In the past, the most sought-after and highly compensated technicians were the best trained. That is to say, they could perform a good retinoscopic refraction, obtain manual keratometry (K) values and applanation IOPs that were spot on, anticipate tests the physician would like performed, and do so in a timely fashion. While these skills are still highly valued by some, for newer practices, their overall value has plummeted. Why is this? Technology.
Let’s start with refraction. Today, there are dozens of autorefractors that perform all sorts of higher-level scans and blur effects. In addition, some will automatically load the phoropter with the initial refraction. While some skill is required to fine-tune the prescription, it is not nearly as much as it takes to do a refraction from scratch, and, in many cases, no refinement is required at all.
Manual Ks? Who needs them. In multiple studies, the central power determined by the Lenstar (Haag-Streit) has been shown to be equivalent to manual Ks. Corneal topography can further rule out any significant corneal pathology. In my practice, I have never performed manual keratometry and have found the outcomes of the Lenstar to be incredibly accurate.
Applanation tonometry? Certainly helpful, but the latest Tono-Pen Avia (Reichert Technologies) requires no calibration and is quite accurate. In patients with extreme values of IOP, an applanation may be desirable, but, in these few cases, the physician can perform it at the time of evaluation.
The list goes on and on: OCTs to evaluate angle anatomy, macular status, etc. In the end, the more important skill for today’s technician is the ability to effectively use this new technology, in addition to being able to use EMR. So, when it comes time to expand and hire a new technician, look more for the computer-savvy applicant than the highly experienced one.