The following opinion is presented on-line for informational use only and does not replace the official version. (Mich Dept of Attorney General Web Site - www.ag.state.mi.us) STATE OF MICHIGAN FRANK J. KELLEY, ATTORNEY GENERAL Opinion No. 5132 July 7, 1977 OPTOMETRY: Testing of human eye by unsupervised, non-professional persons. The testing of the human eye in a public screening by an unsupervised, non-professional who employs a tonometer to evaluate a departure from the normal, does not constitute the practice of optometry. Robert B. Britton, O.D. President Board of Examiners in Optometry 1116 South Washington Avenue Lansing, Michigan 48926 You have asked for my opinion as to whether the testing of the human eye, in a public screening by an unsupervised, non-professional person who employs a tonometer to evaluate a departure from the normal constitutes the practice of optometry. The question arises from the fact that a voluntary glaucoma screening program is being performed in the state in the course of which unsupervised, non-professional persons are using a tonometer to determine if a person may have glaucoma. The practice of optometry is defined in 1909 PA 71; MCLA 338.251 et seq; MSA 14.641 et seq, Sec. 7, pertinent part as follows: 'Sec. 7. The practice of optometry is hereby defined as being either 1 or any combination or part of the following: ' (b) The employment of objective or subjective physical means to determine the accommodative or refractive conditions or the range or powers of vision of muscular equilibrium of the human eye; ' (e) The employment of objective and subjective means for the examination of the human eye for the purpose of as certaining any departure from the normal; measuring the powers of vision, and adapting lenses for the aid thereof. The provisions of this act shall not be considered or construed to apply to physicians and surgeons duly licensed to practice medicine or surgery within the provisions of Act No. 237 of the Public Acts of 1899, or acts amendatory thereto, or duly licensed to practice osteopathic medicine or surgery within the provisions of Act No. 162 of the Public Acts of 1903, as amended, nor shall said provisions apply to prevent persons selling spectacles or eyeglasses or prescription from any duly qualified optometrist or physician; nor to prevent a person or persons selling glasses as an article of merchandise and not trafficking or attempting to traffic upon assumed skill.' MCLA 338.257; MSA 14.747 The tonometer is an instrument that measures intraocular pressure or tension. An intra-ocular pressure or tension result outside the normal range may indicate the presence of glaucoma. In the screening program, the person taking the test is not given the numerical reading but rather is informed whether he has passed the screening test. Although a tonometer reading is vaulable in determining the presence of glaucoma, it is my understanding that a tonometer reading is only one of several factors used in making that determination. Glaucoma is a complex disease and its detection can be difficult and complex. Eye pressure can fluctuate and elevated eye pressure may not be a sign of glaucoma. Only when the tonometer test is part of a complete eye examination and a visual field test, can glaucoma be definitively detected. The practice of optometry is defined as the employment of objective and subjective means for the examination of the human eye for the purpose of ascertaining any departure from the normal. The tonometer test is an objective test since the result is usually given by a numerical reading. The person performing the test does not perform any subjective analysis, either during or after the test. Since no subjective analysis is involved, 1909 PA 71, supra, Sec. 7(e), does not prohibit such a procedure. Only tests using both subjective and objective means to ascertain a departure from normal are considered the practice of optometry. It may be argued that the term 'and' in 1909 PA 71, supra, Sec. 7(e), should be interpreted as meaning 'or'. However, 1909 PA 71, supra, Sec. 7(b), uses the phrase 'employment of objective or subjective physical means'. It must be assumed that the legislature intended the differing use of 'and' in Sec. 7(e) and 'or' in Sec. 7(b). In construing statutes, words must be interpreted according to their ordinary usage and sense in which they are understood and employed in common language. When the legislature uses a certain phrase or word in a statute, the court must presume it was used in the normally accepted meaning. See Chrysler Corp v Washington, 52 Mich App 229; 217 NW2d 66 (1974). It should be noted that this opinion concerns the use of the tonometer as the practice of optometry. This opinion does not refer to the use of the tonometer as the practice of medicine under the Medical Practice Act, 1973 PA 185; MCLA 338.1801 et seq; MSA 14.542(1) et seq, or the practice of osteopathic medicine under the Osteopathic Act, 1903 PA 162; MCLA 338.101a et seq; MSA 14.571(1) et seq. Therefore, it is my conclusion that the testing of the human eye in a public screening by an unsupervised non-professional who employs a tonometer to evaluate a departure from the normal, does not constitute the practice of optometry for the reasons stated above. However, a word of caution should be added. As I have noted, the detection of glaucoma is difficult and complex and persons who have been tested in the course of a public screening by use of a tonometer may be incorrectly advised; that is, the objective reading of the tonometer may not accurately determine the presence or absence of this disease. I therefore strongly recommend that all persons who are concerned about glaucoma, or are of an age where they ought to be concerned, visit a physician or a licensed professional optometrist for a more thorough test to determine the presence or absence of this condition. Frank J. Kelley Attorney General