All About Opticians

If you really desire a position that is a part of healthcare and will involve true patient and doctor interaction, then you may want to consider becoming a Certified Ophthalmic Assistant, or COA, instead of an optician. COAs are involved with real, hands-on medical procedures, and often act as the liaison between patients and other true healthcare practitioners.

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 the area of true healthcare. We do try to 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 an ophthalmic technologist (OT). She serves as a speaker before industry groups and private organizations. She is widely recognized for her teaching of continuing education courses to ophthalmic technicians both nationally and internationally. She teaches at the annual meetings of the Association of Technical Personnel in Ophthalmology (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 offices, on an as needed basis. She has published numerous articles in eye industry publications that include the Ophthalmic Professional magazine, the ATPO member only Viewpoints Journal, and the Journal of Ophthalmic Photography, a publication of the Ophthalmic Photographers Society (OPS). 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 currently serves as immediate past president on the board of directors of the ATPO, serves as an ATPO representative on the IJCAHPO as a IJCAHPO Council member, is an member at large on the board of directors of the CAOTP, and is the program director of the OPSSA. She developed and continues to moderate “Ophthalmic Techs on Facebook,” a group of over 2500 AOPs since March 2015, and is the owner and principal member of Ophthalmic Seminars of San Antonio. She works full time with Doctors Kristin Story Held and Allison Paige Young at Stone Oak Ophthalmology as their senior ophthalmic technician.

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 own optical shop, which is situated in our waiting room. I personally appreciate having a knowledgeable optician available. Anytime I encounter a spectacle problem and have confirmed the manifest refraction to be correct, I can easily consult with our optician, who can help troubleshoot the spectacle issues with me. 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 great 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, which is 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 be implanted. The figures that we gather from these measurements are used to calculate the lens implant power, along with other measurements. There are also Diagnostic A-Scans that are used to measure intraocular tumors, etc. However, diagnostic A-Scan instruments are mostly 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 used when clinical examination proves to be difficult, mainly due to the existence of intraocular opacities or diagnostic doubts. In these cases, the implementation of 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 common 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

JCAHPO certifications and examinations include knowledge and performance of techniques in the administration of eye drops, ointments, and irrigating solutions to the eye, and knowledge about oral medications and non-invasive techniques.

For more information, visit jcahpo.org/certification. There, you’ll find the prerequisites that are 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: Total number of IJCAHPO certificants: 26,824 worldwide. (IJCAHPO Value Report July 31, 2019)https://documents.jcahpo.org/documents/Value_Report.pdf

This is the most current information on the IJCAHPO website.

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, without formal training, it can be overwhelming. I highly recommend that while a person learns on the job that they also attend live seminars, online webinars, and perform self-study by reading books and ophthalmic publications. There are 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 some 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 to take the COA test. Four years later, I took and passed the COT test. 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 sit for the IJCAHPO certification test to be certified. A degree opens many doors to OT. For example, when ophthalmic industry considers hiring an OT, one 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 huge!!! ATPO developed a Career Development Taskforce and has partnered with ASCRS and IJCAHPO. We are currently in the process of surveying ophthalmologists’ needs. Anecdotally, we are aware of a shortage of ophthalmic technicians, and we hope to be able to prove it. Additionally, ATPO has launched the “Train the Trainer” program in an effort to help practices to train their 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.

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. ATPO has performed salary surveys every other year since 2007. ATPO members have access to the survey as part of their membership benefits.

2019 Salary and Benefits is available from a the ATPO Online Store: https://atpo.site-ym.com/store/viewproduct.aspx?id=15500025

John: (laughs) Let’s try that again… I don’t think our members are going to spend $50 just to find out. Can you give us some idea of what a basic entry level COA might expect for a salary? Or even a comparison to an optician starting salary? It is OK to say, “no.”

Here is what the Bureau of Labor Statistics Occupational Outlook says about opticians: “2015 median pay = $34,840 per year, or $16.75 per hour.

Sergina: I will agree to refer to the Bureau of Labor Statistics. I have worked at my current practice for over twenty years, and personally do not know what the current salary figures are for the different levels of certification. I would like to add that a base salary is comfortable, and there are opportunities to add to that with writing, teaching, etc.

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 sat to the right of the ophthalmologist. I handed him instruments and had them ready before he needed them. I enjoyed nearly eight years in the operating room and I miss it to this day.

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: Yes. Now, I heard there are some states that require an OT to be a Certified Surgical Technologist. There are many certified OT who are assisting in operating rooms that have been grandfathered in. New OTs will have to check state laws if they desire to assist in the operating room. IJCAHPO OSC certification is not recognized as a qualification, in some states.

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

Sergina: Sure! You’ll start the day running by grabbing the 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 an 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, as well. 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 over and over on multiple patients throughout the day. Some patient are follow-ups, and do not require every test at every visit. Sometimes, we assist in 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: It is my understanding that optometry has its own certification. 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 www.aoa.org

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 wonderful and it will allow a person better career options. However, we all can’t afford college, we all may not be college material, or we may just want to have a career that brings us the meat and potatoes to live. The pay is really good, and there is security in knowing that you’ll always have a job no matter the economy or if you have to move. The demand is high for us and that’s a good thing!!

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 hard for the layperson. So, opticians have an 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 are confused about the difference between IJCAHPO and ATPO and think they are a member of both, when they become certified. This 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.

IJCAHPO 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.

ATPO’s mission is to support the exceptional delivery of physician-led patient care through education, training, career development, and advocacy for allied ophthalmic professionals.

ATPO 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.