216-RICR-40-05-20
216-RICR-40-05-20. Optometrists (version Periodic Refile, 01/02/2002 to 04/17/2003)
RULES AND REGULATIONS
PERTAINING TO OPTOMETRISTS
(R5-35-OPT)
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Health
January 1964
As Amended:
January 1974
December 1989
January 1983
February 1990
June 1987
May 1992
June 1987 (E)
September 1993
October 1987 (E)
November 1993
January 1988 (E)
February 1997
March 1988
August 1999
November 2001
January
2002
(re-filing
in
accordance with the provisions
of section 42-35-4.1 of the
Rhode Island General Laws, as
amended)
i
INTRODUCTION
These Rules and Regulations Pertaining to Optometrists (R5-35-OPT) are promulgated pursuant to
the authority conferred under sections 5-35-5 and 5-35-1.1 of the General Laws of Rhode Island, as
amended, and are established for the purpose of adopting minimum standards for the certification of
optometrists in Rhode Island.
In accordance with the provisions of section 42-35-3 (c) of the General Laws of Rhode Island, as
amended, consideration was given in arriving at the amendments as to: (1) alternative approaches to the
regulations; (2) duplication or overlap with other state regulations; and (3) any significant economic impact on
small business as defined in Chapter 42-35 of the General Laws as a result of the amended regulations. Based
on the available information, no known alternative approach, duplication or overlap or significant economic
impact was identified.
These rules and regulations shall supersede any previous Rules and Regulations Pertaining to
Optometrists promulgated by the Department of Health and filed with the Secretary of State.
ii
TABLE OF CONTENTS
Page
PART I
Definitions
1
1.0
Definitions
PART II
Licensure And Certification Requirements/ Optometrists
3
2.0
License and Certification Requirements
3
3.0
Qualifications for Licensure and Certification
3
4.0
Application/Fee
6
5.0
Examinations
8
6.0
Internship
9
7.0
Continuing Education
11
8.0
Issuance and Renewal of License and Certification
12
9.0
Practice of Optometry
13
10.0
Denial, Suspension and Revocation of License and Certification
16
PART III
Advertising, Sanctions, Practices And Procedures, Severability
17
11.0
Advertising
17
12.0
Sanctions/Violations
17
13.0
Practices and Procedures
17
14.0
Severability
17
APPENDIX I
18
APPENDIX II
20
APPENDIX III
21
APPENDIX IV
24
APPENDIX V
25
1
PART I DEFINITIONS
Section 1.0 Definitions
Wherever used in these rules and regulations, the following terms shall be construed to mean:
1.1
"Act" refers to Chapter 5-35 of the General Laws of Rhode Island, as amended, entitled
"Optometrists."
1.2
"Advisory Committee for Opticianry" refers to the Board established pursuant to section 5-35-2.1
of the Act to advise the Director, the Administrator of the Division and the Board of Examiners in
Optometry on all matters pertaining to the licensing and regulation of opticianry in this state.
1.3
"Amplified practice" means an optometrist licensed in this state to practice optometry and authorized
by the Board to administer and prescribe all topical pharmaceutical agents in the treatment of
conditions of the human eye and its appendages, including anterior uveitis and glaucoma, without
surgery or other invasive techniques, and in accordance with the requirements herein.
1.4
"Board" refers to the Board of Examiners for Optometry established under the provision of section
5-35-2 of the Act.
1.5
"Certified optometrist" means an optometrist licensed in this state to practice optometry and
authorized by the Board to administer and prescribe topical ocular pharmaceutical agents in the treat-
ment of ocular conditions of the anterior segment of the human eye and its appendages, (with the
exception of uveitis and glaucoma) without surgery or other invasive techniques and in accordance with
the requirements herein.
1.6
"Direct supervision" means that the preceptor provides one-to-one oversight of the intern at all
times.
1.7
"Director" refers to the Director, Rhode Island Department of Health.
1.8
"Division" refers to the Division of Professional Regulation, Rhode Island Department of Health.
1.9
"Optometrist" means an individual licensed in this state to practice optometry pursuant to the provisi-
ons of Chapter 5-35 of the General Laws and the rules and regulations herein.
1.10 “Optometry” means the profession whose practitioners are engaged in the art and science of the
evaluation of vision and the examination of vision and the examination and refraction of the human eye
which includes: the employment of any objective or subjective means for the examination of the human
eye or its appendages; the measurement of the powers or range of human vision or the determination of
the accommodative and refractive powers of the human eye or the scope of its functions in general and
the adaptation of lenses, prisms, and/or frames for the aid thereof; the prescribing, directing the use of or
administering ocular exercises, visual training, vision training, or orthoptics, and the use of any optical
2
device in connection therewith; the prescribing of contact lenses for, or the fitting or adaptation of
contact lenses to the human eye; the examination or diagnosis of the human eye to ascertain the
presence of abnormal conditions or functions; and the topical application of drugs to the eye, to wit,
mydriatics, miotics, and the use of topical anesthetics, provided, however, that no optometrist licensed
in this state shall treat by the use of these drugs or attempt to perform any surgery and shall be used only
for the purpose of detecting any diseased or pathological condition of the eye, or the effects of any
disease or pathological condition of the eye, further provided however, that with respect to presently
licensed optometrists, only presently licensed optometrists who: (1) have satisfactorily completed a
course in pharmacology, as it applies to optometry, at an institution accredited by a regional or
professional accreditation organization which is recognized by the national commission on accreditation,
with particular emphasis on the topical application of drugs to the eye for the purposes of detecting any
diseased or pathological condition of the eye; or the effects of any disease or pathological condition of
the eye, approved by the Board of Examiners in Optometry and the Chief of Pharmacy of the
Department; and (2) have successfully completed an examination given by the Board in conjunction with
the Chief of Pharmacy of the Department, shall be permitted to apply drugs topically to the eye for the
purpose of detecting any diseased or pathological condition of the eye, or the effects of any disease or
pathological condition of the eye. The Chief of Pharmacy shall consult and advise the Board with
respect to that portion of the examination dealing with pharmacology.
1.11
“Vision training”, as referenced in section 1.10 herein, includes:
a)
“vision therapy” means the assessment, diagnosis, treatment, or prescription of treatment for
conditions of the visual system or management of a patient with vision therapy, visual training,
visual rehabilitation, orthopics or eye exercises. Anyone who holds him/herself out as being
able to do so for the rehabilitation and/or treatment of physical, physiological, sensorimotor,
neuromuscular or perceptual anomalies of the eyes or vision system or who prescribes or
utilizes lenses, prisms, filters, occlusion, or other devices for the enhancement, rehabilitation
and/or treatment of the visual system or prevention of visual dysfunctions, except under the
supervision and management of a licensed optometrist, is engaged in the practice of optometry.
b)
“Low vision rehabilitation” means the evaluation, diagnosis, and management of the low
vision patient, including but not limited to, prescription, low vision rehabilitation therapy,
education and interdisciplinary consultation when indicated. Any person who prescribes or
provides comprehensive low vision care for the rehabilitation and/or treatment of the visually
impaired or legally blind patient, prescribes corrective spectacles, contact lenses, prisms, or
filters, employs any means for the adaptation of lenses, low vision devices, prisms, filters,
evaluates the need for, recommends, or prescribes optical, electronic or other low vision
devices; or recommends or provides low vision rehabilitation services independent of a clinical
treatment plan prescribed by an optometrist or ophthalmologist shall be considered to be
engaged in the practice of optometry.
3
PART II LICENSURE AND CERTIFICATION REQUIREMENTS FOR OPTOMETRISTS
Section 2.0 Licensure and Certification Requirements
2.1
Any person practicing or offering to practice optometry in this state must be licensed as an optometrist
in Rhode Island in accordance with the statutory and regulatory requirements herein.
2.1.1 Furthermore, optometrists licensed in this state who desire to administer and prescribe topical
pharmaceutical agents in the treatment of ocular conditions of the human eye and its
appendages, without the use of surgery or other invasive techniques, must be certified by the
Board in accordance with the requirements herein. Provided, however, that as of March 20,
1997, individuals who are licensed and certified to prescribe certain topical therapeutic
pharmaceutical agents may continue to prescribe said medications in accordance with that
certification; and those individuals who hold diagnostic pharmaceutical privileges as of March
20, 1997, may continue to exercise those privileges.
Section 3.0 Qualifications For Licensure and Certification
Basic Licensure Requirements
3.1
An applicant seeking licensure to practice optometry in this state must:
a)
be of good moral character;
b)
be not less than eighteen (18) years of age;
c)
have attended at least two (2) years of an undergraduate college and have graduated from a
school or college of optometry which maintains a course in optometry of no less than four (4)
years and approved by the Division;
d)
have successfully passed all sections of the National Board Examination;
e)
have successfully completed a full-time internship in optometry for a period of six (6) months
under the supervision of a (registered) licensed optometrist or duly licensed doctor of medicine
practicing ophthalmology; and
f)
have successfully passed a clinical competency examination for licensure approved by the
Board.
g)
Candidates seeking initial licensure in Rhode Island must be certified in the use of therapeutic
pharmaceuticals in accordance with the requirements of section 5-35-1.2 of the General Laws,
and section 3.2 of these regulations.
4
Therapeutic Pharmaceutical Certification Requirements: Level One (Required of all Applicants)
3.2
Candidates seeking initial licensure in Rhode Island and any applicant who is already licensed in this
state as an optometrist who is not yet certified to administer and prescribe topical therapeutic
pharmaceutical agents in the treatment of conditions of the human eye and its appendages who seeks
certification in this state to use topical therapeutic pharmaceutical agents in the diagnosis and treatment
of conditions of the human eye and its appendages without the use of surgery or other invasive
techniques must meet or have previously met the following requirements:
a)
have graduated from an accredited College of Optometry;
b)
have successfully completed the prerequisite academic courses as set forth in Appendix II;
or if graduated from an accredited College of Optometry before January 1, 1988:
have successfully completed a post-graduate course of no less than ninety-six (96) hours of
approved didactic instruction in accordance with the provisions of Appendix III herein; and
c)
have successfully completed seventy-two (72) hours of clinical therapeutic training with a
board-certified ophthalmologist and in accordance with the provisions of Appendix IV herein.
Such clinical therapeutic training shall consist of seventy-two (72) hours of no less than a three
(3) month time period, which shall be in addition to the six hundred (600) hours of no less than
a six (6) month Internship Program as set forth in Appendix I. These preceptorships may be
done concurrently.
d)
have satisfactorily passed the International Association of Boards of Optometry examination in
"The Treatment and Management of Ocular Disease" approved by the Director; and
e)
have satisfactorily passed a clinical examination as approved by the Board.
Therapeutic Pharmaceutical Certification Requirements: Level Two: Certification Requirements
Related to Amplification of Privileges to Treat Glaucoma and Certification/Educational
Requirements Related to Amplification of Privileges to Treat Anterior Uveitis
3.3
On and after July 1, 2000 all applicants for initial licensure or any licensed applicant who seek
certification to use all topical pharmaceuticals used in the treatment of conditions of the human eye and
its appendages including, but not limited to, the removal of superficial foreign bodies from the eye and
the treatment of the diseases of anterior uveitis and glaucoma, without the use of surgery or other
invasive techniques, must, in addition to the requirements set forth in section 3.2 (above), complete the
following requirements:
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a)
complete a transcript quality course of study, which shall include, but not be limited to, the
appropriate use of all such topical pharmaceuticals to be administered and prescribed by duly
licensed optometrists. The Director of Health may direct the Board of Examiners in
Optometry to provide for an accredited school or college of optometry to administer this
course of study or such other training as acceptable to the Board which shall include the
following:
i)
A minimum of twenty-four (24) hours of classroom study comprised of no less than
fourteen (14) hours of study on the advanced diagnosis and treatment of glaucoma, to
include the pharmacology of such treatment. The course shall also include no less than
ten (10) hours relating to additional conditions of amplified practice which shall
include: two (2) hours on the treatment of anterior uveitis; one (1) hour on cortico-
steroids and anti-inflammatory medications; two and one-half (2 ½) hours on anti-viral
and anti-fungal agents and protozoal parasites; one (1) hour on anti-infectives and
combination drug therapy; two (2) hours on the treatment of ocular emergencies and
one and one-half (1 ½) hours on standards of care, scope of practice and risk
management.
Or:
successful completion of the International Association of Boards of Optometry examination in "The
Treatment and Management of Ocular Disease" administered after January 1, 1999.
b)
Upon successful completion of the transcript quality course of study and the written
examination, or the International Association of Boards of Optometry examination in "The
Treatment and Management of Ocular Disease" administered after January 1, 1999, a duly
licensed optometrist may prescribe all such topical pharmaceuticals exclusive of those used in
the treatment of glaucoma. Prescriptive privileges for those topical pharmaceuticals used in the
treatment of glaucoma will commence upon completion of subsection 3.3(c) (below) and
acceptance of such by the Board.
Therapeutic Pharmaceutical Certification Requirements: Level Two: Certification Requirements
Related to Amplification of Privileges to Treat Glaucoma:
c)
submit a completed form for each patient (see Appendix V for suggested format) providing
evidence that the applicant has performed written consultations with an ophthalmologist which
satisfies the following requirements:
i)
The applicant has consulted with an ophthalmologist regarding no less than twenty
(20) glaucoma-related patients and the ophthalmologist has provided written
confirmation of this consultation.
ii)
Up to ten (10) of these glaucoma-related patients may have been diagnosed as
glaucoma-related up to one (1) year prior to completion of the requirements in
subsection 3.3(b) above. All twenty (20) glaucoma-related patients shall be followed
6
for a minimum of one (1) year or until the patient is stabilized (i.e., symptoms
controlled, vision loss arrested, medication changes not required) whichever is longer;
and
iii)
For each glaucoma-related patient, the applicant shall develop, in consultation with the
ophthalmologist, the following:
A)
A confirmatory evaluation and diagnosis by the ophthalmologist;
B)
A written plan for diagnostic workup for each patient. This workup shall
include the measurement of the patient's visual acuity, pupil assessment,
biomicroscopy, intraocular pressure, visual field, anterior chamber angle and
evaluation of the optic nerve; and
C)
A treatment plan for each patient which shall take into account the assessment
of the optic nerve, the level of the intraocular pressure, and stability of the
clinical course.
iv)
The methodology of consultation required in sections 3.3 (c)(i) and 3.3 (c)(ii) shall be
left to the professional discretion of the ophthalmologist and the applicant; provided,
however, the applicant may submit to the Board of Examiners in Optometry the
completed form once the patient has reached the agreed upon treatment plan
(including target pressure and compliance with medications).
3.4
Upon completion of the aforementioned requirements, the Director may certify those applicants found
to have satisfactorily met all the requirements herein.
Section 4.0 Application For License, Certification and Fees
4.1
Licensure
4.1.1 Application for licensure shall be made on forms provided by the Division, which shall be com-
pleted, notarized and submitted to the Division at least thirty (30) days before the scheduled
date of internship. Such application shall be accompanied by the following documents:
a)
a certified copy of birth certificate or proof of legal entry into the United States;
b)
three (3) letters of reference from reputable individuals (other than relatives) who have
known the applicant for at least two (2) years;
c)
a recent identification photograph of the applicant, head and shoulder front view
approximately 2 x 3 inches in size;
7
d)
a chronological resume of experience from the time of graduation from college of
optometry to the date of application;
e)
a statement from the Board of Examiners in Optometry in each state in which the ap-
plicant has held or holds licensure to be submitted to the Board of this state attesting
to the licensure status of the applicant during the time period the applicant held
licensure in said state;
f)
supporting certified transcripts of education credentials as required in section 3.1
herein signed by the dean or registrar of the school of optometry verifying the dates of
attendance and completion of program in optometry. Such documentation must
consist of original statements and/or photocopies bearing the signature of the dean or
registrar and the imprint of the school seal; and
g)
the results of the written National Board Examination submitted directly to the Board
by the National Board.
h)
the application fee of fifty dollars ($50.00) made payable to the General Treasurer,
state of Rhode Island (non-refundable).
4.1.2 Upon completion of his/her internship, the applicant shall submit the following:
a)
documented evidence of satisfactory completion of internship in optometry in
accordance with section 6.0 herein and of a clinical competency examination as
prescribed by the Board;
b)
evidence of completion requirements for certification in the use of therapeutic
pharmaceuticals as approved by the Board as set forth in section 4.2.2; and
c)
such other information as may be deemed necessary by the Division and/or the Board.
4.2
Certification in the Use of Therapeutic Pharmaceuticals
Application for certification in the use of topical therapeutic pharmaceuticals shall be made on forms
provided by the Division which shall be completed, notarized and submitted to the Division at least
thirty (30) days before the scheduled date of the Board meeting. Such application shall be accom-
panied by the documents (non-returnable) set forth below:
4.2.1 Applicants who graduated prior to 1 January 1988:
a)
a copy of current license;
8
b)
supporting certified transcripts of post-graduate training courses of study in general
and ocular therapeutic pharmacology (didactic and clinical) in accordance with the
requirements of Appendix III herein;
c)
the results of the International Association of Boards of Optometry examination in
"The Treatment and Management of Ocular Disease" as approved by the Director and
submitted directly to the Board by the organization and/or agency administering the
approved examination; and
d)
such other information as the Division and/or Board may deem necessary.
4.2.2 Applicants who graduated on or after 1 January 1988:
a)
a copy of supporting transcripts of training courses of study in general and ocular
therapeutic pharmacology;
b)
the results of the International Association of Boards of Optometry examination in
"The Treatment and Management of Ocular Disease";
c)
certified statement submitted directly to the Board by the board-certified ophthal-
mologist of the applicant's satisfactory completion of seventy-two (72) hours of no
less than a three (3) month clinical therapeutic training as set forth in section 3.2 herein;
said seventy-two (72) hours of clinical training may run concurrently with and be
credited toward any internship requirements;
d)
evidence of satisfactory completion of a clinical competency examination as approved
by the Board; and
e)
such other information as the Board and/or Division may deem necessary.
4.3
Certification in the Use of Amplified Therapeutic Pharmaceuticals
Application for certification in the use of amplified therapeutic pharmaceuticals shall be made on forms provided
by the Division which shall be completed, notarized, and submitted to the Division at least thirty (30) days
before the scheduled date of the Board meeting. Such application shall be accompanied by the documents
(non-returnable), transcripts and records described in section 3.3 herein.
Section 5.0 Examinations
5.1 Examinations For Licensure
Applicants for licensure to practice optometry shall be required to successfully pass the following examinations
as approved by the Board to test the applicants' knowledge and skills to practice optometry in this state
pursuant to the statutory and regulatory requirements herein:
9
5.1.1
All parts and all sections of the National Board Examination of the National Board of
Examiners in Optometry (NBEO); and
5.1.2
A regional or national clinical competency examination and/or such other examination(s) as
approved by the Board.
5.2
Re-examination
5.2.1 Any applicant who twice fails the National Board Examination for optometric licensure and/or the
International Association of Boards of Optometry examination in "The Treatment and Management of
Ocular Disease" will be required to satisfactorily complete a course of at least one semester in an
accredited college of optometry in subject(s) failed prior to being eligible to take further re-examina-
tion.
5.2.2 Opportunity for re-examination of any applicant who, three times, fails the clinical competency
examination for licensure and/or certification, shall be subject to the applicant's completion of additional
requirements as may be recommended by the Board on an individual basis.
5.3
Without Examination
A license to practice optometry may be issued without examination to an applicant who has been duly
licensed by examination as an optometrist under the laws of another state provided:
a)
the applicant meets the qualifications to practice optometry in this state in accordance with
sections 3.1 and 3.2 herein;
b)
the Board of Examiners in Optometry in each state in which the applicant holds or has held
licensure submits to the Board of this state a statement attesting to the licensure status of the
applicant during the time period the applicant held licensure in said state;
c)
that such state accords a like privilege to holders of licenses issued in this state and the
applicant has not failed to pass the exam required in this state; and
d)
the applicant submits the license application form with supporting certified documentation of
credentials and application fee of sixty-two dollars and fifty cents ($62.50) made payable to
the General Treasurer, State of Rhode Island.
5.3.1 An optometrist from out-of-state seeking certification in this state as a certified optometrist as defined
in section 1.5 herein must meet the requirements of sections 4.2, and 5.3 herein to be a "Certified
Optometrist" in this state.
Section 6.0 Internship
10
6.1
Every applicant seeking licensure to practice optometry in this state shall be required after having
successfully passed the National Board Examination, to complete a full-time (no less than thirty-five
(35) hours per week) internship in optometry for a period of six (6) months under the supervision of a
registered (licensed) optometrist or a duly licensed doctor of medicine practicing ophthalmology
approved as a preceptor by the Board.
6.1.1
Sites for the clinical internship may vary from experiences at clinics or such other health
facilities or centers, provided, however, that no less than three (3) days per week during the
full-time internship is spent in the preceptor's office in general practice.
6.1.2
Notwithstanding the provisions of section 6.1.1 above, interns at the completion of their
internship must have received clinical experiences in those areas listed in Appendix I.
6.2
Prior to commencing internship, applicants for internship and preceptorship shall submit to the Board
completed application forms and such other information as the Board deems appropriate to insure
compliance with the requirements herein.
6.3
Interns shall be under the direct supervision of their preceptor(s) during their full-time internship period.
6.4
Applicants must successfully pass a clinical competency examination approved by the Board and in
accordance with section 5.1 herein.
6.5
Preceptors
6.5.1 Preceptors shall provide direct supervision to interns at all times, as defined in section 1.6.
Such supervision shall be provided by a registered (licensed) optometrist or a duly licensed
doctor of medicine practicing ophthalmology pursuant to section 5-35-12 of the Act.
6.5.2 Requirements for Serving as a General Optometric Preceptor
a)
The preceptor must be in practice for five (5) years.
b)
The preceptor must submit a formal application including his curriculum vitae.
c)
An optometrist must be certified in the use of therapeutic pharmaceuticals.
d)
There must be spectacle dispensing capabilities on the premises.
e)
The office of the preceptor must be equipped with more than one examination room.
f)
The Board reserves the right to review the qualifications of all candidates for
preceptorships.
11
6.5.3 Preceptors shall submit application forms with required information to the Board to receive
approval to serve as preceptors.
6.5.4 Violations of the requirements herein by any intern and/or preceptor may be cause for the
Board to impose the following penalties:
a)
Interns: may be the loss of accumulated internship hours and discontinuation of any
licensure issued on the basis of an internship which was carried out in violation of this
section; and
b)
Preceptors: may be the loss of the privilege to serve as preceptor, and/or other
disciplinary action, if warranted.
Section 7.0 Continuing Education
7.1
For Re-Licensure and Re-Certification
Every optometrist licensed to practice optometry with certified and/or amplified privileges in this state under the
provisions of the Act and these rules and regulations herein shall on or before the 31st day of January of every
third year (beginning with the January 2002 renewal cycle) submit to the Board satisfactory evidence of having
completed in the preceding three (3) calendar years, no less than sixty (60) hours of continuing education in
optometry or other related health field, in course(s) that shall include thirty (30) or more hours of approved
courses in pharmacology for the treatment and management of ocular conditions of the eye offered by a
provider meeting the Guidelines For Continuing Optometric Education of the American Optometric Association
or any course approved by the Board. Furthermore, the Board will only accept:
a)
a maximum of twelve (12) hours every three (3) years in an approved home study course(s);
b)
a maximum of twelve (12) hours every three (3) years in an approved practice management
course(s);
c)
a maximum of six (6) hours every three (3) years in approved lectures to professional groups;
and
d)
one (1) hour credit for each publication of a paper in any national or regional journal up to a
maximum of six (6) credit hours every three (3) years.
7.1.1 Optometrists licensed to practice optometry without therapeutic certification must show evidence of
forty-eight (48) hours of continuing education in optometry or other related health fields in the three (3)
calendar years preceding the most recent license renewal. Furthermore, the Board will only accept:
a)
a maximum of twelve hours every three (3) years in approved home study course(s);
12
b)
a maximum of twelve (12) hours every three (3) years in an approved practice management
course(s);
c)
a maximum of six (6) hours every three (3) years in approved lectures to professional groups;
and
d)
one (1) hour credit for each publication of a paper in any national or regional journal up to a
maximum of six (6) credit hours every three (3) years.
7.1.2 The Board may waive the continuing education requirement in specific circumstances for due cause
such as hardship or for any sufficient reason, if satisfactory evidence is submitted to the Board to that
effect.
7.1.3 Two hours of continuing education credits per year will be allowed for those who serve as general
optometric preceptors during that year. The preceptor cannot receive credits for the same intern in two
different years.
7.1.4 Continuing education courses taken outside of the state of Rhode Island must be approved by the
Council on Optometric Practitioner Education (COPE).
Section 8.0
Issuance and Renewal of License/Certification and Fee
8.1
Upon completion of the aforementioned requirements, the Director may issue a license and/or certifica-
tion to those applicants found to have satisfactorily met all the requirements herein. Said license and/or
certification shall expire annually on the 31st day of January, unless sooner suspended or revoked.
8.2
On or before the 31st day of December of each year, the Administrator of the Division shall mail an
application for renewal of license and/or certification to each person to whom a license or certification
has been issued or renewed during the current year. Every person licensed or certified who intends to
practice optometry during the ensuing year shall file a renewal application duly executed together with
the renewal fee for licensure of one hundred twenty-five dollars ($125.00) made payable to the
General Treasurer, State of Rhode Island on or before the 31st day of January in each year.
8.3
Upon receipt of a renewal application accompanied by evidence of completion of the prescribed
continuing education program requirements as set forth in section 7.0 herein, including payment of fee,
the accuracy of the application shall be verified and license and/or certification shall be granted effective
1 February in that year.
8.4
In case of neglect or refusal to pay, said Division shall revoke or suspend such license provided,
however, that no license shall be so suspended or revoked without first giving sixty days' notice in each
such case of neglect or refusal and within such period any such optometrist shall have the right to
receive a renewal of such license on payment of the renewal fee, together with an added penalty of fifty
dollars ($50.00).
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8.5
Retirement from practice for a period not exceeding five (5) years shall not deprive the holder of a
license of the right to renew such license upon payment of all annual renewal fees remaining unpaid, and
a further fee of fifty dollars ($50.00).
Section 9.0
Practice of Optometry
9.1
Pursuant to section 3.3 herein, certified optometrists as defined in section 1.5 herein with amplified
privileges, as defined in section 1.3 herein, may:
(i)
remove superficial foreign bodies from the conjunctiva, lid and cornea without surgery or other
invasive techniques; and
(ii)
administer and prescribe topical pharmaceutical agents as provided herein for the treatment of
ocular conditions of the human eye and its appendages without surgery or other invasive
techniques, and in accordance with the prevailing standards of practice as those of duly
licensed physicians providing similar services.
(iii)
Treatment of glaucoma with a beta blocker shall require prior consultation with the patient's
physician, or other appropriate physician, with the patient's consent. Treatment of glaucoma
shall exclude treatment of infantile and congenital glaucoma. Treatment of acute angle closure
glaucoma shall be limited to initiation of immediate emergency care.
9.2
Patients diagnosed with glaucoma or anterior uveitis shall be managed on a continuing basis by an
optometrist in consultation with an ophthalmologist, as appropriate.
9.3
Scope of Medications
9.3.1 The medications which may be used by optometrists certified in accordance with section 3.2,
but not holding amplified privileges in accordance with section 3.3 herein, include topical
medication (mast cell inhibitors or stabilizers), lubricants, decongestants, mucolytics, an-
tibiotics, and steroids with a clinical potency not exceeding 1/4% methyl-prednisolone or
equivalent.
9.3.2 Topical steroid treatment required beyond fourteen (14) days may be continued only in
consultation with an ophthalmologist.
9.3.3 Optometrists authorized by the Board as having amplified privileges, in accordance with
section 3.3 herein, may utilize all topical pharmaceutical agents in the treatment of conditions of
the human eye and its appendages, including anterior uveitis and glaucoma, without surgery or
other invasive techniques, and in accordance with the requirements herein.
9.4
Minimum/Initial Examination of New Patients
14
Pursuant to section 5-35-18 of the Act, every person practicing optometry shall, prior to prescribing eye-
glasses, lenses or spectacles perform the following minimum examination of the patient and record same on
case record:
a)
name of patient, age, address, date and case history;
b)
visual acuity with and without present glasses, (O.D., O.S., O.U.);
c)
external ocular examination;
d)
ophthalmoscopy (internal ocular examination);
e)
visual fields study (when indicated);
f)
skiametry (static or dynamic); (the use of an automated refractor shall only be considered as
an additional test for skiametry);
g)
habitual phorias at distance and near;
h)
subjective refraction and visual acuity at distance and near;
i)
phorias at distance and near with new therapy;
j)
color vision and stereopsis;
k)
recording of complete description of new therapy;
l)
tonometry;
m)
diagnostic pharmaceuticals (when indicated);
n)
gonioscopy (in glaucoma patients initially and when deemed medically appropriate); and
o)
in glaucoma patients, dilated fundus examination with binocular indirect ophthalmoscopy,
unless contraindicated.
9.4.1 For contact lenses the following additional procedures must be performed:
a)
ophthalmometry;
b)
black light examination, installation of fluorescein and analysis of pattern;
c)
verification of lenses; and
15
d)
a comprehensive biomicroscopic evaluation of the anterior segment of the eye with and without
the contact lenses in place. This shall be done at frequent intervals to assure that no ocular
damage may result from prudent use of contact lenses.
9.5
Minimum Equipment for Optometric Practice
At any location where an optometrist practices his or her profession, except for house and nursing home calls,
an optometrist shall have at least the following equipment available:
a)
Snellen or projection acuity chart;
b)
lensometer or equivalent lens neutralizing device;
c)
keratometer-ophthalmometer or equivalent;
d)
ophthalmoscope-direct and indirect;
e)
retinoscope;
f)
trial frame and lens set and/or phoropter-refractor;
g)
tonometer;
h)
slit-lamp biomicroscope;
i)
field testing device;
j)
color perception test - Ishihara or equivalent; and
k)
gonioscopy lens.
Section 9.6
Spectacle or Eyeglass Prescriptions
A spectacle prescription shall contain all of the information necessary for the accurate fabrication, fitting and
dispensing of the spectacles (eyeglasses). All spectacle prescriptions shall contain at least the following
information:
a)
Power - sphere, cylinder amount and axis, and prism amount and axis.
b)
Lens type - single vision, bifocal, trifocal, progressive, or other.
c)
Lens Color - Any pertinent data.
d)
Expiration Date - As determined by the prescribing doctor's assessment of the patient's visual
status.
16
e)
Specific Instructions for Use.
f)
Name, address and telephone number of prescribing doctor.
g)
Signature and license number of doctor.
h)
An optometrist who writes or fills a spectacle prescription shall maintain a file of that
prescription for a period of five years.
Special Instructions When Indicated
1.
Lens Materials - glass, CR-39, high-index material, polycarbonate, or other.
2.
Lens Coating - scratch gard, anti-reflective, absorptive tint, or other.
3.
Tempering - heat, chemical or other.
4.
Pupillary Distances - distance and/or near-point.
Section 10.0
Denial, Suspension or Revocation of License and/or Certification
10.1
In addition to any and all other remedies provided in the Act, pursuant to section 5-35-19 of the Act,
the Administrator of the Division and the Director may, after due notice and hearing, as provided in the
Act and section 12.0 herein, refuse to grant, refuse to renew, suspend or revoke any license and/or
certification provided for in the Act to any person who is not of good moral character or who has been
guilty of gross unprofessional conduct or conduct of a character likely to deceive or defraud the public
or for any fraud or deception committed in obtaining such license or certification, and of gross
unprofessional conduct as defined in the aforementioned section of the Act.
17
PART III ADVERTISING, VIOLATIONS, PRACTICES, PROCEDURES AND SEVERABILITY
Section 11.0
Advertising
11.1
Pursuant to section 5-35-20(b) of the General Laws of Rhode Island, as amended, no optometrist
licensed by and practicing in this state shall advertise by written or spoken word of a character tending
to deceive or mislead the public.
11.2
In addition to section 11.1 herein any and all advertising conducted by any optometrist shall conform
to the provisions of Chapter 6-13.1 of the General Laws of Rhode Island, as amended, entitled
"Deceptive Trade Practices Act."
11.3
Any person practicing pursuant to the provisions of Chapter 5-35 of the General Laws of Rhode
Island, as amended, shall be required to post his name on the premises where the services are being
offered in such a manner as to be clearly visible to the public at the entrance to the premises and on any
sign visible outside of the premises which offers the delivery of optometric services.
11.4
Advertisement of any type (electronic or print media) shall also include the names, addresses of the
responsible optometrist.
Section 12.0
Violations
12.1
Any violations of the statutory and regulatory requirements herein shall be subject to the statutory
sanctions as set forth in the Act.
Section 13.0
Rules Governing Practices and Procedures
13.1
All hearings and reviews required under the provisions of the Act shall be held in accordance with the
provisions of the Rules and Regulations of the Rhode Island Department of Health Regarding
Practices and Procedures Before the Department of Health and Access to Public Records of the
Department of Health (R42-35-PP).
Section 14.0
Severability
14.1
If any provision of these rules and regulations or the application thereof to any individual or
circumstances shall be held invalid, such invalidity shall not affect the provisions or application of the
regulations which can be given effect, and to this end the provisions of the regulations are declared to
be severable.
18
APPENDIX I
OPTOMETRIC INTERNSHIP PROGRAM
All interns must spend a minimum of 600 hours of no less than three (3) full days per week for a six (6) month period under the
supervision of an approved preceptor(s). The balance of the time may be utilized to complete the enclosed list of clinical
experiences. In addition, applicants shall be required to complete the clinical training period of seventy-two (72) hours of no less
than three (3) months in accordance with section 3.2(f) herein.
I. General Practice - 3 days per week
Preceptor Signature (Address)
II. Other Clinical Experiences
1) Specialized Diagnostic and Treatment Programs
Signature and Date Completed
a. Binocular Indirect Ophthalmoscopy
b. Gonioscopy
c. Fundus C.L.
d. Anterior Segment Photography
Fundus Photography
e. Visual Field Techniques
f. Prosthesis
2) Office Administrative Procedures
a. Bookkeeping Systems
b. Re-call Programs
c. Patient Records
d. Office Records
e. Monthly, Quarterly and Annual Forms
f. Third Party Forms and Programs
3)
Business/Practice Management
(Dealing with people)
a. Employee Relationships, Policies and Benefits
b. Malpractice
c. Patient Communication Techniques
d. Comprehensive and Quality Eyecare
4)
Ophthalmic Materials and Manufacturing
a. Frame, Lens Selection and Measurements
b. Repairs and Adjustments
c. Ophthalmic Lens and Frame Fabrication
5)
Contact Lenses
a. C.L. Selection
b. Care, After Care and Management of the Contact Lens Patient
c. Complications and Problem Solving of Contact Lenses
d. Therapeutic C.L.
e. C.L. Manufacturing (RLI)
19
6)
Low Vision
a. Determining the Visual Acuity, Diagnosis and Prognosis of the
Low Vision Patient
b. Telescopic and Microscopic Lenses
c. Other Low Vision Aids
d. Non-optical Aids
e. Managing the Low Vision Patient
7)
Visual Perception and Visually Related
Learning Problems
a. Binocular Vision Dysfunctions
b. Diagnosis of Visually Related Learning Problems
c. Visual Perception Therapy Techniques
d. Perceptual Motor Therapy Techniques
e. Orthoptics and Vision Therapy
8)
Hospital, Surgical and Ophthalmological
Rotation
INTERN'S SIGNATURE
ADDRESS
DATE
20
APPENDIX II
PREREQUISITES
1.
Graduation from an accredited College of Optometry including:
2.
Successful completion of courses in the following areas:
a)
General and ocular pharmacology, not less than 60 hours;
b)
General and ocular physiology or equivalent, not less than 30 hours;
c)
General and ocular pathology or equivalent, not less than 30 hours.
21
APPENDIX III
CURRICULUM OUTLINE
COURSE IN OCULAR THERAPEUTICS
DIDACTIC CURRICULUM
HOURS INSTRUCTORS
I.
Basic Principles
18
M.D.
Ph.D.
a) Review of fundamental concepts
Pharmacologist
Certified Optometrists
b) Cellular response in infection,
inflammation and trauma
c)
Microorganism and ocular disease
d)
Pharmacokinetics and
pharmacodynamics
e)
Theory, application, prescription
writing, patient communication,
patient management considerations,
practice management
f)
Routes of drug administration
II.
Ocular Therapeutic Agents
9
M.D.
Ph.D.
a)
Pharmacology of ocular therapeutics
Pharmacologist
1. Anti-infective agents
2. Anti-inflammatory agents
3. Autonomic drugs and beta
blockers
4. Secretory inhibitors
5. Hyperosmotics
6. Antihistamines
III.
Clinical Diseases and Treatment of
42
Ophthalmologists
the Anterior Segment of the Eye
and
Certified Optometrists
a)
Introduction:
Microbiology and immunology as they
Ph.D./M.D.
pertain to lid and anterior segment
of the eye
b)
Diseases of the eyelid:
Ophthalmologists
1. Hordeolum
2. Chalazion (acute) To include
differential Dx of benign and
malignant tumors of the lid.
3. Blepharitis
4. Foreign body removal from the upper lid
5. Tumors of the lids
22
c)
Diseases of the conjunctiva:
1.
Conjunctivitis, (acute), (bacterial). Includes treatment with topical antibacterial agents.
2.
Conjunctivitis, acute, nonbacterial, nonherpetic (presumed viral). Includes treatment with
antibacterials and/or decongestants. Also includes differential diagnosis of other noninfective
causes of red eye.
3.
Conjunctivitis, allergic. Includes treatment by topical decongestants and/or topical
antihistamines.
4.
Conjunctivitis, chemical. Includes emergency first aid plus antibacterials, decongestants, etc.
and indications for referrals.
5.
Conjunctival foreign body. Includes anesthetic and cotton tip applicator technique for removal.
6.
Pingueculitis. Includes treatment modality.
7.
Inflamed pterygium. Includes treatment modality and differential diagnosis of other conjunctival
tumors which may appear similar.
8.
Dry Eye. Includes causes and treatment modalities and various manifestations of diagnosing similar
local ocular diseases and systemic significance (e.g. cicatricial pemphigoid).
d)
Diseases of the Cornea:
1.
Punctate keratitis, acute, bacterial or nonherpetic viral induced. Includes chronic punctate keratitis (as
might be seen in contact lens induced or dry eye induced keratitis), differential diagnosis to rule out
true stromal infiltrate or corneal ulcer, and appropriate management techniques, and possible use of
topical antibacterials and/or decongestants.
2.
Chemical of UV induced keratitis. Includes proper management techniques.
3.
Corneal abrasion. Includes differential diagnosis of corneal lacerations or more serious injuries
requiring surgical intervention, and possible antibiotic, cycloplegic, or patching treatments.
4.
Recurrent corneal erosions. Includes proper management techniques employing lubrication and
patching.
5.
Contact lens induced abrasions and overwear syndromes. Includes differential diagnosis of true
bacterial keratitis.
6.
Endothelial dystrophy. Includes differential diagnosis of other corneal dystrophies, degenerations and
metabolic diseases involving the cornea which may appear similar. Also includes techniques of
treatment using hypertonic agents.
7.
Red Eye. Differential diagnosis ruling out conditions not listed above for referral.
8.
Diseases of the Sclera.
HOURS
INSTRUCTOR
IV.
Glaucouma and Anterior Uveitis
5
Ophthalmologist
a)
Differential Dx. and Referral
consistent with the regulatory
provisions herein
b)
Classification of glaucoma
23
V.
Consultation and Referral in
2
Ophthalmologist
Anterior Segment Eye Disease
and
Certified Optometrist
a)
Appropriate ophthalmological con-
sultation and referral
b)
Determining need for medical
consultation other than
ophthalmology
c)
Patient stabilization in severe
ocular trauma
VI.
Ocular Manifestation of Systemic
10
Ophthalmologist
and Treatment
Internist (M.D.)
a)
Endocrine Disorders
Endocrinologist
b)
Neurological Disorders
c)
Cardiovascular and Cerebrovascular
Disorders
d)
Collagen Vascular Disorders
e)
Hematological Disorders
f)
Metabolic and chromosomal Disorders
g)
Ocular Effects of Systemic Medication
h)
Interpretation of Laboratory Findings
VII.
Ocular Allergy and Immunology
3
M.D./Ph.D.
a)
Differential Diagnosis
b)
Treatment of Ocular Allergy
c)
Ocular Conditions with Implied
Immunological Roles
VIII.
Ocular Urgencies and Emergencies
5
Ophthalmologist
a)
Clinical Diagnosis and Management
b)
Emergency Equipment
IX.
Legal Aspects of Ocular Therapeutic
2
OD / JD
Care
a)
Malpractice Issues
b)
R.I. Requirements pertaining to
Malpractice Insurance
c)
Standards of care Total Hours 96
24
APPENDIX IV
CLINICAL TRAINING
The preceptor shall be responsible for the clinical training and shall furthermore be responsible to
certify to the Board of Examiners that the optometrist has satisfactorily completed in no less than
three (3) months, at least seventy-two (72) hours of clinical training and during said time
participated in the diagnosis, treatment and management of the following numbers of patients:
Patients with Diseases of the Eyelids
50
Patients with Diseases of the Conjunctiva
50
Patients with Diseases of the Cornea
50
The ratio of ophthalmologists to optometrists for the clinical training shall be 1::2 preferably,
however, not to exceed 1::4. The clinical training must be validated by the preceptor to the
Board.
October 23, 2001
optometrists-final regs-november01.doc
25
APPENDIX V
SUGGESTED FORMAT FOR CONSULTATION FORM
Case Number:
Optometrist:
Print Name
Address
Ophthalmologist:
Print Name
Address
Date Consultation Initiated:
Sign and Date Upon Initiation of
Consultation:
Sign and Date Upon Initiation of
Consultation:
Date Submitted to Board of
Examiners in Optometry:
Sign and Date Upon Completion:
(At one year or when the patient is
stable--whichever occurs later)
Sign and Date Upon Completion:
(At one year or when the patient is stable--
whichever occurs later)
Component:
Findings:
Interim Consultation:
Date:
Notes:
VISUAL ACUITY
üCORRECTED
üUNCORRECTED
PUPIL ASSESSMENT
BIOMICROSCOPY
INTRAOCULAR PRESSURE
VISUAL FIELDS
ANTERIOR CHAMBER
ANGLE
EVALUATION OF OPTIC
NERVE
GONIOSCOPY
DILATED FUNDUS
EXAMINATION
TARGET PRESSURE
MEDICATIONS
Treatment Plan:
26
OPTOMETRY REGULATIONS
Upon promulgation of the current set of amendments to the Rules and Regulations Pertaining to
Optometrists, there will be five (5) levels of practice for optometrists who are currently licensed in Rhode
Island. These levels include:
Optometrists with no pharmaceutical privileges
Ø
Encompasses basic optometric education
Ø
This level of practice is now obsolete (i.e., no new practitioners may be certified at this level).
‚
Optometrists with diagnostic pharmaceutical privileges
Ø
Encompasses basic optometric education and an additional course in diagnostics
Ø
This level of practice is now obsolete (i.e., no new practitioners may be certified at this level).
ƒ
Optometrists with therapeutic pharmaceutical privileges (required entry level as of January
1994)
Ø
Encompasses basic optometric education
Ø
If the optometrist graduated prior to 1 January 1988, 96 hours of course work is also required in
addition to the requirements below.
Ø
If the optometrist graduated after 1 January 1988, no less than 72 hours of a clinical practicum
over a three (3) month period is required, wherein a minimum of 50 patients with diseases of the
eyelid; 50 patients with conjunctiva; and 50 patients with diseases of the cornea are seen.
„
Optometrists with amplified privileges (includes treatment of anterior uveitis) (required entry
level as of July 1, 2000)
All of the above is required (for therapeutic privileges) plus the following additional requirements:
Ø
Transcript quality course (24 hours) in treatment of glaucoma and anterior uveitis
Ø
Examination upon completion of transcript quality course (including pharmacology) or
Ø
successful completion of the International Association of Boards of Optometry examination in
"The Treatment and Management of Ocular Disease" administered after January 1, 1999.
Optometrists with amplified privileges (includes treatment of glaucoma and anterior uveitis)
All of the above is required (for therapeutic privileges) plus the following additional requirement:
Ø
Co-manage twenty (20) glaucoma patients for one year or until the patient is stable (whichever
occurs later).