Scope of Practice and Prescriptive Authority
Scope: diagnose, treat, refer
Maine optometrists are not limited to refraction. Within the statute and Board rules they examine, diagnose, and treat disorders of the visual system and eye, including prescribing lenses and, for certified licensees, drugs. The scope is still bounded: optometrists do not perform surgery, do not hold themselves out as ophthalmologists, and must refer when a condition exceeds their authority or competence.
Prescriptive authority
Maine uses a certification model for therapeutic pharmaceutical agents (TPAs). A licensee who has met the Board's TPA requirements may prescribe and administer agents listed in the Board's formulary-typically topical and oral medications for infection, inflammation, allergy, glaucoma, and pain. The formulary and any controlled-substance limits control; do not assume that “TPA” means any drug. Schedule I and Schedule II controlled substances are outside optometric prescribing, and prescribing must be for a legitimate therapeutic purpose with a patient record.
Procedures
Limited procedures expressly allowed by statute or rule-such as removal of superficial foreign bodies-do not create general surgical authority. Anything involving incision, laser, or operating-room care belongs to medicine.
Worked example. A patient has a red eye with purulent discharge, normal vision, and no proptosis or fever. A TPA-certified optometrist diagnoses bacterial conjunctivitis and prescribes a topical antibiotic, documenting findings and follow-up. A non-TPA licensee may examine and diagnose but must not prescribe; the patient is referred. If the patient had proptosis, fever, or pain with eye movement, both would refer urgently for orbital cellulitis.
Traps that cost marks: treating the formulary as unlimited; prescribing for a family member without a record; and calling a permitted minor procedure “surgery” in the wrong direction-or using it to justify a scalpel.