Unlicensed Practice, Delegation, and Supervision of Ancillary Personnel
Unlicensed practice
Only a licensed optometrist may practice optometry or use the protected titles. Practicing without a license, or helping an unlicensed person practice, violates the act and can result in criminal penalties and board action against any licensee involved. A lapsed or inactive licensee is unlicensed for practice purposes.
Delegation and supervision
Ancillary personnel may perform delegated tasks under the supervising optometrist's direction. Delegable tasks are technical and do not require optometric judgment: obtaining history, visual acuity, autorefraction data, tonometry where permitted, frame adjustment, and teaching contact lens handling. Nondelegable tasks include refraction and prescription determination, diagnosis, contact lens fitting parameters, and patient counseling about diagnosis.
Supervision levels
Know whether the board requires direct supervision (supervisor on site) or general supervision (available by phone). The level depends on the task and the assistant's training. The supervising optometrist remains responsible for the delegated act.
Worked example. An assistant performs autorefraction and writes the result on a form. The optometrist reviews the data, performs the final refraction, and signs the prescription. The assistant's data collection is delegable; the final refraction and prescription are not. If the assistant instead selects the contact lens base curve and orders lenses, that exceeds delegation.
Traps. Treating an assistant's years of experience as authority to diagnose; assuming a certified assistant can practice independently; failing to document who performed each test; delegating to an unlicensed person without any supervision.