When a patient walks into the University of Iowa Department of Ophthalmology, the first person they’re likely to encounter isn’t a physician or a fellow—it’s an ophthalmic technician. They’re the ones who guide patients through the foundational assessments that make every exam possible. And according to Clinic Manager Karen Eicholtz, MBA, COA, they’re one of the department’s greatest strengths. 

“We have approximately 50 techs in our clinic,” Eicholtz explains. “Ophthalmology is extremely intricate. Even in a regular exam there are so many technical steps involved.” 

Those steps aren’t simple checkboxes. A technician must be skilled in everything from gathering patient history to assessing refraction, eye pressure, color vision, muscle function, and more — not to mention administering drops and ensuring patients are ready for whatever testing or imaging the provider orders next. Every skill influences the quality of the physician’s exam and ultimately the patient’s care. 

Raising the Bar: Certification and Skill Development 

To ensure they’re performing these tasks at the highest level, Iowa invests heavily in credentialing. The national certification body, the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO), establishes a professional standard that techs can carry anywhere. “Certification shows that you actually have a credential behind what you’re doing,” Eicholtz says. “There are skills you can do, but then there’s reasoning behind the skills. Getting certified clarifies that you understand what you’re doing.

Techs can pursue several levels, including Certified Ophthalmic Assistant (COA), Certified Ophthalmic Technician (COT), and the more advanced Certified Ophthalmic Medical Technologist (COMT). Iowa pays for the exams when techs pass, and the department’s tiered compensation structure rewards progression through raises and career advancement. In 2024, Eicholtz applied for and received a $10,000 Catalyst grant from the University, which helps cover the costs of technicians’ certification. “We applied for this again this year and are just waiting for approval for this funding,” Eicholtz said. 

But certification is only part of the story. “We constantly ask techs: what skills do you want to learn?” Eicholtz says. “Refraction and checking pressure are the hardest skills. I once asked an ophthalmologist, ‘How long does it take you to teach someone to refract?’ and he said, ‘A lifetime.’” Faculty play a key role too, particularly in primary care and glaucoma clinics, offering real-time teaching and feedback that helps techs sharpen these essential abilities. 

Cross-Training: Building a More Flexible, Confident Team 

In such a large department with many subspecialty clinics, flexibility matters. Years ago, techs often stayed permanently in one area. Not anymore. “We’ve really had to home in on cross-training,” Eicholtz says. “Techs are starting to understand the value of being able to walk into a clinic and know what to do. And it uplifts them and it encourages them to get certified.” 

Once a tech can confidently perform a comprehensive eye exam, they can transition into nearly any subspecialty, adapting to each provider’s needs through preference guides and mentorship from fellow techs. The result? A more resilient clinical environment and more empowered technicians. 

Preventing Burnout: Culture Counts 

Techs spend full days with patients, and not every patient arrives in good spirits. Burnout can be a real risk, but Eicholtz takes a proactive approach. “Communication is really big,” she says. “What’s causing you to burn out? Do you want to change service? Do you need variety? A break? We try to make their lives better however we can.” Hiring the right people from the start is key. “I’ve turned down people who had certifications because their personality wasn’t going to gel with our culture,” she notes. “You need to have a team mindset. Keeping morale up is a big deal.” 

A Unique Place to Grow 

What truly sets Iowa apart, Eicholtz says, is the experience technicians gain here. “We have high-acuity patients that you don’t always see in private practice,” she says. “There are people flown in on helicopters. People who’ve had really bad accidents. That’s why Iowa is considered the best of the best and techs get to learn from that every day.” It’s challenging work. It’s meaningful work. And for many, it becomes a career they never expected. “I want what’s best for them in their career,” Eicholtz says. “That’s what I did for myself, and I love seeing them grow.” 

Iowa’s ophthalmic technicians are more than assistants—they’re vital clinical partners. Their expertise, compassion, and versatility keep the department moving forward, enabling world-class eye care for every patient who walks through the door.