Some offices may have seen a drop in the amount of business, and some difficult decisions are going to have to be made in response. It makes sense to assess costs and look for efficiency in the office during times of economic certainty, so it is no surprise that employers will take a long look at their expenses to make the most of any financial investment.

What might come as a surprise, however, is that the employer’s best investment is one that can be grown and developed inexpensively, often at little or no cost. That investment? Employees. The training of your employees and the values imparted to them by that training should be considered in any discussion of staff efficacy or performance.  

Develop Your Investment
If you provide your employees with support and direction, you can expect to receive greater responsibility, loyalty and expertise in return. A serious commitment to your employees’ development underscores their role as representatives of the office—professionals who are accountable for carrying out the intentions of the employer, whether the employer is present or not. Employees are entrusted to unlock the doors each morning and do the work each day. Every time an employee interacts with a patient, a particular image of the office is painted. What kind of image do you want it to be? Probably a professional, inclusive, medical environment, in which patients will feel both comfortable and confident in your care, right?

Foundations of Learning
Big (and basic) nuggets of information constitute a solid foundation for further learning. For instance, when explaining prism shape and lens mechanics, you might break it down like this:
• Light is bent toward the base of a prism, and the image is displaced toward the apex.
• Diopter: A 1.00D lens displaces the image 1cm at a distance of 1m.
• Focal length is a reciprocal of lens power, f = 1/D Cylinder power.
• Lens cylinder has no power along its axis and full power 90º away.
• Visible light occupies a very small area on the electromagnetic scale.
• Lens clock.
• Index of refraction = the speed of light in a vacuum / the speed of light in the material.

But, how is this intention supposed to manifest itself? How does such a specific and complex vision materialize? You’ll have to build up to that vision by building up your employees—by educating them, defining their responsibilities and maintaining a high standard of performance. In order to perform at their highest (especially now), employees will require guidance, a clear sense of where their responsibility begins and ends, a climate of teamwork, and behavior to model. But, at times, difficult choices may have to be made. People may even have to be let go. The office needs to function at an efficient level. Just remember that both overstaffing and letting staff underperform are inefficient.

All facets of your managerial role in the office are not necessarily obvious. As the doctor, you occupy a position of influence. But, as a doctor, your time is most likely best spent caring for patients. So, the office needs someone in place who is accessible to handle decision-making. And, the staff needs to know where to go to get any questions answered, particularly any question about policy or procedure, when you are inaccessible. From there, employees should be free to operate while being held to a high performance standard. There should be no hesitation on their part to recommend the best lens, treatment or frame options. After all, we’re talking about improving the patient’s vision.

While experience is the best teacher, the education and training of your employees must not be left to chance. Clarification of each role and an adherence to a planned schedule of development will produce a more satisfactory experience for both trainer and trainee.  

The Value of Structure

Structure the employee development process by maintaining a file that can be referred to by both trainer and trainee when it comes to measuring successes and to determining any retraining needs. Knowledge grows from a combination of information and experience. The philosophy "learn as you go,” is a vague one at best. A training plan makes the experience more objective and less about the personalities of the parties involved. Sometimes training will require a real effort, a vigilance to stay on track.

Other times, examples of the concepts seem to come into the office at exactly the right time–– when an employee is ready to build on an optical concept. Be flexible. You’ll need to allow for occasional deviation from the lesson plan. Use your syllabus as a template, but remember that each person’s experience teaching or learning will color the actual result. Show flexibility when areas require less or more than the planned amount of study. While no two experiences are ever the same, there are patterns in training. Make the most of each individual’s strengths. Working with a trainee has something in common with speaking with patients: How well you are understood often depends on how well you adjust your message to the level of knowledge of your audience. Familiarize your trainee with a few major concepts early on, and you can come back to these fundamental concepts as building blocks for development.

The Saturation Point
After time, the new employee will often begin to slow down under the weight of all this new, specialized information. Avoid the mistake of covering information of a more and more complex nature—such a steady stream of increasingly complex input is bound to overwhelm the trainee. Instead, the best trainers deliberately teach meaningful building blocks first. Then, as the trainee reaches a saturation point in their level of knowledge, it is time to teach simpler points, or even rote tasks, which are easier to learn. This model of pacing—bigger things first, and simpler information later—can be applied to a few areas of the office:

• Dispensing and lens selection.
• Lens fundamentals first. Prism shapes meet at base to make a plus lens, and prism shapes meet at apex to make a minus lens. Later, lens thickness and lens de-centration of lenses is better understood, because trainee has a better handle on overall lens shape.
• In-house surfacing. The trainee can learn to enter computation, tape lens blanks, rough and fine lenses, pull and file lens blanks. Then, later, he or she can learn simpler data entry—and then, develop the finer points of each technique.
• In-house finishing lab. Start with fundamentals, such as base curve, the lens clock, diopter, prism and cylinder, for a frame of reference. The lens clock gives understandable, approximate power readings. Then, develop the trainee’s lensmeter skills. Teach him or her to edge, de-center and block in small quantities at first. By sharing concrete, basic optical principles early on, the trainer ensures a firmer grasp on abstract concepts when they present themselves to the trainee. 
There Are No Guarantees

While you’ll want to do all you can to make sure the training process goes as well as possible, several factors will remain beyond your control, including the trainee’s aptitude, the amount of time spent with the trainee, the schedule of the trainee and, of course, the pace of the office. With several factors beyond your control, it makes sense to do all you can to influence those within it. The worlds of opticianry and para-optometry involve specialized knowledge and a very low margin of error. It’s important to screen your applicants to get the best fit. Offices are generally staffed with supportive people, making coping much easier. And, a sense of humor seems essential enough to be considered a prerequisite for the job.

Such a goal as passing the certification and licensing exam or state exam may be very satisfying for the employee when completed, as well as a great investment in that employee, and an empowering measure toward employee retention. Generally, the rewards of passing the exams are usually financial and morale-based. Employees can usually expect better pay, and employers can expect the employee to demonstrate a particular standard of knowledge, making that employee’s time more valuable to the employer—and better spent in the office. For example, knowledgeable dispensers will recommend premium lenses with confidence.  

Strategy and a Syllabus
While there is no absolute guide, a solid training plan puts forward principles to be revisited at a later date, as the employee’s experience and knowledge grows. It is a very rewarding transformation to witness—especially when new employees begin to actively support the existing staff. This example of a training strategy and syllabus is divided into five phases. The first three phases of the syllabus require one week each, and phases 4 and 5 each require two weeks. But, remember to be flexible. As discussed earlier, various factors may intrude upon the training schedule and force it to be modified. By the two-month mark, provided the employee continues to grow, an extended training schedule can be maintained on a bi-weekly or monthly basis. At this point, a change of approach is likely in order. Rather than shadowing or active training, have the trainee update the trainer on his or her progress. This way, both you and the trainer have a much better idea of what the new employee is learning and retaining. Consider the following training strategy and syllabus as an example. Your particular experience is bound to differ from it, but what is important is to foster learning at various levels, and to keep coming back to those same basics, so that your trainee may grow while not forgetting the foundation of his or her knowledge.  

Alphabet Soup
As an employer, you can “get the most” from your investment in staffers by continuing their professional development. While this article primarily deals with the laboratory and dispensing optician, there are many certifications possible, including American Board of Opticianry Certified (A.B.O.C.), National Contact Lens Examiner Certified (N.C.L.E.).

The A.B.O.C.-N.C.L.E. offers advanced certifications, such as A.B.O.C.-A.C. and N.C.L.E.-A.C. At the highest level, there is A.B.O.M., or master optician. The para-optometric section of the American Optometric Association offers Certified Para-Optometric (C.P.O.), Certified Para-Optometric Assistant (C.P.O.A.) and Certified Para-Optometric Tech (C.P.O.T).

There are also state licensing exams and state optician societies. Also, there are avenues of education outside of traditional certification. Lens sales consultants can provide education on the best use of various products. Optician education can also be found online through independent educators, training companies and trade magazines. Lastly, the Opticians Association of America (OAA) and the National Academy of Opticianry (NAO) are two excellent resources for your staff members.

Training Strategy and Syllabus

• Phase One:
Theory and application: First, introduce principles that are useful at face value and that you will eventually build upon. For example, that pupils constrict and eyeballs converge as the eye accommodates for near vision. To the new trainee, this immediately explains why reading glasses use a smaller pupillary distance (PD), and why bifocals have two PDs. Later, however, the trainee will extend this concept and understand that the tolerance for PD is greater horizontally than vertically because patients’ eyes are accustomed to moving horizontally when they accommodate. And, they will understand why lenses often de-center inward—because frame PD is usually greater than patient PD. Eventually, he or she should learn that oblique astigmatism is challenging, because it doesn’t follow the 180º-axis or the 90º-axis. This example demonstrates that one, simple principle acts a foundation for knowledge that will be imparted or learned experientially later in the training. Note the value of teaching simple facts early in training.

Hands-on experience:
If your practice has an in-house finishing lab, have the trainee observe lens edging. Lensometry: checking in simple spheres. Instruct the trainee to always move the lensmeter power drum toward greater plus power to avoid having the operator’s eye add more plus power. Even though the trainee may not understand fully what he or she is doing, this is a building block for more complex concepts and skills. Also, have him or her view blocked lenses from the back to show how their OCs are de-centered. Blocks get affixed to the lenses with a sticker. The edger clamps the lens by the block. From the back, the dot marking the optical center will be de-centered (to match the PD). Some people readily grasp abstractions, but others will enjoy seeing the lens blocked up and de-centered. This is also a good opportunity to educate the trainee on the standard 1/3-2/3 edge bevel—the bevel is one-third of the distance from the front edge of the lens and two-thirds from the back—though this ratio will change with high-index lenses.

Unanticipated learning:
Some things that the trainee may learn during this phase during situations that arise include custom lens tinting or how to de-center lenses outward because of a wide PD.

Frame measurements: A = horizontal, B = vertical; DBL = distance between lenses (at their closest point); ED = effective diameter (twice the greatest distance from center of box to lens edge. Sometimes this is greater than diagonal measurement); MSDS = material safety data sheets, which are made available for all substances used in the office and lab.

Manual application of safety bevel to a finished lens. Although most edgers will apply this automatically, the trainee needs to learn how to produce a safety bevel on a lens manually. At some point, he or she will need to manually correct an imperfect lens bevel. As learning continues, this may mean saving an otherwise-ruined lens, or re-edging patient lenses in an emergency.  

• Phase Two:
Theory and application. Lens power comes from the difference between the front and back curves, as well as the lens material. During this phase, the trainee learns that lens material choice affects base curve or lenses in the frame.  

Hands-on experience. Now, the trainee will learn how to apply the safety bevel to a finished lens in a smooth, uninterrupted motion; observe the opticians in the front of office for half of the day; practice manual application of safety bevel (on junk or rejected lenses at first, and later applying safety bevel to a pair of finished lenses successfully); order lenses via online form, fax form or telephone; dispense spectacles; observe frame adjustments made at dispensing; and practice bending the eyewire of a frame that holds a high plus lens to get a good fit.

Unanticipated learning: If the opportunity arises, the trainee may learn how straight-top trifocal lenses compare with bifocals and single-vision lens designs. The trainee may also have the opportunity to learn the importance of reducing loss by resizing a chipped lens to prevent a remake.

Understanding frame measurements when ordering; index of refraction; myopia, hyperopia and presbyopia; and base curve, back curve and lens clock. Trainees should also be knowledgeable about progressive addition lenses—particularly, they should understand that the major reference point on them is below the distance vision zone, which indicates how much vertical prism is present. Likewise, the concept of accommodation and near/distance optical centers of bifocal lenses should be familiar, as well as the idea of prism.

Verification of more complex lenses on lensometer. The trainee should check at least one pair of PALs each day to determine the distance power, add power, and the vertical or horizontal prism.  

• Phase Three:
Theory and application: The trainee will learn and understand the concept of index of refraction as a measurement of lens material. Convey the idea that a higher index means greater density, so less lens material is needed and the lens will be thinner. This may result in greater benefit from AR lenses. The index of refraction is defined as the speed of light in a vacuum divided by the speed of light through the lens material.

Hands-on experience:
The trainee applies a satisfactory hand-bevel to lenses in most cases. Time is set aside for the trainee to use the manual polisher and groover machines on junk or rejected lenses. This builds proficiency with the machinery, and becomes a back-up method to the automatic edger’s polish and groove cycles. In the future, difficult lenses may be grooved or polished using these manual devices to get the best results. The trainee will also try his or her hand at tinting a gradient lens, in order to learn the mechanics of the dipper and tint tank. Also, much discussion and training will focus on PALs, allowing the trainee to have several reference points from which to understand the lens.

Unanticipated learning: If the doctor uses press-on prism as a diagnostic tool, and spectacles with this prism are then verified, the trainee has the opportunity to observe how prism moves an image, learning the tangible effect of optical theory. The trainee may also gain further experience with severely chipped lenses, as something to repair or replace—the trainee’s judgment abilities may be developed.

Index of refraction is defined, understood and memorized for several materials. The trainee learns that prism is present in nearly all zones of PALs, and that press-on prism is a diagnostic tool that enables the doctor to try out prism added to prescription.

Verification of lenses to assist lab team. The trainee is moving into a schedule in which less time is set aside to teach verification, through which the trainee will be able to actively assist the team. The trainee’s duties in the front of the office are expanded, and he or she continues to edge lenses.  

• Phase Four:
Theory and application: Actually, at this phase, there won’t be much new material introduced—rather, this will be time for the trainee to work with what he or she has learned to date, cementing the knowledge already gained.

Hands-on experience: The trainee will work unsupervised for periods of time—e.g., covering lunch breaks. And, he or she will continue to practice making a manual safety bevel.

Unanticipated learning: The trainee may need to cover a staff member in the event of an absence or a busier schedule.

Vocabulary: The trainee should be comfortable with the concepts of myopia, hyperopia and presbyopia by this point, and he or she should be familiar with different needs from different prescription eyeglasses.

Goal: Continuing verification of at least one pair of PALs per day—more if possible.  

• Phase Five:
Theory and application: During the final phase of training, concepts already taught are continuously refined and focused. New theories are fewer and farther between.

Hands-on experience: The trainee will learn how to neutralize a PAL of unknown prescription for pre-exam work-up information. Unanticipated learning: The trainee may have the opportunity to verify a prescription containing prism.

Vocabulary: By now, the trainee should have a working knowledge of the principles of base curve, back curve and the lens clock.

Goal: The trainee will understand optical power and the mathematical representation of front and back lens curves as well as powers in vertical and horizontal meridians. Remember, not all trainees learn the same way. Some may prefer the concept of the power cross to visualizing powers on an actual lens.  

There you have it––an overview of training. Through a grounded understanding of optics, lenses and frames, your staff can reduce remakes, increase patient satisfaction and solve problems more quickly. Committing to employee training is a win-win for both the employer and employee. While the greater economic picture may be beyond the control of the individual, there are things we can do as individuals within the practice to make ourselves more valuable. Continue forward momentum by helping your staff members to maintain professional growth and knowledge.  
Mr. Coronis is an independent author, and an American Board of Opticianry-approved speaker. He can be reached at