Scope of Practice and Prescriptive Authority
This domain tests the legal boundaries of New Hampshire optometric practice: what an optometrist may diagnose and treat, what pharmaceutical agents may be used, and when referral is required. The exam distinguishes optometric care from surgery and general medical practice.
Core scope
Optometrists examine, diagnose, and treat conditions of the eye and visual system. Practice includes refraction, contact lenses, low-vision care, and treatment of ocular disease within the scope defined by RSA 327 and Board rules. Optometrists must refer patients whose conditions exceed that scope. The statutory exclusion of surgery is central: optometrists do not perform surgical procedures, including laser surgery, and may not hold themselves out as doing so.
Prescriptive authority
Prescriptive authority is limited to agents used for diagnosis and treatment of ocular conditions, under the conditions set by statute and Board rule. It does not authorize treating unrelated systemic disease or prescribing outside the optometric scope. Controlled substances, if authorized, require compliance with prescription monitoring and recordkeeping rules. Diagnostic dilation and therapeutic prescribing are different authorities and should not be conflated.
Worked example
A patient presents with a red eye. The optometrist diagnoses bacterial conjunctivitis and prescribes a topical antibiotic, documenting the indication and follow-up. That is within ocular therapeutic scope. If the examination instead reveals a retained intraocular foreign body requiring surgical removal, the optometrist must refer rather than attempt removal. If the patient also asks for blood-pressure medication, the optometrist cannot prescribe it merely because the eye examination revealed vascular changes.
Traps that cost marks
- Equating “treatment” with unlimited medical practice.
- Assuming any ocular procedure is permitted because it is minor.
- Confusing diagnostic pharmaceutical authority with therapeutic authority.
- Prescribing for a family member or without a documented patient relationship.
- Failing to refer when the condition exceeds statutory scope.