3041.
(a) The practice of optometry includes the prevention and diagnosis diagnosis, prevention, treatment, and management of disorders and dysfunctions of the visual system, and the treatment and management of certain disorders and dysfunctions of the visual system, as authorized by this chapter, as well as the provision of habilitative or rehabilitative optometric services, and is the doing of any or all of
the following:(1) The examination of the human eye or eyes, or its or their appendages, eyes and their adnexa, including through the use of all topical and oral diagnostic pharmaceutical agents that are not controlled substances, and the analysis of the human vision system, either subjectively or objectively.
(2) The determination of the powers or range of human vision and the accommodative and refractive states of the human eye or eyes, including the scope of its or their
functions and general condition.
(3) The prescribing prescribing, using, or directing the use of, or using, of any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.
(4) The prescribing of contact and spectacle lenses for, or the fitting
prescribing, fitting, or adaptation of contact and spectacle lenses to, the human eye, eyes, including lenses that may be classified as drugs or devices by any law of the United States or of this state. state, and diagnostic or therapeutic contact lenses that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
(5)The use of topical pharmaceutical agents for the purpose of the examination of the human eye or eyes for any disease or pathological condition.
(b)(1)An
optometrist who is certified to use therapeutic pharmaceutical agents, pursuant to Section 3041.3, may also diagnose and treat the human eye or eyes, or any of its or their
appendages, for all of the following conditions:
(A)Through medical treatment, infections of the anterior segment and adnexa, excluding the lacrimal gland, the lacrimal drainage system, and the sclera in patients under 12 years of age.
(B)Ocular allergies of the anterior segment and adnexa.
(C)Ocular inflammation, nonsurgical in cause except when comanaged with the treating physician and surgeon, limited to inflammation resulting from traumatic iritis, peripheral corneal inflammatory keratitis, episcleritis, and unilateral nonrecurrent nongranulomatous idiopathic iritis in patients over 18 years of age.
(D)Traumatic or recurrent conjunctival or
corneal abrasions and erosions.
(E)Nonmalignant ocular surface disease and dry eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(H)Pursuant to subdivision (e), glaucoma in patients over 18 years of age, as described in subdivision (k).
(I)Through medical treatment, acquired blepharoptosis.
(J)Through medical treatment, ametropia and presbyopia.
(2)For purposes of this section, “treat” means the use of therapeutic pharmaceutical agents, as described in subdivision (c), and the procedures described in subdivision (d).
(c)In diagnosing and treating the conditions listed in subdivision (b), an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may use or prescribe, including for rational off-label purposes, all of the following therapeutic pharmaceutical agents:
(1)Topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including,
but not limited to, topical miotics.
(2)Topical lubricants.
(3)Antiallergy agents. In using topical steroid medication for the treatment of ocular allergies, an optometrist shall consult with an ophthalmologist if the patient’s condition worsens 21 days after diagnosis.
(4)Topical and oral anti-inflammatories.
(5)Topical antibiotic agents.
(6)Topical hyperosmotics.
(7)Topical and oral antiglaucoma agents pursuant to the certification process defined in subdivision (e).
(8)Nonprescription medications used for the rational treatment of an ocular disorder.
(9)Oral antihistamines.
(10)Prescription oral nonsteroidal anti-inflammatory agents.
(11)Oral antibiotics for medical treatment of ocular disease.
(12)Topical and oral antiviral medication for the medical treatment of herpes simplex viral keratitis, herpes simplex viral conjunctivitis, periocular herpes simplex viral dermatitis, varicella zoster viral keratitis, varicella zoster viral conjunctivitis, and periocular varicella zoster viral dermatitis.
(13)Oral analgesics that are not controlled substances.
(5) For an optometrist certified pursuant to Section 3041.3, diagnosing and treating nonmalignant conditions and diseases of the anterior segment of the human eyes and their adnexa, and preventing conditions and diseases of the human eyes and their adnexa, including the following:
(A) Using or prescribing, including for rational off-label purposes, topical and oral prescription and nonprescription therapeutic pharmaceutical agents that are not controlled substances and are not antiglaucoma agents or limited or excluded by subdivision (b). For purposes of this section, “controlled substance” has the same meaning as used in the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and the United States Uniform Controlled Substances Act (21 U.S.C. Sec. 801 et seq.).
(14)Codeine
(B) Prescribing the oral analgesic controlled substance codeine with compounds, hydrocodone with compounds, and tramadol as listed in the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and the United States Uniform Controlled Substances Act (21 U.S.C. Sec. 801 et seq.). The use of these agents shall be seq.), limited to three days, with a
referral to an ophthalmologist if the pain persists.
(15)Additional therapeutic pharmaceutical agents pursuant to subdivision (f).
(d)An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following procedures:
(1)Corneal scraping with cultures.
(2)Debridement of corneal epithelia.
(3)Mechanical
epilation.
(4)Collection of blood by skin puncture or venipuncture for testing patients suspected of having diabetes.
(5)Suture removal, with prior consultation with the treating physician and surgeon.
(6)Treatment or removal of sebaceous cysts by expression.
(7)Administration of oral fluorescein to patients suspected as having diabetic retinopathy.
(8)Use of an auto-injector to counter anaphylaxis.
(9)Ordering of smears, cultures, sensitivities, complete blood count, mycobacterial culture, acid fast stain, urinalysis, tear fluid analysis,
and X-rays necessary for the diagnosis of conditions or diseases of the eye or adnexa. An optometrist may order other types of images subject to prior consultation with an ophthalmologist or appropriate physician and surgeon.
(10)A clinical laboratory test or examination classified as waived under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) and designated in paragraph (9) necessary for the diagnosis of conditions and diseases of the eye or adnexa, or if
otherwise specifically authorized by this chapter.
(C) If also certified under subdivision (c), using or prescribing topical and oral antiglaucoma agents for the medical treatment of all primary open-angle, exfoliation, pigmentary, and steroid-induced glaucomas in persons over 18 years of age. In the case of steroid-induced glaucoma, the prescriber of the steroid medication shall be promptly notified if the prescriber did not refer the patient to the optometrist for treatment.
(D) If also certified under subdivision (d), administration of immunizations for influenza, herpes zoster virus, pneumococcus, and SARS-CoV-2 in compliance with individual Advisory Committee on
Immunization Practices (ACIP) vaccine recommendations published by the federal Centers for Disease Control and Prevention (CDC) in persons over 18 years of age.
(E) Utilizing the following techniques and instrumentation necessary for the diagnosis of conditions and diseases of the eye and adnexa:
(i) Laboratory tests or examinations ordered from an outside facility.
(ii) Laboratory tests or examinations performed in an office classified as waived under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578), which shall also be allowed for detecting indicators of possible systemic disease that manifests in the eye for the purpose of facilitating
appropriate referral to or consultation with a physician and surgeon.
(iii) Skin testing performed in an office to diagnose ocular allergies, limited to the superficial layer of the skin.
(iv) X-rays ordered from an outside facility.
(v) Other imaging studies ordered from an outside facility subject to prior consultation with an appropriate physician and surgeon.
(vi) Other imaging studies performed in an office, including those that utilize laser or ultrasound technology, but excluding those that utilize radiation.
(F) Performing the following procedures, which are excluded from restrictions imposed on the performance of surgery by paragraph (6) of subdivision (b), unless explicitly indicated:
(i) Corneal scraping with cultures.
(ii) Debridement of corneal epithelium.
(iii) Mechanical epilation.
(iv) Collection of blood by skin puncture or venipuncture for laboratory testing authorized by this subdivision.
(v) Suture removal subject to comanagement requirements in paragraph (7) of subdivision (b).
(vi) Treatment or removal of sebaceous cysts by expression.
(11)
(vii) Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter. nonsurgical means.
(12)The use or prescription of diagnostic or therapeutic contact lenses, including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
(13)Removal of foreign bodies
(viii) Foreign body removal from the cornea, eyelid, and conjunctiva with any appropriate instrument other than a scalpel. instrument. Corneal foreign bodies shall be nonperforating, be no deeper than the midstroma, and reasonably anticipated not to require no surgical repair upon removal.
(14)For
(ix) Lacrimal irrigation and dilation in patients over 12 years of age, lacrimal irrigation and dilation, excluding probing of the nasal lacrimal nasolacrimal tract. The board shall certify any optometrist who graduated from an accredited school of optometry before May 1, 2000, to perform this procedure after submitting proof of satisfactory completion of 10 procedures under the supervision of an ophthalmologist as confirmed by the ophthalmologist. Any optometrist who graduated from an accredited school of
optometry on or after May 1, 2000, shall be exempt from the certification requirement contained in this paragraph.
(x) Administration of oral fluorescein for the purpose of ocular angiography.
(15)
(xi) Intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available.
(16)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(17)
(xii) Use of any noninvasive medical device or technology
authorized pursuant to subdivision (f). devices delivering intense pulsed light therapy or low-level light therapy that do not rely on laser technology, limited to treatment of conditions and diseases of the adnexa.
(G) Using additional noninvasive medical devices or technology that:
(i) Have received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition or disease authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those
noninvasive medical devices or technologies.
(ii) Have been approved by the board through regulation for the rational treatment of a condition or disease authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each noninvasive medical device or technology approved by the board pursuant to this paragraph.
(b) Exceptions or limitations to the provisions of subdivision (a) are as follows:
(1) Treatment of the following is excluded from the practice of optometry in a patient under 18 years of age, unless explicitly allowed otherwise:
(A) Anterior segment inflammation.
(B) Conditions or diseases of the sclera.
(2) Use of any oral prescription steroid anti-inflammatory medication for a patient under 18 years of age shall be done pursuant to a documented, timely consultation with an appropriate physician and surgeon.
(3) Use of any nonantibiotic oral prescription medication for a patient under five years of age shall be done pursuant to a documented, prior consultation with an appropriate physician and surgeon.
(4) The following classes of agents are excluded from the practice of optometry unless they have an explicit United States Food and Drug Administration-approved indication for treatment of a condition or disease authorized under this section:
(A) Antiamoebics.
(B) Antineoplastics.
(C) Biologicals.
(D) Coagulation modulators.
(E) Hormone modulators.
(F) Immunomodulators.
(5) The following are excluded from authorization under subparagraph (G) of paragraph (5) of subdivision (a):
(A) A laboratory test or imaging study.
(B) Any noninvasive device or technology that constitutes surgery under paragraph (6).
(6) Performing surgery is excluded from the practice of optometry. “Surgery” means any act in which human tissue is cut, altered, or otherwise infiltrated by any means. It does not mean an act that solely involves the administration or prescribing of a topical or oral therapeutic pharmaceutical.
(7) (A) Treatment with topical and oral medications authorized in subdivision (a) related to an ocular surgery shall be comanaged with the ophthalmologist that performed the surgery, or another ophthalmologist designated by that surgeon, during the customary preoperative and postoperative period for the procedure. For purposes of this subparagraph, this may involve treatment of ocular inflammation in a patient under 18 years of age.
(B) Where published, the postoperative period shall be the “global” period established by the federal Centers for Medicare
and Medicaid Services, or, if not published, a reasonable period not to exceed 90 days.
(C) Such comanaged treatment may include addressing agreed-upon complications of the surgical procedure occurring in any ocular or adnexal structure with topical and oral medications authorized in subdivision (a) in a patient over 18 years of age.
(e)
(c) An optometrist certified pursuant to Section 3041.3 shall be certified for the treatment of glaucoma, as described in subdivision (k), in patients over 18 years of age after the optometrist meets the following applicable
to medically treat authorized glaucomas under this chapter after meeting the following requirements:
(1) For licensees who graduated from an accredited school of optometry on or after May 1, 2008, submission of proof of graduation from that institution.
(2) For licensees who were certified to treat glaucoma under this section before January 1, 2009, submission of proof of completion of that certification program.
(3) For licensees who completed a didactic course of not less than 24 hours in the diagnosis, pharmacological, and other treatment and management of glaucoma, submission of proof of satisfactory completion of the case management requirements for certification established by the
board.
(4) For licensees who graduated from an accredited school of optometry on or before May 1, 2008, and who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board under Chapter 352 of the Statutes of 2008.
(f)(1)Any topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use
therapeutic pharmaceutical agents pursuant to Section 3041.3 shall be deemed to be authorized if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer before using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
(2)Any other topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 and does not meet the requirements in paragraph (1) shall be deemed authorized if
approved by the board through regulation for the rational treatment of a condition authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the board pursuant to this paragraph.
(3)This subdivision shall not be construed to authorize any of the following:
(A)Any therapeutic pharmaceutical agent, medical device, or technology involving cutting, altering, or otherwise infiltrating human tissue by any means.
(B)A clinical laboratory test or imaging study not authorized by paragraphs (1) to
(16), inclusive, of subdivision (d).
(C)Treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018, unless specifically authorized by this section.
(g)(1)An optometrist certified pursuant to Section 3041.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(d) An optometrist certified pursuant to Section 3041.3 shall be certified to administer
authorized immunizations, as described in subparagraph (D) of paragraph (5) of subdivision (a), after the optometrist meets all of the following requirements:
(A)
(1) Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) or the Accreditation Council for Pharmacy Education that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)
(2) Is certified in basic life support.
(C)
(3) Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(D)
(4) Applies for an immunization certificate on a board-approved form.
(2)For the purposes
of this section, “immunization” means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(h)
(e) Other than for prescription ophthalmic devices described in subdivision (b) of Section 2541, any dispensing of a therapeutic pharmaceutical agent by an optometrist shall be without charge.
(i)The practice of optometry does not include performing surgery. “Surgery” means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means. “Surgery” does not include those procedures specified in paragraphs (1) to (15), inclusive, of subdivision (d).
This subdivision does not limit an optometrist’s authority to utilize diagnostic laser and ultrasound technology within the optometrist’s scope of practice.
(j)
(f) An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(k)For purposes of this chapter, “glaucoma” means either of the following:
(1)All primary open-angle glaucoma.
(2)Exfoliation and pigmentary glaucoma.
(3)(A)Steroid induced glaucoma.
(B)If an optometrist treats a patient for
steroid induced
glaucoma, the optometrist shall promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrist for treatment.
(l)For purposes of this chapter, “adnexa” means ocular adnexa.
(m)In an emergency, an optometrist shall stabilize, if possible, and immediately refer any patient who has an acute attack of angle closure to an ophthalmologist.
(g) For the purposes of this chapter, all of the following definitions shall apply:
(1) “Adnexa” means the overlying coats of the anterior segment, the eyelids, the lacrimal system, and the skin extending from the eyebrows inferiorly, bounded by the medial, lateral, and inferior orbital rims, excluding the extraocular muscles and orbital contents.
(2) “Anterior segment” means the portion of the eye anterior to the vitreous humor.
(3) “Ophthalmologist” means a physician and surgeon, licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, specializing in treating eye disease.
(4) “Physician and surgeon” means a physician and surgeon licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code.
(5) “Prevention” means use or prescription of an agent or noninvasive device or technology for the purpose of inhibiting the development of an authorized condition or disease.
(6) “Treatment” means use of or prescription of an agent or noninvasive device or technology to alter the course of an authorized condition or disease once it is present.
