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Legal Q & A: Polycarbonate Lenses for minors

Question: Is the prescription of polycarbonate lenses required for minors, under either Florida law or Florida Medicaid regulations?

Answer: There is no provision in the Florida Statutes that specifically requires the prescription of polycarbonate lenses for minors. However, the Florida Board of Optometry has adopted Rule 64B13-3.010, Florida Administrative Code, establishing standards of practice for optometrists. This rule requires optometrists to provide that degree of care which is full and complete and consistent with the conditions presented by the patient. The prescription of polycarbonate lenses may be required by this standard of practice in situations where the optometrist is aware the minor will be wearing the lenses in an athletic event or is aware the minor is at risk due to a prior eye injury or condition. The optometrist’s failure to prescribe polycarbonate lenses in these specific situations may constitute a breach of the appropriate standard of practice.

Polycarbonate lenses are not required for minors under Florida Medicaid regulations. The Florida Medicaid Visual Services Coverages and Limitations Handbook states Medicaid may only reimburse for polycarbonate lenses, instead of plastic lenses, for recipients with one or more of the following conditions:

The recipient is monocular; the corrected sight in the poor eye being 20/50 or worse.

The recipient has significant amblyopia.

The recipient has had a retinal detachment or is significantly at risk for retinal detachment, e.g., lattice degeneration, history of retinal detachment in the family, posterior vitreous detachment, retinal holes.

The recipient has a seizure disorder.

The recipient has Marfan’s Syndrome, an ocular prosthesis, or keratoplasty.

The recipient is in an occupation or physical exercise sport where there is high risk of eye trauma and the eyes must be protected beyond the usual plastic lens spectacle correction.