COA Exam Flashcards

Q: How many questions are on the COA exam?

The COA exam has 200 multiple-choice questions and a 180-minute time limit.

Q: What score is needed to pass the COA exam?

IJCAHPO uses a criterion-referenced modified Angoff passing standard rather than a fixed published percentage.

Q: What should COA flashcards focus on?

Focus on applied office tasks: accurate history documentation, visual acuity technique, pupil checks, tonometry safety, basic optics, medication checks, instrument use, urgent symptom triage, and infection control.

Q: What happens after a failed COA attempt?

Local COA materials note that a retest application must be received within 12 months of the initial examination, with separate first and second retest fees.

Question 1

Cornea

Accepted Answer

The clear anterior surface that provides most of the eye's focusing power. It must remain transparent and smooth, so edema, scarring, or irregular shape can reduce vision even when the retina is healthy.

Question 2

Anterior chamber

Accepted Answer

The fluid-filled space between the cornea and iris. It contains aqueous humor, and its depth is clinically important before dilation or angle-related glaucoma evaluation.

Question 3

Iris and pupil

Accepted Answer

The iris controls pupil size to regulate light entering the eye. Pupil testing documents size, equality, direct and consensual response, and whether an afferent defect is suspected.

Question 4

Lens

Accepted Answer

The crystalline lens fine-tunes focus behind the pupil. Cataract, lens displacement, or loss of accommodation can affect acuity, glare, and near vision.

Question 5

Retina

Accepted Answer

The light-sensitive neural tissue lining the back of the eye. It converts light into nerve signals, so retinal disease can cause field loss, distortion, floaters, flashes, or reduced central vision.

Question 6

Macula

Accepted Answer

The central retinal area used for sharp detail and reading vision. Macular disease often affects central acuity and may cause distortion even when peripheral vision remains usable.

Question 7

Optic nerve

Accepted Answer

The nerve pathway carrying visual information from retina to brain. Damage can affect acuity, color vision, pupils, and visual fields.

Question 8

Snellen fraction

Accepted Answer

A visual acuity notation comparing the test distance with the distance at which a standard eye reads the same optotype. A larger denominator means poorer distance acuity.

Question 9

Testing one eye at a time

Accepted Answer

Distance acuity is recorded separately for each eye, with the fellow eye fully occluded without pressure. Testing both eyes together can hide unilateral vision loss.

Question 10

Pinhole acuity

Accepted Answer

Pinhole testing reduces blur from uncorrected refractive error. Improvement suggests a refractive component; little or no improvement raises concern for ocular disease or other nonrefractive causes.

Question 11

Near visual acuity

Accepted Answer

Near acuity checks reading vision at a controlled working distance with the patient's usual near correction when appropriate. Record the chart type, distance, correction, and each eye's result.

Question 12

Counting fingers, hand motion, and light perception

Accepted Answer

These are used when a patient cannot read the largest chart optotypes. Document the response and testing distance so later examiners can compare severity and change.

Question 13

Confrontation visual fields

Accepted Answer

A screening method comparing the patient's peripheral vision with the examiner's. It is not as detailed as automated perimetry, but it can reveal major field defects that need follow-up.

Question 14

Intraocular pressure (IOP)

Accepted Answer

The pressure inside the eye, usually estimated by tonometry. IOP is one glaucoma risk factor, but diagnosis depends on the full clinical picture, not a single pressure reading.

Question 15

Goldmann applanation endpoint

Accepted Answer

The examiner adjusts force until the inner edges of the fluorescein semicircles just meet. Too much or too little contact can distort the pressure reading.

Question 16

Fluorescein in applanation tonometry

Accepted Answer

Fluorescein helps make the tear meniscus visible under cobalt blue light, allowing the examiner to align the mires and judge the applanation endpoint.

Question 17

Tonometry safety check

Accepted Answer

Before touching the eye, confirm identity, explain the test, use proper anesthetic if required, avoid contaminated tips, and follow cleaning protocols between patients.

Question 18

Corneal factors in IOP readings

Accepted Answer

Corneal thickness, edema, scarring, irregularity, or squeezing can affect measured pressure. Unexpected readings should be interpreted with technique and ocular findings in mind.

Question 19

Myopia

Accepted Answer

Nearsightedness caused when light focuses in front of the retina without correction. It is corrected with minus lenses that diverge light before it enters the eye.

Question 20

Hyperopia

Accepted Answer

Farsightedness caused when light tends to focus behind the retina without accommodation or correction. It is corrected with plus lenses that converge light.

Question 21

Astigmatism

Accepted Answer

A refractive error caused by unequal curvature in different meridians, often from the cornea or lens. Cylinder power and axis describe the correction.

Question 22

Presbyopia

Accepted Answer

Age-related loss of near focusing ability from reduced accommodation. Patients often report difficulty with near tasks and may need added plus power for reading.

Question 23

Sphere, cylinder, and axis

Accepted Answer

Sphere corrects myopia or hyperopia, cylinder corrects astigmatism, and axis identifies the meridian of cylinder placement. All three must be recorded accurately.

Question 24

Autorefraction

Accepted Answer

An objective estimate of refractive error produced by an instrument. It is a starting point for refraction, not automatically the final prescription.

Question 25

Chief complaint

Accepted Answer

The patient's main reason for the visit, documented in the patient's own words when possible. It guides the exam sequence, urgency, and focused history questions.

Question 26

History of present illness

Accepted Answer

A structured description of the current problem, including onset, location, duration, symptoms, severity, related events, and what improves or worsens it.

Question 27

Medication and allergy reconciliation

Accepted Answer

Ask about prescription drugs, over-the-counter products, eye drops, supplements, allergies, and reactions. Accurate lists reduce medication errors and help identify contraindications.

Question 28

Ocular history

Accepted Answer

Prior eye disease, surgery, trauma, contact lens use, glasses history, and current eye medications can change testing choices and clinical risk.

Question 29

Systemic history relevant to eye care

Accepted Answer

Conditions such as diabetes, hypertension, autoimmune disease, thyroid disease, and neurologic disorders can affect ocular findings and should be documented when relevant.

Question 30

Ophthalmic medication rights

Accepted Answer

Before instilling a drop, verify the right patient, medication, concentration, eye, timing, and documentation. Stop and clarify any mismatch before administration.

Question 31

Mydriatic drops

Accepted Answer

Drops used to dilate the pupil for examination or testing. Patients should be warned about temporary blur and light sensitivity, and risk factors should be reviewed before use.

Question 32

Topical anesthetic drops

Accepted Answer

Drops that numb the ocular surface for procedures such as tonometry or foreign body evaluation. They are for supervised clinical use and should not be sent home for pain control.

Question 33

Ophthalmic antibiotic drops

Accepted Answer

Used for bacterial infection risk or treatment when ordered. Teach patients to avoid touching the bottle tip to the eye, lashes, skin, or contaminated surfaces.

Question 34

Glaucoma medication adherence

Accepted Answer

Pressure-lowering drops work only when used as directed. Ask about missed doses, side effects, cost barriers, and technique before assuming treatment failure.

Question 35

Slit lamp

Accepted Answer

A binocular microscope with an adjustable light beam used to examine the anterior eye and, with lenses, posterior structures. Proper positioning and chin-forehead contact improve exam quality.

Question 36

Lensometer

Accepted Answer

An instrument used to verify spectacle lens power, including sphere, cylinder, axis, add, and prism when present. It helps compare current glasses with the patient's needs.

Question 37

Keratometer

Accepted Answer

An instrument that measures anterior corneal curvature. It supports contact lens fitting, corneal assessment, and cataract surgery measurements.

Question 38

Amsler grid

Accepted Answer

A central vision self-monitoring tool. New wavy lines, missing areas, or distortion should be reported promptly, especially in patients at risk for macular disease.

Question 39

Fundus photography

Accepted Answer

Imaging that documents posterior segment appearance. A useful image must be correctly labeled, focused, centered on the requested area, and clear enough for comparison.

Question 40

Sudden flashes and new floaters

Accepted Answer

These symptoms can signal retinal tear or detachment. Treat the report as urgent and alert the ophthalmologist or follow the office emergency protocol promptly.

Question 41

Chemical splash to the eye

Accepted Answer

Immediate copious irrigation takes priority over routine intake steps. Notify the physician and continue emergency protocol while gathering exposure details when possible.

Question 42

Sudden painless vision loss

Accepted Answer

Abrupt vision loss without pain can still be an emergency, including vascular or retinal causes. Escalate promptly instead of scheduling as a routine complaint.

Question 43

Painful red eye with decreased vision

Accepted Answer

This combination is high risk. Possible causes include corneal ulcer, acute angle closure, uveitis, or other urgent disease, so the assistant should notify the clinician quickly.

Question 44

Eye trauma with possible open globe

Accepted Answer

Do not press on the eye, remove protruding material, or perform pressure testing. Protect the eye and alert the physician immediately.

Question 45

Hand hygiene in eye care

Accepted Answer

Perform hand hygiene before and after patient contact and after contact with contaminated surfaces or equipment. Eye clinics require strict technique because instruments often contact tears and mucous membranes.

Question 46

Disinfecting reusable ophthalmic devices

Accepted Answer

Reusable devices that contact the ocular surface must be cleaned and disinfected according to office protocol and manufacturer guidance before use on another patient.

Question 47

Drop bottle contamination

Accepted Answer

The bottle tip should not touch the eye, lashes, lids, fingers, or other surfaces. A contaminated tip can transfer organisms between patients or back into the medication.

Question 48

Contact lens hygiene teaching

Accepted Answer

Patients should wash hands before handling lenses, use approved solutions, avoid water exposure, replace cases as directed, and stop lens wear for painful redness until evaluated.

Question 49

Relative afferent pupillary defect (RAPD)

Accepted Answer

An abnormal pupil response suggesting asymmetric afferent pathway function, often screened with the swinging flashlight test. It should be documented and reported because it may indicate optic nerve or severe retinal disease.

Question 50

Extraocular muscle screening

Accepted Answer

Assessing versions and alignment helps identify restricted movement, cranial nerve palsy, or strabismus. Ask about diplopia and observe for unequal movement in each gaze direction.

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