Scope Of Practice

The scope of the practice of optometry in Tennessee is specifically defined but includes many aspects which if not particularly regulated could lead to serious ramifications for the consuming public. This rule is to designate specific areas in the practice of optometry GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 for regulation, the violation of which may result in disciplinary action pursuant to T.C.A. §§ 63-8-120(a)(2), 63-8-120(9) and 63-8-120(10). (1) Practice of Optometry – For the safety and welfare of the citizens of the State of Tennessee, the practice of optometry is defined to be the science and art of examining, diagnosing, treating, and managing conditions of the visual system, conditions and pathology related to the human eye and related structures, for the purpose of protecting, enhancing, and maintaining visual performance and the integrity of the human eye and related structures. (a) The practice of optometry includes: 1. The measurement of the vision system and muscular anomalies, by employment of any means approved by the United States Food and Drug Administration or related agency, including the use or furnishing of any self-testing device, the use of any computerized or automatic refracting device, including applications designed to be used on a computer or video conferencing via an Internet device either in-person or in remote locations. The practice of optometry also includes prescribing ophthalmic correction to remedy or relieve defects of vision performance or muscular anomalies by means including but not limited to spectacle eyeglasses, contact lenses for orthotic, prosthetic, therapeutic, or cosmetic purposes, prisms, devices, and the employment of vision therapy or orthoptics for the aid thereof, and low vision rehabilitation. 2. Examining, diagnosing, treating, and managing conditions rational to the health and preservation of the human eye and related structures by employment of any means approved by the United States Food and Drug Administration or related agency, including the use or prescription of any self-testing, self-administered treatment or drug delivery devices, the use of any computerized or automatic devices, including applications designed to be used on a computer or video conferencing via an Internet device either in-person or in remote locations. 3. The administration of pharmaceutical agents, performing or ordering of procedures and laboratory tests, primary eye care procedures, and ophthalmic surgery except for procedures and devices as defined in T.C.A. § 63-8- 102(12)(E)(ii). 4. Examining, diagnosing, treating, and managing must be by an optometrist within the scope of his or her education, training, and experience and in accordance with T.C.A. §§ 63-8-101, et seq., the ethics of the profession and applicable law. The practice of optometry is defined by diagnostic devices, pharmaceuticals, treatment devices, primary eye care procedures, and ophthalmic surgery unless specifically excluded by the Tennessee Board of Optometry, pursuant to rules promulgated under the Administrative Procedures Act. 5. Nothing in this rule shall be construed as allowing any agency, board, or other entity of this state other than the Tennessee Board of Optometry to determine what constitutes the practice of optometry. (b) Specific Exclusions – The following ophthalmic surgery procedures are excluded from the practice of optometry, except for the preoperative and postoperative care related to these procedures and other items as defined in T.C.A. § 63-8-102(12)(E)(ii): 1. Retina laser procedures; and 2. Laser or non-laser procedures into the vitreous chamber of the eye to treat any retinal or macular disease. GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 3. Surgery related to the removal of the eye from a living human being; 4. Administration of general anesthesia or ophthalmic surgery performed with general anesthesia; 5. Surgery requiring full thickness excision of the cornea or sclera – for penetrating keratoplasty or corneal transplant; 6. Surgery requiring incision of the iris and ciliary body; 7. Surgery requiring incision of the retina; 8. Surgical extraction of the crystalline lens; 9. Surgical placement of intraocular implants; 10. Incisional or excisional surgery of the extraocular muscles; 11. Surgery of the eyelid for incisional cosmetic or mechanical repair of blepharochalasis; 12. Surgery of the bony orbit, including orbital implants; 13. Incisional or excisional surgery of the lacrimal system; and 14. Surgery of the conjunctiva including pterygium surgery or full thickness conjunctivoplasty with graft or flap. (2) Co-Management. (a) Definitions 1. Co-Management – The cooperative and active participation in the delivery of services and treatment to patients between optometrists and other health care providers. 2. Consultation – The deliberations between optometrists and other health care providers with respect to the diagnosis or treatment of any particular patient. (b) Intent – It is the intent of this rule to promote the cooperation of optometrists and other health care providers, when appropriate for total patient care, and cooperation in the delivery of that care within the scope of their respective professional practices. This rule provides the framework within which optometrists may work when co-managing a patient’s care. (c) Practice of Co-Management – The provision of eye care services or treatment which may include both consultation and active participation. 1. The decision to receive co-managed health care rests solely with the patient. However, the decision should be made during consultation between the patient and all appropriate health care providers who may be involved in the co- management of care for that patient. 2. An optometrist may provide follow-up care within the scope of optometric practice for a patient’s medical or surgical eye problem. GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 3. If post-operative care of a patient is requested, the optometrist should provide a report to the surgeon of all treatment and services rendered. (d) Records 1. Optometrist’s Office – Any consultation, treatment, services or care provided for a co-managed patient in an optometrist’s private office not shared by the co- managing health care provider, must be fully and completely documented in the optometrist’s records for that patient. 2. In the case of a patient who is receiving services and/or treatment from more than one (1) health care provider in a health care facility where only one (1) comprehensive set of records is kept, an optometrist, if called upon to provide services or treatment, must sign that record and include the treatment or service provided each time the patient receives such services or treatment. The optometrist must also request the other health care providers to sign the record and include the treatment or services provided each time the patient receives such services or treatment. (3) Universal Precautions for the Prevention of HIV Transmission – The Board adopts, as if fully set out herein, rules 1200-14-03-.01 through 1200-14-03-.03 inclusive, of the Department of Health and as they may from time to time be amended, as its rule governing the process for implementing universal precautions for the prevention of HIV transmission for health care workers under its jurisdiction. (4) Administration, Sale, Dispensing and Prescribing of Drugs, Including Controlled Substances. (a) Optometrists licensed within this State shall be subject to discipline for administering, dispensing, selling, prescribing, or otherwise distributing any drug or controlled substance to any person which is: 1. Not in the course of professional practice, or not in good faith to relieve pain and suffering, or not in good faith to diagnose and treat conditions or diseases of the eye or eyelid; or 2. In violation of any law of this state or of the United States. (5) Orthoptics and Vision Therapy – Any person other than a doctor of medicine or an osteopathic physician who examines, diagnoses, manages and treats conditions or diseases of the eye or eyelid is considered to be practicing optometry in accordance with T.C.A. § 63- 8-102(12). This includes managing a patient through vision therapy, visual training, visual rehabilitation, orthoptics or eye exercises. “Orthoptic training” means any ocular exercise for the correction or relief of abnormal muscles or functions of the eyes in accordance with T.C.A. § 63-8-102(11). A person who hold him/herself out as being able to remedy or relieve defects of vision or muscular anomalies or other abnormal conditions of the eyes by engaging in orthoptic training or by adjusting, fitting or adapting lenses or prisms to remedy or relieve defects of vision or muscular anomalies is engaged in the practice of optometry, as defined in Tennessee Code Annotated § 63-8-102(12). (6) Eye Examination Requirements – All eye examinations performed by licensees shall include the professionally recognized components listed in subpart (3)(a)2.(i) of Rule 1045-02-.08 for spectacles and in subpart (3)(a)2.(ii) of Rule 1045-02-.08 for contact lenses. (7) Use of Titles – Any person who possesses a valid, unsuspended and unrevoked license issued by the Board has the right to use the titles “Optometrist,” “Doctor of Optometry,” GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 “Optometric Physician,” or “O.D.” and to practice optometry, as defined in T.C.A. §§ 63-8- 102. Violation of this rule or T.C.A. §§ 63-8-113 and 63-8-120 regarding use of titles shall constitute unprofessional conduct and subject the licensee to disciplinary action.