Throughout my medical career, I have been extremely grateful to have the privilege to work with numerous dedicated and talented ophthalmic technicians. These individuals have improved patients' clinical experiences in my offices and enhanced my ability to provide high-quality glaucoma care to my patients. Ophthalmic technicians are not only my coworkers, but they are also among my dearest friends. Words cannot adequately express how valuable a good technician can be to a successful glaucoma practice.

In my humble opinion, ophthalmic technicians in the busy glaucoma practice have among the most demanding jobs in their field. Detailed yet focused histories are critical to optimizing glaucoma care. Furthermore, technicians in the glaucoma clinic are required to check not only visual acuities, refractions, and intraocular pressures but also corneal pachymetry, visual fields, scans taken with multiple imaging technologies, and photographs as well as to assist on numerous in-office surgical and laser procedures. An outstanding ophthalmic technician is worth his or her weight in gold to doctors.

Over the years, I have had the opportunity to train numerous technicians. Early on, I learned that my colleagues and I could optimize and shorten the training process by providing our technicians with a more formal training program. While in academic medicine, we established a training program that allowed us to enhance our recruitment of top-notch technician candidates and ensured their certification within 12 to 18 months following their initial hiring. By investing in our technicians, the quality of both our patients' care and their experiences improved significantly.

The concept of this guide was born of these experiences. Several nationally recognized individuals contributed to this project, and I hope our efforts will be as beneficial to you as it has been enjoyable for us to write these chapters.

GUIDE'S OBJECTIVES

The purpose of the “Ultimate Technician's Survival Guide” is to (1) introduce new technicians to what is required by their profession and (2) provide technicians with critical information in the following areas:

  • Key technical skills
  • Patient workup
  • Special testing
  • Perioperative surgical care
  • Office procedure preparation
  • Electronic medical record/electronic health record solutions
  • Common ophthalmic terminology
  • Medication review
  • Ophthalmic technician certification and advancement opportunities

My fellow contributors and I also want to encourage technicians to become certified and enjoy a thoroughly rewarding professional career. Finally, we wish to express our gratitude for the outstanding efforts of glaucoma ophthalmic technicians everywhere.

GLAUCOMA OVERVIEW

Did you know that, of the nearly 3 million people in the United States with glaucoma, approximately onehalf of them do not know they have the disease?
Unfortunately, more than 100,000 of these people are legally blind. Another 5 to 10 million people are at increased risk of developing glaucoma. Early detection is critical, because glaucoma is most often asymptomatic until the disease is very advanced. Fortunately, new advances in diagnosis and treatment have made early detection possible and have dramatically improved the chances that affected patients will do well. Regular eye examinations are important to help determine if patients are at risk of developing glaucoma.

What is glaucoma?
Glaucoma is a group of diseases of the eye that result in optic nerve damage. Increased fluid buildup inside the eye (which raises intraocular pressure) is an important risk factor for the development of glaucoma. The optic nerve acts as a channel to relay messages to the brain. As the optic nerve deteriorates, the person begins to lose peripheral (side) vision first. Amazingly, often at least 50% of the optic nerve is damaged before any vision is lost at all. By the time a person notices vision loss, often over 90% of optic nerve damage has occurred! Unfortunately, some people are legally blind before they ever seek medical attention.

Who gets glaucoma?
Anyone can get glaucoma, but those at higher risk of developing glaucoma are

  • Over the age of 60
  • Of African and/or Latino/Hispanic descent
  • Relatives of people with glaucoma
  • Very nearsighted (myopic)
  • Diabetic
  • Users of extensive amounts of steroids

How is glaucoma diagnosed?
A typical glaucoma screening examination involves the following tests:

  • Tonometry, which measures the pressure within the eye
  • Gonioscopy, which examines the drainage angle of the eye
  • Perimetry (visual field testing), which tests for peripheral and central vision loss
  • Ophthalmoscopy, a magnified eye examination to look for optic nerve damage and other ocular findings that may predispose a patient to glaucoma

In addition to these tests, advanced imaging technology is now available to patients. Optical coherence tomography, for example, potentially allows your doctor to detect glaucoma earlier than ever before and helps him or her to monitor the progression of the disease.

How is glaucoma treated?
Glaucoma is best managed by

  • Medications
  • Laser surgery
  • Conventional microsurgery

Clinicians are now able to provide not only standard incisional glaucoma surgery but also new cuttingedge glaucoma care. More minimally invasive glaucoma surgeries such as ab interno trabeculectomy and canaloplasty are now available to patients. These surgeries can increase patients' safety and speed their postoperative recovery. Several tiny microstents are also being evaluated for the management of glaucoma, and I hope they will be available to patients in the near future.

What can I do to prevent glaucoma?
Doctors recommend a glaucoma eye examination as part of regular eye examinations for children, teenagers, and adults. Everyone should have a thorough glaucoma examination around the age of 40 and then every 2 to 4 years afterward. Someone of African or Latino/Hispanic descent, who is 60 years of age or older, or who has a family history of glaucoma, is at higher risk, and it is recommended that he or she have a thorough examination every 1 to 2 years after age 35. Patients diagnosed with glaucoma are routinely examined even more frequently.

Glaucoma is the second leading cause of blindness in the United States. Although vision loss due to glaucoma cannot be reversed, early detection and treatment can help halt further deterioration of the person's eyesight. The ophthalmic technician's role in the care of glaucoma patients cannot be underestimated. Your efforts are extremely important. By providing doctors with accurate information, you assist them in both the diagnosis and management of glaucoma.