Scope of Practice, Pharmaceuticals, and Diagnostic Testing
Domain 4 - Scope of practice, including pharmaceutical agents and diagnostic testing
This domain tests the boundary between permitted optometric care and prohibited practice. It covers refractive care, contact lenses, ocular disease, therapeutic pharmaceutical agents, diagnostic agents, and referral obligations.
Core rules
- Scope includes refraction, contact lens fitting, low-vision rehabilitation, diagnosis and management of ocular conditions, and authorized pharmaceutical agents.
- Therapeutic authority is not unlimited. Nebraska law and Board rules define which drugs may be used and any certification, formulary, or reporting requirements. Surgery and invasive procedures are outside optometric scope unless expressly authorized.
- Diagnostic testing such as tonometry, ophthalmoscopy, visual fields, and imaging may be performed and interpreted only within the optometrist’s competence and applicable rules.
- Delegation to unlicensed staff is limited; staff may perform technical tasks but may not make diagnoses, prescribe, or interpret results as the optometrist’s clinical judgment.
- Referral or co-management is required when a condition exceeds scope, competence, or available equipment.
Worked example
An optometrist diagnoses a corneal abrasion and prescribes a topical antibiotic. That is generally within therapeutic scope if the drug is authorized and the optometrist is licensed for it. If the eye also has a retained intraocular foreign body requiring surgical removal, the optometrist must refer rather than attempt removal.
Traps
Do not assume every drug is permitted because the licensee has a DEA number. Do not let staff “read” imaging for the optometrist. Do not treat a diagnosis as a screening. Do not ignore the duty to refer when the condition is outside scope.