History + Documentation
9%of exam
Chief ComplaintOcular HistoryMeds + AllergiesSOAP Notes
Visual Assessment
7%of exam
SnellenNear VisionPinholeLow Vision
Visual Field Testing
6%of exam
ConfrontationAmsler GridAutomated FieldsReliability
Pupil Assessment
7%of exam
PERRLARAPDAnisocoriaSwinging Light
Tonometry
7%of exam
IOPGoldmannNCTDisinfection
Keratometry
2%of exam
Corneal CurveMiresContact LensIOL Planning
Lensometry
3%of exam
SphereCylinderAxisAdd Power
Biometry
3%of exam
Axial LengthA-ScanIOL PowerCataract
Diagnostic Ultrasound
2%of exam
A-ScanB-ScanMedia OpacityPosterior Segment
Supplemental Testing
3%of exam
BATPAMColor PlatesTear Tests
Microbiology
2%of exam
Standard PrecautionsAsepsisCulturesTransmission
Pharmacology
6%of exam
DropsMydriaticsCycloplegicsSide Effects
Surgical Assisting
3%of exam
Aseptic TechniqueInstrument PrepLaser SafetySite ID
Patient Services
8%of exam
EducationTriageAccessibilityVital Signs
Optics + Spectacles
2%of exam
Lens PowerPrismFramesAdjustments
Contact Lenses
2%of exam
Soft LensRGPHygieneOverwear
Equipment Maintenance
2%of exam
CleaningCalibrationTroubleshootingSafe Use
Ethics + Legal
4%of exam
HIPAAConsentScopeDocumentation
General Medical Knowledge
8%of exam
AnatomySystemic DiseaseTerminologySafety
Refraction
5%of exam
Ophthalmic Imaging
5%of exam
OCTFundus PhotoImage QualityDocumentation
Ocular Motility Testing
4%of exam
VersionsDuctionsCover TestDiplopia
Quick Facts
- Exam
- COA
- Credential
- Certified Ophthalmic Assistant
- Body
- IJCAHPO
- Level
- Entry core
- Questions
- 200 scored
- Time
- 180 minutes
- Delivery
- Pearson VUE
- Scoring
- Modified Angoff
- Fee
- $300 initial
- Blueprint
- August 1 2025
Core History
COMFS: complaint, ocular, meds, family, social.
ComplaintOcular historyMeds/allergiesFamilySocial
COA vs COT
COA
- Entry core
- Assistant level
- 200 scored
COT
- Intermediate core
- Technician level
- Skill evaluation
Assistant before technician
History + Documentation
- CC
- Reason for visit
- HPI
- Symptom story
- Ocular Hx
- Eye disease history
- Medical Hx
- Systemic conditions
- Meds
- Current medications
- Allergies
- Drug reaction risk
- Family Hx
- Inherited eye risks
- Social Hx
- Smoking work driving
- SOAP
- Structured note
- OD/OS/OU
- Right left both
Snellen Fraction
Top is test; bottom is normal.
20 feetNormal distanceHigher bottom worse
Acuity vs Refraction
Acuity
- Measures seeing
- Snellen result
- Screening output
Refraction
- Finds correction
- Diopter result
- Rx process
Seeing vs correcting
Visual Acuity
- Snellen top
- Testing distance
- Snellen bottom
- Normal-eye distance
- 20/40
- Worse than normal
- Pinhole
- Refractive screen
- CF
- Counting fingers
- HM
- Hand motion
- LP
- Light perception
- NLP
- No light perception
- Near card
- Reading distance test
- Stereoacuity
- Depth perception
Confrontation vs Automated
Confrontation
- Gross screen
- Exam room
- Fast comparison
Automated
- Mapped field
- Reliability indices
- Disease monitoring
Screen vs quantify
Fields + Pupils
- Confrontation
- Gross field screen
- Amsler
- Macula distortion grid
- Perimetry
- Mapped visual field
- Fixation loss
- Reliability warning
- False positive
- Trigger happy
- False negative
- Missed seen stimulus
- PERRLA
- Pupils equal reactive
- RAPD
- Afferent defect
- Swinging light
- Compares optic nerves
- Anisocoria
- Unequal pupils
Pupil Check
Size, shape, reaction, RAPD.
MeasureCompareLightSwinging test
RAPD vs Anisocoria
RAPD
- Afferent problem
- Swinging light
- Optic nerve cue
Anisocoria
- Size difference
- Light/dark compare
- Autonomic cue
Input vs size
Pupil Picker
- Compare optic nerves→Swinging light(RAPD)
- Unequal pupils→Measure light/dark
- Direct reflex→Same-eye response
- Consensual reflex→Opposite-eye response
- Poor near response→Check accommodation
- Pharmacologic concern→Alert physician
Goldmann Endpoint
Inner fluorescein edges just touch.
Too wide lowOverlap highTouch correct
Goldmann vs NCT
Goldmann
- Applanation contact
- Fluorescein mires
- More precise
NCT
- Air puff
- No contact
- Screening tool
Contact vs air
IOP Picker
- Precise IOP needed→Goldmann
- Screening only→NCT
- Bedside patient→Tono-Pen
- Mires too wide→Increase force
- Mires overlap→Decrease force
- After tonometer use→Disinfect tip
Tonometry + Keratometry
- IOP
- Intraocular pressure
- GAT
- Gold standard applanation
- NCT
- Air puff screen
- Tono-Pen
- Handheld applanator
- Fluorescein
- Goldmann endpoint aid
- Mires touch
- Correct GAT endpoint
- Thick cornea
- IOP may overread
- Thin cornea
- IOP may underread
- K reading
- Corneal curvature
- Distorted mires
- Poor keratometry quality
Keratometry vs Biometry
Keratometry
- Corneal curvature
- K readings
- Contact lens cue
Biometry
- Axial length
- IOL planning
- Cataract cue
Curve vs length
Lensometry + Refraction
- Sphere
- All meridians
- Cylinder
- Astigmatic difference
- Axis
- No cylinder power
- Add
- Near plus power
- Prism
- Image displacement
- Plus lens
- Thick center
- Minus lens
- Thick edge
- Myopia
- Minus correction
- Hyperopia
- Plus correction
- SE
- Sphere plus half cyl
- Transpose
- Add flip rotate
- Vertex
- Lens-eye distance
Biometry + Ultrasound
- Axial length
- Front-back eye length
- A-scan
- One-dimensional echo
- B-scan
- Two-dimensional image
- IOL power
- Cataract implant planning
- Immersion
- Less compression error
- Contact A-scan
- Cornea touch risk
- Dense cataract
- Ultrasound indication
- Retinal detachment
- B-scan concern
A-Scan vs B-Scan
A-scan
- One dimension
- Axial length
- IOL calculation
B-scan
- Two dimensions
- Posterior image
- Opaque media
Measure vs image
Test Picker
- Macula distortion→Amsler grid
- Glare complaint→BAT
- Color defect→Ishihara
- Dry eye→Schirmer/TBUT
- Angle depth→Van Herick
- Corneal thickness→Pachymetry
Supplemental Tests
- BAT
- Glare testing
- PAM
- Potential acuity
- Ishihara
- Color vision plates
- Schirmer
- Tear production
- TBUT
- Tear stability
- Rose Bengal
- Surface staining
- Pachymetry
- Corneal thickness
- Van Herick
- Angle depth screen
Microbiology
- Standard precautions
- All patients
- Hand hygiene
- Before and after
- Clinical asepsis
- Reduce microorganisms
- Disinfection
- Kills many pathogens
- Sterilization
- Kills all microbes
- Bacteria
- Cellular organisms
- Virus
- Host-cell dependent
- Fungus
- Yeast or mold
- Specimen
- Culture sample
- Fomite
- Contaminated object
Mydriatic vs Cycloplegic
Mydriatic
- Dilates pupil
- Retina view
- Light sensitivity
Cycloplegic
- Stops focusing
- Pediatric refraction
- Blurred near
Pupil vs focus
Drop Picker
- Need dilation→Mydriatic
- Stop accommodation→Cycloplegic
- Numb cornea→Anesthetic
- Corneal stain→Fluorescein
- Multiple drops→Wait 5 min
- Systemic risk→Punctal occlusion
Pharmacology
- Mydriatic
- Dilates pupil
- Cycloplegic
- Paralyzes accommodation
- Anesthetic
- Numbs surface
- Fluorescein
- Stains tear film
- Antibiotic
- Bacterial treatment
- Steroid
- Inflammation suppression
- NSAID
- Nonsteroid inflammation
- Lubricant
- Artificial tears
- Punctal occlusion
- Limits systemic absorption
- Five minutes
- Between drops
Aseptic vs Sterile
Aseptic
- Prevents contamination
- Technique concept
- Clinical workflow
Sterile
- No living microbes
- Field status
- Surgical standard
Method vs state
Surgery + Equipment
- Aseptic technique
- Prevent contamination
- Sterile field
- Protected workspace
- Site ID
- Correct eye check
- Time-out
- Final safety pause
- Laser safety
- Eye protection required
- Instrument prep
- Ready sterile tools
- Calibration
- Accuracy check
- Maintenance log
- Service documentation
- Slit lamp
- Anterior exam tool
- Lens cleaner
- Optics protection
Ocular Emergency
Chemical burns irrigate before paperwork.
Irrigate nowAlert physicianDocument after
Triage Picker
- Chemical splash→Irrigate now(Then alert)
- Flashes floaters→Urgent retina(Same day)
- Sudden vision loss→Alert physician(Emergency)
- Severe eye pain→Urgent evaluation(Do not delay)
- Post-op shield issue→Call surgeon(Follow protocol)
- Routine refill→Check chart(Follow policy)
Patient Services + Ethics
- Triage
- Urgency sorting
- Flashes/floaters
- Retina warning
- Chemical burn
- Immediate irrigation
- Consent
- Permission before procedure
- HIPAA
- Protect PHI
- Scope
- Stay within role
- Education
- Clear patient instructions
- Accessibility
- Adapt communication
- Vital signs
- BP pulse respirations
- Dissatisfaction
- Acknowledge escalate document
Contact Lenses
- Soft lens
- Flexible hydrogel
- RGP
- Rigid gas permeable
- Base curve
- Lens curvature
- Diameter
- Overall lens size
- Overwear
- Hypoxia risk
- No water
- Acanthamoeba prevention
- Rub rinse
- Deposit removal
- Red painful eye
- Stop lens wear
HIPAA vs Consent
HIPAA
- Privacy rule
- PHI sharing
- Minimum necessary
Consent
- Procedure permission
- Patient agreement
- Before action
Privacy vs permission
General Medical
- Cornea
- Major refraction
- Lens
- Accommodation
- Retina
- Neural tissue
- Macula
- Central vision
- Optic nerve
- CN II
- EOMs
- Move eyes
- Aqueous
- Anterior fluid
- Vitreous
- Posterior gel
- Diabetes
- Retinopathy risk
- Thyroid
- Orbit disease risk
- Inflammation
- Immune response
- Infection
- Pathogen invasion
Transposition
Add sphere, flip cyl, rotate axis.
New sphereOpposite cylinderAxis plus 90
OCT vs Fundus Photo
OCT
- Layer cross-section
- Signal strength
- Macula/nerve
Photo
- Surface documentation
- Color record
- Disc/retina
Layers vs surface
Imaging Picker
- Retinal layers→OCT
- Disc documentation→Fundus photo
- Leakage pattern→FA
- Choroid detail→ICG
- Poor signal→Repeat image
- Media opacity→B-scan
Imaging
- OCT
- Cross-section retina
- Fundus photo
- Retinal documentation
- FA
- Fluorescein angiography
- ICG
- Choroidal angiography
- Red-free
- Nerve fiber view
- Stereo disc
- Cup-depth documentation
- Artifact
- Nonclinical image flaw
- Signal strength
- OCT quality cue
Versions vs Ductions
Versions
- Both eyes
- Binocular movement
- Together gaze
Ductions
- One eye
- Monocular movement
- Isolated muscle
Both vs one
Motility
- Versions
- Both eyes move
- Ductions
- One eye moves
- Cover test
- Tropia screen
- Alternate cover
- Phoria screen
- NPC
- Convergence near point
- Nystagmus
- Rhythmic movement
- Diplopia
- Double vision
- Stereo
- Binocular depth
Common Traps
Exam item count
200 scored questions ≠ Not 100 items
Passing score myth
Modified Angoff ≠ Not fixed percent
Snellen fraction
Top is distance ≠ Bottom is benchmark
Pinhole meaning
Improves refractive blur ≠ Not disease cure
RAPD vs pupil size
RAPD is afferent ≠ Anisocoria is size
GAT endpoint
Edges just touch ≠ Not full overlap
Multiple drops
Wait five minutes ≠ Do not stack
A-scan vs B-scan
A-scan measures ≠ B-scan images
K vs AL
K is cornea ≠ AL is eye length
Sterile vs clean
Sterile kills all ≠ Clean reduces soil
Contact lens pain
Stop lens wear ≠ Do not reassure
Scope boundary
Assist and document ≠ Do not diagnose
Last Minute
- 1.COA has 200 scored
- 2.Time limit is 180 minutes
- 3.Blueprint effective August 2025
- 4.History is highest: 9%
- 5.Patient services: 8%
- 6.General medical: 8%
- 7.Acuity/pupils/IOP: 7% each
- 8.Snellen top is distance
- 9.Pinhole screens refraction
- 10.RAPD uses swinging light
- 11.GAT mires just touch
- 12.Keratometry measures cornea
- 13.A-scan measures axial length
- 14.OCT shows retinal layers
- 15.Wait five minutes between drops
- 16.Chemical burn: irrigate immediately
- 17.Protect PHI; stay in scope
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