History + Documentation
10%of exam
Chief ComplaintOcular HistorySOAP NoteHIPAA
Visual Assessment
15%of exam
Refractometry + Lensometry
15%of exam
Ocular Motility + Binocular
10%of exam
Diagnostic Testing + Imaging
20%of exam
Patient Care + Pharmacology
15%of exam
Surgical Assisting
15%of exam
Quick Facts
- Exam
- COT
- Credential
- Certified Ophthalmic Technician
- Body
- IJCAHPO
- Level
- Intermediate
- MCQ
- 200 questions
- Time
- 180 min MCQ
- Skills
- 7-station evaluation
- Delivery
- Pearson VUE
- Fee
- $325 initial
- Renew
- 3 yrs, 27 CE
History + Documentation
- CC
- Reason for visit
- HPI
- Symptom story
- OD/OS/OU
- Right, left, both
- Meds + allergies
- Drug reaction risk
- Ocular Hx
- Past eye disease
- Family Hx
- Inherited eye risk
- SOAP
- Structured chart note
- HIPAA
- Protect patient information
- Minimum necessary
- Share only needed
Snellen Fraction
Top is test, bottom is normal
Top: your distanceBottom: normal distanceBigger bottom worse
RAPD vs Anisocoria
RAPD
- Afferent problem
- Swinging light
- Optic nerve cue
Anisocoria
- Size difference
- Light and dark
- Autonomic cue
Input vs size
Visual Acuity Scale
- Snellen top
- Testing distance
- Snellen bottom
- Normal-eye distance
- 20/40
- Worse than normal
- 20/20-2
- Missed two letters
- Pinhole
- Screens refractive blur
- CF
- Counting fingers
- HM
- Hand motion
- LP / NLP
- Light or none
- Tumbling E
- Nonreader acuity chart
- Teller cards
- Infant preferential looking
Pupils, Color + Screens
- PERRLA
- Pupils equal, reactive
- RAPD
- Afferent pupil defect
- Swinging light
- Detects RAPD
- Anisocoria
- Unequal pupil size
- Direct reflex
- Same eye constricts
- Consensual reflex
- Other eye constricts
- Ishihara
- Red-green color plates
- Amsler grid
- Central distortion screen
- Confrontation
- Gross field screen
Lensometry Order
Sphere first, then cylinder power
Most plus meridianThen orthogonalDifference is cylinder
Retinoscopy vs Subjective
Retinoscopy
- No responses needed
- Neutralize reflex
- Children reliable
Subjective
- Patient compares
- Phoropter choices
- Needs cooperation
Objective vs subjective
Refraction Tool Picker
- No patient responses→Retinoscopy
- Refine astigmatism→JCC
- Balance final sphere→Duochrome
- Quick starting Rx→Autorefractor
- Read glasses power→Lensometer
- Corneal curvature→Keratometer
- Child hidden hyperopia→Cycloplegic refraction
Refractive Errors
- Myopia
- Minus lens correction
- Hyperopia
- Plus lens correction
- Astigmatism
- Cylinder lens correction
- Presbyopia
- Age near-focus loss
- Emmetropia
- No correction needed
- Anisometropia
- Unequal eye powers
- WTR
- Steep vertical meridian
- ATR
- Steep horizontal meridian
Transposition
Add sphere, flip cylinder, rotate ninety
New sphere sumsCylinder sign flipsAxis plus ninety
Optics + Formulas
- Diopter
- 1 / focal length (m)
- Lens power
- P = 1/f (meters)
- Vergence
- L' = L + P
- Spherical equivalent
- Sphere + half cylinder
- Prism diopter
- 1 cm shift at 1 m
- Prentice rule
- Prism = decentration × power
- Transposition
- Add sphere, flip cylinder
- Vertex
- Lens-to-eye distance
- Plus lens
- Converges light rays
Refraction + Lensometry Tools
- Phoropter
- Subjective refraction lenses
- Retinoscopy
- Objective refraction reflex
- JCC
- Refines cylinder axis, power
- Duochrome
- Red-green sphere balance
- Autorefraction
- Machine starting point
- Lensometer
- Reads spectacle power
- Neutralize order
- Sphere before cylinder
- Cycloplegic refraction
- Reveals hidden hyperopia
- PD
- Pupillary distance (mm)
EOM Innervation
SO4, LR6, all the rest CN3
SO: CN IVLR: CN VIRest: CN III
Cover-Uncover vs Alternate
Cover-uncover
- Manifest tropia
- Fusion intact
- One eye covered
Alternate cover
- Total deviation
- Breaks fusion
- Tropia plus phoria
Tropia vs total
Motility + Binocular Vision
- Versions
- Both eyes together
- Ductions
- One eye alone
- Cover-uncover
- Detects tropia
- Alternate cover
- Total deviation
- NPC
- Convergence near point
- Esotropia
- Eye turns inward
- Exotropia
- Eye turns outward
- SO4-LR6-rest3
- Muscle nerve rule
- Worth 4-dot
- Fusion and suppression
- Stereopsis
- Binocular depth vision
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
Tonometer Picker
- Precise IOP needed→Goldmann(Gold standard)
- Screening only→NCT(Air puff)
- Bedside or supine→Tono-Pen
- Mires too wide→Add force(Reads low)
- Mires overlap→Reduce force(Reads high)
- After each patient→Disinfect tip
Tonometry + IOP
- IOP normal
- 10 to 21 mmHg
- Goldmann
- Applanation gold standard
- Imbert-Fick
- Flattens 3.06 mm
- Mires touch
- Correct GAT endpoint
- NCT
- Air-puff screening
- Tono-Pen
- Handheld applanation
- Thick cornea
- Reads falsely high
- Thin cornea
- Reads falsely low
- Pachymetry
- Corneal thickness (microns)
A-Scan vs B-Scan
A-scan
- One dimension
- Axial length
- IOL calculation
B-scan
- Two dimensions
- Posterior image
- Opaque media
Measure vs image
Imaging Picker
- Retinal layers→OCT
- Glaucoma nerve fiber→OCT RNFL
- Dense media opacity→B-scan
- Document optic disc→Fundus photo
- Vascular leakage→FA
- Count endothelial cells→Specular microscopy
Visual Fields
- Static perimetry
- Fixed points, varied intensity
- Humphrey 24-2
- Standard glaucoma pattern
- Humphrey 10-2
- Dense central field
- Arcuate scotoma
- Classic glaucoma defect
- False positive
- Trigger-happy responses
- False negative
- Missed seen stimulus
- Fixation loss
- Eye drifted off
- Mean deviation
- Overall field loss
OCT vs B-Scan
OCT
- Uses light
- Retinal layers
- Clear media
B-scan
- Uses sound
- Penetrates opacity
- Dense cataract
Light vs sound
Imaging + Instruments
- OCT
- Cross-section retinal layers
- RNFL
- Nerve fiber thickness
- B-scan
- Images through opacity
- Fundus photo
- Retina surface record
- FA
- Fluorescein leakage study
- Specular microscopy
- Counts endothelial cells
- Topography
- Full corneal map
- Slit lamp
- Magnified segment exam
- Gonioscopy
- Views drainage angle
- PAM
- Potential acuity estimate
Keratometry vs Biometry
Keratometry
- Corneal curvature
- K readings
- Contact lens cue
Biometry
- Axial length
- IOL planning
- Cataract cue
Curve vs length
Keratometry + Biometry
- Keratometry
- Central corneal curvature
- K reading
- Diopters or millimeters
- Distorted mires
- Irregular corneal surface
- Axial length
- Front-back eye length
- A-scan
- Ultrasound axial length
- IOL Master
- Optical biometry
- SRK/T
- IOL power formula
- Cup-to-disc
- Normal 0.3 or less
Drop Order
Watery first, ointment last, wait five
Aqueous drops firstGels then ointmentsSpace 3-5 minutes
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
- Child true refraction→Cyclopentolate
- Multiple drops→Wait 3-5 min
- Ointment plus drop→Ointment last
Ophthalmic Pharmacology
- Tropicamide
- Short mydriatic, mild cycloplegic
- Phenylephrine
- Sympathomimetic dilator
- Cyclopentolate
- Pediatric cycloplegic
- Atropine
- Long-acting cycloplegic
- Proparacaine
- Topical anesthetic
- Timolol
- Beta-blocker lowers production
- Latanoprost
- Prostaglandin increases outflow
- Fluorescein
- Stains corneal defects
- Drop spacing
- Wait 3-5 minutes
- Punctal occlusion
- Limits systemic absorption
Tropicamide vs Phenylephrine
Tropicamide
- Parasympathetic block
- Mild cycloplegia
- Routine dilation
Phenylephrine
- Sympathomimetic
- No cycloplegia
- Dilator muscle
Block vs stimulate
Triage Picker
- Chemical splash→Irrigate now(Before paperwork)
- Flashes and floaters→Urgent retina(Same day)
- Sudden painless loss→Suspect CRAO(Emergency)
- Before dilation→Check angle depth(Van Herick)
- Severe eye pain→Alert physician
- Routine refill→Follow policy
Anatomy, Pathology + Triage
- Ciliary body
- Aqueous and accommodation
- Trabecular meshwork
- Drains aqueous humor
- Endothelium
- Pumps cornea clear
- Tear film
- Lipid, aqueous, mucin
- Macula
- Central detailed vision
- Keratoconus
- Cone-shaped thinning cornea
- Nuclear cataract
- Common aging lens
- Glaucoma
- Optic nerve damage
- Flashes + floaters
- Urgent retina check
- Chemical burn
- Irrigate immediately
Aseptic vs Sterile
Aseptic
- Prevents contamination
- Technique concept
- Clinical workflow
Sterile
- No living microbes
- Field status
- Surgical standard
Method vs state
Surgical Assisting
- Phacoemulsification
- Ultrasound emulsifies lens
- Incision
- 2.2 to 2.8 mm
- OVD
- Protects corneal endothelium
- Monofocal IOL
- One focal distance
- Multifocal IOL
- Distance and near
- PCO
- Secondary cataract clouding
- YAG capsulotomy
- Opens cloudy capsule
- Intravitreal
- Pars plana injection
- Tech role
- Assist, prep, document
Sterile Technique + Microbiology
- Aseptic technique
- Prevents contamination
- Sterile field
- No living microbes
- Standard precautions
- Treat all patients
- Disinfection
- Kills most pathogens
- Sterilization
- Kills all microbes
- Autoclave
- Steam sterilization
- Spore test
- Confirms sterilization
- Surgical scrub
- 2 to 3 minutes
- Time-out
- Confirms correct eye
Common Traps
Exam length
200 multiple-choice ≠ Not 100
Two-part exam
MCQ plus 7 skills ≠ Not MCQ alone
Goldmann endpoint
Edges just touch ≠ Not overlapping
Thin cornea IOP
Reads falsely low ≠ Not high
Cover test type
Cover-uncover finds tropia ≠ Alternate finds total
Ultrasound scans
A-scan measures ≠ B-scan images
Phenylephrine effect
Dilates only ≠ No cycloplegia
Drop spacing
Wait 3-5 minutes ≠ Do not stack
Last Minute
- 1.COT has 200 MCQ
- 2.Skill Evaluation: seven stations
- 3.MCQ time is 180 minutes
- 4.Initial fee is $325
- 5.Diagnostic testing weighs heaviest
- 6.Normal IOP 10 to 21
- 7.Goldmann mires just touch
- 8.Thin cornea reads IOP low
- 9.Snellen top is distance
- 10.RAPD uses swinging light
- 11.Retinoscopy needs no responses
- 12.Lensometer: sphere before cylinder
- 13.Wait five minutes between drops
- 14.Chemical burn: irrigate first
- 15.Recertify every three years
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