Technician Level

Exam Study Guide

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Motivation

According to the Joint Commission, approximately 70% of the 15,000 certified ophthalmic medical personnel are assistants, and about 26% are technicians.  I can tell you that this number has not changed much over the years, and this fact amazes me.  Of course, some assistants are recently certified, but many remain COAs for many years.  Another the Joint Commission statistic tells us that certified technicians make more money than assistants do, a significant amount more.  The kicker is that these assistants, in most cases, are doing technician level work.  They're just not getting paid for it.

Don't get me wrong on this.  The "COT" after your name does not mean that you necessarily deserve more money or that you are going to get paid more money.  Those who are motivated to get certified at the technician level are generally more skilled and take more responsibility on the job;  responsibilities such as administration, supervision, and training other OMPs.

Introduction

The Joint Commission has organized the material you need to know for the written exams into "content areas".  The technician is expected to know the assistant level content areas and some additional technician level content areas, which are listed below.  On the left is the approximate percentage of exam questions that will be asked in the particular content area.  The column of numbers in the middle is the approximate number of questions from the particular content area that would be asked on a 200 question exam.  This serves as a guide as to the relative importance (weight) of the particular content area.

Click on the hyperlink, or scroll down to see the sub-listings under each content area.   The study guide consists of comments and recommended reading for each of the content areas.  When you follow a link, a new window may open, so you will need to allow pop-ups on this site if you have a pop-up blocker.  Close the window when finished with the pop-up to return to this window.

There are references and hyperlinks in the study guide to four types of study materials. 

• Many references are to the book Ophthalmic Medical Assisting, which is the "homestudy" course published by the AAO.  Those applying for assistant level certification are required to complete this course in order to apply for the assistant level exam, so you may have access to this book.  This book has recently been revised (third edition), but the second edition will be fine for study purposes. 
• Some hyperlinks go to sources on the web.  If one of these links gets broken for some reason, please e-mail me so that I can find a new source for the info.
• Many of the links go to the modules that are available for CE credit on this website.
• Some of the links go to PDF files of articles from the old Ophthalmic Trainer Newsletter, which some of you may remember.  These articles are not available for CE credit.

I'm already a certified assistant, can't I just skip the assistant level material and study only the technician level content areas?

This is a dangerous tactic.  About 29% of the exam questions will come from the assistant level content areas.  The questions will not be assistant level questions.  You are expected to know more than an assistant, so the questions will be more difficult on the tech exam.  In the modules available on eyetec.net, we do not separate out different levels of difficulty.  There is assistant, technician, and technologist level information in every module.  We feel that this is information every OMP should know, no matter what level of certification.

How difficult will the exam be?

According to the Joint Commission, the pass rate for the tech exam is significantly lower than it is for the assistant level exam.  Although you would expect this exam to be more difficult, I think the lower pass rate has more to do with a lack of preparation.  If you follow the recommendations of this study guide, you will be prepared.

How much time will it take me to study for this exam?

I would figure about 10 hours for the Ophthalmic Medical Assisting book.  There are over 45 modules on eyetec.net that are relevant to this exam, at one hour each, that would be another 45 hours.  If you figure another 5 hours for practice test questions, you are in the neighborhood of about 60 hours.  If you manage to study 2 hours a day, that would be about a month's worth of studying.

What about practice questions?

Practice questions get you acclimated to the testing environment and they help you study for the exam.  The eyetec.net modules that you will be studying have post-test questions associated with them.  Although, for obvious reasons, we cannot give you the answers to the post-tests, the answers come directly from the module content.  Each module has 15 questions associated with it.

If 650+ post-test questions are not enough for you, the Joint Commission website has books available with practice questions, and eyetec.net has practice tests available.

The Skill Evaluation

If you pass the written exam, you will have to pass a skill evaluation before you become certified.  Follow this link for information on the skill evaluation.

7%

8%

4%

4%

6%

10%

14%

10%

12%

10%

4%

8%

3%

14

16

8

8

12

20

28

20

24

20

8

16

6

1. HISTORY TAKING

2. BASIC SKILLS AND LENSOMETRY

3. PATIENT SERVICES

4. BASIC TONOMETRY

5. INSTRUMENT MAINTENANCE

6. GENERAL MEDICAL KNOWLEDGE

7. CLINICAL OPTICS

8. BASIC OCULAR MOTILITY

9. VISUAL FIELDS

10. CONTACT LENSES

11. INTERMEDIATE TONOMETRY

12. OCULAR PHARMACOLOGY

13. PHOTOGRAPHY

1. HISTORY TAKING

Comments:  Read the chapter in Ophthalmic Medical Assisting on history taking.  Read the eyetec.net module on history taking.       

A. Presenting Complaint/History of Presenting Illness

1. Signs and symptoms

Comment:  A clinical sign is an objective observation of the patient's physical condition.  An example of a sign is a red eye.  A symptom is a subjective description from the patient that cannot be objectively verified.  A example of symptom is pain.

2. Triage

3. Refractive status

4. Injury

5. Contact lenses

6. Confidentiality

B. Past Ocular History

1. Refractive status problems

2. Injury

3. Diseases and prescriptions

4. Surgery and laser

5. Contact lenses

C. Family History

1. Diabetes

2. Glaucoma

3. Hypertension

4. Ocular diseases and dystrophies

5. Strabismus

6. Other

D. Systemic Illness, Past and Present

1. Hypertension

2. Diabetes

3. Cardiac problems

4. Pulmonary problems

5. Arthritis

6. Sickle Cell disease

7. Surgical procedures

8. Major infections

9. Other

E. Medications

1. Aspirin-containing medications

Comment: Here is a list of aspirin containing medications.  Common ones are Anacin, Bufferin, Ecotrin, Norgesic, and Percodan.

2. Diuretics

Comment: Common diuretics are Aldactone (spironolactone), Dyazide (triamterene), Hydrodiuril (hydrochlorothiazide), Lasix (furosemide), and Maxzide (triamterene).   Diuretics cause your body to loose water and are commonly used to treat high blood pressure.

3. Blood pressure medications

Comment:  Go to this page for a list of BP meds.

4. Birth control pills

Comment:  Here is a list of birth control meds.

5. Steroids

Comment:  Common oral steroids are prednisone, prednisolone, and methylprednisolone. 

6. Other

Comment:  Wow. "Other" covers a lot of territory.  Hopefully there won't be too many "other" questions.

F. Allergies and Drug Reactions

1. Penicillin

2. Sulfa

3. Local Anesthesia

4. Fluorescein

Comment:  Know the most common reaction to fluorescein, which is transient nausea.  A less common reaction is hives.  Anaphylaxis has been documented, but is rare.

5. Other

G. Partially Sighted Patient

Comments:  Read the section in Ophthalmic Medical Assisting on the "Visually Impaired" (look this term up in the index)

1. Onset of visual loss

2. Use of low vision aids

3. Problems/goals

4. Home/family/community support

2. BASIC SKILLS AND LENSOMETRY       Top of Page

A. Method of Measuring/Recording Acuity

Comment:  Read the chapter in Ophthalmic Medical Assisting that covers vision testing.

1. Distance acuity

2. Near acuity

3. Children

4. Low vision

5. Illumination of target and background

6. Pinhole

7. Artifacts

8. Recording

B. Color Vision Testing

Comments:  Read the section in Module 23 about color vision testing.  Read the section in Ophthalmic Medical Assisting on the "Color vision tests" (look this term up in the index).

1. Color plates

2. D-15

3. Farnsworth-Munsell

4. Physiology

5. Children

C. Lensometry

Comments: You will need to know how to perform manual lensometry.  It is important that you actually learn the procedure on a real manual lensometer, and not rely on the descriptions in the book.  Doing so will make it much easier for you to answer questions about the procedure.  If you only use an auto-lensometer in your work situation, you may be able to find a manual lensometer in your optical shop or an outside optical shop that you are friendly with.  Read the section in Ophthalmic Medical Assisting on lensometry.

1. Sphere

2. Cylinder power/axis

3. Prism

Comment: Read Module 31 and Module 17

4. Multifocal power

5. Multifocal induced prism

Comment:  Read Module 18, Section 2

6. Base curve

Comment: Read Module 17, Section 2

7. Lensometer

8. Lens "clock"

Comment: Read Module 17, Section 2

9. Estimation with loose lenses

Comment: Read Module 16, Section 2

10. Aphakic lenses

11. Recording prescription

12. Transposition

Comment:  Read the section in Module 19 on transposition.

D. A-scan Biometry

Comment:  Read Module 1 and Module 2

E. Exophthalmometry

Comment:  Read the part in Module 29, Section 5.

F. Amsler Grid

Comment: Read the section on the Amsler Grid in Module 12, Section 3

G. Schirmer Tests

Comment:  Read this page.

H. Evaluation of Pupil

Comments:  Read Module 44.

I. Estimation of Anterior Chamber Depth

Comment:  Read Module 44.

3. PATIENT SERVICES         Top of Page

A. Ocular Dressings and Shields

Comment:  Read the sections in Ophthalmic Medical Assisting. Look up "dressings" in the index.

1. Indications

2. Proper use

B. Drug Delivery (Advantages/Disadvantages)

Comment:  Read this PDF article.

1. Drops

Comment:  Know your cap colors.  Dilating drops have red tops, beta blocker drops have yellow tops, alphagan has a purple top, prostaglandin drops have a teal colored top (e.g. Xalatan).

2. Ointments

3. Sustained release

4. Injections

5. Systemic

6. Complications

C. Spectacle Principles

Comment:  Read the chapter on "opticianry" in Ophthalmic Medical Assisting.

1. Interpupillary distance

Comment: Read Module17.

2. Frames

3. Multifocals

4. "Safety" lenses and frames

Comment: Read Module 18.

5. Adjustment and repair

6. Care of spectacles

7. Lens materials

Comment: Read Module 18.

D. Assisting Patients

Comments:  Read the chapters in Ophthalmic Medical Assisting on "Patients with Special Considerations" and "Minor Surgical Assisting".

1. Physically disables

2. Visually disabled

3. Pediatric/children

E. Minor Surgery

1. Assisting surgeon

2. Instructing patient

4. BASIC TONOMETRY        Top of Page

Comments:  As with all skill areas, it is important that you have experience performing Goldmann applanation tonometry.  Experience will make it much easier for you to answer exam questions.  Read the chapter on tonometry in  Ophthalmic Medical Assisting (Comprehensive Medical Eye Exam), and read the section on tonometry in Module 41.

A. Indentation

1. Principles

2. Errors

3. Cleaning and sterilizing

4. Advantages/disadvantages

5. Technique

B. Applanation

1. Principles

2. Errors

3. Cleaning and sterilizing

4. Advantages/disadvantages

5. Technique

C. Non-Contact

D. Complications/Contraindications

 

E. Scleral Rigidity

1. General concepts

2. Methods of assessing scleral rigidity

F. Factors Altering Intraocular Pressure

1. Squeezing eyelids

2. Heartbeat

3. Breath holding

4. Tight collar

5. Body position

6. Other

5. INSTRUMENT MAINTENANCE       Top of Page

Comments:  Familiarity with ophthalmic instruments is important to being able to answer the exam questions.  Know what each instrument is used for and know what it looks like.  If it has a bulb or a battery, know how to change the bulb or battery.  Read the chapter in Ophthalmic Medical Assisting on "Care of Ophthalmic Lenses and Instruments".

A. Acuity Projectors

B. Ophthalmoscopes

1. Direct

2. Indirect

C. Retinoscopes

D. Lensometers

E. Perimeters

F. Tangent Screen

G. Phoropters

H. Slit Lamps

I. Ultrasound

J. Keratometers

K. Lenses

L. Tonometers

M. Muscle Light

N. Special Instruments

O. Surgical Instruments

 

Comments:  Read the chapters in Ophthalmic Medical Assisting on "Anatomy and Physiology of the Eye", "Diseases and Disorders of the Eye", and "Optics and Refractive States of the Eye".

A. Cardiopulmonary Resuscitation

Comment:  You are no longer required to be CPR certified to be able to take the exams, but many offices require this for their medical personnel.  Read the CPR booklet that comes with a CPR course.  Read the chapter on "Patient Interaction, Screening, and Emergencies" in Ophthalmic Medical Assisting.

1. Fainting

2. Cardiac arrest

3. Acute drug reaction

 

Comment: The eyetec modules currently (as of 3-07) cover all areas of ocular anatomy and physiology, except for the external eye (lids, lacrimal, conjunctiva) and the orbit.

B. Anatomy

1. Cardiovascular

Module 9 -  General Medical Knowledge - Part 2

2. Respiratory

Module 8 -  General Medical Knowledge - Part 1

3. Endocrine

Module 9 -  General Medical Knowledge - Part 2

4. Nervous

Module 8 -  General Medical Knowledge - Part 1

5. Ocular

Module 23 - The Posterior Segment, Part 1

Module 27 - Extraocular Muscle Anatomy and Physiology

Anterior Segment: Module 43, Module 44, Module 45

 

C. Physiology

1. Cardiovascular

Module 9 -  General Medical Knowledge - Part 2

2. Respiratory

Module 8 -  General Medical Knowledge - Part 1

3. Endocrine

Module 9 -  General Medical Knowledge - Part 2

4. Nervous

Module 8 -  General Medical Knowledge - Part 1

5. Ocular

Module 23 - The Posterior Segment, Part 1

Module 27 - Extraocular Muscle Anatomy and Physiology

Anterior Segment: Module 43, Module 44, Module 45

 

D. Systemic Diseases

1. Diabetes

Module 9 -  General Medical Knowledge - Part 2

2. Hypertension

Module 9 -  General Medical Knowledge - Part 2

3. Cancer

4. Atherosclerosis

Module 9 -  General Medical Knowledge - Part 2

5. Blood

6. Infections

7. Blood dycrasia

8. Infectious Diseases

Module 8 -  General Medical Knowledge - Part 1

Module 9 -  General Medical Knowledge - Part 2

E. Ocular Diseases

1. Refractive errors

Module 16 - Optics: Physical, Geometric, and Physiologic

Module 40 - Refractive Surgery

2. Infection

3. Injury

4. Red eye

Comment:  Read this PDF file.

5. Presbyopia

Module 4 - Accommodation and Near Vision

6. Other common disorders

Module 24 - The Posterior Segment, Part 2

Module 26 - Fluorescein Angiography, Part 2

Module 41 - Glaucoma, Part 1

Module 42 - Glaucoma, Part 2

Anterior Segment: Module 43, Module 44, Module 45

 

F. Ocular Emergencies

Comment:  Read this PDF file.  Read the chapter in Ophthalmic Medical Assisting on "Patient Interaction, Screening, and Emergencies".

1. First aid

2. Management in the absence of the physician

G. Metric Conversions

Comment:  Read this article.

H. Fundamentals of Microbial Control

Comment:  Read the chapter in Ophthalmic Medical Assisting on "Microbiology and Aseptic Technique".

1. Sanitation

2. Disinfection

3. Sterilization

4. Contamination

7. CLINICAL OPTICS       Top of Page

A. Optics

Module 16 - Optics: Physical, Geometric, and Physiologic

Module 17 - Clinical Optics: Part 1

Module 18 - Clinical Optics: Part 2

Module 19 - Clinical Optics: Part 3

1. Geometric

2. Clinical

3. Physiologic

B. Retinoscopy

Module 6 -  Retinoscopy in Minus Cylinder

Module 7 -  Retinoscopy in Plus Cylinder

1. Principles

2. Techniques

C. Refractometry

Module 46 - Refractometry

Module 47 - More on Refractometry

Module 20 - Handling Glasses Complaints

1. Fogging

Module 3 - Refractometry Techniques

2. Astigmatic dials

3. Cross cylinder

Module 3 - Refractometry Techniques

4. Duochrome

5. Accommodation

Module 4 - Accommodation and Near Vision

6. General principles

Module 3 - Refractometry Techniques

D. Advanced Spectacle Principles

Module 19 - Clinical Optics: Part 3

Module 20 - Handling Glasses Complaints

1. Vertex distance

Module 3 - Refractometry Techniques

2. Prism correction

Module 17 - Clinical Optics: Part 1

3. Bicentric grinding (slab off)

Module 18 - Clinical Optics: Part 2

4. Aphakic spectacles

Module 3 - Refractometry Techniques

E. Low Vision Aids

Comment:  Read this article.

8. BASIC OCULAR MOTILITY         Top of Page

A. Extraocular Muscle Actions

Module 27

B. Strabismus

1. Phoria/tropia

Module 5 - Ocular Motility - Cover Tests

2. Horizontal deviations

Module 5 - Ocular Motility - Cover Tests

3. Vertical deviations

Module 5 - Ocular Motility - Cover Tests

4. Paralytic- including primary and secondary

Comment:  Read this article.

5. Pseudostrabismus

C. Amblyopia Detection

Module 28

D. Evaluation Assessment Methods

Modules 27, Module 28, Module 29, Module 30

1. Cover/uncover, alternate cover tests

Module 5 - Ocular Motility - Cover Tests

2. Krimsky/Hirschberg

3. Diagnostic positions of gaze

4. Maddox rod

5. Worth 4-dot

6. Stereopsis

7. Near point of convergence/accomodation

8. Ductions and versions, head tilt

9. Vergences

10. Risley prism

11. Diplopia (e.g. Redglass)

12. Fusion (e.g., Bagolini lens)

9. VISUAL FIELDS          Top of Page

A. Visual Pathways

Module 11 - The Visual Pathways and Visual Field Defects

1. Retina

2. Retinal nerve fiber layer

3. Optic nerve

4. Chiasm

5. Optic tract

6. Lateral geniculate body

7. Optic radiation

8. Occipital cortex

B. Visual Fields

Module 12 - Visual Field Testing

1. Definition of the visual field

2. The "island of vision" analogy

3. Visual field terminoglogy (isopters, threshold, apostilb, decibel)

C. Methods of Measuring the Visual Field

Module 12 - Visual Field Testing

1. Screening (single simulus, multiple stimuli, Harrington-Flocks screener, others)

2. Threshold perimetry

D. Techniques

Module 12 - Visual Field Testing

Module 13 - Visual Fields - Automated, Monitoring for Reliability

Module 15 - Visual Fields - Advanced Concepts

1. Manual (confrontation, tangent screen, autoplot, arc perimeter, Goldmann)

2. Automated (Humphrey, Octopus, Dicon, others)

3. Kinetic perimetry

4. Static perimetry

E. Errors in Visual Field Testing

Module 13 - Visual Fields - Automated, Monitoring for Reliability

Module 14 - Visual Fields - Automated, What the Printout tells us about Reliability

1. Machine calibration

2. Stimulus selection

3. Correcting lens (power and positioning)

4. Patient preparation (instructions, positioning, comfort, special situations, e.g., low vision, wheelchairs)

5. Test selection

6. Catch trials, fixation losses, fluctuation

7. Artifactual loss

F. Visual Field Defects from Disease

Module 11 - The Visual Pathways and Visual Field Defects

1. Retinal disease

2. Optic nerve disease (glaucoma, drusen, optic neuritis)

3. Neurological

4. Non-organic

10. CONTACT LENSES        Top of Page

A. Basic Principles

1. Hard lenses

2. Soft lenses

3. Toric lenses

4. Astigmatism

5. Bifocal

6. Aphakic

7. Extended wear

8. Gas permeable

9. Truncated

10. Bandage lenses

11. Oxygen permeability

12. Lens characteristics

13. Rigid

B. Fitting Procedures

1. Keratometry

Comment:  Read this article.

2. Corneal diameter

3. Pupil diameter

4. Tear secretion

5. Eyelid tightness and fissure size

6. Fluorescein pattern

7. Spectacle prescription conversion

8. Over-refraction

9. Pediatric

10. Contraindications

C. Patient Instruction

1. Insertion

2. Removal

3. Cleaning

4. Storage

5. Hygiene

6. Solutions

7. Wearing time

D. Trouble Shooting Problems

1. Tight

2. Loose

3. Vascularization

4. Ulcers

5. Spectacle blur

6. Giant papillary conjunctivitis

7. Deposits

8. Pain

9. Keratoconus

10. Edema

11. Solutions

12. Modifications

13. Vision

E. Verification of Lenses

1. Power

2. Base curve

3. Diameter

4. Central thickness

5. Edge profile

11. INTERMEDIATE TONOMETRY         Top of Page

Module 41, Module 42

A. Aqueous Humor Dynamics

B. Glaucoma

1. Basic mechanisms

2. Angle closure

3. Open angle

4. Cupping

5. Basic medical management

6. Basic surgical management

12. OCULAR PHARMACOLOGY

Read this article about drug delivery.

Comment:  Know your cap colors.  Dilating drops have red tops, beta blocker drops have yellow tops, alphagan has a purple top, prostaglandin drops have a teal colored top (e.g. Xalatan).

A. Anesthetics

Read this article.

B. Mydriatics and Cyclopegics

Read this article.  Read about phenylephrine,  tropicamide, cyclopentolate, homatropine, and atropine.

C. Epinephrine

Read this article.

Read Module 41 and Module 42 about glaucoma.

D. Beta-Blockers

Read Module 41 and Module 42 about glaucoma.

Read about beta blockers.

E. Miotics

Read Module 41 and Module 42 about glaucoma.

Read about pilocarpine and carbachol.

F. Steroids

Read this article.

G. Antibiotics

Read this article.

H. Carbonic Anhydrase Inhibitors

Read Module 41 and Module 42 about glaucoma.

I. Vasoconstrictors

Read this article.

J. Antihistamines

Read this article and follow drug name links.

K. Osmotic Agents

Read Module 41 and Module 42 about glaucoma.

Read about mannitol, glycerin, and isosorbide.

L. Nonsteroidal Anti-inflammatories

Read this article.

M. Others

Read about these alpha agonists (glaucoma): apraclonidine, and brimonidine.

Read about these prostaglandin analogs (glaucoma): travaprost, bimatoprost, and latanaprost.

13. PHOTOGRAPHY         Top of Page

A. Basics of Photography

Module 21 - Basics of Photography, Part 1

Module 22 - Basics of Photography, Part 2

1. Film

2. Exposure

3. Focal length

4. Depth of field

5. Synchronization

6. Beam splitters

7. Reticules

8. Ocular

9. Focus

10. Video

11. Astigmatic correction

B. Fundus Photography

Module 10 -  Fundus Photography

C. Defects/Artifacts

Module 10 -  Fundus Photography