Scope of Practice Flashcards
What does it mean if a person engage in the practice of optometry or to advertise or hold themselves out as an optometrist without a valid, unrevoked CA optometry license?
Unlawful
What does an optometrist examine?
Human eyes or eyes, or its or their appendages, and the analysis of human vision system. (Subjective or Objective)
What does an optometrist do for human vision?
Powers/range of vision, accommodative and refractive state
What can an optometrist prescribe/directing the use of?
Optical devices in connection with ocular exercise, visual training, vision training or orthoptics
What can an optometrist prescribe for lenses?
Contact lenses, spectacle lenses, or fitting/adaptation of contact and spectacle lenses
An optometrist certified to use TPA may?
Diagnosed and treat eye or their appendages
Optometrist can manage infections of anterior segment and adnexa except
But excluding the lacrimal gland, lacrimal drainage system and sclera of patients under 12 years old
Optometrist can manage ocular allergies of
Anterior segment and adnexa
Optometrist can manage ocular inflammation that is limited to?
Nonsurgical cases except when co managed with treating surgeon/physician.
Traumatic iritis, peripheral corneal inflammatory keratitis, episcleritis, and unilateral nonrecurrent nongranulomatous idiopathic iritis who are over 18 years old
Optometrists can manage which areas of abrasions and erosions?
Traumatic or recurrent conjunctival or cornea
Optometrists can manage malignant or nonmalignant ocular surface disease and dry eye disease?
Nonmalignant
Optometrist can manage nonsurgical ocular pain except
When co managed with treating physician/surgeon
Optometrist can treat POAG, exfoliate/pigmentary glaucoma and steroid induced glaucoma at over what age range?
Patients over 18 years old
What does “treat” mean?
The use of TPA
Optometrist can use TPA including rational off label purposes of what TPA?
- Topical pharm agents for examination for eyes for any diseases/pathological conditions; topical miotics
- Topical lubricants
- Anti-allergy agents
- Topical/oral anti-inflammatories
- Topical/oral antibiotic agents
- Topical hyperosmotics
- Topical/oral anti-glaucoma agents
- Nonprescription medication used for rational treatment
- Oral anti-histamines
- Oral nonsteroidal anti-inflammatory agents
- Topical/oral antivirals
- Oral analgesics - not controlled substances
- Codeine w/ compound, hydrocodone w/ compound, and tramadol
If using topical steroid for treatment of ocular allergies of a patient and it started to worsen 21 days after diagnosis what should an optometrist do?
Consult ophthalmologist
How long can an optometrist rx codeine w/ compound, hydrocodone w/ compound and tramadol?
Limited to 3 days
What if patient is on codeine w/ compound, hydrocodone w/ compound or tramadol for 3 days without relief?
Referral to ophthalmologists
What medical treatment used for topical/oral antiviral medication?
HSV keratitis, HSV conjunctivitis, periorbital HSV dermatitis, HZV keratitis, HZV conjunctivitis, and periocular HZV dermatitis
Certified TPA optometrists can perform what procedures?
- Corneal scraping with cultures
- Debridement of corneal epithelium
- Mechanical epilation
- Collection of blood by skin puncture/venipuncture for testing patients suspected with DM
- Suture removal w/ prior consultation with treating physician/surgeon
- Treatment/removal of sebaceous cysts by expression
- Administration of oral fluorescein to patients suspected for having diabetic retinopathy
- Auto-injector to counter anaphylaxis
- Ordering smears, cultures, sensitivities, CBC, mycobacterial culture, acid fast stain, urinalysis, tear fluid analysis, and x ray for diagnosis of conditions/diseases of eye or adnexa
- Punctal occlusions by plugs (no laser, diathermy, cryotherapy or surgery)
- Use/prescription of diagnostic/therapeutic CL
- Removal FB from cornea, eyelid and conjunctiva other than scalpel
- Lacrimal irrigation and dilation of patients over 12 years old
- Intravenous injection for ocular angiography at directions of ophthalmologists who are immediately available
- Superficial layer of skin testings for ocular allergies
- Non invasive medical devices or technology approved by the FDA with successful clinical training. Any of them that does not involve cutting, altering or infiltrating human tissues.
What kind of corneal FB can be removed?
Nonperforating and no deeper than midstroma and require no surgical repair upon removal of FB
Optometrists can treat glaucoma (age over 18) under what requirements?
- Graduated from accredited school on or after 5/1/2008 with proof of graduation
- Certified to treat glaucoma prior to 1/1/2009 with proof of completion of certification program
- Completed didactic course of no less than 24 hrs in the diagnosis, pharmacological, or other treatment/management of glaucoma along side proof of completion
- Who graduated from an accredited school on or before 5/1/2008 with submission of required certification established by the board
Optometrist can be certified to administer immunization if they meet what requirements?
- Complete immunization training program endorsed by CDC or the accreditation council for Pharm Education that included hands on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines and maintains that training
- Certified in BLS
- Complies all state and federal recordkeeping and reporting requirements including providing documentation to PCP and entering info in appropriate immunization registry designated by immunization branch of State Department of Public Health
- Applies immunization certificate on a board approved form
What does “immunization” mean?
Administration of immunization for influenza, HZV and pneumococcus in compliance with individual Advisory Committee on Immunization Practices vaccine recommendations for persons over than 18 years old
What does “surgery” mean?
Any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical/laser
Can optometrist utilize diagnostic laser and ultrasound technology?
Yes
What is telehealth?
Mode of delivering health care services and public health via info and communication technologies to facilitate diagnosis, consultation, treatment, education care management, self management of patient’s health care while patient is at the originating site and provider is distance
Telehealth facilitate self management and care giver support for patient and includes real time interaction and without presence of patient (synchronous interactions/asynchronous store and forward transfer)
If optometrist treat patient for steroid induced glaucoma what else should him/her do?
Notify the prescriber of steroid medication
In case of acute angle closure attack what should the optometrist do?
Stabilize then immediately refer to an ophthalmologist
What does “infectious” mean?
Lesion suspected to be caused by an pathogen
Peripheral infectious corneal ulcer
Infectious corneal ulcers limited to the area of the eye lies outside the central 5mm diameter of the cornea
Preceptorship service
65 hours of training in dx and treatment of ocular, systemic diseases completed in no less than 2 months nor more than 1 year in 1 or more ophthalmologist’s office or optometric clinic.
Authorized by accredited school/college/ophthalmological residency review committee in CA
Preceptors needs to be CA licensed ophthalmologists certified and good standing with Medical board of CA
What does “referral” mean?
Primary responsibility for the treatment of a patient is transferred from the TPA optometrist to consulting ophthalmologist
What TPA include?
- Mydriatics, cycloplegics, anaesthetic agents and agents used for reversal of mydriasis
- Topical lubricants
- Topical/oral anti-allergy agents
- Topical steroid anti-allergy agents
- Topical/oral NSAID, topical steroid anti-inflammatory
- Topical antibiotics; oral antibiotics
- Topical hyperosmotics
- Topical anti-glaucoma agents
- Topical antiviral and oral acyclovir
- Codeine with compound, hydrocodone with compound, tramadol ( 3 days only)
- Topical miotics for diagnostic purpose
What oral antibiotics can an optometrist prescribe and limited to what kind of infection?
Tetracyclines
Dicloxacillin
Amoxicillin
Amoxicillin with clavulanate
Erythromycin
Clarythromycin
Cephalexin
Cephadroxil
Cefaclor
Trimethoprim with sulfamethoxazle
Ciprofloxacin
Azithromycin
Eyelid infection and chlamydia
What does “approve” means to a TPA certified optometrist?
One can perform lacrimal irrigation and dilation of patients over 12 years old
