What to Expect in Your First 30 Days as an Ophthalmic Technician

During the first 30 days of being an ophthalmic technician, there is a lot to learn. Of course, this depends on prior work experience. I began my ophthalmic career at a private practice as a scribe.

I was lucky that my office had an on-the-job training program to get their staff certified as technicians. They handed out a textbook and study materials to all new employees, and, in order to keep my position, I had to pass all of their tests, as well as keep up with their many doctors with different specialties. I passed a 30 day, 60 day, 90 day, 6 month, and 1 year test before I could apply to take my technician certification through The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO).

There are some key points that a new ophthalmic technician should be prepared for, and here are some of them.

Many people are brand new to ophthalmology when learning to be technicians, so I was fortunate to have some relevant experience through scribing and earning my technician certification. When I had my second interview and was following the scribe, I listened to the vocabulary and terms the doctor was using, as well as watching the scribe document, and thought to myself how unfamiliar everything was; it was like they were speaking a foreign language. I realized then that if I wanted this job I had a lot to learn. Many new technicians feel the same way when beginning their positions.

Personally, I learned a great deal of terminology through scribing for an amazing doctor that did everything from refractive surgery to oculoplastics. I remember having a conversation with one of our technicians during which she said that she would love to learn to scribe so that she could know more about the diagnostic process, as well as hear how things were explained to the patients. Even if you aren’t able to train as a scribe, it is still a great idea for new technicians to observe their doctors in order to see new terminology in action.

I currently work for a doctor who performs general eye exams, refractive surgery, and cataract surgery. My skills and requirements are different from those of a technician working for a retinal specialist, corneal specialist, or even a glaucoma specialist, and while basic ocular terminology is universal, there are phrases, abbreviations, and nuances specific to each of these different areas of eye care.

A general health history is important because so many things are, or can be, linked to eye health. For example, many people don't understand the importance and the impact diabetes can have on the eyes. Uncontrolled blood sugar can cause bleeding in the eyes, macular swelling, and visual fluctuations.

Knowing what has happened in a patient’s past or even knowing what medications they are taking can give the technician and doctor an insight on how their eyes may be doing. Most healthcare software includes ocular history, family history, social history, and general health history, all of which a new technician will become proficient in gathering.

When I was working as a scribe, refracting was out of my field. All I knew was that the ophthalmologists only trusted a select few technicians to perform a quality refraction - one that they could trust. When I became a tech, I was given the opportunity to become of of these select few.

Learning to refract was a challenge! Like most new skills, it takes a lot of practice and with more experience gets a little easier. One of the greatest challenges regarding refractions is that they are subjective and depend greatly upon clear communication with the patient. The latter helps the patient to cooperate, and the technician gets more reliable answers when the patient knows what to expect.

In order to perform a refraction, you will need a phoropter, an understanding of the basics of a prescription, and knowledge of some important tips to follow.

Before beginning the refraction, the ophthalmic technician should be checking BCVA (best corrected visual acuity). By checking this first, the technician can get a good idea of where to begin. If available, an autorefraction or the patient’s glasses are great starting points. Then, based on what the patient reads on the Snellen chart, the ophthalmic technician can get an idea of what changes to make using the phoropter.

The order of a refraction is important to accurately fine tune the prescription. First, check the sphere, being careful not to give too much minus power.

Another good tip to keep in mind is that every line on the Snellen chart equals approximately a quarter of a diopter. For example, if a patient is seeing 20/30 with no correction or glasses and they don't like an additional +0.25--or one click of plus power, I will give them one quarter of minus sphere (-0.25) and see what their reaction is. If they are reading better on the eye chart, then in order to reach the 20/20 line from their 20/30 starting point, they may require a correction of minus half a diopter or -0.50. Two steps of minus power gains the patient two lines on the Snellen chart. Following the sphere, the ophthalmic technician will want to use the Jackson-Cross Cylinder to find the axis of the patient’s astigmatism, and then pinpoint the correct amount of cylinder.

I am a little bit of a perfectionist, and an important thing to remember when refracting is to know when to stop. Sometimes, depending on the patient and his or her individual needs and or health conditions, the 20/20 line may not be achievable. The art of refracting really just takes experience and practice. The more experience you have, the easier it becomes to predict or guess what the patient may need based upon their answers.

An extremely important part of the examination is checking the patient's IOP or intraocular pressure through tonometry. When asking my work family what they had a tough time learning in their first 30 days, this is what intimidated them the most. Ophthalmic books have great photography and step-by-step instructions on how to perform tonometry. However, when I was learning, I still felt that there was so much room for error. There are even automated simulators and practice equipment available that can help new technicians practice.

Patients are haunted by the air puff tests. I can't stress enough how important communication is with your patient during this part of the exam. I always explain that nothing is going to shoot towards them, and I am only looking at their eye with a blue light. After they know what to expect, they are immediately comforted and able to hold still much better.

Developing a routine helps the technician stay on track and be as efficient as possible without missing important information or documentation. You have probably heard this before, but if it's not documented, it didn't happen. In a fast-paced work environment, routine is a wonderful skill to perfect and will help a new technician avoid omitting important details in the chart.

Different clinics and different doctors equal different preferences. A good technician will want to get to know his or her doctor and be able to almost anticipate what the doctor is going to ask for, whether it’s additional testing or imaging. This will come with time as you work more closely with your clinician.

Additionally, techs are able to form relationships with patients themselves and make sure that their experience within the clinic is a positive one. The technician position is an integral role within the practice, and can provide one with very rewarding experiences should you choose to take the challenge!