All About Opticians

John Seeger Interview UPDATED 1-12-2024

Suppose you desire a position that is a part of healthcare and will involve actual patient and doctor interaction. In that case, consider becoming a Certified Ophthalmic Assistant, or COA, instead of an optician. COAs are involved with actual, hands-on medical procedures and often act as liaisons between patients and other healthcare providers.

John note here: Don’t confuse a COA with an optician who has been able to create a job that mimics that of a COA. We assume that 95% of all opticians rarely do anything that would fall under healthcare. We will connect you with those other 5% when we can.

To learn more about the positions available under the COA umbrella, I spoke with Sergina Flaherty, COMT, OSC.

Sergina is a Certified Ophthalmic Medical Technologist (COMT). She serves as a speaker before industry groups and private organizations. She is a leader recognized for the dynamic teaching style of ophthalmic technicians nationally and internationally. She currently teaches at the annual meetings of the American Academy of Ophthalmic Professionals (AAOP), formally known as ATPO, International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO), American Society of Cataract and Refractive Surgeons (ASCRS), Caribbean Association Ophthalmic Technical Personnel (CAOTP), Ophthalmic Personnel Society of San Antonio (OPSSA), and brings her custom designed training seminars to ophthalmology and optometry practices, on an as-needed basis. She has published numerous articles in eye industry publications, including the American Academy of Ophthalmology Eyenet magazine and Ophthalmic Professional (OP) magazine. She’s written multiple articles for ATPO member-only Viewpoints Journal before the organization became AAOP. She’s written several articles for the Journal of Ophthalmic Photography, an Ophthalmic Photographers Society (OPS) publication. She has also contributed numerous articles to the online blog of the Local Eye Site, a job search company for eye care professionals.  

As a prominent ophthalmic technologist in the country, Sergina is a Past President of the Association of Technical Personnel in Ophthalmology, ATPO, now known as the American Academy of Ophthalmic Professionals, AAOP. She currently serves AAOP on their Editorial Committee. She serves on the Ophthalmic Professional Magazine as a member of the advisory board. She serves as a member-at-large on the board of directors of the Caribbean Association of Ophthalmic Personnel (CAOTP). She is the program director of the Ophthalmic Personnel of San Antonio (OPSSA). She developed and continues to moderate “Ophthalmic Techs on Facebook,” a group of over 5800 AOPs since March 2015. She is the owner and principal educator at Ophthalmic Seminars of San Antonio. She works full-time with Doctors Allison Paige Young, Kristin Story Held, and Jana Nicole Waters as their senior ophthalmic technician at Stone Oak Ophthalmology.

John: Whew! I think you will agree, Sergina is an expert who deserves our attention for a few minutes.

John: Before we jump into the role of the COA, can you briefly tell me what, if any, interactions you have with opticians?

Sergina: I work full-time in a comprehensive ophthalmology office. We own our optical shop. I appreciate having a knowledgeable optician available. Anytime I encounter a spectacle problem and have confirmed the manifest refraction to be correct, I can quickly consult our optician, who can help troubleshoot the spectacle issues. Then, as a team, we can provide full service to the patient.

John: Just off the top of my head, when I think of “COA,” a few things pop up. First is that from what I can tell there are many, many, m-a-n-y levels of certification. Can you tell us a little about that?

Sergina: Yes, there are three core levels of certification and four additional ones. The IJCAHPO is our certifying body.

IJCAHPO Certification Levels COA – Certified Ophthalmic Assistant –Basic level COA – Certified Ophthalmic Technician – Intermediate level COMT – Certified Ophthalmic Medical Technologist – Advanced level

Additional JCAHPO certifications OSA – Ophthalmic Surgical Assistant – for ophthalmic personnel who assist ophthalmologists in the operating room ROUB – Registered Ophthalmic Ultrasound Biometrist – for ophthalmic personnel who provide pre-operative measurements by use of an A-Scan CDOS – Certified Diagnostic Ophthalmic Sonographer – for ophthalmic personnel who perform diagnostic B-Scan OSC – Ophthalmic Scribe Certification – For ophthalmic personnel who scribe for their ophthalmologists and a tremendous first certification for the beginner ophthalmic assistant.

John: Um, hold up a second, A Scan and B Scan?

Sergina: Yes. A Biometrist uses an A-Scan, an ultrasound machine that uses sound waves to measure axial eye length. A-Scans are also optical biometers that use light to measure axial eye length. A-Scans are required when a patient needs cataract surgery, where an intraocular lens will replace the patient natural lens. The ophthalmologist will use the figures we gather from these measurements to calculate the lens implant power and other measurements. Diagnostic A-Scans can also measure intraocular tumors. However, diagnostic A-Scan instruments are primarily found in large clinical settings and at universities.

B-Scan is different from the A-Scan. It is used only for diagnostic purposes. B-scan is helpful when clinical examination proves to be difficult, mainly due to intraocular opacities or diagnostic doubts. In these cases, implementing a B-mode ultrasound examination can streamline or modify the management of a patient’s condition.

John: Mmmm… OK.   Certified AOPs, or Allied Ophthalmic Personnel, perform assigned procedures under the direction or supervision of a physician licensed to practice medicine and surgery and qualified in ophthalmology.  Some everyday tasks performed by ophthalmic technicians at all levels of certification include:  History taking Obtaining chief complaint Maintaining instruments Providing patient services  Taking eye measurements Administering tests and evaluation Performing a variety of clinical tasks

The International Joint Commission of Allied Heath Personnel on Ophthalmology, IJCAHPO, is the certifying body for ophthalmic assistants and provides the examinations and certifications. Examinations include: Knowledge and performance of techniques in administering eye drops and ointments. Irrigating solutions to the eye. Learning about oral medications and non-invasive techniques.  For more information, visit www.jcahpo.org/certification. You’ll find the prerequisites required to pursue JCAHPO certification at each level.

John: Are these national, regional or state-by-state certifications? Are they transferrable from state-to-state?

Sergina: IJCAHPO certification is worldwide. In IJCAHPO’s annual report for 2020-2021, there were 33,909 worldwide certificate holders. IJCAHPO certifications are national and can cross state and county lines in the United States.

John: The second thing that comes to mind is education levels. I had a student once that left our opticianry program only to return when he found the training for COA/Surgical tech overwhelming. Can you talk a little about the varying educational expectations?

Sergina: There are various roads to becoming an ophthalmic technician. On-the-job training is one such road. However, with formal training, it can be manageable. While people learn on the job, they should also attend live seminars and online webinars and perform self-study by reading books and ophthalmic publications. Also, find a mentor willing to share knowledge and help you gain expertise. There are a few ophthalmic programs available throughout the USA. These programs can run anywhere from six months to a few years. Some programs qualify one to sit for a particular level of certification. There are also ophthalmic technicians who, like myself, received their training in the US Army. My training was six months, and I took the AAO Home Study course to qualify for the COA test. Four years later, I took and passed the COT test, and six years later, I took and passed the COMT test.

John: If understand you, all levels of certifications require no formal college degrees?

Sergina: No formal college degrees are required. However, there are formal OT programs available throughout the USA where one can get an associate’s degree. After attending a formal program, one must still sit for the IJCAHPO certification test to become certified. However, a bachelor of science degree opens many doors to an OT. For example, when the ophthalmic industry considers hiring an OT, a candidate with a degree will be considered before one without a degree.

John: Can you tell us about demand, job growth expectations and your view on the future of the COA certifications?

Sergina: The demand is enormous!!! Anecdotally, our various ophthalmic groups have voiced a significant need for help and complained of a shortage of ophthalmic technicians. To address this problem AAOP has developed a “Train the Trainer” program and book to help practices to train their existing ophthalmic technicians to become in-office trainers, with the thought that if they can train within, they can hire inexperienced people to become ophthalmic technicians. Growth potential is very good with all the various levels and certifications available. Our profession is also recession and depression-proof. I can confirm this as a fact, as during the 2008 bust, I did not only keep my job, but I continued to make the same salary. My mortgage was never on the line, and neither was my job.

John: You know I have to ask. Are there any figures on income for the different certification levels?

Sergina: I’m glad you asked, John. Here is what the Bureau of Labor Statistics Occupational Outlook says about opticians: “2020 median pay = $ 42,480 per year, or $20.42 per hour. These are exceptional starting wages. Higher levels of certification bring higher income, of course.

John: I mentioned the surgical tech level of certification. Just how “hands-on” or maybe better “hands-in,” if you will, do some techs get?

Sergina: I assisted in cataract and retinal cases earlier in my career. I scrubbed in and directly assisted the ophthalmologist. I handed him instruments and had them ready before he needed them. These days, I am in the surgery center running the Lensx Femtosecond laser for our cataract patients, and I love it!

John: Just to be clear here, a COA may actually assist a doctor of ophthalmology during surgery, right? I mean operating rooms, scalpels, blood and sutures?

Sergina: Yep. Now, some states require an OT to be a Certified Surgical Technologist. Certified OT assisting in operating rooms now have been grandfathered in. New OTs will have to check state laws and the surgical facility if they desire to assist in the operating room. In some states, IJCAHPO’s Ophthalmic Surgical Assistant, OSA, certification is a recognized qualification.

John: Can you describe the typical day in the life of a base-level COA?

Sergina: Sure! You’ll start the day by grabbing a chart or entering the electronic medical record (EMR) and calling your patient. Once in the examination room, you would collect a medical and social history, obtain a chief complaint, check the patient’s visual acuity, perform lensometry, perform manifest refractometry, muscle testing, confrontation visual fields, pupil testing, tonometry, and dilate the patient. You may perform a corneal topography, especially if the patient wears contact lenses. The doctor may ask for an optical coherence tomography (OCT), formal visual field testing, ophthalmic fundus, or external photography. These tests are all dependent on what the ophthalmologist finds on initial examination.

The ophthalmologist may have a patient return at another date for some testing. The technician may repeat this process repeatedly on multiple patients throughout the day. Some patients will be follow-ups and only require some tests at some visits. Sometimes, we assist during in-office procedures, for example, irrigation and drainage of a chalazion, removal of an eyelid lesion, or YAG laser capsulotomy. Some technicians perform pre-operative measurements and perform a-scan biometry.

John: Any idea on the numbers of optometry practices versus ophthalmology practices that employ COAs?

Sergina: I understand that optometry has its certification for staff to assist the optometrist. The American Optometric Association developed a program for their paraoptometric staff. There are four levels of certification. Certified Paraoptometric – CPO – Entry level Certified Paraoptometric Assistant – CPOA – Intermediate level Certified Paraoptometric Technician – CPOT – Advanced level Paraoptometric Coding Specialist – CPOC – Specialty level To read more about these, visit  https://www.aoa.org/paraoptometrics/certification

John: I’m known for putting people on the spot. Would you recommend COA as a job to your own child or a high school senior trying to make a career choice?

Sergina: Absolutely, and without reservation! I am frustrated by our high schools, as they push college on every student. Now, don’t get me wrong. College is excellent and will provide a person with great career options. However, we all can’t afford college, may not be college material, or may want a career that brings us the meat and potatoes to live. The pay is excellent, and there is security in knowing that you’ll always have a job, no matter the economy or if you have to move to another city or state. The demand is high for us, and that’s a good thing! And, with each move, we can garner higher wages.

John: Let’s guess that at least one of our members is reading this and thinking, “Heck, yeah, that was more like what I was looking for!” What would be their next step?

Sergina: Call the ophthalmologist in their community and tell them you are interested. Ophthalmologists love opticians that want to cross over, as they already understand optics. Optics can be challenging for the layperson. So, opticians have the upper hand. The rest can be learned on the job.

John: Thank you. Is there anything you would like to add?

Sergina: Many ophthalmic technicians need clarification about the difference between IJCAHPO and AAOP. They think they will be a member of both when they become certified, which is far from the truth.

IJCAHPO is a commission of twenty-two regular member organizations with representatives from each organization. IJCAHPO is our certifying body. Certifications – IJCAHPO | International Joint Commission on Allied Health Personnel in Ophthalmology

IJCAHPO’s goals are: 1. Development of standards of conduct, examination, certification, and recertification of allied ophthalmic personnel 2. Development of continuing education and services for allied health personnel in ophthalmology 3. Provide a forum for ophthalmic–related organizations to collaborate 4. Support of the accreditation process for medical programs for training and education of allied health personnel in ophthalmology.

AAOP is a professional membership organization of AOP, an organization of high-quality standards and professional ethics, and dedicated to quality vision care under the direction of an ophthalmologist. Our mission is to provide, expand, and support scientific and educational opportunities for ophthalmology allied health personnel and advocate for its members and the profession. About AAOP – American Academy of Ophthalmology

AAOP goals are: 1. To advocate for the profession 2. Set standards and encourage IJCAHPO certification 3. Offer continuing education 4. Discuss issues confronting the profession 5. Provide national and international channels of communication among members 6. Enhance the image of ophthalmic medical personnel.

Thank you for this opportunity to help your readers’ understanding of my profession.

John here again – Get it? A COA has a true role within healthcare. An optician has a true role in business. Decide which you want to be, and don’t confuse one with the other. COA is not for everyone; neither is optician. Again, know the difference before you make a decision.