Medical Model

Expand Medical Eyecare–and Make Legal Precautions Part of Your Growth Plan

By Pamela Miller, OD, FAAO, JD, FNAP

Sept. 6, 2017

Adding new instrumentation and medical eyecare services gives you the opportunity to better serve patients, but it also may open up legal vulnerabilities. Before adding a new service to the care you provide, it is best to consult with your state optometric board and your attorney. Here are points to keep in mind as you upgrade your patient care.

Is it Legal in Your State & With Your License?
Just because a procedure is legal for an OD to perform in one state, or even in many states, doesn’t mean that it’s legal to perform in your state. And if it’s legal in your state, it may not be covered under your license without additional training and certification.

For example, some states now allow ODs to use laser equipment for certain procedures. However, only optometrists who have undergone specific continuing education and certification are legally permitted to use the equipment.

Also be careful comparing your legal ability to use equipment with that of other ODs. If an optometrist is working in a practice owned by an ophthalmologist, they may be permitted to do more in the delivery of care due to the coverage of the OMD’s license, under which they are working.

There also can be different kinds of licenses for the eye diseases you encounter. For instance, take the difference between a therapeutic license and a glaucoma license in the state where I practice, California. With a therapeutic license, you can diagnose glaucoma, but need to send to a specialist for initial care, before seeing the patient after that for follow-up care. A glaucoma license would allow you to forego sending the patient to a specialist if you determine that you can provide the needed treatment in your office.

Which Drugs Are You Legally Permitted to Prescribe?
Some medications may require a Drug Enforcement Agency (DEA) license to prescribe. For instance, you may want to treat a patient for shingles, a viral infection on the eye, or a corneal ulcer, by prescribing the narcotic oxycodone.

In some states, there are laws regulating how many different medications you can prescribe for certain conditions. For that reason, you may need to prescribe a combination drug, rather than two separate drugs. For example, some states have a law that says you can’t use more than two drugs simultaneously to treat glaucoma. To follow the legal guidelines, therefore, you could use a combination drug that includes two of the medications you want the patient to have, such as Tobramycin and dexamethasone.

Make Patient Aware of Risk
If you’re doing a procedure that carries risk either for doing the procedure–or not doing it–the patient should sign a release. For example, patients should be given an information sheet stressing the importance of dilation, and letting them know that if they choose to forego dilation, they are risking having vision-threatening eye conditions go undetected.

If you’re inserting punctal plugs, or removing a foreign body, patients should sign a consent form acknowledging risk. Sometimes that risk is beyond the OD’s control, or doing, such as when removing a piece of metal that has started to corrode or may be deeper than it is safe for the doctor to remove under his or her license. If in doubt, err on the side of patient safety and your own scope of knowledge, expertise, training and level of comfort.

Stay Abreast of Changes to the Law
State optometric boards usually send out notices to ODs in their state when laws affecting scope of care are changed, but it’s helpful to check in yourself with your board annually to see if any changes have been enacted that affect the care you deliver.

Don’t jump the gun, and get ready to provide a new service that the state legislature has just passed a law allowing you to perform. It also needs to be approved by your state optometric board before it is legal for you to provide the service, or do the procedure. Once the state legislature votes to allow ODs to offer a new service, and the governor signs the bill, the state board must then figure out how to implement the new law.

For example, the state board may impose regulations around the new expanded scope of care, requiring that ODs receive additional training, or continuing education, before adding the service to their practice.


Pamela Miller, OD, FAAO, JD, FNAP,
has a solo optometric practice in Highland, Calif. She has a law degree, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com.

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