Diagnostic and Therapeutic Privileges, Including Glaucoma and Ocular Disease
What the exam tests
This domain tests diagnostic testing, therapeutic decision-making, and disease monitoring within Kentucky optometric scope. Glaucoma is a frequent theme because it requires both diagnostic skill and careful long-term management.
Core rules
- Diagnostic privileges include history, visual acuity, refraction, tonometry, slit-lamp examination, dilated fundus examination, gonioscopy, visual fields, and imaging such as OCT when clinically indicated.
- Therapeutic privileges include topical and oral medications for authorized ocular conditions, management of inflammation, infection, allergy, dry eye, and glaucoma when the optometrist holds the required authority.
- Glaucoma management requires more than a single pressure reading. Assess optic nerve structure, visual fields, angle anatomy, corneal thickness, and risk factors. Document baseline and monitoring data.
- Laser and incisional surgery remain outside optometric scope unless specifically authorized; co-management and referral to ophthalmology are appropriate when surgery or uncontrolled disease requires it.
Worked example
A 62-year-old patient has IOP 28 mmHg in the right eye, optic-nerve cupping, and a corresponding visual-field defect. Gonioscopy shows an open angle. The optometrist documents the diagnosis of primary open-angle glaucoma, initiates a topical prostaglandin analogue, educates the patient, and schedules follow-up to assess pressure and tolerance. If pressure remains uncontrolled or the angle is closed, referral is indicated.
Traps
Starting glaucoma therapy without gonioscopy can miss angle closure. Treating on pressure alone ignores structure and function. Failing to document baseline fields or nerve imaging makes later progression hard to prove.
Key points
- Glaucoma care requires pressure, nerve, field, and angle assessment.
- Gonioscopy is essential before treating suspected glaucoma.
- Document baseline and follow-up data.
- Laser and incisional surgery are outside optometric scope unless authorized.
- Refer uncontrolled or surgical disease.