Investigational Managers MeetingInvestigational Managers MeetingAugust 30, 2006August 30, 2006

Fort Lauderdale, FL Fort Lauderdale, FL Robert M. Easton, Jr., O.D., F.A.A.O.Robert M. Easton, Jr., O.D., F.A.A.O.

Optometric PhysicianOptometric PhysicianMember, Florida Board of Optometry Member, Florida Board of Optometry

OptometryChapter 463Rules 64B13

What constitutes a What constitutes a complete examination of complete examination of

the eye?the eye?CPT Procedure Codes, Laws, and CPT Procedure Codes, Laws, and

Rules Rules 92004 New Patient 92004 New Patient 92014 Established Patient92014 Established Patient 463.005(c) Minimum procedures 463.005(c) Minimum procedures

which shall constitute a visual which shall constitute a visual examination. examination.

64B13-3.007 (2) (a-l) Minimum 64B13-3.007 (2) (a-l) Minimum Procedures for Vision AnalysisProcedures for Vision Analysis

Optometry’s Required Eye Optometry’s Required Eye ExamExam

Patient History; medical and ocular, includes patient’s chief complaintPatient History; medical and ocular, includes patient’s chief complaint Family History; medical and ocularFamily History; medical and ocular Visual Acuity; unaided and aided in each eyeVisual Acuity; unaided and aided in each eye External Examination External Examination Pupillary Examination must document size, direct and consensual Pupillary Examination must document size, direct and consensual

responseresponse Visual Field by confrontation using finger counting in each quadrantVisual Field by confrontation using finger counting in each quadrant Ophthalmoscopy, internal examination; recording c/d ratio, a/v ratio, Ophthalmoscopy, internal examination; recording c/d ratio, a/v ratio,

and any other abnormalities. A dilated exam is required on all New and any other abnormalities. A dilated exam is required on all New PatientsPatients

Biomicroscopy or Slit Lamp Examination of lids, lashes, conj, cornea, Biomicroscopy or Slit Lamp Examination of lids, lashes, conj, cornea, a/c, iris, lens. Corneal Iris Angle assessment of narrow or wide a/c, iris, lens. Corneal Iris Angle assessment of narrow or wide

Tonometry or pressure of each eye with the time it was taken Tonometry or pressure of each eye with the time it was taken Refraction for distance with acuities, and near refraction assessment of Refraction for distance with acuities, and near refraction assessment of

accommodation with acuitiesaccommodation with acuities Extra ocular muscle balance assessment by cover test, phorias, Extra ocular muscle balance assessment by cover test, phorias,

stereopsis, versionsstereopsis, versions Other tests indicated based upon the patient history or by objective Other tests indicated based upon the patient history or by objective

signs and symptoms discovered during the eye examsigns and symptoms discovered during the eye exam Diagnosis which can be cross referenced to a ICD-9 codeDiagnosis which can be cross referenced to a ICD-9 code Treatment Plan such as correction, medications, referral, and when to Treatment Plan such as correction, medications, referral, and when to

returnreturn

What Equipment must an What Equipment must an Optometrist have to perform a Optometrist have to perform a

complete examination?complete examination?

463.005 (b)  Minimum equipment 463.005 (b)  Minimum equipment which a licensed practitioner which a licensed practitioner shall at all times possess to shall at all times possess to engage in the practice of engage in the practice of optometry. optometry.

64B13-3.004 (1-8) Minimum 64B13-3.004 (1-8) Minimum Equipment RequirementsEquipment Requirements

(1) Ophthalmoscope(s)(1) Ophthalmoscope(s)

(2) Tonometer(2) Tonometer

(3) Retinoscope(3) Retinoscope

(4) Keratometer or (4) Keratometer or TopographerTopographer

(5) Biomicroscope or Slit (5) Biomicroscope or Slit LampLamp

(6) Phoropter or trial frame, (6) Phoropter or trial frame, trial lenses, and prismstrial lenses, and prisms

(6) Phoropter or trial frame, (6) Phoropter or trial frame, trial lenses, and prismstrial lenses, and prisms

(7) Standard Acuity (7) Standard Acuity ChartsCharts

(8) Field Testing (8) Field Testing EquipmentEquipment

Certified Optometrist’s Certified Optometrist’s equipmentequipment

64B13-3.011 (4) (c)64B13-3.011 (4) (c)1.1. Goldmann applanation tonometerGoldmann applanation tonometer2.2. Static threshold visual field unitStatic threshold visual field unit3.3. GonioscopeGonioscope4.4. Fundus cameraFundus camera5.5. BiomicroscopeBiomicroscope6.6. Stereoscopic view of optic nerve Stereoscopic view of optic nerve

using lenses such as digital high using lenses such as digital high mag, Volk 90, hruby lensmag, Volk 90, hruby lens

Goldmann TonometerGoldmann Tonometer

Visual Field UnitVisual Field Unit

GonioscopeGonioscope

Fundus CameraFundus Camera

Biomicroscope or Slit Biomicroscope or Slit LampLamp

Stereoscopic Viewing Stereoscopic Viewing LensesLenses

Foreign Body RemovalForeign Body Removal

463.014 463.014 (4)  Surgery of any kind, (4)  Surgery of any kind, including the use of lasers, is including the use of lasers, is expressly prohibited. expressly prohibited. Certified Certified optometrists may remove optometrists may remove superficial foreign bodies. For the superficial foreign bodies. For the purposes of this subsection, the purposes of this subsection, the term "superficial foreign bodies" term "superficial foreign bodies" means any foreign matter that is means any foreign matter that is embedded in the conjunctiva or embedded in the conjunctiva or cornea but which has not cornea but which has not penetrated the globe.penetrated the globe.

Foreign Body Removal Foreign Body Removal ToolsTools

SpudSpud Disposable Syringe NeedleDisposable Syringe Needle Alger BrushAlger Brush

SpudSpud

Disposable Syringe Disposable Syringe NeedleNeedle

Alger BrushAlger Brush

Distinction of Duties in Distinction of Duties in the officethe office

463.002  Definitions463.002  Definitions 6)  "Direct 6)  "Direct supervision" means supervision supervision" means supervision to an extent that the licensee to an extent that the licensee remains on the premises while all remains on the premises while all procedures are being done and procedures are being done and gives final approval to any gives final approval to any procedures performed by an procedures performed by an employee. employee.

Distinction of Duties in Distinction of Duties in the officethe office

463.002  Definitions463.002  Definitions7)  "General 7)  "General supervision" means the responsible supervision" means the responsible supervision of supportive personnel by supervision of supportive personnel by a licensee who need not be present a licensee who need not be present when such procedures are performed, when such procedures are performed, but who assumes legal liability thereof. but who assumes legal liability thereof. Except in cases of emergency, "general Except in cases of emergency, "general supervision" shall require the easy supervision" shall require the easy availability or physical presence of the availability or physical presence of the licensee for consultation with and licensee for consultation with and direction of the supportive personnel. direction of the supportive personnel.

Distinction of Duties in Distinction of Duties in the officethe office

463.009  Supportive personnel.463.009  Supportive personnel.--No person other --No person other than a licensed practitioner may engage in the than a licensed practitioner may engage in the practice of optometry as defined in s. 463.002(5). practice of optometry as defined in s. 463.002(5). Except as provided in this section, under no Except as provided in this section, under no circumstances shall non-licensed supportive circumstances shall non-licensed supportive personnel be delegated diagnosis or treatment personnel be delegated diagnosis or treatment duties; however, such personnel may perform data duties; however, such personnel may perform data gathering, preliminary testing, prescribed visual gathering, preliminary testing, prescribed visual therapy, and related duties under the direct therapy, and related duties under the direct supervision of the licensed practitioner. Non-licensed supervision of the licensed practitioner. Non-licensed personnel, who need not be employees of the personnel, who need not be employees of the licensed practitioner, may perform ministerial duties, licensed practitioner, may perform ministerial duties, tasks, and functions assigned to them by and tasks, and functions assigned to them by and performed under the general supervision of a performed under the general supervision of a licensed practitioner, including obtaining information licensed practitioner, including obtaining information from consumers for the purpose of making from consumers for the purpose of making appointments for the licensed practitioner. The appointments for the licensed practitioner. The licensed practitioner shall be responsible for all licensed practitioner shall be responsible for all delegated acts performed by persons under her or his delegated acts performed by persons under her or his direct and general supervision. direct and general supervision.

Typical Optometric Typical Optometric ViolationsViolations

463.007  Renewal of license; continuing 463.007  Renewal of license; continuing education.education.-- 3)  Unless otherwise provided by -- 3)  Unless otherwise provided by law, the board shall require licensees to law, the board shall require licensees to periodically demonstrate their professional periodically demonstrate their professional competence, as a condition of renewal of a competence, as a condition of renewal of a license, by completing up to 30 hours of license, by completing up to 30 hours of continuing education during the 2-year period continuing education during the 2-year period preceding license renewal. For certified preceding license renewal. For certified optometrists, the 30-hour continuing education optometrists, the 30-hour continuing education requirement shall include 6 or more hours of requirement shall include 6 or more hours of approved transcript-quality coursework in ocular approved transcript-quality coursework in ocular and systemic pharmacology and the diagnosis, and systemic pharmacology and the diagnosis, treatment, and management of ocular and treatment, and management of ocular and systemic conditions and diseases during the 2-systemic conditions and diseases during the 2-year period preceding application for license year period preceding application for license renewal. renewal.

Typical Optometric Typical Optometric ViolationsViolations

463.016  Grounds for 463.016  Grounds for disciplinary action; action by disciplinary action; action by the board.the board.- f)  Advertising - f)  Advertising goods or services in a manner goods or services in a manner which is fraudulent, false, which is fraudulent, false, deceptive, or misleading in form deceptive, or misleading in form or content. or content.

Typical Optometric Typical Optometric ViolationsViolations

463.014  Certain acts prohibited.463.014  Certain acts prohibited.-- -- (1)(a)  No corporation, lay body, (1)(a)  No corporation, lay body,

organization, or individual other than a organization, or individual other than a licensed practitioner shall engage in the licensed practitioner shall engage in the practice of optometry through the means of practice of optometry through the means of engaging the services, upon a salary, engaging the services, upon a salary, commission, or other means or inducement, commission, or other means or inducement, of any person licensed to practice optometry of any person licensed to practice optometry in this state. Nothing in this section shall be in this state. Nothing in this section shall be deemed to prohibit the association of a deemed to prohibit the association of a licensed practitioner with a multidisciplinary licensed practitioner with a multidisciplinary group of licensed health care professionals, group of licensed health care professionals, the primary objective of which is the the primary objective of which is the diagnosis and treatment of the human body. diagnosis and treatment of the human body.

Proper Entrance SignProper Entrance Sign

Proper Display of LicenseProper Display of License

Other Equipment Needed Other Equipment Needed but not required but not required

Other Equipment Needed Other Equipment Needed but not requiredbut not required

Other Equipment Needed Other Equipment Needed but not required but not required

Thank YouThank You