New93 role standards, now public
MedTality
Role standards

Dental and vision

Optometrist

What a newly licensed optometrist must do safely on their own: examine the whole eye, prescribe correction and treatment within their state's scope, and recognize and route sight- and life-threatening disease the same day. Drawn from the national board examinations US licensing boards use to make that decision.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
4
Version
1

Built from National Board of Examiners in Optometry, American Academy of Ophthalmology, Federal Trade Commission. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent optometrist does on day one, dimension by dimension.

Clinical skills

  • Measures acuity, refraction, pupils, fields and binocular function accurately, and treats a result that does not fit as a finding rather than a nuisance.
  • Examines the anterior and posterior segment with the technique the complaint needs, including a dilated peripheral retinal examination when the symptoms put the retina at risk.

Workflow and tools

  • Writes a record that shows what was examined, what was found, what the optometrist concluded and why, and what the patient was told and agreed to.
  • Prescribes and fits spectacles and contact lenses that meet the patient's visual needs, confirms the fit on the eye, and releases the prescription as the law requires.

Patient communication

  • Explains the diagnosis, plan and warning signs so the patient knows what to do, when to come back, and when not to wait.
  • Adjusts how information is given to what the patient can read, see, hear and understand, without talking down to them.

Compliance and safety

  • Matches the urgency and destination of a referral to the risk, and closes the loop so the patient actually arrives.
  • Prescribes ocular medication that fits the diagnosis, the patient and the state's scope, and follows up to see whether it worked or harmed.

Role knowledge

  • Builds a differential from the history and findings, ranks the sight- and life-threatening causes first, and does not close on a benign explanation that does not account for the findings.
  • Knows what their state's practice act lets them treat and do, and co-manages or refers at that boundary rather than stretching it.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Tells a patient with new flashes, floaters or a shadow in their vision that the retina is fine, or sends them away, without a dilated examination of the peripheral retina, relying on an undilated view or a photograph alone.

    A retinal tear found early is sealed with a laser in the office; one missed becomes a detachment that needs surgery and can cost the central vision.

  • Books a routine or next-day appointment, or lets the patient decide when to go, for a finding that needs care the same day - a retinal artery occlusion, suspected giant cell arteritis, a retinal detachment, acute angle closure, papilledema or a pupil-involving third nerve palsy.

    Each of these loses sight or life by the hour: a stroke or aneurysm behind the eye finding, arteritis that blinds the second eye, or a detachment that reaches the macula overnight.

  • Would record an examination, test or finding that was not performed, including a dilated fundus examination recorded as normal when the patient was not dilated, or would alter an entry to hide what happened.

    The next clinician trusts the record that the retina was examined, and a false entry is fraudulent documentation in every jurisdiction.

  • Attributes reduced vision to refractive error, dry eye or cataract and ends the workup when the findings do not fit that explanation - vision that does not improve with refraction or pinhole, a relative afferent pupillary defect, or a disc or field abnormality - without investigating or referring.

    Optic neuropathy, macular disease, a compressive lesion or arteritis goes untreated while the patient is told it is only their eyes getting older.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not perform surgery, lasers, injections or prescribe oral or controlled medicines beyond what their state's optometry practice act authorizes and they are credentialed to do.Refers to or co-manages with ophthalmology, and checks their own state's act, since scope differs sharply between US states and between countries.
  • Does not manage a neurological or systemic emergency found in the eye - retinal artery occlusion, giant cell arteritis, papilledema, a pupil-involving third nerve palsy - in the office.Sends the patient for emergency care the same day, calls ahead, and sends the findings in writing.
  • Does not withhold a spectacle or completed contact lens prescription, charge for it, or make its release depend on buying eyewear.Gives the patient their prescription as the FTC Eyeglass and Contact Lens Rules require, and verifies contact lens prescriptions for sellers.
  • Does not keep treating a condition that is not responding in the expected time or that needs a subspecialist.Refers with the history of treatment so far, and says in the record who now owns the patient's care.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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