Scope of Practice and Delegation
This domain tests the boundary between what an optometrist may lawfully do and what must be referred, plus what tasks may be handed to assistants. The exam favours scenario questions: a task is described and you must decide whether it is within scope, requires additional certification, or must not be delegated.
Core rules and concepts
- Scope is set by statute and regulations, and is limited further by individual competence. Holding a licence does not make every permitted act automatically within your personal scope.
- Reserved acts commonly include diagnosis, final refraction sign-off, prescribing, and invasive procedures. These cannot be delegated to unlicensed assistants.
- Delegation to technicians or optical assistants is lawful for defined tasks such as pretesting, autorefraction, tonometry, imaging, and frame adjustment, provided there is a written protocol and the required level of supervision.
- Supervision is not a shield. The delegating optometrist remains accountable for selection of the task, training, and review of results.
- Expanded scope, such as therapeutic prescribing or laser procedures, usually requires extra certification, registration endorsement, and sometimes a defined referral relationship.
Worked example
An assistant performs non-contact tonometry and autorefraction, and the optometrist reviews the results before the consultation. This is generally acceptable where a protocol and supervision exist. If the assistant tells the patient the pressure is normal and no further test is needed, that is outside scope because it is interpretation and advice, not measurement. The reasoning is that delegation covers tasks, not professional judgement, and accountability stays with the optometrist.
Traps that cost marks
- Believing supervision transfers liability to the supervisor's employer rather than preserving the clinician's accountability.
- Treating a task as delegable because it is simple, ignoring whether it is a reserved act.
- Assuming expanded-scope authority is automatic once registered.
- Letting assistants give diagnostic conclusions or modify prescriptions.