As an optometrist, you have the authority to diagnose, treat, and manage a wide range of ocular conditions. However, the state you practice in can impact your ability to perform certain procedures and treatments.
Each state has slightly different scopes of practice for optometrists. Understanding your state’s recognized optometrist scope of practice can help you know which procedures you can and cannot perform.
Read ahead to learn the main differences in an optometrist’s practical, prescriptive, and surgical authority by state.
What Is the Scope of an Optometrist?
Doctors of optometry are primary healthcare specialists trained in examining and treating vision defects, ocular conditions, signs of injury, and general eye health issues. Optometrists receive formal optometric education and state licenses that allow them to perform specific procedures within their scope of practice.
While optometrists learn the full scope of practice in optometry school, some states do not authorize these professionals to perform specific procedures. Because the optometric scope of practice varies across states, understanding the scope of practice in your state is crucial.
- Practice authority: An optometrist’s authorization to perform procedures within their scope of practice. Only four states (Kentucky, Alaska, Louisiana, and Oklahoma) have full-practice authority, allowing optometrists to perform all procedures within their education and training.
- Prescriptive authority: An optometrist’s authorization to prescribe specific medications and controlled substances, as dictated by the Drug Enforcement Administration
- Surgical authority: An optometrist’s authorization to perform specific surgical procedures, such as laser treatment
The procedures and treatments an optometric physician can perform within these scopes vary in each state. Generally, optometrists can treat the following conditions:
- Retinal disorders
- Color blindness
- Systemic diseases
However, the treatments they can provide depend on their practice, prescriptive, and surgical authority. For instance, some states do not permit optometrists to perform injections or laser surgery, which are common treatments for specific conditions.
Optometrists can also prescribe contact lenses and glasses, recommend treatments outside their scope of practice, and perform pre- and postoperative care.
An optometrist’s practice authority relates to the eye care procedures they can perform within their general scope of practice. As a primary health care provider, a licensed optometrist can perform various procedures to diagnose, treat, and monitor ocular conditions.
Glaucoma is a group of eye diseases that can damage the optical nerve, causing vision loss. This condition affects approximately 3 million Americans and is the second-leading cause of blindness globally.
As of 2021, optometrists across all states can treat glaucoma topically. However, an optometrist’s ability to perform laser surgery to treat glaucoma depends on their state, as we will discuss below.
Injectables To Treat Conditions Other Than Anaphylaxis
Certain states allow optometrists to give injectable treatments for reasons other than to treat anaphylaxis. The following states currently allow optometrists to provide injectables to treat anaphylaxis and other needs:
- New Mexico
- North Carolina
- North Dakota
- West Virginia
An optometrist’s prescriptive authority is their ability to prescribe drugs to patients. Optometrists often prescribe therapeutic drugs to treat ocular diseases or relieve symptoms. They also prescribe diagnostic drugs or pharmaceutical agents to identify certain eye conditions, as listed in the Optometric Formulary.
Optometrists can prescribe specific controlled substance classifications depending on their state. The U.S. Drug Enforcement Administration classifies drugs into five schedules, as follows:
- Schedule I: Drugs with no accepted medical use and a high potential for abuse
- Schedule II: Drugs with a high potential for abuse and the potential to cause severe dependence
- Schedule III: Drugs with a moderate to low potential for dependence
- Schedule IV: Drugs with low potential for abuse and dependence
- Schedule V: Drugs with an even lower potential for abuse
The optometrist scope of practice for prescriptions includes Schedule II (Hydrocodone only) through Schedule V. Still, each state dictates the schedule of drugs optometrists are permitted to prescribe to patients.
This map from Scope of Practice Policy breaks down the allowable schedules in each state.
Notably, certain opticians can dispense contact lenses and glasses to patients. A dispensing optician has specialized training and continuing education to sell, measure, and distribute prescription eyewear, but does not have prescriptive power.
As of 2022, optometrists across all 50 states have the authority to prescribe some form of oral medication to treat various eye conditions. These therapeutic pharmaceutical agents often include:
- Anti-inflammatory drugs
While the permitted drug schedule still varies by state, this change enables patients to receive necessary treatments from their primary eye care providers.
Oral Steroid Prescriptions
The following states do not authorize optometrists to prescribe oral steroids:
- New York
- South Carolina
- Washington, D.C.
All states not listed here include oral steroid prescriptions in an optometrist’s scope of practice.
Surgical authority is an optometrist’s authority to perform certain minor surgical procedures. While ophthalmologists are responsible for performing the bulk of advanced ocular surgical procedures, optometrists in certain states have the authority to perform laser treatments beyond foreign body removal.
Certain states provide laser authority within the optometry scope of practice. Optometrists in the following states can perform YAG capsulotomy, ALT, and SLT laser procedures:
In Mississippi, optometrists can only perform YAG capsulotomy procedures.
The following states permit optometrists to perform laser peripheral iridotomy surgery:
Alaska and Oklahoma also permit optometrists to perform photorefractive keratectomies, a surgical procedure to correct nearsightedness, farsightedness, and astigmatism.
The states not listed here currently do not allow laser surgery within an optometric practice. However, some states are working toward an expanded scope of practice for laser procedures. For example, California will soon allow optometrists to perform specific laser surgeries.
Additional Surgical Procedures
An optometrist’s authority to perform additional surgical procedures depends on their state as well. Optometrists in the following states benefit from a scope expansion that allows them to perform certain ophthalmic procedures:
- North Carolina
- North Dakota
- West Virginia
Differences Between Optometrists vs. Ophthalmologists
An ophthalmologist is a medical doctor who can diagnose all eye conditions and visual problems. These professionals go through four years of undergraduate college, four years of medical school, and between three and eight years of additional training. Their scope of practice goes beyond that of an optometrist to treat abnormal conditions and perform specialized procedures.
While the roles of ophthalmologists and optometrists sometimes overlap, and these two professionals often work as a team, they have different scopes of practice.
For instance, while optometrists can perform minor surgical procedures in certain states, ophthalmologists are responsible for performing a broader range of surgical procedures. These forms of ophthalmic surgery may include:
- Cataract surgery
- Orbital surgery
- Glaucoma surgery
- Oculoplastic surgery
- Strabismus surgery
Optometrists act as the first line of care for issues related to the human eye. They often give referrals to ophthalmologists when treatments and procedures outside their scope of practice are necessary.
While an optometrist’s scope of practice varies significantly by state, new public health policies frequently enter the roster to expand an optometrist’s surgical, prescriptive, and practice authority.
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