DEPARTMENT OF ADMINISTRATIVE SERVICES
Division of Professional Regulation
2100 Board of Examiners in Optometry
Statutory Authority: 24 Delaware Code,Section 2104(1) (24 Del.C. 2104(1))
PLEASE TAKE NOTICE, pursuant to 29 Del.C. Chapter 101 and 24 Del.C. Section 2104(1), the Delaware Board of Examiners in Optometry proposes to revise its rules and regulations. The proposed revisions clarify the Board’s law as it relates to therapeutic licensing for reciprocity applicants. Specifically, the proposed revisions to Rule 4.0 provide that an applicant, therapeutically licensed in another state, must demonstrate that that state allows the use and prescription of diagnostic and therapeutic drugs at least equivalent to that permitted by Delaware. If the state from which the applicant seeks reciprocity is not therapeutically equivalent, the applicant must meet the requirements of 24 Del.C. §2108. Proposed revisions to Rule 11.0 further clarify the requirements for therapeutic certification and specify that the 40 hours of clinical experience required under §2108(b) must be obtained no earlier than 24 months prior to application.
A public hearing will be held on the proposed Rules and Regulations on Thursday, June 15, 2000 at 6:45 p.m. in the Second Floor Conference Room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware, 19904. The Board will receive and consider input in writing from any person on the proposed Rules and Regulations. Any written comments should be submitted to the Board in care of Susan Miccio at the above address. The final date to submit written comments shall be at the above scheduled public hearing. Anyone wishing to obtain a copy of the proposed Rules and Regulations or to make comments at the public hearing should notify Susan Miccio at the above address or by calling (302) 739-4522.
This notice will be published in two newspapers of general circulation not less than twenty (20) days prior to the date of the hearing.
Board of Examiners in Optometry
1.0 Definitions
2.0 Qualifications and Examinations
3.0 Internship
4.0 Reciprocity
5.0 Use of Diagnostic Drugs
6.0 Use of Therapeutic Drugs
7.0 Minimum Standards of Practice
8.0 Ethics
9.0 Hearings
10.0 Continuing Education Requirements
11.0 Therapeutic Certification
12.0 Unprofessional Conduct
1.0 DEFINTIONS
Dispensing: The practice of optometry shall include the dispensing of contact lenses. “Dispensing” shall be defined as: “Contact lens dispensing” means the fabrication, ordering, mechanical adjustment, dispensing, sale and delivery to the consumer of contact lenses. Contact lenses must be dispensed in accordance with a written contact lens prescription from a licensed physician or optometrist which includes lens curvature, diameter, power, material, manufacturer and an expiration date not to exceed one year, together with appropriate instructions for the care and handling of the lenses. The term does not include the taking of any measurements of the eye or the cornea and evaluating the physical fit of the contact lenses.
Duly licensed: For purposes of 24 Del.C. §2106(a) and these regulations, the term “duly licensed” shall be defined as: a person who satisfies the applicable requirements under 24 Del.C. §§2107, 2108, 2110 and 2111 (or alternatively §2109 and §2111), and who has been issued a license in good standing in accordance with §2112. A person holding a valid temporary license shall not be deemed to be duly licensed for purposes of Chapter 21, Title 24 and these regulations, and may only engage in the practice of optometry as outlined in §2110 and Section 3 of these regulations.
Premises: For purposes of 24 Del.C. §2118(b) and these regulations, the phrase “on the same premises” shall be defined as: being within the immediate physical boundaries of the office of the licensed supervising practitioner. The “office” of the licensed supervising practitioner shall not include space, within a building or structure owned or leased by the licensed supervising practitioner, in which the licensed supervising practitioner does not engage in the practice of medicine, osteopathy, ophthalmology or optometry.
Supervision: For purposes of 24 Del.C. §2118(b) and these regulations, the term “supervision” shall be defined as: the physical presence of the licensed practitioner at some time during the fitting for the purpose of evaluating and verifying the contact lens fit and the patient’s ocular health.
2.0 QUALIFICATIONS AND EXAMINATIONS
2.1 Every candidate for registration must meet the following qualifications:
2.1.1 Have received a degree of “Doctor of Optometry” from a legally incorporated and accredited optometric college or school which has been approved by the appropriate accrediting body of the American Optometric Association.
2.1.2 Pass the substantive and clinical examinations required by 2.2 of these regulations.
2.1.3 Complete the internship required by 24 Del.C. §2110 and Section 3 of these regulations. An individual is duly licensed after completing the internship requirement as well as all the other requirements in §2107 of this statute. (For reciprocal applicants, see Section 4 of these regulations.)
2.1.4 All applicants for therapeutic licensure must be CPR certified for both children and adults. All therapeutic optometrists must keep their CPR certification for both children and adults current.
2.1.5 Has not engaged in conduct that would constitute grounds for disciplinary action, and has no unresolved disciplinary proceedings pending in this or any other jurisdiction. It shall be the responsibility of the candidate to submit to the Board a certified statement of good standing from each jurisdiction where he/she is currently or has been previously licensed.
2.2 Every candidate shall pass, at a score determined by the National Board of Examiners in Optometry, the substantive and clinical portions of the examination given by the National Board of Examiners in Optometry. The clinical examination given by the National Board of Examiners in Optometry may be taken as part of the National Board Examination or as a separate clinical skills and/or TMOD examination given by the National Board of Examiners in Optometry as the State Board shall designate.
3.0 INTERNSHIP
3.1 An internship is a course of study in which applicants receive part of their clinical training in a private practice setting under the supervision of a licensed optometrist or ophthalmologist. An active, licensed Optometrist or Ophthalmologist may act as a supervisor. Any applicant’s participation in such an internship program must be approved by the Board and is subject to the following terms and conditions:
3.1.1 A letter from the practitioner with whom the applicant will be interning stating the goals, duties and the number of hours he/she will be working. If the applicant is not doing his/her internship with a therapeutically certified optometrist or ophthalmologist, he/she must also complete an additional one hundred (100) hours of clinical internship with a therapeutically certified Optometrist, Medical doctor or Osteopathic physician.
3.1.2 Each applicant who will be participating in the internship program must provide the name and address of the supervisor and the dates of the internship for approval by the Board before the internship may begin.
3.1.3 A letter must be received by the Board from the supervisor verifying the completion of the internship.
3.1.4 For purposes of this Section and 29 Del.C. §2110, the term “duration” shall be defined as “a period of no less than six (6) months and no greater than the period ending on the date of the next Board meeting following the end of the six (6) month period.” No intern may practice on a temporary license beyond the duration of the internship.
3.2 Subject to the approval requirements stated above, a candidate’s internship requirements may be satisfied while the candidate is a member of the Armed Forces if he/she:
3.2.1 Functions as a fully credentialed therapeutically certified optometric practitioner; and (for purposes of this Section equivalent to the Air Force regulations).
3.2.2 Performs his optometric duties on a full-time basis in a completely equipped eye clinic.
3.3 Full-time: minimum of 35 hours per week.
3.4 All supervisors must supervise the interns on a one-to-one basis whenever an applicant performs a task which constitutes the practice of optometry. No supervisor may be a supervisor for more than one intern, or student extern, at a time. Only one intern shall be permitted in any practice for any period of time.
3.5 All acts which constitute the practice of optometry under 24 Del.C. §2101(a) may be performed by the intern only under the following conditions:
3.5.1 The supervisor shall be on the premises and immediately available for supervision at all times;
3.5.2 All intern evaluations of any patient shall be reviewed by the supervisor prior to final determination of the patient’s case before the patient leaves the premises; and
3.5.3 A supervisor shall at all times effectively supervise and direct the intern.
3.6 A violation of any of the conditions enumerated in this rule may be grounds for the Board to revoke their approval of an internship program. The Board may also revoke its approval of an internship program if it determines that either the supervising optometrist or the intern has engaged in any conduct described by 24 Del.C. §2113(a). Furthermore, any violation of the terms of this rule by a supervising optometrist who is a licensed optometrist shall be considered unprofessional conduct and a violation of 24 Del.C. §2113(a)(7).
4.0 RECIPROCITY (ENDORSEMENT)
4.1 The Board shall waive the internship requirement for an applicant holding a valid license to practice optometry, issued by another jurisdiction, and who has practiced for a minimum of five years in such other jurisdiction with standards of licensure which are equal to or greater than those of 24 Del.C. Ch. 21 and grant a license by reciprocity to such applicant. The five years of practice experience must be obtained in states(s) with licensure standards at least equal to those of Delaware. The applicant shall contact the Healthcare Integrity Protection Data Bank/National Practitioner Data Bank requesting that verification be sent to the Board regarding his/her licensure status. In addition, the applicant shall contact each jurisdiction where he/she currently is licensed, or has been previously licensed, or otherwise authorized to practice optometry, and request that a certified statement be provided to the Board stating whether or not there are disciplinary proceedings or unresolved complaints pending against the applicant. In the event there is a disciplinary proceeding or unresolved complaint pending, the applicant shall not be licensed until the proceeding or complaint has been resolved.
4.2 Applicants from jurisdictions which have the same basic qualifications for licensure as this State, but do not have essentially comparable or higher standards to qualify for ‘therapeutic’ licensing, shall be required to meet the conditions of subsections (a) and (b), 24 Del.C. §2108.
4.3 “Standards” as used in this Section are defined in Rules 6.0 & 7.0 of these regulations.
4.3 In addition, The applicant shall include, as part of the application, copies of state licensing and/or practice statutes and regulations pertaining to the practice of Optometry for each the jurisdiction through which he/she is seeking reciprocity or claiming qualifying practice experience.
4.4 “Standards of licensure,” as used in 24 Del.C. §2109, shall refer to the qualifications of applicants set forth at §2107.
4.5 The “standards to qualify for ‘therapeutic’ licensing,” as used in 24 Del.C.§2109 with regard to therapeutic reciprocity, shall refer to the standards of diagnostic and therapeutic practice as set forth in 24 Del. C. §2101(b).
4.6 An applicant shall not be licensed by reciprocity as a Delaware therapeutically certified optometrist unless:
4.6.1 He/she demonstrates that the state in which he/she is therapeutically certified allows the use and prescription of diagnostic and therapeutic drugs which is at least equivalent to that permitted under a Delaware therapeutic optometrist license as set forth in §2101(b), OR
4.6.2 He/she has met the requirements of §2108(a) and (b) and Rule 11.0.
5.0 USE OF DIAGNOSTIC DRUGS
5.1 Licensees who have been duly authorized by the Board may, for diagnostic purposes only, make use of the following classes of topical ophthalmic drugs: (1) anesthetics, (2) mydriatics, (3) cycloplegics, and (4) miotics; provided, however, that any such authorization by the Board shall not be construed as authorizing any licensee to dispense or issue a prescription for diagnostic drugs.
5.2 Authorization by the Board under this regulation shall be evidenced by an appropriate designation on the certificate of registration and license.
5.3 The provisions of Section 5.1 shall not preclude a licensee from using: ancillary diagnostic agents including, but not limited to dyes, schirmer strips, etc.
6.0 USE OF THERAPEUTIC DRUGS
6.1 Therapeutically certified optometrists may use and/or prescribe the following pharmaceutical agents for the treatment of ocular diseases and conditions:
6.1.1 Topical and oral administration:
6.1.1.1 Antihistamines and decongestants
6.1.1.2 Antiglaucoma
6.1.1.3 Analgesics (non-controlled)
6.1.1.4 Antibiotics
6.1.2 Topical administration only:
6.1.2.1 Autonomics
6.1.2.2 Anesthetics
6.1.2.3 Anti-infectives, including antivirals and antiparasitics
6.1.2.4 Anti-inflammatories
6.2 Authorization by the Board under this regulation shall be evidenced by an appropriate designation on the certificate of registration and license.
7.0 MINIMUM STANDARDS OF PRACTICE
7.1 Equipment
7.1.1 Acuity chart
7.1.2 Opthalmoscope
7.1.2.1 Direct
7.1.2.2 Indirect
7.1.3 Keratometer
7.1.4 Biomicroscope
7.1.5 Tonometer
7.1.6 Gonioscope
7.1.7 Access to Visual Field
7.1.8 Access to Retinal Camera
7.1.9 Phoropter
7.2 Examination and Treatment
7.2.1 General Examination:
7.2.1.1 Case history
7.2.1.2 Acuity measure
7.2.1.3 Internal tissue health evaluation
7.2.1.4 External tissue health evaluation
7.2.1.5 Refraction
7.2.1.6 Tonometry
7.2.1.7 Visual fields (in appropriate cases)
7.2.1.8 Retinal photos (in appropriate cases)
7.2.1.9 Treatment, recommendations and directions to the patients, including prescriptions
7.2.1.10 Name of attending optometrist
7.2.2 During a contact lens examination:
7.2.2.1 Assessment of corneal curvature
7.2.2.2 Acuity through the lens
7.2.2.3 Directions for the care and handling of lenses and an explanation of the implications of contact lenses with regard to eye health and vision
7.2.2.4 Name of attending optometrist
7.2.2.5 Assessment of contact lens fit
7.2.3 During a follow-up contact lens examination:
7.2.3.1 Assessment of fit of lens
7.2.3.2 Acuity through the lens
7.2.3.3 Name of attending optometrist
7.2.3.4 Ocular health assessment
7.3 A complete record of examinations and treatment shall be kept in a current manner.
8.0 ETHICS
8.1 It shall be the ideal, the resolve and the duty of all licensees to:
8.1.1 Keep the visual welfare of the patient uppermost at all times.
8.1.2 Promote in every possible way, better care of the visual needs of mankind.
8.1.3 Enhance continuously their educational and technical proficiency to the end that their patients shall receive the benefits of all acknowledged improvements in vision and eye care.
8.1.4 See that no person shall lack for visual care, regardless of his financial status.
8.1.5 Advise the patient whenever consultation with an optometric colleague or reference for other professional care seems advisable.
8.1.6 Hold in professional confidence all information concerning a patient and use such data only for the benefit of the patient.
8.1.7 Conduct themselves as exemplary citizens.
8.1.8 Maintain their offices and their practices in keeping with current professional standards of care.
8.1.9 Promote and maintain cordial and unselfish relations with members of their own profession and other professionals for the exchange of information to the advantage of mankind.
8.1.10 Maintain adequate records on each patient for a period of not less than five years from the date of the most recent service rendered.
8.2 A licensee must honor a patient’s request to forward the patient’s complete prescription and ophthalmic or contact lens specification to another licensed physician of medicine, osteopath, optometrist, or a nationally registered contact lens technician working under the direct supervision of an optometrist, ophthalmologist or osteopathic physician, if all financial obligations to the licensee have been satisfied. It shall be the obligation of a licensee to tender to a patient upon request his/her final prescription for ophthalmic lenses or contact lens(es) specification, if all financial obligations to the licensee have been satisfied. For purposes of this section, a final prescription or specification results when a patient is released to routine follow-up care. No licensee shall be required to tender a contact lens prescription beyond one (1) year from the date the contact lens(es) were dispensed.
8.3 It shall be considered unlawful for a licensee to delegate to a lay individual, whether an employee or not, any act or duty which would require, on the part of such individual, professional judgment. The fitting of contact lenses, tonometry, refraction, treatment of eye disease, low vision and vision therapy, etc. shall not be so delegated unless under the direct supervision of the licensee.
8.4 No licensee shall do anything inconsistent with the professional standards of the optometric and allied health professions.
8.5 No licensee shall use unethical, misleading or unprofessional advertising methods, including, but not limited to: baiting patients to purchase materials in exchange for free or reduced fees for professional services.
8.6 No licensee when using the doctor title shall qualify it in any other way than by use of the word “optometrist”. He/she may, however, when not using the prefix, use after his/her name the “O.D.” degree designation, consistent with other provisions of 24 Del.C. Ch. 21.
8.7 No licensee shall practice in or on premises where any materials, other than those necessary to render his professional services, are dispensed to the public.
8.8 No licensee shall locate in a merchandising store or practice his profession among the public as the agent, employee or servant of, or in conjunction with either directly or indirectly, any merchandising firm, corporation, lay firm or unlicensed individual.
8.9 No licensee shall practice his profession in conjunction with, or as an agent or employee of an ophthalmic merchandising business (commonly known as “opticians”) either directly or indirectly in any manner. Nor shall any licensee use any name other than the name recorded in the files of the State Board for his optometric registration and licensure.
8.10 Corporations, except those allowed under Chapter 6 of Title 8 of the Delaware Code, lay firms and unlicensed individuals are prohibited from the practice of optometry directly or indirectly and from employing, either directly or indirectly, registered and licensed optometrists to examine the eyes of their patients. Licensees so employed will be considered guilty of unprofessional conduct, and in violation of 24 Del.C. §2113(a)(3) and (6).
8.11 No licensee shall hold himself forth in such a way as to carry the slightest intimation of having superior qualifications or being superior to other optometrists, unless he is qualified by a specialty board approved by the State Board.
8.12 No licensee holding an official position in any optometric organization shall use such position for advertising purposes or for self-aggrandizement.
8.13 Since the law states that a certificate must be displayed in every office where the profession of optometry is practiced, and since no certificate for branch offices has previously been issued, the State Board shall issue branch office certificates with the words “Branch Office” thereon emblazoned under the registry number, with the certificate being a duplicate of that originally issued.
8.14 A violation of any of the provisions of these regulations will be considered to be unprofessional conduct.
9.0 HEARINGS
9.1 All complaints shall be referred to the Division of Professional Regulation for investigation and a contact person from the Board will be appointed at the next meeting.
9.2 Hearings are conducted in accordance with the Administrative Procedures Act.
10.0 CONTINUING EDUCATION REQUIREMENTS
10.1 All persons licensed to practice Optometry in the State of Delaware shall be required to acquire 12 hours of continuing education every two years. All therapeutic licensed optometrists shall be required to acquire an additional 12 hours of therapeutics and management of ocular disease and keep their CPR certification for both children and adults current. No practice management courses will be accepted.
10.2 These continuing optometric education requirements are necessary for licensure every two years.
10.3 Licensees will be required to comply before May 1 of odd numbered years.
10.4 It shall be the responsibility of the candidate for relicensure to submit to the appropriate State of Delaware agency evidence of his/her compliance with these requirements. The appropriate state agency shall notify the candidate at least 30 days in advance of the need to renew his/her license, and shall request that the candidate submit evidence of compliance with the continuing education requirements stated herein, along with other fees and documents required. Failure to be notified by such agency shall not relieve licensee from this obligation.
10.5 Self-Reported Study
10.5.1 Non-therapeutic - Of the 12 hours biennial requirement for non-therapeutic licensees, a maximum of 2 hours may be fulfilled by self-reported study.
10.5.2 Therapeutic - Of the 24 hours biennial requirement for therapeutic licensees, a maximum of 4 hours may be fulfilled by self-reported study.
10.5.3 Self-reported study may include:
10.5.3.1 Reading of Optometric journals
10.5.3.2 Optometric tape journals
10.5.3.3 Optometric audiovisual material
10.5.3.4 Other materials given prior approval by the Board.
Proof of completion from the sponsoring agency is required for credit.
10.6 Any new licensee shall be required to complete continuing education equivalent to one hour for each month between the date of licensure and the biennial renewal date. The first twelve (12) hours of pro-rated continuing education must be in the treatment and management of ocular disease.
10.7 Continuing Education courses given by the following organizations will receive credit. Meetings of (Scientific Session Portion Only)
10.7.1 American Optometric Association
10.7.2 Delaware Optometric Association
10.7.3 American Academy of Optometry
10.7.4 Recognized state regional or national optometric societies
10.7.5 Schools and colleges of Optometry
10.7.6 Meetings of other organizations as may be approved by the Board.
10.7.7 COPE-approved courses (with the exception of Practice Management courses)
10.8 Failure to Comply. When the State Board of Examiners in Optometry deems someone to be deficient in continuing education requirements, the license will be revoked. In the event that any optometrist licensed in this State fails to meet continuing education requirements, his or her license shall be revoked, except when proven hardship makes compliance impossible. The Board shall reinstate such license upon presentation of satisfactory evidence of successful completion of continuing education requirements and upon payment of all fees due.
10.9 Licensure--Renewal
10.9.1 All licenses are renewed biennially (every 2 years). A licensee may have his/her license renewed by submitting a renewal application to the Board by the renewal date and upon payment of the renewal fee prescribed by the Division of Professional Regulation along with evidence of completion of continuing education requirements. The failure of the Board to give, or the failure of the licensee to receive, notice of the expiration date of a license shall not prevent the license from becoming invalid after its expiration date.
10.9.2 Any licensee who fails to renew his/her license by the renewal date may still renew his/her license during the one (1) year period immediately following the renewal date provided the licensee pay a late fee in addition to the prescribed renewal fee.
10.9.3 Any licensee who intends not to renew his/her license because he/she retired from practice or has ceased practice in the State of Delaware, shall so indicate such reason(s) on the renewal application. Failure to do so will result in the Board taking mandatory action to revoke the license.
10.10 Exemptions
An exemption may be granted to any optometrist who can demonstrate to the Board an acceptable cause as to why he/she should be relieved of this obligation. Exemptions will be granted only in unusual or extraordinary circumstances. Licensees must petition the Board for exemptions. Should the Board deny the request, the licensee must complete the requirements. Examples of circumstances for which the Board might grant exemptions include prolonged illness, extended absence from the country, etc.
11.0 THERAPEUTIC CERTIFICATION
11.1 The examination identified in 24 Del.C. §2108(b) is the national examination administered by the Association of Regulatory Boards of Optometry (ARBO) for treatment and management of ocular disease. A copy of the certificate representing passage of the examination must be submitted with the application for therapeutic licensure.
11.2 All applicants for therapeutic licensure must be CPR certified for both children and adults. All optometrists must keep their CPR certification for both children and adults current.
11.3 For applicants currently licensed in Delaware and applicants for reciprocal licensure pursuant to the requirements of §2108, 40 hours of treatment and management of ocular disease training may be accumulated with a therapeutically certified optometrist, a medical doctor, or an osteopathic doctor. Proof of 40 hours of treatment and management of ocular disease training must be submitted in writing by the supervising doctor. by letter. If an applicant’s supervisor is a therapeutically certified optometrist practicing in a state other than Delaware, proof of similar therapeutic practice standards licensing requirements in the other state must be submitted.
11.4 Applicants must have completed their forty (40) hours of clinical experience within twenty-four (24) months of their initial application for therapeutic licensure. No clinical experience older than 24 months (prior to application) will be accepted for therapeutic certification.
11.5 The same reciprocity rules apply for therapeutic licensing as for other optometry licensing.
11.5 All newly licensed optometrists shall be required to be therapeutically certified. Their six month internship should be done with a therapeutically certified optometrist, M.D. or D.O. However, if a therapeutically certified optometrist, M.D. or D.O. is not available, the intern may do an internship with a non-therapeutically certified optometrist, provided the intern complete an additional 100 hours of clinical experience in the treatment and management of ocular disease supervised by a therapeutically certified optometrist, M.D. or D.O. during their internship.
11.7 For applicants not currently licensed in Delaware (Refer to Reciprocity).
12.0 UNPROFESSIONAL CONDUCT
A violation of any of the provisions of these regulations will be considered to be unprofessional conduct.