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 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.
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 comanagement 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.
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 comanaging 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. § 638-102(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," "Optometric Physician," or "O.D." and to practice optometry, as
defined in T.C.A. §§ 63-8102. 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.
