As an ophthalmic technician with 15 years of experience, I’ve had the opportunity to train and be trained by some incredible people nationwide. What I love most is the problem-solving nature of the field; ophthalmologists are puzzle solvers, often with one or two of the pieces missing.
The role of an ophthalmic technician is to aid the ophthalmologist in solving these puzzles by taking on responsibilities that allow the ophthalmologist to focus on diagnosis and treatment, leading to optimal patient care.
The role of an ophthalmic technician
But what is the role of an ophthalmic technician, officially? Professional Eyecare Associates of America (PECAA) states: “Ophthalmic assistants play a supporting role to ophthalmologists, educating patients, recording patient information, administering medications, performing basic eye exams, taking basic ocular measurements, applying bandages, preparing and cleaning observation rooms, and assisting the ophthalmologist during minor procedures. Many of these duties take place before the patient’s appointment with the ophthalmologist.”1
An article published by CRSToday in 2018 dove deep into the role of an ophthalmic tech.2 One key phrase they used when describing the ophthalmic technician was “care extenders,” which highlights very concisely the purpose of a technician. They are there to allow doctors to see more patients, spreading out or “extending” their services.
The many hats of an ophthalmic tech
The article in CRSToday breaks down the role of the clinical technician into multiple positions, including:
- Work-up technician responsible for:
- Taking the patient's chief complaint
- Performing the preliminary refraction
- Checking intraocular pressure (IOP)
- Dilating the patient
- Diagnostic testing technician who performs any ancillary testing
- Scribe who transcribes the doctor’s findings in the medical record
In addition to clinical technicians, there are surgical technicians whose job it is to educate patients, perform biometry, and schedule surgeries. There are a few simple steps that can be taken in training and management that can help a technician perform at their highest level—regardless of practice size—while fostering a long-term interest in their career and building loyalty to your practice.
1. Set realistic expectations for ophthalmic technicians
The expectation that a technician will arrive on day one and complete all of the above-listed functions exactly to the preference of that particular is unrealistic but, unfortunately, not uncommon. The duties of an ophthalmic technician vary from practice to practice, and what you need from them will likely differ from their previous position. Essentially, setting a technician up for success boils down to communication.
In a nutshell, people cannot expect to get something they do not ask for. In a 2021 article published by Forbes Magazine entitled “13 ‘Right’ Ways For Leaders To Set Expectations With Employees,”3 it was stressed that expectations need to be clearly laid out and not assumed. Use plain, positive words when explaining what you need to be done, even if the technician has years of experience at a different office.
2. Prioritize onboarding new ophthalmic techs
Onboarding is vital to a successful practice, it improves employee retention and job satisfaction, as well as productivity and understanding of roles.4 New technicians are often hired in a time of immediate need, where they will begin working in the clinic as soon as possible, which makes formal onboarding difficult.
One way to help a technician prepare for their role even before they begin is by supplying them with a detailed job description, and introducing them to the team members they will be working with directly.5 Provide them with the educational materials given to patients and an employee handbook, which includes information about the office’s policies and values.
These resources will educate the technicians on the verbiage they should use and help them build confidence when interacting with patients. Reassure the technician that you know the onboarding process takes time and that there isn’t an expectation that they should know everything right away.
The timeline for this process will vary from case to case, determined by the tech’s base knowledge and the complexity of the position. If it's an extensive practice and the technician has been hired to do a single task, like routine visual fields or imaging, the onboarding may take 2 weeks; if they’re to scribe for a doctor, it could be more like 3 to 6 months.
The online hiring resources Indeed and the Harvard Business Review both agree that it takes time to adjust to any new job,6,7 with the estimates being anywhere from 2 months to 1 year, so keep that timeline in mind when training a new technician.
Setting KPIs for ophthalmic technicians
The 2021 article from Forbes suggests using KPIs (key performance indicators) to make sure expectations are being met. These are quantifiable targets that need to be met in a certain time frame. Although often associated with financial sectors, they can be useful when applied to ophthalmology.
For example, when training an ophthalmic tech, setting the expectation that they be able to complete a concise patient history in an average of 8 minutes or less, and then giving them a time frame, such as 1 month, to meet that goal consistently is a reasonable KPI.
Common KPIs for an ophthalmology practice could include the number of patients seen in a day, the amount of enhanced lenses patients select, or even positive reviews online. KPIs allow technicians to focus on what is most important for the practice, and improve on specific aspects of their responsibilities.
Further considerations while onboarding a new ophthalmic tech
When hiring a new technician, introduce them to the entire team. This lets them know the other employees' roles and who they can go to if they have questions about specific aspects of the office. It also helps to team up the new hire with a trusted veteran employee to show them precisely how to perform their new position.
Lastly, make sure the technician has a functional workspace upon hiring. Russell Fumuso, MD, FAAO, a New York-based ophthalmologist, encourages the use of a professional designer who focuses on ophthalmic offices, not just medical offices, when building or renovating to maximize efficiency.8
If your office is not facing a full overhaul, he suggests simply asking the other technicians what they think works, and what they need that they don’t have. At the very least, provide a space to triage calls and complete prior authorizations, and ensure all the equipment works as expected. Removing simple barriers like this immediately lets the technician focus on more critical aspects of their job.
Communicate preferences to ophthalmic technicians
In many cases, there is a correct way to perform a task to ensure safety and efficiency, but in other instances, it can be a matter of personal preference. In these instances, rather than faulting the technician, tell them in clear terms your preferred method.
A simple example is whether or not established patients should remove their contact lenses before seeing the doctor. I have worked for some doctors who prefer to see the lenses on the patient, whereas others would rather see the patient without the lenses. As a new tech, no matter which option I chose, I would have been “wrong” to one of those doctors.
It may seem like semantics, but phrasing it as your preference rather than correcting the technician lessens the risk that they will feel like they are being told they are doing something “wrong.” It reduces the likelihood of them having a defensive rather than a productive response.
3. Determine the motivating factors for your ophthalmic tech
As natural puzzle solvers, it may aid ophthalmologists and their management team to approach setting their technicians up for success like a puzzle. Finding out what motivates a technician is another piece to ensuring their and, in turn, the practice’s success. Some individuals are motivated by money, others by leisure, others by recognition or praise—learning what motivates a technician will make it easier to provide incentives to improve their skills.
In 2000, a psychological theory was published in the journal American Psychology entitled The Theory of Self-Determination,9 which argued the concept that people are self-motivated by three main things: autonomy, competence, and relatedness. It stated that people want to feel as if they have control, think that they’re good at what they do, and be socially accepted.
Some people are much more responsive to one particular type of motivation over another (someone seeking autonomy may be more motivated by less direct management, whereas others seek praise as validation of their competence). Ensuring access to all of these things will help the technician achieve long-term success.
A note on giving constructive feedback
Feedback is essential, but temper it with time. Human Resource Managers Shacoya Jacobs writes that constant observation and tweaking a person’s routine will decrease productivity and morale, which can ultimately lead to an employee leaving the practice.10 It breaks down autonomy and gives a sense that the technician isn’t trusted.
Criticism can be given in two forms, “constructive” or “destructive.” Well-worded feedback can encourage growth and improve productivity, but if worded poorly, it risks destroying confidence and morale. For example, if a technician is consistently spending too much time in the exam room working up patients, it would be destructive to say, “We’re always running behind because you spend too much time chatting with patients instead of working.”
A more constructive approach would be to remove blame and say “We need to find ways to streamline patient intake. I know we can get caught in the exam lanes sometimes by talkative patients, let’s work on ways to get ourselves out of those situations so we can run more on time.” It’s possible the technician had not realized they were slowing down clinic. By wording the criticism as a group problem, they don’t need to feel personally attacked or belittled.
Even positive feedback can be given incorrectly. If a technician has been leaving lenses out, rather than putting them back where they belong, and one day they put the lenses back exactly how you like them, rather than saying, “It took you 2 months but you finally managed to put the lenses back correctly!” offer praise by saying “I really like how you put the lenses away! It keeps them safe and I know exactly where to find them. Thank you.”
4. Teach the “whys” as well as the “hows” to ophthalmic techs
Many offices focus on checklists and scripts for new technicians to ensure everything gets done. Although a final checklist can be reassuring, it should not be the backbone of a tech’s education.
Knowing why each test is performed is one of the most important lessons for a technician. It helps them ask better questions of the patient and determine what additional testing may need to be completed, which aids the ophthalmologist by anticipating the need.
Example: The “whys” and “hows” of a dry eye exam
The prevalence of dry eye disease (DED) in the United States makes knowing the signs of dry eye an important skill for ophthalmic technicians. According to the National Eye Institute, nearly 16 million Americans have dry eye disease,11 and it’s likely many of the patients the technicians interact with on a daily basis will be in that category. Learning how to anticipate the needs of the ophthalmologist with those patients can avoid bottlenecks in patient flow and ultimately improve patient care.
Evaluating a patient for dry eye requires a combination of pointed questioning by the technician, followed up with one or a variety of tests. First, when taking a patient's history, the technician should be mindful of existing diagnoses the patient has or medications they are taking that can contribute to dry eye. For example, Sjögren’s syndrome, lupus, and sarcoidosis all carry a high risk of dry eye.
Allergy medications and antidepressants also can contribute to dry eye symptoms. Utilizing questionnaires—such as The Standard Patient Evaluation of Eye Dryness (SPEED) or Ocular Surface Disease Index (OSDI)—enables eyecare professionals to quickly and efficiently screen patients for the severity of dry eye disease over time.12,13
If a patient is complaining of blurred, varying visual acuity, light sensitivity, scratchy burning eyes, or redness, dry eye testing is likely warranted. One of the oldest dry eye tests, which is still used routinely today, is Schirmer's test. Developed in 1903 by Otto Schirmer, MD, this test involves placing a Schirmer strip between the upper and lower lid of a patient and then waiting for 5 minutes to see the amount of tears that have wicked onto the strip.
This is then measured and evaluated by the ophthalmologist. Other common tests include a tear breakup time, which evaluates how long it takes tears to dissipate on the surface of the eye, ocular surface staining, and meibomian gland examination.12,13 Most ophthalmologists have their own preferred method of testing for dry eye, and they can educate their technicians on how they prefer it performed to ensure it will be conducted appropriately.
5. Develop excellence through education
Technicians need to understand not just what to say, but why they say it. If training a relatively new technician, like someone with medical experience but not ophthalmology, or someone previously in the front office but transitioning to the back office, prioritize their patient interactions.
If your practice does a lot of cataract surgery, make sure the technician understands how cataracts develop, the symptoms, and how a patient’s vision will change after surgery. Ensure they understand the different lens options, not just the cost of each lens, but the benefits and drawbacks so patients can make informed decisions.
When training a new technician, history-taking is often viewed as a top priority, and though that is an important part of being a great technician, a chief complaint can be tweaked or rewritten. Incorrect information can lead a patient to distrust an office, which harms the practice. In addition, improperly fielding a call, turning a patient away who has a red painful eye when they should be seen urgently, or going rogue with advice on treating a possible infection could harm the patient.
To avoid those things from happening, allow new technicians to listen to how procedures are explained to patients or explain the procedures to the technicians so they know what should be said. Give them the chance to ask questions as the patient so they can learn how to field questions, and stress that they can always get back to the patient with an answer if they don’t have one immediately.
A technician doesn’t need to know everything to display competence; they just need to know they have support when they don’t know what to do or say.
6. Provide opportunities for continued learning for ophthalmic techs
The field of ophthalmology is being transformed by innovation on what can seem like a near-daily basis. It’s exciting, but it also creates a moving target when it comes to making a knowledge base. What was commonplace (i.e., understanding of myopia management, macular degeneration treatment, meibomian gland deficiencies) becomes antiquated in just a few years.
Even if it isn’t feasible to take an entire staff to Hawaiian Eye or American Academy of Ophthalmology (AAO) conventions, the doctors and managers who do go can bring back what they found most interesting and discuss it with their technicians. To make technicians passionate about the same things you’re passionate about, share your experiences.
When technicians talk about the most exciting case they ever saw or the strangest pathology, it’s usually couched around a story of a doctor pulling them into an exam room to show them the findings. These experiences can be constructed. The act of triage or “fielding calls” is often something that is left to the most senior technicians.
Still, those are the types of scenarios that offer the most opportunity for learning for a newer technician. This doesn’t mean transferring the call of a patient with sudden vision loss to an unskilled technician, but making sure they’re included in the discussion afterward so they can learn from those situations.
Certification resources for ophthalmic technicians
Encourage certification as a goal for new technicians. The International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO) provides resources for technicians to learn from before taking their certification exam, and working toward certification ensures the technicians are always learning.
In addition, a study conducted by the Kentucky Eye Institute found that certified personnel were significantly more efficient in categories such as doctor productivity, triage, effective patient flow, and number of patients per hour.14 The website coareview.com has some helpful resources, and even free trial questions, to help your technician prepare for their exam.
In closing
These are not all the keys to success but rather broad strokes to a successful picture. Success ultimately hinges on the doctor or manager being a strong communicator.
This means providing clear leadership, learning the technician’s motivation, and using as many opportunities as possible to educate their staff and inspire an interest in the field of ophthalmology.
