Scope of Optometric Practice and Prescriptive Authority (TPA/TPA+GC)
Scope of practice
Massachusetts optometrists examine, diagnose, treat, and manage disorders of the visual system, eye, and adnexa; prescribe and fit spectacles and contact lenses; and use diagnostic pharmaceutical agents. The statutory definition and 246 CMR set the boundary between optometry and medicine. Optometrists do not perform surgery, use lasers, or provide injectable treatment; they refer when a condition exceeds optometric scope.
Prescriptive authority: TPA and TPA+GC
TPA certification permits the use of therapeutic pharmaceutical agents for specified ocular conditions under Board regulation; TPA+GC adds glaucoma certification. The credentials are not automatic with licensure. The optometrist must complete Board-approved pharmacology and clinical training, pass the required examination, and maintain certification. Prescribing must be within the approved formulary and scope, documented, and consistent with the standard of care. TPA alone does not authorize glaucoma treatment.
Worked example
A TPA-certified optometrist diagnoses bacterial conjunctivitis and prescribes a topical antibiotic. That is within TPA scope if the drug and condition are covered and the record documents the diagnosis, drug, dose, and follow-up. The same optometrist diagnoses primary open-angle glaucoma and wants to start latanoprost. Without TPA+GC, the optometrist must refer or co-manage; TPA certification alone is insufficient.
Traps
Diagnostic drugs are not therapeutic authority. TPA is not TPA+GC. A drug’s availability does not create authority to prescribe it. Do not ignore formulary limits, referral duties, or documentation; “scope” is a legal limit, not merely a clinical preference.