608) 266-2112.
Section 11. Opt 6.03 and Opt 6.04 are repealed and recreated to read:
Opt 6.03. Certificate to use diagnostic pharmaceutical agents. (1) A licensed optometrist who has submitted an adverse drug reaction referral plan in accordance with s. Opt 6.025 is authorized to use diagnostic pharmaceutical agents if any of the following applies: (a) The board initially issued a license to practice optometry to the optometrist on or after August 1, 2006.
(b) The department issued a certificate to the optometrist under s. 449.17, 2003 Stats. (c) The board issued a certificate under sub. (2) to an optometrist issued a license to practice optometry before August 1, 2006.
(2) An optometrist licensed prior to August 1, 2006 shall be certified by the board to use diagnostic pharmaceutical agents if all of the following are completed:
(a) The optometrist submits an application to the department.
(b) The optometrist submits satisfactory evidence of 60 classroom hours of a course of study that is in accordance with sub. (3) and that was completed prior to entering the examination required in par. (c).
(c) The optometrist submits satisfactory evidence of passing one of the following:
1. Section 9, ocular pharmacology, National Board of Examiners in Optometry administered only after 1981.
2. Parts I and II, National Board of Examiners in Optometry administered only after 1986.
3. An exam administered as part of the course of study under par. (b) that, as determined by the board, satisfactorily assesses competency in the subject matter described in sub. (3). The board may require additional evidence to approve the exam.
(3) A satisfactory course of study under par. (2) (b) at an approved institution shall include at least 30 classroom hours of a course of study in pharmacology and emphasizes the systemic effects of and reactions to pharmaceutical agents, including the treatment of any adverse reactions that may occur, in accordance with s. 449.17 (1m) (b), Stats. Opt 6.04. Certificate to use therapeutic pharmaceutical agents and remove foreign bodies from eyes. (1) A licensed optometrist who has submitted an adverse drug reaction referral plan in accordance with s. Opt 6.025 is authorized to use therapeutic pharmaceutical agents and remove foreign bodies from an eye or from an appendage to the eye if any of the following applies: (a) The board initially issued a license to practice optometry to the optometrist on or after August 1, 2006.
(b) The board issued a certificate to the optometrist under s. 449.18, 2003 Stats. (c) The board issued a certificate under sub. (2) to an optometrist issued a license to practice optometry before August 1, 2006.
(2) An optometrist licensed prior to August 1, 2006 shall be certified by the board to use therapeutic pharmaceutical agents under this section if all of the following are completed:
(a) The optometrist has a certificate to use diagnostic pharmaceutical agents in accordance with s. Opt 6.03. (b) The optometrist submits an application to the department.
(c) The optometrist has completed all of the following:
1. One hundred classroom hours of post doctorate study in the use of therapeutic pharmaceutical agents and the removal of superficial foreign bodies from an eye or from an appendage to the eye, on or after January 1, 1987 at an approved institution and achieved a minimum passing score.
2. Passed one of the following approved examinations:
a. An exam administered as part of the course of study under subd. 1. that, as determined by the board, satisfactorily assesses competency. The board may require additional evidence to approve the exam.
b. The Treatment and Management of Ocular Disease, TMOD®, National Board of Examiners in Optometry exam administered after 1985 with a minimum passing score as determined by the board in accordance with s. Opt 3.07. (3) An optometrist authorized under this section may not remove a foreign body from an eye or from an appendage to an eye if the foreign body is deeper than Bowman's layer of the cornea or deeper than the conjunctiva, in accordance with s. 449.18 (5), Stats. Section 12. Opt 6.05 is created to read:
Opt 6.05. Prescribing therapeutic pharmaceutical agents. (1) Therapeutic pharmaceutical agents may be prescribed or administered by an optometrist only for the ocular therapeutic purposes for which the drugs are intended. These drugs shall be prescribed or administered in accordance with minimum standards and procedures established in the optometric profession. An optometrist may not prescribe or administer a therapeutic pharmaceutical agent which is not authorized under s. SPS 10.03. Approved agents may be used in combination only with other approved agents when appropriate. (2) Prior to prescribing beta blockers or carbonic anhydrase inhibitors for the treatment of glaucoma, any oral antiviral, or any other therapeutic pharmaceutical agent under s. SPS 10.03 that may have significant systemic adverse drug reactions, the optometrist shall inform the patient's primary physician of the treatment plan and document that contact on the patient's chart. If the patient does not identify a primary physician, the patient shall be referred to a physician to determine the presence or absence of any systemic contraindications to the intended therapeutic agent. Following that assessment, and prior to prescribing, the prescribing optometrist shall contact the examining physician, documenting that contact on the patient's chart. (3) Closed-angle glaucoma shall be considered an emergency in which the treating optometrist shall make immediate referral directly to a physician who specializes in the treatment of diseases of the eye and shall institute any emergency procedures as are directed by that physician.
Section 13. EFFECTIVE DATE. The rules adopted in this order shall take effect on the first day of the month following publication in the Wisconsin Administrative Register, pursuant to s. 227.22 (2) (intro.), Stats. ------------------------------------------------------------------------------------------------------------
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