Scope of Practice and Prescriptive Authority
Scope defined by statute and rule
NC optometrists examine, diagnose, treat, and manage disorders of the visual system. Scope includes refractive care, contact lenses, low vision, topical and oral medications for ocular conditions, ordering laboratory tests, and minor in-office procedures within Board rules. Incisional surgery and procedures reserved by law to other professions are outside scope. When a condition exceeds competence or statutory authority, refer.
Prescriptive authority
- Prescriptive authority is an incident of licensure, not a separate unrestricted license.
- Prescribe only after an appropriate patient evaluation and with a documented medical purpose. A prescription is a medical order, not a customer convenience.
- Federal and state controlled-substance rules apply if the drug is controlled. DEA registration and Board compliance are required; not every optometrist has or needs every category.
- Labeling, refills, and records must meet Board and pharmacy rules. Avoid self-prescribing and prescribing for family without a real patient relationship and record.
- Use accepted treatment guidelines and monitor for adverse effects.
Worked example
A patient presents with a superficial corneal foreign body after grinding metal. The OD documents vision and slit-lamp findings, removes the foreign body, prescribes a topical antibiotic, and schedules follow-up. That is within scope if there is no deep penetration or infection. If the examination shows a full-thickness laceration with a flat anterior chamber, the OD should shield the eye, avoid pressure, and refer emergently; continuing to treat would exceed scope and the standard of care.
Traps that cost marks
- Assuming “oral medications” means any drug at any dose.
- Prescribing without a documented examination.
- Treating a red eye with steroids before ruling out herpes or infection.
- Failing to refer when vision loss, severe pain, or trauma exceeds comfort or authority.