Ophthalmic technicians can make pretty high paying salaries, ranging anywhere from around $26,000 to $70,000 depending on location, experience, and duties. Those working in surgical centers, with duties helping out in surgical procedures, may earn more than those in. Ophthalmology articles covering symptoms, examination, diagnosis, medical and surgical treatment, prognosis, and follow-up. Peer reviewed and up-to-date recommendations written by leading experts.

• Ophthalmology Workup Guidelines

Cornea The refractive cataract work-up Part two of a seven-part corneal/anterior segment survival guide. TELLO, BGS, COMT, OSC The rush of an ordinary clinic day should not impede an ophthalmic technician’s performance during a refractive cataract preliminary exam. Understanding the exam process helps to make the exam efficient for the physician and results in the optimal patient experience and outcome. To improve the performance of ophthalmic technicians working with the refractive cataract surgeon, we offer the following best practices. From the beginning Start by defining cataracts for patients. Cataracts occur when the lens becomes cloudy and hard.

They typically develop from normal aging or from eye trauma, previous eye surgery, or use of certain medications, such as oral steroids. Patients may present with complaints such as blurred vision, poor night vision, sensitivity to light and glare, ghost images, double vision, and/or decreased color sensitivity. Ready for surgery? At first, patients may come into the ophthalmologist’s office hoping new glasses will correct their eye problems.

The thought of having surgery might not even cross their minds. The patient may not be able to target one specific visual complaint. COMPONENT OF WORK-UP ELEMENTS SPECIAL CONSIDERATIONS Chief Complaint/HPI Glare, halos, ghosting, difficulty with activities of daily living If necessary, have patient sign Activities of Daily Living form Ocular History Review previous note for PSC cataract If +, ask about diabetes and previous steroid use Medication and Allergies Reconcile current medications and drug allergies Current use of products containing aspirin or blood thinners Past or current use of tamsulosin (Flomax) Latex allergy? Visual Acuity with Best Correction Glare test if VA 20/40 or better. Patient must have a complaint of glare Potential acuity meter if VA 20/50 or worse No special considerations Eye dominance Patient may be unaware of eye dominance Lensometry Document latest glasses prescription Refraction Should be included in every cataract work-up. Glare testing is to be done with the patient's best corrected vision when patient is refracted The ophthalmic technician must identify whether the patients are potential candidates for refractive cataract surgery.

Ophthalmology Workup Guidelines

The problem: A complaint of blurry vision does not automatically indicate a cataract diagnosis. If patients are frustrated with a deficit in their daily activities or notice a change in their daily functioning, an efficient ophthalmic technician should investigate whether symptoms interfere with quality of life.

Cortical cataract with pseudoexfoliation. IMAGES COURTESY ROSA LONG, CRA For example, patients may complain of a change in their driving behaviors or a change in their hobbies, such as trouble seeing the golf ball, difficulty playing cards, or the need for more light while reading. These practical changes in daily functioning may significantly impact their daily activities and result in frustration and possible depression. It’s the technician’s job to help them realize that surgery may be necessary to solve their visual issues. Set the proper expectations Once patients realize that removing their cataracts prevents severe vision loss, they typically have several questions. It is wise to touch upon traditional cataract surgery, monovision, and recent innovations in cataract surgery.

This includes femtosecond lasers, premium IOLs, toric IOLs for astigmatic correction, and how technological advancements such as intraoperative aberrometry may improve outcomes. (See Refractive cataract surgery Q&A, right.) Physicians value team members with diverse skills, so an ophthalmic technician should also be able to multitask and play the role of surgical coordinator. The surgical coordinator can readily answer questions about surgical clearance by the primary care doctor, pre-op and post-op eye drops, post-op restrictions, special testing, and lens options. Refractive cataract surgery Q&A BY KENDALL DONALDSON, MD, MS Q: What if an established patient comes for cataract evaluation?

A: Treat patient as a new patient and do complete work-up with the addition of glare, potential acuity meter, refraction, and dilation. Q: What if a patient has a poor prognosis due to other serious pathology like macular degeneration? A: Explain to the patient that he/she would be able to see better peripherally, and would facilitate the retina exam due to improved view in.

Q: How long should soft and gas permeable contact lens wearers remove lenses prior to pre-operative measurements? A: One week for soft contact lens wearers and four weeks for RGP contact lens wearers. Q: How long before a patient can drive after cataract surgery?

A: If visual acuity is better than 20/50 on the other eye, patient can drive two days after surgery. Effects of anesthesia could interfere with patient driving to first day post-operative visit. Q: When is it OK to use makeup?

A: One week after surgery. Q: When is it OK to wash hair? A: Day of surgery (be careful not to get any soap in the eye to prevent rubbing) Q: When is it OK to resume blood thinner? A: Immediately after surgery. At times, the patient may be unable to stop anticoagulation due to severity of systemic illness and associated risks of discontinuation. Q: What if old glasses obstruct new vision? A: Have old lens replaced with plano lens until final prescription is given.

Tello, BGS, COMT, OSC educates patients on premium IOLs. IMAGES COURTESY ROSA LONG, CRA Understand the process During the explanation of the cataract surgery process, be clear in emphasizing that every eye is different in terms of size, depth, and curvature of the cornea. This way, the patients understand the need for routine yet careful measurements, such as axial length, specular microscopy, and topography, to obtain accurate data. It is important to make patients aware that traditional cataract surgery involves the use of a surgical blade to perform corneal incisions and anterior capsulotomies. Also, clearly share that a femtosecond laser performs four aspects of cataract surgery: corneal incisions, primary incision, paracentesis, and limbal relaxing incisions. Moving forward Our refractive cataract surgeon, Kendall Donaldson, MD, MS, has her own plan of pre-op and post-op drops.

Drug combinations including Besivance, Vigamox, Pred Forte, Durezol, Ilevro, Ketorolac, and Nepafenac (among others) are frequently used. The combination of a steroid, nonsteroidal agent and antibiotic agent are standard post-operative protocol. Our refractive cataract surgeon tries to minimize the amount of drops used to avoid compliance issues and minimize ocular surface complaints. OP Part three will detail refractometry in the cornea clinic.