(a) “Practice of optometry” means the examination or measurement by any subjective or objective means including automated or testing devices for the diagnosis, treatment, and prevention of conditions of the human eye, lid, adnexa, and visual system as outlined below.

(1) “Practice of optometry” includes all of the following:

a. Use, adapting, and fitting of all types of lenses or devices except as provided in paragraph (a)(2) of this section.

b. Dispensing of any type of contact lenses that must be dispensed in accordance with a written, current contact lens prescription from a licensed physician or optometrist, including information that the Board may specify by rule or regulation.

c. Determination of refractive error or visual, muscular, or anatomical anomalies of the eye.

d. Provision or prescription of vision therapy, low-vision rehabilitation, or developmental or perceptual therapy.

(2) A license to practice optometry includes the utilization of any method or means which the optometrist is educationally qualified to provide, as established by the Delaware State Board of Examiners in Optometry and:

a. Includes performance of minor procedures on the surface of the skin of the ocular adnexa, of the cornea and conjunctiva of the globe and lid that can be performed safely with topical anesthesia and that would not require the use of injections or penetration of the globe, and the cutting or closure of human tissue by suture or staple, glue, adhesive, soldering, or cauterization. Also excludes anterior corneal stromal puncture, collagen cross-linking, postsurgical pterygium or conjuctival graft gluing of amniotic membranes, mechanical polishing of the corneal basement membrane, or any procedure that requires full- or partial-thickness incision of the sclera or cornea. Such minor procedures include:

b. Prohibits surgery.

c. Prohibits the use of ophthalmic lasers or other modalities in which tissue is burned, vaporized, cut, or otherwise irreversibly altered by thermal, light-based, electromagnetic, radiation, chemical, ultrasound, infusion, cryotherapy, or similar means, excluding the use of pharmaceutical agents described in paragraph (a)(3) of this section.

d. Procedures must meet the standard of care as if performed by a physician.

(3) “Practice of optometry,” as it relates to pharmaceutical agents, means as follows:

a. Includes the use of pharmaceutical agents for the diagnosis and treatment of diseases, disorders, and conditions of the eye and adnexa based on the licensing requirement that satisfies the requirement for graduate level coursework that includes general and ocular pharmacology as follows:

1. Prescription for controlled substances.

A. Schedule II controlled substances containing Hydrocodone, with a limitation on maximum 72-hour supply.

B. Schedules III, IV, and V controlled substances, with a limitation on maximum 72-hour supply.

2. Prescription for the use of an oral steroid with a limitation not to exceed a single 6-day methylprednisolone dose pack.

b. Includes the use of an epinephrine auto-injector to counteract anaphylaxis.

c. Excludes prescription for oral immuno-suppressives except for the use of oral steroids under § 2101(a)(3)a.2. of this title.

d. Excludes the prescription of oral antifungals.

e. Excludes the prescription of oral antimetabolites.

f. Excludes the prescription of any substance delivered intravenously or by injection.

g. Excludes any medication used solely for the treatment of systemic conditions outside the scope of an optometrist.

(b) For purposes of this chapter, the term “diagnostically certified optometrists” applies only to those currently licensed in the category and if that license lapses, the licensee could only relicense by meeting current licensing requirements in § 2107 of this title. The duties of a nondiagnostically certified optometrist are limited to those that do not utilize therapeutic pharmaceutical agents or perform procedures that require subsequent treatment with therapeutic pharmaceutical agents.

(c) In administering this chapter, the State Board shall, by rule or regulation, specify those acts, services, procedures and practices which constitute the “practice of optometry” within the definitions of this section and consistent with having submitted proof of graduate level coursework that includes general and ocular pharmacology.

(d) For purposes of disability insurance, workers’ compensation, standard health and accident, sickness and other insurance policies, programs and plans, if the optometrist is authorized by law to perform the particular services, the optometrist shall be entitled to compensation for services under the said programs. Individuals entitled to such services shall have freedom to choose between any optometrist and any physician skilled in diseases of the eye.

(e) The practice of optometry also includes services provided by telemedicine and participation in telehealth. For the purposes of this section, “telehealth” is defined as the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation. “Telemedicine” means a form of telehealth which is the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation. “Distant site” means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth. “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used; provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties. “Store and forward transfer” means the transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

25 Del. Laws, c. 113, § 1; Code 1915, § 894; 37 Del. Laws, c. 69, § 1; 38 Del. Laws, c. 49, § 1; Code 1935, § 1003; 47 Del. Laws, c. 106, § 1; 24 Del. C. 1953, § 2101; 54 Del. Laws, c. 30; 59 Del. Laws, c. 250, §§ 1, 2, 13; 66 Del. Laws, c. 1, § 1; 69 Del. Laws, c. 288, § 1; 70 Del. Laws, c. 186, § 1; 72 Del. Laws, c. 172, §§ 1-3; 80 Del. Laws, c. 80, § 12; 80 Del. Laws, c. 356, § 1; 81 Del. Laws, c. 78, § 11.