Scope of Practice and Prescriptive Authority: What an Optometrist May Treat and Prescribe
Domain 3 tests the boundary between what a DC optometrist may do independently and what requires referral. The exam concentrates on pharmaceutical authority - diagnostic versus therapeutic agents - and on documentation, prescription form, and referral duties.
Core clinical scope
- Refraction, binocular and accommodative assessment, ocular health examination, contact lens fitting, low vision, and vision therapy are all within practice.
- Optometrists may use and prescribe topical diagnostic agents (anesthetics, mydriatics and cycloplegics, dyes) and therapeutic agents for conditions of the eye and adnexa to the extent the Act authorizes.
Limits on authority
- Surgery, laser procedures, and treatment of disease outside the eye and adnexa are outside scope.
- Prescribing controlled substances requires federal DEA registration plus a separate DC controlled-substance registration, with prescription-monitoring review where required.
- Authority is not extended by implication: anything the statute does not list is not authorized. When a condition exceeds topical management, stabilize and refer.
Prescriptions and contact lenses
- A valid prescription identifies the patient, drug, strength, quantity, directions, prescriber name and license number, and date.
- Patients are entitled to a copy of their contact lens prescription; withholding it to keep the sale is a violation.
Worked example
A soft-lens wearer presents with a painful red eye, a corneal epithelial defect, and a mild anterior chamber reaction. The optometrist prescribes a topical fluoroquinolone, documents infiltrate size and location, schedules 24-hour follow-up, and instructs the patient to return immediately for worsening pain or vision loss. Reasoning: topical anti-infective therapy is within prescriptive authority, the record must support the judgment, and the short follow-up interval reflects the standard of care for a potentially sight-threatening condition. If perforation or endophthalmitis were suspected, same-day ophthalmology referral would replace management.
Traps that cost marks
- Confusing diagnostic and therapeutic authority - a drug approved for examination is not automatically approved for treatment.
- Assuming oral corticosteroids are within scope.
- Prescribing for self or family without a genuine patient record.
- Writing a controlled substance without the DEA and DC registrations in place.