| (a) The optometrist or therapeutic optometrist shall, in the
initial examination of the patient for whom contact lenses are prescribed:
(1) Personally make and record, if possible, the following
findings of the conditions of the patient as required by §351.353 of
the Act:
(A) biomicroscopy examination (lids, cornea, sclera, etc.),
using a binocular microscope;
(B) internal ophthalmoscopic examination (media, fundus, etc.),
using an ophthalmoscope or biomicroscope with fundus condensing lenses; videos
and photographs may be used only for documentation and consultation purposes
but do not fulfill the internal ophthalmoscopic examination requirement; and
(C) subjective findings, far point and near point;
(2) Either personally make and record or authorize an assistant
present in the same office with the optometrist or therapeutic optometrist
to make and record the following findings required by §351.353 of the
Act. The authorization for assistants to make and record the following findings
does not relieve the optometrist or therapeutic optometrist of professional
responsibility for the proper examination and recording of each finding required
by §351.353 of the Act:
(A) case history (ocular, physical, occupational, and other
pertinent information);
(B) visual acuity;
(C) static retinoscopy O.D., O.S., or autorefractor;
(D) assessment of binocular function;
(E) amplitude or range of accommodation;
(F) tonometry; and
(G) angle of vision, to right and to left.
(3) Personally notate in the patient's record the reasons why
it is not possible to make and record the findings required in subsection
(a) of this section;
(4) When a follow-up visit is medically indicated, schedule
the follow-up visit within 30 days of the contact lens fitting, and inform
the patient on the initial visit regarding the necessity for the follow-up
care; and
(5) Personally or authorize an assistant to instruct the patient
in the proper care of lenses.
(b) The optometrist or therapeutic optometrist and assistants
shall observe proper hygiene in the handling and dispensing of the contact
lenses and in the conduct of the examination. Proper hygiene includes sanitary
office conditions, running water in the office where contact lenses are dispensed,
and proper sterilization of diagnostic lenses and instruments.
(c) The fitting of contact lenses may be performed only by
a licensed physician, optometrist, or therapeutic optometrist. Ophthalmic
dispensers may make mechanical adjustments to contact lenses and dispense
contact lenses only after receipt of a fully written contact lens prescription
from a licensed optometrist, therapeutic optometrist, or a licensed physician.
An ophthalmic dispenser shall make no measurement of the eye or the cornea
or evaluate the physical fit of the contact lenses, by any means whatever,
subject solely and only to the exception contained in the §351.005 of
the Act.
(d) The willful or repeated failure or refusal of an optometrist
or therapeutic optometrist to comply with any of the requirements in the Act, §351.353
and §351.359, shall be considered by the board to constitute prima facie
evidence that the licensee is unfit or incompetent by reason of negligence
within the meaning of the Act, §351.501(a)(2), and shall be sufficient
ground for the filing of charges to cancel, revoke, or suspend the license.
The charges shall state the specific instances in which it is alleged that
the rule was not complied with. After the board has produced evidence of the
omission of a finding required by §351.353, the burden shifts to the
licensee to establish that the making and recording of the findings was not
possible.
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