WHAT YOU'LL LEARN
The role that pharmacology plays in an ophthalmic tech's job
The four crucial elements of pharmacology for ophthalmic techs
A breakdown of commonly used medications
How to communicate with the doctor and patient
Introduction
Who is this course for? Why is it needed?
This course is designed to help technicians quickly identify ophthalmic medications, their uses, possible complications, and improve medication compliance. This course will act as a foundation for technicians to build their pharmacology knowledge on.
What role does pharmacology play in an ophthalmic technician’s job?
What is pharmacology?
Pharmacology is the branch of medicine that deals with the uses of medications, their effects, and how they work. In most ophthalmic practices, technicians will be expected to refill prescriptions, give instructions to patients on how they are supposed to use their medications, explain possible side effects, and reduce noncompliance.
Why do ophthalmic techs need to know pharmacology?
Part of the responsibility of an ophthalmic technician is to educate patients. Without a basic knowledge of ophthalmic medications and their uses, they cannot be expected to fulfill a key part of their job. It is easy to be discouraged by the vast amount of ophthalmic medications on the market; however, there are ways technicians can simplify their uses, and keep patient care at the center of their concern.
Although many systemic medications have ophthalmic side effects, from certain antidepressants that can cause dry eye to prostate medications, which can lead to complications during eye surgery, for this course, the focus will only be ophthalmic medications.
The four crucial elements of pharmacology for ophthalmic techs
Memorization
Although it is not practical for most technicians to memorize hundreds of name brand and generic ophthalmic medications that are currently on the market, picking up on patterns can help technicians quickly identify the type of medication a drop is or the family it comes from. For example, some glaucoma medications are beta blockers, which lower eye pressure by reducing the amount of fluid produced in the eye. All medications ending with the suffix ‘lol’ (such as Timolol and Istalol) are beta blockers. Medications ending in ‘one’ are commonly steroids. Being able to recognize the class of medication, as well as their side effects, can help technicians perform their job efficiently.
Ophthalmic Technicians will come up with many helpful ways to remind themselves of what could be overwise seen as an overwhelming amount of information about drops. For example, “Red Top Means Stop” is a helpful reminder that dilating drops will all have the same red tops, and although some last for only a few hours, others can last for days, and these drops may all be kept in the same area. So, prior to instilling a dilating drop into a patient’s eye, take a moment to read the label.
When taking patient history, technicians can easily gather all the information they need by remembering to ask STEPS:
- Sig – How is the patient using the drops; how many times a day and in which eye. The word ‘Sig’ is short for ‘Signetur’, a Latin word that means ‘let it be labeled’.
- Time taken last – when was their last dose
- Ease of use – Is the patient able to use the drops easily, and are they remembering to take the drops.
- Problems – Always ask if the patient is having any other problems with their drops. For example, ask if the patient need any refills or if they are struggling to afford their medications. Although some constraints are out of the control of the clinician, knowing the patient has a problem is the only way they can help.
- Side Effects – Is the patient experiencing stinging, burning, or light sensitivity? Ask if any of the side effects severe enough to deter the patient from using their medication.
Patient education
When starting a new medication, patients need to be educated on three key points. Remember PUP:
- Purpose – Why are they being put on this medication? What is the diagnosis, and what will the medication do to treat their symptoms?
- Usage – How often will they be taking it, and for how long?
- Possible side effects – What should the patient expect to experience, what might they experience, and what should they watch out for?
Simply stated, patients need to understand why they are taking a medication, how they should be using it, and what they could experience as a result of taking the medication.
For example, if a patient is being given a cycloplegic medication to help an acute attack of iritis, it is crucial that the patient be educated that one of the side effects of cycloplegic medications is blurred vision. Without that key information, the patient may associate the blurred vision with their iritis, or make the assumption that the medication is making their symptoms worse, and discontinue them.
Many patients being put on glaucoma medications will be using those drops long term, possibly for the rest of their lives, but if that is not explained to them, they may think the treatment is over when their bottle is empty, like running a course of antibiotics, and discontinue treatment. The reverse is also common; patients will continue using medications longer than needed, or use a medication in both eyes when it is only indicated for one because they do not understand the purpose of the medication or its possible side effects.
Reducing noncompliance
Noncompliance is when a patient either does not use their medication at all, or they are not using their medication as directed. Noncompliance occurs when a patient cannot or will not use their medications correctly. It could be a cost barrier, difficulty remembering to take their medications, or a lack of understanding of the importance of their medication.
The most direct way to reduce patient noncompliance is through proper patient education. In the example of cycloplegia causing blurred vision, if the patient has been properly educated to expect blurred vision as a side effect, they should not be alarmed. However, if they're not properly informed of the side effects, they may be led to believe that they're losing their vision as a result of their condition. In some cases, noncompliance is more nuanced. For example, a medication may be prescribed and the patient may be properly educated, but then their insurance will not cover the medication, or will require prior authorization in order to pay for the medication. It is also the job of the ophthalmic technician to prepare the patient for this reality.
The ophthalmic technician can help reduce noncompliance in many ways. Completing prior authorizations in a timely manner will help patients get their medications faster, but communicating to the patient that an insurance company requesting a prior authorization is not the same thing as a rejection is equally important. Often, patients will go to the pharmacy, learn that their medication is not covered, and assume that’s the end of the process.
If a patient is struggling to remember their medications, it can help to discuss their routine. If it’s a drop they’ll be using several times a day, would it help to set an alarm or carry the drops with them? If they live with someone, could that person be put in charge of instilling the medication? Is there a place in their home they could put the medication so they would remember to take it more easily? Try to identify something they do every day without fail, and piggyback their drop use onto that activity—for example, their morning coffee, or an afternoon dog walk.
As stated before, discussing side effects with patients is another key to overcoming noncompliance. If a patient is unaware that a symptom is normal, they may simply discontinue their medications.
Education is the final and possibly most important step of noncompliance reduction because it is involved in every aspect of the process. Patients need to know why they are taking their medications. Glaucoma medications, because they may have no noticeable side effects, are at high risk of noncompliance. Patients are more likely to discontinue these medications on a whim if they do not understand why they are taking them, and what to expect or—in the case of glaucoma medications—what not to expect.
Patients will often avoid admitting that they are not taking their medications, so the technician may be required to do a little investigation. For example, if a patient cannot recall how many bottles of eye drops they use to treat their glaucoma, which eye they are supposed to use it in, or how many times a day, that patient is probably not using their drops properly. It is because of this that the technician, as tempting as it may be, cannot lead the patient when going over their current medication regimen.
Ask the patient if they are experiencing any problems with their medications. This includes side effects, such as stinging and burning, but also difficulty remembering to take their medications. Ask the patient if they have any problems getting their drops from the pharmacy. Working through these issues can help reduce noncompliance.
When a doctor prescribes a medication for a patient using insurance, that medication may require a prior authorization prior to being filled by the pharmacy. The purpose of a prior authorization is to prevent doctors from writing unnecessary medications by having to justify their requests with medical information.
When prescribing a new medication, the role of the ophthalmic technician is crucial because prior authorizations will often ask about prior medications a patient was on, length of usage, other medications they may be on, or previous surgeries they may have had. To answer these questions quickly and accurately, there needs to have been a proper patient history taken.
Medication breakdown
Color-coding
Ophthalmic medications often use a color-coded system to indicate the “family” of medication that the drop is in. Although it can be helpful to know that medications used for dilation will almost always come with a red top, and steroids will almost always be dispensed with a pink top, keep in mind that glaucoma medications come with yellow, purple, and at least four separate shades of blue and green, so it’s best not to rely on colored tops to identify drops with patients.
Figure 1: These are all blue, but two are glaucoma drops, and one is an artificial tear.
Common medications
Every doctor will have their own preferred drops, and new drops are being made available all the time, so this list is only meant to represent a few of the most commonly used and available medications, their uses, and simple ways the ophthalmic technician can remember them.
The drops can be broken down into five main categories:
Anesthetic
Anesthetic drops numb the surface of the eye, but they have many other uses in the ophthalmic practice that are not as straightforward. The two main types of anesthetic drops used in the office are Proparacaine and Tetracaine. The suffix ‘caine’ indicates an anesthetic. They are in the same family as other medications such as lidocaine and novocaine.
Mydriatic
Mydriatic drops dilate the pupils, and can be used to look at the back of the eye as well as therapeutically. Dilating drops relax the focusing muscle in the eye, the side effect of which is often blurred vision. The most commonly used mydriatic drop is tropicamide, because it only lasts for a few hours. Longer lasting mydriatic drops, such as cyclopentolate, atropine, and homatropine can keep the eye dilated for several days.
Dilating drops traditionally have a red top.
Antibiotic
Antibiotic eye drops are given to treat or in some cases prevent bacterial infection. Antibiotics derived from cephalosporins will generally have names that end in “cin” such as bacitracin, neomycin, and Moxifloxacin.
Antibiotic eye drops often have a tan top.
Steroid
Corticosteroids are used to relieve swelling, irritation, and redness. They are often given after eye surgery to aid in healing. Steroids will often have names ending in “one,” such as prednisolone, dexamethasone, and fluorometholone.
Steroids may have a pink, white, or even tan top, so avoid attempting to identify them by bottle top.
Glaucoma medications
Glaucoma medications can be broken up into six categories: Alpha Agonists (Alphagan P), Beta Blockers (Betimol, Timolol, Timoptic, Istalol), Carbonic Anhydrase Inhibitors (Azopt, Trusopt), Myoptic (also known as Clolinergic) (Pilocarpine, Isopto, Pilopine), Prostaglandin Analogs (TravatanZ, Lumigan, Xalatan, Zioptan), and Rho Kinase (Rhopressa). There are also combination drops that include multiple families in a single dose for ease of use and compliance (Combigan, Cosopt, Simbrinza).
Common contraindications and reactions
The most common side effect of ophthalmic medications is stinging upon instillation. With some glaucoma medications and cyclosporin, these side effects generally subside after a few weeks, but educating the patient that stinging is normal and often temporary can help reduce noncompliance and contraindications.
As mentioned earlier, glaucoma medications work to lower the pressure within the eye, but in most cases, patients will not feel any different and their vision will not improve from the drops, and the lack of tangible results can be a common misconception when it comes to glaucoma medication.
Beta blockers, when taken in pill form, lower heart rate and blood pressure. When taken in drop form, some patients will experience lethargy. These unpleasant side effects can lead to noncompliance, especially if the medication's value is not properly communicated.
The importance of proper communication
What to flag when communicating with your doctor
If a patient isn’t using their drops as prescribed, make sure the doctor knows. Record how they are using their drops, how they're supposed to be using them, and the reason for the discrepancy.
If a patient cannot afford their medication, the doctor needs to know. Not being able to afford medication is one of the main reasons why patients discontinue or never even start their ophthalmic medications. In many cases, there are alternative medications available that may be more affordable, or the doctor may have access to samples. Often, prior authorizations may be required for insurance companies to cover expensive medications. Explain to the patient the process of prior authorizations and that it may take a few days to get an answer from their insurance company so their expectations are set appropriately.
Proper wording can be the key to connecting with patients
Always ask the patient to bring their drops with them to their appointment. If they have brought their drops, thank them for their compliance and reinforce the importance of their medication. If they haven’t, stress the importance of using the drops. If a patient is confused or if there is any doubt of what medication they’re getting, the technician should call the pharmacy and speak with them directly, either while the patient is in the office or after, if time does not allow.
Patients may get defensive if they feel as if they are being quizzed on their drop regime. Avoid language that could come off as antagonizing. When a patient feels quizzed they will often defer their instructions to their bottles, or they will simply say they are using their drops “as instructed.”
The technician should reassure the patient that they are confirming how the drops are being used, because it is more important than how they were told to use them.
When asking a patient their drop instructions, it can be helpful to ask them broad questions. For example, ask, “are you still using your eye drops?” If the patient is not using their drops due to side effects or expense or some other reason, this question will save the technician a lot of investigation. If the patient is using their drops, it can help put the patient at ease as the bar of compliance has been set at its lowest possible point.
Key takeaways and quiz
In conclusion
Having a strong knowledge of pharmacology can turn a good technician into an invaluable asset to a practice, but more important than what they bring to their employer is what they can do for their patients. Technicians who can help reduce noncompliance through proper education and support can help prevent vision loss in their patients.
Although there are many tips and tricks that technicians can use to help remember what drops do and how to use them, don’t simply rely on color-coded tops: they’re guides, not rules.
Patient education is the key to avoiding noncompliance. Even the best medications in the world do no good if they’re not being used properly.
The ophthalmic technician shouldn’t lead the patient when asking about medications, because knowing how the patient is taking a medication is more relevant than how they are supposed to take it.
