RULES AND REGULATIONS PERTAINING TO OPTOMETRISTS (R5-35-OPT) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS Department of Health January 1964 AS AMENDED: January 1974 January 1982 June 1987 June 1987 (E) October 1987 (E) January 1988 (E) March 1988 December 1989 May 1992 September 1993 November 1993 INTRODUCTION These amendments to the Rules and Regulations Pertaining to Optometrists (R5-35-OPT) are promulgated pursuant to the authority conferred under sections 5-35-5 and 5-35-1.1 of the General Laws of Rhode Island, as amended, and are established for the purpose of adopting revisions to the requirements for the certification of optometrists. In accordance to the provisions of section 42-35-3 (c) of the General Laws of Rhode Island, as amended, consideration was given in arriving at the amendments as to: (1) alternative approaches to the regulations; (2) duplication or overlap with other state regulations; and (3) any significant economic impact on small business as defined in Chapter 42-35 of the General Laws as a result of the amended regulations. Based on the available information, no known alternative approach, duplication or overlap or significant economic impact was identified. These rules and regulations shall supersede any previous rules and regulations pertaining to optometrists promulgated by the Department of Health and filed with the Secretary of State. TABLE OF CONTENTS PAGE PART I DEFINITIONS 1 R5-35-OPT 1.0 Definitions PART II LICENSURE AND CERTIFICATION REQUIREMENTS/ 2 OPTOMETRISTS R5-35-OPT 2.0 License and Certification Requirements 3.0 Qualifications for Licensure and Certification 4.0 Application/Fee 5.0 Examinations 6.0 Internship 7.0 Training Program for Certification 8.0 Continuing Education 9.0 Issuance and Renewal of License and Certification 10.0 Practice of Optometry 11.0 Denial, Suspension and Revocation of License and Certification PART III ADVERTISING, SANCTIONS, PRACTICES AND PROCEDURES, SEVERABILITY 17 12.0 Advertising 13.0 Sanctions 14.0 Practices and Procedures 15.0 Severability APPENDIX I 18 APPENDIX II 21 APPENDIX III 22 APPENDIX IV 26 PART I DEFINITIONS Section 1.0 Definitions Wherever used in these rules and regulations, the following terms shall be construed to mean: 1.1 "Act" refers to Chapter 5-35 of the General Laws of Rhode Island, as amended, entitled Optometrist and Opticians." 1.2 "Advisory Committee for Opticianry" refers to the Board established pursuant to section 5-35-2.1 of the Act to advise the Director, the Administrator of the Division and the Board of Examiners in Optometry on all matters pertaining to the licensing and regulation of opticianry in this state. 1.3 "Board" refers to the Board of Examiners for Optometry established under the provision of section 5-35-2 of the Act. 1.4 "Division" refers to the Division of Professional Regulation, Rhode Island Department of Health. 1.5 "Director" refers to the Director, Rhode Island Department of Health. 1.6 "Optometrist" means an individual licensed in this state to practice optometry pursuant to the provisions of Chapter 5-35 of the General Laws and the rules and regulations herein. 1.7 "Certified Optometrist" means an optometrist licensed in this state to practice optometry and authorized by the Board to administer and prescribe topical ocular pharmaceutical agents in the treatment of ocular conditions of the anterior segment of the human eye and its appendages, (with the exception of uveitis and glaucoma) without surgery or other invasive techniques and in accordance with the requirements herein. 1.8 "Direct supervision" means that the preceptor provides one-to- one oversight of the intern at all times. PART II LICENSURE AND CERTIFICATION REQUIREMENTS FOR OPTOMETRISTS Section 2.0 Licensure and Certification Requirements 2.1 Any person practicing or offering to practice optometry in this state must be licensed as an optometrist in Rhode Island in accordance with the statutory requirements herein. 2.1.1 Furthermore, optometrists licensed in this state who desire to administer and prescribe topical ocular pharmaceutical agents in the treatment of ocular conditions of the human eye and its appendages, without the use of surgery or other invasive techniques must be certified by the Board in accordance with the requirements herein. Section 3.0 Qualifications For Licensure and Certification 3.1 An applicant seeking licensure to practice optometry in this state must: a) be of good moral character; b) be not less than eighteen (18) years of age; c) have attended at least two (2) years of an undergraduate college and have graduated from a school or college of optometry which maintains a course in optometry of no less than four (4) years and approved by the Division; d) have successfully passed the National Board Examination of the National Board of Examiners including the Pharmacology section; e) have successfully completed a full-time internship in optometry for a period of six (6) months under the supervision of a (registered) licensed optometrist or duly licensed doctor of medicine practicing ophthalmology; and f) have successfully passed the clinical competency examination for licensure administered by the Board. g) (Effective January 1, 1994, candidates seeking initial licensure in Rhode Island) must be certified in the use of therapeutic pharmaceuticals in accordance with the requirements of section 5-35-1.2 of the general laws, and these regulations. 3.2 An applicant seeking certification in this state to administer and prescribe topical ocular pharmaceutical agents in the treatment of ocular conditions of the eye and its appendages without the use of surgery or other invasive techniques must meet the requirements as follows: 3.2.1 Applicants who graduated prior to 1 January, 1988 must: a) be licensed in this state as an optometrist; b) have graduated from an accredited College of Optometry; c) have successfully completed the prerequisite academic courses as set forth in Appendix II; d) have successfully completed a post-graduate course of no less than ninety-six (96) hours of approved didactic instruction followed by successful completion of clinical training in accordance with the provisions of section 7.0 herein; and e) have satisfactorily passed the International Association of Boards of Optometry examination in "The Treatment and Management of Ocular Disease" approved by the Director; and f) beginning 1 January, 1988 and thereafter, have satisfactorily passed the Clinical Competency Examination administered by the Rhode Island State Board of Examiners following completion of the didactic and clinical training for certification. 3.2.2 Applicants who graduate on or after January 1, 1988 must: a) have graduated from an accredited College of Optometry; b) have satisfactorily passed, prior to commencing the clinical therapeutic training as set forth in section c) below, the Interna- tional Association of Boards of Optometry examination in "The Treatment and Management of Ocular Disease" as approved by the Director; c) have successfully completed seventy-two (72) hours of clinical therapeutic training with a Board Certified Ophthalmologist and in accordance with the provisions of Appendix IV herein. Such clinical therapeutic training shall consist of seventy-two hours of no less than a three (3) month time period, which shall be in addition to the six hundred (600) hours of no less than a six (6) month Internship Program as set forth in Appendix I; and d) have satisfactorily passed upon completion of the optometric internship and clinical therapeutic training, the Clinical Competency Examination administered by the Board. 3.3 Upon revision of the National Board examination, to include the components of the IAB Treatment and Management of Ocular Disease Examination, successful completion of Part II of the National Board examination containing those components shall satisfy the requirements of sections 3.2.1 e and 3.2.2 b above. Section 4.0 Application For License and Certification and Fees 4.1 Licensure 4.1.1 Application for licensure shall be made on forms provided by the Division, which shall be completed, notarized and submitted to the Division at least thirty (30) days before the scheduled date of internship. Such applica- tion shall be accompanied by the following documents: a) a certified copy of birth certificate; b) three (3) letters of reference from reputable individuals (other than relatives) who have known the applicant for at least two (2) years; c) a recent identification photograph of the applicant, head and shoulder front view approximately 2 x 3 inches in size; d) a chronological resume of experience from the time of graduation from college of optometry to the date of application; e) a statement from the Board of Examiners in Optometry in each state in which the applicant has held or holds licensure to be submitted to the Board of this state attesting to the licensure status of the applicant during the time period the applicant held licensure in said state; f) supporting certified transcripts of education credentials as required in section 3.1 herein signed by the dean or registrar of the school of optometry verifying the dates of attendance and completion of program in optometry. Such documentation must consist of original statements and/or photocopies bearing the signature of the dean or registrar and the imprint of the school seal; and g) the results of the written National Board Examination of the National Board of Examiners including Pharmacology examination, submitted directly to the Board by the National Board. 4.1.2 Upon completion of his/her internship, the applicant shall submit the following: a) documented evidence of satisfactory completion of internship in optometry in accordance with section 6.0 herein and of the clinical competency examination as prescribed by the Board; b) the application examination fee of forty dollars ($40) made payable to the General Treasurer, State of Rhode Island (non- refundable); c) for applicants seeking initial licensure after 1 January 1994, evidence of completion requirements for certification in the use of therapeutic pharmaceuticals as approved by the Board as set forth in section 4.2.2; and d) such other information as may be deemed necessary by the Division and/or the Board. 4.1.3 The Board at its discretion reserves the right to require any or all applicants to appear before the Board for an interview. 4.2 Certification in the Use of Therapeutic Pharmaceuticals Application for certification shall be made on forms provided by the Division which shall be completed, notarized and submitted to the Division at least thirty (30) days before the scheduled date of the Board meeting. Such application shall be accompanied by the following documents (non-returnable); 4.2.1 Applicants who graduated prior to 1 January 1988: a) a copy of current license; b) supporting certified transcripts of post- graduate training courses of study in general and ocular therapeutic pharmacology (didactic and clinical) in accordance with the require- ments of section 7.0 herein; c) the results of the International Association of Boards of Optometry examination in "The Treatment and Management of Ocular Disease" as approved by the Director and submitted directly to the Board by the organization and/or agency administering the approved examination; and d) such other information as the Division and/or Board may deem necessary. 4.2.2 Applicants who graduated on or after 1 January 1988: a) a copy of supporting transcripts of training courses of study in general and ocular therapeutic pharmacology; b) the results of the International Association of Boards of Optometry examination in "The Treatment and Management of Ocular Disease"; c) certified statement submitted directly to the Board by the Board Certified Ophthalmologist of the applicant's satisfactory completion of seventy-two hours of no less than a three (3) month clinical therapeutic training as set forth in section 3.2.2 herein; said seventy- two (72) hours of clinical training may run concurrently with and be credited toward any internship requirements. d) evidence of satisfactory completion of the Clinical Competency Examination administered by the Board; and e) such other information as the Board and/or Division may deem necessary. 4.2.3 The Board at its discretion reserves the right to require any or all applicants to appear before the Board for an interview. 4.3 Upon revision of the National Board Examination to include the components of the IAB Treatment and Management of Ocular Disease Examination, successful completion of Part II of the National Board examination containing those components shall satisfy the requirements of sections 4.2.1 c and 4.2.2b above. Section 5.0 Examinations 5.1 Examinations For Licensure Applicants for licensure to practice optometry shall be required to successfully pass the following examinations as approved by the Board to test the applicants' knowledge and skills to practice optometry in this state pursuant to the statutory and regulatory requirements herein: 5.1.1 The National Board Examination of the National Board of Examiners in Optometry (NBEO) including the Pharmacology section; and 5.1.2 The Regional or National Clinical Competency Examination administered during or upon completion of the internship program in accordance with section 6.0 herein, and/or such other examination(s) as approved by the Board. 5.2 Examinations For Certification To Treat Ocular Conditions Applicants seeking certification to administer and prescribe topical ocular pharmaceutical agents to treat ocular conditions of the human eye i.e., conditions of the anterior segment and its appendages (except uveitis and glaucoma) without surgery or other invasive techniques shall be required to successfully pass the International Association of Boards of Optometry examination in "The Treatment and Management of Ocular Disease" as approved by the Director in accordance with section 3.2.1 and 3.2.2 herein and the Clinical Competency Examination administered by the Board. 5.3 Re-examination 5.3.1 In case of failure in any one subject of the written examination as required in section 5.1 and 5.2 above, such applicant after the expiration of six (6) months and within two (2) years may take the examination in said subject upon payment to said division of an additional fee of five dollars ($5.00) for each such examination. The results of the examination are to be made known to the applicant within sixty (60) days of the date of said examination. 5.3.2 Any applicant who twice fails the National Board Examination for optometric licensure and/or the International Association of boards of Optometry examination in "The Treatment and Management of Ocular Disease" - will be required to satisfactorily complete a course of at least one semester in an accredited college of optometry in subject(s) failed prior to being eligible to take further re-examination. 5.3.3 Opportunity for re-examination of any applicant who, three times, fails the Clinical Competency Examination for Licensure and/or certification, shall be subject to the applicant's completion of additional requirements as may be recommended by the Board on an individual basis. 5.4 Without Examination A license to practice optometry may be issued without examination to an applicant who has been duly licensed by examination as an optometrist under the laws of another state provided: a) the applicant meets the qualifications to practice optometry in this state in accordance with section 3.1 herein; b) the Board of Examiners in Optometry in each state in which the applicant holds or has held licensure submits to the Board of this state a statement attesting to the licensure status of the applicant during the time period the applicant held licensure in said state; c) that such state accords a like privilege to holders of licenses issued in this state and the applicant has not failed to pass the exam required in this state; and d) the applicant submits the license application form with supporting certified documentation of credentials and application fee of fifty dollars ($50.00) made payable to the General Treasurer, State of Rhode Island. 5.4.1 An optometrist from out-of-state seeking cer- tification in this state as a certified optometrist as defined in section 1.7 herein must meet the requirements of sections 4.2 and 5.4 herein to be a "Certified Optometrist" in this state. Section 6.0 Internship 6.1 Every applicant seeking licensure to practice optometry in this state shall be required after having successfully passed the National Board Examination, to complete a full-time (no less than thirty-five (35) hours per week) internship in optometry for a period of six (6) months under the supervision of a registered (licensed) optometrist or a duly licensed doctor of medicine practicing ophthalmology approved as a preceptor by the Board. 6.1.1 Sites for the clinical internship may vary from experiences at clinics or such other health facilities or centers, provided, however, that no less than three (3) days per week during the full-time internship is spent in the preceptor's office in general practice. 6.1.2 Notwithstanding the provisions of section 6.1.1 above, interns at the completion of their internship must have received clinical experiences in those areas listed in Appendix I. 6.2 Prior to commencing internship, applicants for internship and preceptorship shall submit to the Board completed application forms and such other information as the Board deems appropriate to insure compliance with the requirements herein. 6.3 Interns shall be under the direct supervision of their preceptor(s) during their full-time internship period. 6.4 Upon completion of the internship program applicants must successfully pass a two-part comprehensive Clinical Competency Examination approved by the Board and in accordance with section 5.1 herein. 6.5 Preceptors: 6.5.1 Preceptors shall provide direct supervision to interns at all times, as defined in Section 1.8 Such supervision shall be provided by a registered (licensed) optometrist or a duly licensed doctor of medicine practicing ophthalmology pursuant to section 5-35-12 of the Act. 6.5.2 Requirements for Serving as an Optometric Preceptor a. The preceptor must be in practice for five years. b. The preceptor must submit a formal application including his curriculum vitae. c. An optometrist must be certified in the use of therapeutic pharmaceuticals. d. An ophthalmologist must be certified by the American Board of Ophthalmology. e. There must be spectacle dispensing capabilities on the premises. f. The office of the preceptor must be equipped with more than one examination room. g. The Board reserves the right to interview and review the qualifications of all candidates for preceptorships. 6.5.3 Preceptors shall submit application forms with required information to the Board to receive approval to serve as preceptors. 6.5.4 Violations of the requirements herein by any intern and/or preceptor may be cause for the Board to impose the following penalties: a. Interns: may be the loss of accumulated internship hours and discon- tinuation of any licensure issued on the basis of an internship which was carried out in violation of this section; and b. Preceptors: may be the loss of the privilege to serve as precep- tor,and/or other disciplinary action, if warranted. Section 7.0 Training Program For General and Ocular Therapeutic Pharmacology 7.1 Pursuant to section 5-35-1.1 of the Act, the post-graduate program for optometrists seeking certification as "certified optometrists" shall consist of no less than ninety six (96) hours of postgraduate didactic instruction in addition to clinical training as outlined in Appendix III and IV for the training in the treatment of ocular conditions, i.e., conditions of the anterior segment of the human eye and its appendages (except uveitis and glaucoma) as approved by the Director and listed in section 10.1 herein. Furthermore: a) the pre-requisites for admission to the program, shall meet the requirements of Appendix II herein: b) the post-graduate course of study is conducted by an institution which has facilities for both the didactic and the clinical training referred herein. Furthermore, said institution is accredited by a Regional or Professional accrediting organization that is recognized and approved by the Council of Post-Secondary Accreditation or the United States Department of Education or its successor. In addition, the courses of instruction have qualified physicians, board certified ophthalmologist(s), optometrist(s), Ph.D's, lawyers, pharmacists, and pharmacologists as instructors as set forth in Appendix IV. Furthermore, the instructors shall be responsible for those specific courses of instruction as set forth in the Curriculum Outline of Appendix III. c) the clinical training shall be under the preceptorship of duly licensed Board Certified Ophthalmologists, who shall submit signed documentation to the Dean of the General and Ocular Therapeutics Program, certifying as to whether or not the applicant has successfully completed the clinical training program as outlined in Appendix IV herein; d) notwithstanding the provisions herein, the postgraduate program must provide clinical experiences to no less than the specified number of patients with specific conditions of the anterior segment of the human eye and appendages (except for uveitis and glaucoma) as set forth in Appendix IV; and e) the ophthalmologist who serves as preceptor for the clinical training in the treatment of ocular conditions of the anterior segment of the human eye in accordance with the requirements herein, may not in the normal course of his or her practice be employed directly or indirectly by optometrists; be affiliated with a referral center owned in part or in whole by optometrists, or which has been given financial support directly or indirectly by optometrists. 7.2 Upon completion of the requirements herein, the grades of the examinations to determine successful completion of the postgraduate program (didactic and clinical) shall be submitted directly to the Board in this state by the university and/or college and accompanied by additional documentation of the requirements of section 7.1 herein. Section 8.0 Continuing Education 8.1 For Re-Licensure Every optometrist licensed to practice optometry in this state under the provisions of the Act shall on or before the 31st day of January of each year submit to the Board satisfactory evidence of current certification in Cardio-Pulmonary Resuscitation, and evidence of having completed in the preceding calendar year, no less than sixteen (16) hours of continuing education in optometry or other related health field, in a course(s) offered by a provider meeting the Guidelines For Continuing Optometric Education of the American Optometric Association or any course approved by the Board. Furthermore, the Board will only accept: a) a maximum of four (4) hours per year in an approved home study course(s); b) a maximum of four (4) hours per year in an approved practice management course(s); c) a maximum of two (2) hours per year in approved lectures to professional groups; and d) one (1) hour credit for each publication of a paper in any national or regional journal up to a maximum of two (2) hours per year. 8.1.1 The Board may waive the continuing education requirement in specific circumstances for due cause such as hardship or for any sufficient reason, if satisfactory evidence is submitted to the Board to that effect. 8.1.2 Two hours of continuing education credits per year will be allowed for those who serve as General Optometric Preceptors during that year. The preceptor cannot receive credits for the same intern in two different years. 8.2 For Re-Certification Certified Optometrists shall be required to submit to the Board on or before the 31st day of January of each year satisfactory evidence of having completed in the preceding calendar year at least sixteen (16) hours of continuing optometric education or related health fields in a course(s) which shall include six (6) or more hours of approved courses in general and ocular pharmacology for the treatment and conditions of the anterior segment of the eye and its ap- pendages. Section 9.0 Issuance and Renewal of License/Certification and Fee 9.1 Upon completion of the aforementioned requirements, the Director may issue a license and/or certification to those applicants found to have satisfactorily met all the requirements herein. Said license and/or certification shall expire annually on the 31st day of January, unless sooner suspended or revoked. 9.2 On or before the 31st day of December of each year, the Administrator of the Division shall mail an application for renewal of license and/or certification to each person to whom a license or certification has been issued or renewed during the current year. Every person licensed or certified who intends to practice optometry during the ensuing year shall file a renewal application duly executed together with the renewal fee for licensure of one hundred dollars ($100.00) made payable to the General Treasurer, State of Rhode Island on or before the 31st day of January in each year. 9.3 Upon receipt of a renewal application accompanied by evidence of completion of the prescribed continuing education program requirements as set forth in section 8.0 herein, including payment of fee, the accuracy of the application shall be verified and license and/or certification shall be granted effective 1 February in that year. 9.4 In case of neglect or refusal to pay, said division shall revoke or suspend such license provided, however, that no license shall be so suspended or revoked without first giving sixty days' notice in each such case of neglect or refusal and within such period any such optometrist shall have the right to receive a renewal of such license on payment of the renewal fee, together with an added penalty of five dollars ($5.00). 9.5 Retirement from practice for a period not exceeding five (5) years shall not deprive the holder of a license of the right to renew such license upon payment of all annual renewal fees remaining unpaid, and a further fee of ten dollars ($10.00). Section 10.0 Practice of Optometry 10.1 Certified optometrists as defined in section 1.7 herein, may administer and prescribe topical ocular pharmaceutical agents as provided herein for the treatment of ocular conditions, i.e., conditions of the anterior segment of the human eye and its appendages (with the exception of uveitis and glaucoma) without surgery or other invasive techniques, and in accordance with the prevailing standards of practice as those of duly licensed physicians providing similar services. 10.1.1 Treatable Diseases: Hordeolum, chalazion, blepharitis, conjunctivitis, pingueculitis, inflamed pterygium, dry eye, keratitis, corneal abrasion, recurrent corneal erosions, corneal dystrophy, removal of superficial foreign body from the conjunctiva, lid and cornea without surgery or other invasive technique in accordance with section 10.1 herein. 10.1.2 Scope of Medications: The medications which may be used include topical medication (mast cell inhibitors or stabilizers), lubricants, decongestants, mucolytics, antibiotics, and steroids with a clinical potency not exceeding 1/4% methyl-prednisolone or equivalent. Topical steroid treatment required beyond fourteen (14) days may be continued only in consultation with an ophthalmologist. 10.2 Minimum Examination of Patient - Pursuant to section 5-35-18 of the Act, every person practicing optometry shall, prior to prescribing eyeglasses, lenses or spectacles perform the following minimum examination of the patient and record same on case record: a) name of patient, age, address, date and case history; b) visual acuity with and without present glasses, (O.D., O.S., O.U.); c) external ocular examination; d) ophthalmoscopy (internal ocular examination); e) visual fields study (when indicated); f) skiametry (static or dynamic); (the use of an automated refractor shall only be considered as an additional test for skiametry); g) habitual phorias at distance and near; h) subjective refraction and visual acuity at distance and near; i) phorias at distance and near with new Rx; j) color vision and stereopsis; k) recording of complete description of new Rx; l) tonometry; and m) diagnostic pharmaceuticals (when indicated). 10.2.1 For contact lenses the following additional procedures must be performed: a) ophthalmometry; b) black light examination, installation of fluorescein and analysis of pattern; c) verification of lenses; and d) a comprehensive biomicroscopic evaluation of the anterior segment of the eye with and without the contact lenses in place. This shall be done at frequent intervals to assure that no ocular damage may result from prudent use of contact lenses. 10.3 Minimum Equipment for Optometric Practice At any location where an optometrist practices his or her profession, except for house and nursing home calls, an optometrist shall have at least the following equipment available: a) snellen or projection acuity chart; b) lensometer or equivalent lens neutralizing device; c) keratometer-ophthalmometer or equivalent; d) ophthalmoscope-direct; e) retinoscope; f) trial frame and lens set and/or phoropter-refractor; g) tonometer; h) slit-lamp biomicroscope; i) field testing device; and j) color perception test - Ishihara or equivalent. Section 10.4 Spectacle or Eyeglass Prescriptions A spectacle prescription shall contain all of the information necessary for the accurate fabrication, fitting and dispensing of the spectacles (eyeglasses). All spectacle prescriptions shall contain at least the following information: A. Power - sphere, cylinder amount and axis, and prism amount and axis. B. Lens type - single vision, bifocal, trifocal, progressive, or other. C. Lens Color - Any pertinent data. D. Expiration Date - As determined by the prescribing doctor's assessment of the patient's visual status. E. Specific Instructions for Use. F. Name, address and telephone number of prescribing doctor. G. Signature and license number of doctor. H. An optometrist who writes or fills a spectacle prescription shall maintain a file of that prescription for a period of five years. Special Instructions When Indicated: 1. Lens Materials - glass, CR-39, high-index material, polycarbonate, or other. 2. Lens Coating - scratch gard, anti-reflective, absorptive tint, or other. 3. Tempering - heat, chemical or other. 4. Pupillary Distances - distance and/or near-point. Section 11.0 Denial, Suspension or Revocation of License and/or Certification 11.1 In addition to any and all other remedies provided in the Act, pursuant to section 5-35-19 of the Act, the Administrator of the Division and the Director may, after due notice and hearing, as provided in the Act and section 13.0 herein, refuse to grant, refuse to renew, suspend or revoke any license and/or certification provided for in the Act to any person who is not of good moral character or who has been guilty of gross unprofessional conduct or conduct of a character likely to deceive or defraud the public or for any fraud or deception committed in obtaining such license or certification, and of gross unprofessional conduct as defined in the aforementioned section of the Act. PART III ADVERTISING, VIOLATIONS, PRACTICES AND PROCEDURES, AND SEVERABILITY Section 12.0 Advertising 12.1 Pursuant to section 5-35-20(b) of the General Laws of Rhode Island, as amended, no optometrist licensed by and practicing in this state shall advertise by written or spoken word of a character tending to deceive or mislead the public. 12.2 In addition to section 12.1 herein any and all advertising conducted by any optometrist shall conform to the provisions of Chapter 6-13.1 of the General Laws of Rhode Island, as amended, entitled "Deceptive Trade Practices Act". 12.3 Any person practicing pursuant to the provisions of Chapter 5- 35 of the General Laws of Rhode Island, as amended, shall be required to post his name on the premises where the services are being offered in such a manner as to be clearly visible to the public at the entrance to the premises and on any sign visible outside of the premises which offers the delivery of Optometric services. 12.4 Advertisement of any type (electronic or print media) shall also include the names, addresses of the responsible optometrist. Section 13.0 Violations 13.1 Any violations of the statutory and regulatory requirements herein shall be subject to the statutory sanctions as set forth in the Act. Section 14.0 Rules Governing Practices and Procedures 14.1 All hearings and reviews required under the provisions of the Act shall be held in accordance with the provisions of the rules and regulations promulgated by the Rhode Island Department of Health entitled "Rules and Regulations Governing the Practices and Procedures before the Rhode Island Department of Health" (R42-35-PP). Section 15.0 Severability 15.1 If any provision of these rules and regulations or the application thereof to any individual or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of the regulations which can be given effect, and to this end the provisions of the regulations are declared to be severable. APPENDIX I OPTOMETRIC INTERNSHIP PROGRAM All interns must spend a minimum of 600 hours of no less than three (3) full days per week for a six (6) month period under the supervision of an approved preceptor(s). The balance of the time may be utilized to complete the enclosed list of clinical experiences. In addition, on and after 1 January 1989, applicants for therapeutic certification shall be required to complete the clinical training period of seventy- two (72) hours of no less than three (3) months in accordance with section 3.2.2 (c) herein. I. General Practice - 3 days per week Preceptor Signature (Address) II. Other Clinical Experiences 1) Specialized Diagnostic and Treatment Programs Signature & Date Completed a. Binocular Indirect Ophthalmoscopy b. Gonioscopy c. Fundus C.L. d. Anterior Segment Photography Fundus Photography e. Visual Field Techniques f. Prosthesis 2) Office Administrative Procedures a. Bookkeeping Systems b. Re-call Programs c. Patient Records d. Office Records e. Monthly, Quarterly & Annual Forms f. Third Party Forms & Programs 3) Business/Practice Management Signature & Date (Dealing with people) Completed a. Employee Relationships, Policies & Benefits b. Malpractice c. Patient Communication Techniques d. Comprehensive & Quality Eyecare 4) Ophthalmic Materials & Manufacturing a. Frame, Lens Selection & Measurements b. Repairs and Adjustments c. Ophthalmic Lens & Frame Fabrication 5) Contact Lenses a. C.L. Selection b. Care, After Care & Management of the Contact Lens Patient c. Complications and Problem Solving of Contact Lenses d. Therapeutic C.L. e. C.L. Manufacturing (Target) 6) Low Vision a. Determining the Visual Acuity, Diagnosis and prognosis of the Low Vision Patient b. Telescopic & Microscopic Lenses c. Other Low Vision Aids d. Non-optical Aids e. Managing the Low Vision Patient 7) Visual Perception & Visually Related Learning Problems a. Binocular Vision Dysfunctions b. Diagnosis of Visually Related Learning Problems c. Visual Perception Therapy Techniques d. Perceptual Motor Therapy Techniques e. Orthoptics & Vision Therapy 8) Hospital, Surgical and Ophthalmological Rotation INTERN'S SIGNATURE (ADDRESS) DATE APPENDIX II PREREQUISITES 1. Graduation from an accredited College of Optometry 2. Successful completion of courses in the following areas: a) General and ocular pharmacology, not less than 60 hours; b) General and ocular physiology or equivalent, not less than 30 hours; c) General and ocular pathology or equivalent, not less than 30 hours. The institution presenting the course shall pre-assess the candidate in the following areas: a) Basic concepts in general physiology; b) Basic concepts in general pharmacology; c) Basic concepts in ocular anatomy, physiology, and pharmacology; and d) Basic concepts in ocular diseases. APPENDIX III CURRICULUM OUTLINE COURSE IN OCULAR THERAPEUTICS (Anterior Segment of the Eye) DIDACTIC CURRICULUM HOURS INSTRUCTORS I. Basic Principles 18 M.D. Ph.D. a) Review of fundamental concepts Pharmacologist Certified Optometrists b) Cellular response in infection, inflammation and trauma c) Microorganism and ocular disease d) Pharmacokinetics and pharmacodynamics e) Theory, application, prescription writing, patient communication, patient management considerations, practice management f) Routes of drug administration II. Ocular Therapeutic Agents 9 M.D. Ph.D. a) Pharmacology of ocular therapeutics Pharmacologist 1. Anti-infective agents 2. Anti-inflammatory agents 3. Autonomic drugs and beta blockers 4. Secretory inhibitors 5. Hyperosmotics 6. Antihistamines III. Clinical Diseases and Treatment of 42 Ophthalmologists the Anterior Segment of the Eye and Except Uveitis and Glaucoma Certified Optometrists a) Introduction: Microbiology and immunology as they Ph.D./M.D. pertain to lid and anterior segment of the eye b) Diseases of the eyelid: Ophthalmologists 1. Hordeolum 2. Chalazion (acute) To include differential Dx of benign and malignant tumors of the lid. 3. Blepharitis 4. Foreign body removal from the upper lid 5. Tumors of the lids c) Diseases of the conjunctiva: 1. Conjunctivitis, (acute), (bacterial). Includes treatment with topical antibacterial agents. 2. Conjunctivitis, acute, nonbacterial, nonherpetic (presumed viral). Includes treatment with antibacterials and/or decongestants. Also includes differential diagnosis of other noninfective causes of red eye. 3. Conjunctivitis, allergic. Includes treatment by topical decongestants and/or topical antihistamines. 4. Conjunctivitis, chemical. Includes emergency first aid plus antibacterials, decongestants, etc. and indications for referrals. 5. Conjunctival foreign body. Includes anesthetic and cotton tip applicator technique for removal. 6. Pingueculitis. Includes treatment modality. 7. Inflamed pterygium. Includes treatment modality and differential diagnosis of other conjunctival tumors which may appear similar. 8. Dry Eye. Includes causes and treatment modalities and various manifestations of diagnosing similar local ocular diseases and systemic significance (e.g. cicatricial pemphigoid). d) Diseases of the Cornea: 1. Punctate keratitis, acute, bacterial or nonherpetic viral induced. Includes chronic punctate keratitis (as might be seen in contact lens induced or dry eye induced keratitis), differential diagnosis to rule out true stromal infiltrate or corneal ulcer, and appropriate management techniques, and possible use of topical antibacterials and/or decongestants. 2. Chemical of UV induced keratitis. Includes proper management techniques. 3. Corneal abrasion. Includes differential diagnosis of corneal lacerations or more serious injuries requiring surgical intervention, and possible antibiotic, cyclo- plegic, or patching treatments. 4. Recurrent corneal erosions. Includes proper management techniques employing lubrication and patching. 5. Contact lens induced abrasions and overwear syndromes. Includes differential diagnosis of true bacterial keratitis. 6. Endothelial dystrophy. Includes differential diagnosis of other corneal dystrophies, degenerations and metabolic diseases involving the cornea which may appear similar. Also includes techniques of treatment using hypertonic agents. 7. Red Eye. Differential diagnosis ruling out conditions not listed above for referral. 8. Diseases of the Sclera. HOURS INSTRUCTOR IV. Glaucouma and Anterior Uveitis 5 Ophthalmologist a) Differential Dx. and Referral consistent with the regulatory provisions herein b) Classification of glaucoma V. Consultation and Referral in 2 Ophthalmologist Anterior Segment Eye Disease and Certified Optom- a) Appropriate ophthalmological con- etrist sultation and referral b) Determining need for medical consultation other than ophthalmology c) Patient stabilization in severe ocular trauma VI. Ocular Manifestation of Systemic 10 Ophthalmologist and Treatment Internist (M.D.) a) Endocrine Disorders Endocrinologist b) Neurological Disorders c) Cardiovascular and Cerebrovascular Disorders d) Collagen Vascular Disorders e) Hematological Disorders f) Metabolic and chromosomal Disorders g) Ocular Effects of Systemic Medication h) Interpretation of Laboratory Findings VII. Ocular Allergy and Immunology 3 M.D./Ph.D. a) Differential Diagnosis b) Treatment of Ocular Allergy c) Ocular Conditions with Implied Immunological Roles VIII. Ocular Urgencies and Emergencies 5 Ophthalmologist a) Clinical Diagnosis and Management b) Emergency Equipment IX. Legal Aspects of Ocular Therapeutic 2 OD / JD Care a) Malpractice Issues b) R.I. Requirements pertaining to Malpractice Insurance c) Standards of care Total Hours 96 APPENDIX IV CLINICAL TRAINING The preceptor shall be responsible for the clinical training and shall furthermore be responsible to certify to the Board of Examiners that the optometrist has satisfactorily completed in no less than three (3) months, at least seventy-two (72) hours of clinical training and during said time participated in the diagnosis, treatment and management of the following numbers of patients: Patients with Diseases of the Eyelids 50 Patients with Diseases of the Conjunctiva 50 Patients with Diseases of the Cornea 50 The ratio of ophthalmologists to optometrists for the clinical training shall be 1::2 preferably, however, not to exceed 1::4. The clinical training must be validated by the preceptor to the Board. .