64B13-3.010. Standards of Practice

(1) An optometrist shall not use or perform any technique, function, or mode of treatment which the optometrist is not professionally competent to perform. Professional competence as used in this rule may be acquired by formal education, supervised training and experience, continuing education programs which have been approved by the Board, or an appropriate combination of such means.

(2) An optometrist shall provide that degree of care which is full and complete, consistent with the patient conditions presented, the professional competency of the optometrist, and the scope of practice of optometry. An optometrist shall advise or assist her or his patient in obtaining further care when, in the professional judgment of the optometrist, the service of another health care practitioner is required.

(3) Certified optometrists employing the topical ocular pharmaceuticals listed in subsection 64B13-18.002(8), F.A.C., Anti-Glaucoma Agents, shall comply with the following:

(a) Upon initial diagnosis of glaucoma of a type other than those specifically listed in section 463.0135(2), F.S., the certified optometrist shall develop a plan of treatment and management.

1. The plan will be predicated upon the severity of the existing optic nerve damage, the intraocular pressure, and stability of the clinical course.

2. In the event the certified optometrist cannot otherwise comply with the requirements of Sections 463.016(1)(s), and 463.0135(1), F.S., a co-management plan shall be established with a physician skilled in the diseases of the human eye and licensed under Chapter 458 or 459, F.S.

(b) Because topical beta-blockers have potential systemic side effects a certified optometrist employing beta-blockers shall, in a manner consistent with Section 463.0135(1), F.S., ascertain the risk of systemic side effects through either a case history that complies with paragraph 64B13-3.007(2)(a), F.A.C., or by communicating with the patient’s primary care physician. The certified optometrist shall also communicate with the patient’s primary care physician, or with a physician skilled in diseases of the eye and licensed under Chapter 458 or 459, F.S., when, in the professional judgment of the certified optometrist, it is medically appropriate to do so. This communication shall be noted in the patient’s permanent record. The methodology of communication is left to the professional discretion of the certified optometrist.

(c) The certified optometrist shall have available, and be proficient in the use of, the following instrumentation:

1. Goldman-type applanation tonometer.

2. Visual fields instrumentation capable of threshold perimetry.

3. Gonio Lens.

4. Fundus Camera or detailed sketch of optic nerve head.

5. Biomicroscope.

6. Binocular indirect ophthalmascope and non-contact fundus lens to provide stereoscopic view of the optic nerve and fundus.

(4) A licensed practitioner is required to advise his or her patients who wear extended wear contact lenses to obtain at six month intervals follow-up evaluations by a licensed optometrist, or a licensed physician skilled in the diagnosis and treatment of diseases and conditions of the human eye.

(5) Follow-up evaluations performed by a licensed practitioner on patients who wear contact lenses shall, at a minimum, consist of biomicroscopy evaluation to ensure corneal integrity. Other tests may be employed at the discretion of the licensed practitioner or as indicated by symptoms and needs of the patient.

(6)(a) To be in compliance with paragraph 64B13-3.007(2)(f), F.A.C., certified optometrists shall perform a pharmacologic dilated fundus examination during the patient’s initial presentation, and thereafter, whenever medically indicated. Fundus imaging is not a substitute for a pharmacologic dilated fundus examination. If, in the certified optometrist’s sound professional judgment, dilation is not performed because of the patient’s age, physical limitations, or conditions, the reason(s) shall be noted in the patient’s medical record.

(b) Licensed optometrists who determine that a dilated fundus examination is medically indicated shall advise the patient that such examination is medically necessary and shall refer the patient to a qualified health care professional for such examination to be performed. The licensed optometrist shall document the advice and referral in the patient’s medical record.

(7) The holder of an optometric faculty certificate pursuant to Section 463.007, F.S., or a certified optometrist serving as faculty or as adjunct professor to a college of optometry, may teach and supervise the performance of diagnosis and treatment functions, for educational purposes only, by students of the college of optometry and this shall not constitute a violation of Section 464.003, F.S., provided the optometric faculty certificate holder/certified optometrist makes all final diagnosis and treatment decisions.

(8) Only a certified optometrist may administer and prescribe ocular pharmaceutical agents. A licensed Practitioner who is not certified may use topically applied anesthetics solely for the purpose of glaucoma examinations, but is otherwise prohibited from administering or prescribing ocular pharmaceutical agents. Certified optometrists may administer and prescribe only those ocular pharmaceutical agents identified by the rule of the Board and oral ocular pharmaceutical agents listed in the statutory formulary.

(9) Only certified optometrists who have successfully completed the Board approved pharmaceutical course and examination specified in Section 463.0055(1)(b), F.S., provided proof of such to the Department are authorized to administer and prescribe the oral ocular pharmaceutical agents or their therapeutic equivalents specified in Section 463.0055(3), F.S.

(10) Controlled substances listed on the statutory formulary of oral pharmaceutical agents may only be administered or prescribed by a certified optometrist who has successfully completed the board approved oral drug course and examination specified in Section 463.0055(1)(b), F.S., provided proof of such to the Department, and after the certified optometrist has acquired a United States Drug Enforcement Administration registration number.

(11)(a) Any prescription for an ocular pharmaceutical agent written by a certified optometrist shall contain the following information:

1. Name of the person for whom the pharmaceutical agent is prescribed,

2. Full name and address of the prescribing certified optometrist,

3. Name of the ocular pharmaceutical agent prescribed and the strength, quantity, and directions for use thereof; and,

4. Prescriber number and signature of the prescribing certified optometrist.

(b) All written prescriptions must comply with the requirements of Sections 456.42 and 893.04, F.S.

(12) When an ocular pharmaceutical agent is either administered or prescribed to a patient by a certified optometrist, such shall be documented in the patient’s record.

Rulemaking Authority 463.005(1) FS. Law Implemented 463.005(1), 463.0055, 463.0135(1) FS. History–New 9-16-80, Amended 12-20-82, Formerly 21Q-3.10, Amended 7-11-88, 6-18-92, 1-28-93, Formerly 21Q-3.010, Amended 3-16-94, Formerly 61F8-3.010, Amended 8-24-94, 9-21-94, 2-13-95, 12-31-95, Formerly 59V-3.010, Amended 6-15-00, 2-7-01, 11-16-05, 11-5-07, 11-4-08, 8-25-16, 12-14-20.