100+ Free ABO Ophthalmology Practice Questions

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Question 1

Score: 0/0

A 68-year-old man reports progressive painless blurring and glare with oncoming headlights at night. Slit-lamp exam reveals a central posterior subcapsular lens opacity. Which systemic association is most strongly linked to this cataract morphology?

Long-term topical beta-blocker use

Chronic systemic corticosteroid therapy

Type 2 diabetes mellitus

Isolated vitamin A deficiency

to track

2026 Statistics

Key Facts: ABO Ophthalmology Exam

250

Multiple-Choice Questions

Two 125-question sections

5 hours

Total Testing Period

4.5 hours testing plus tutorial and break

$2,250

2026 Exam Fee

ABO WQE registration

700

Passing Scaled Score

Scale of 200-1000 (criterion-referenced)

~80%

First-Time Pass Rate

ABO scorecard 2021 = 79.6%

Sept 19, 2026

Next WQE Date

Pearson VUE centers nationwide

The ABO WQE is a 250-question computer-based exam delivered in two 125-question sections over approximately 5 hours (4.5 hours actual testing). The content outline (effective 2026) weights Retina/Vitreous/Tumors 15%, Glaucoma 14%, Lens/Cataract 13%, Cornea/Anterior Segment 13%, Neuro-Ophthalmology 10%, Oculofacial/Lacrimal/Orbit 10%, Pediatrics/Strabismus 10%, Uveitis 8%, and Optics/Refractive Management 8%. Scores are scaled 200-1000 with a fixed passing cut of 700. The 2026 exam fee is $2,250, registration runs April 15-August 5, 2026, and the test is administered September 19, 2026 at Pearson VUE centers.

Sample ABO Ophthalmology Practice Questions

Try these sample questions to test your ABO Ophthalmology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old man reports progressive painless blurring and glare with oncoming headlights at night. Slit-lamp exam reveals a central posterior subcapsular lens opacity. Which systemic association is most strongly linked to this cataract morphology?

A.Long-term topical beta-blocker use

B.Chronic systemic corticosteroid therapy

C.Type 2 diabetes mellitus

D.Isolated vitamin A deficiency

Explanation: Posterior subcapsular cataract (PSC) is classically associated with chronic systemic or topical corticosteroid use, ionizing radiation, and uveitis. PSCs cause disproportionate glare and near-vision difficulty because the opacity sits at the nodal point of the lens. Nuclear sclerotic cataracts are typical of aging; cortical spokes can occur in diabetes.

2During phacoemulsification, the surgeon notes a sudden deepening of the anterior chamber, pupil snap-back, and loss of followability. Which complication is most likely, and what is the correct immediate step?

A.Iris prolapse — lower infusion bottle height only

B.Posterior capsule rupture — stop ultrasound and raise the bottle

C.Posterior capsule rupture — lower the bottle, inject dispersive OVD, then withdraw the phaco tip under viscoelastic

D.Zonular dialysis — increase vacuum to remove remaining cortex quickly

Explanation: The triad of sudden deepening, pupil snap, and loss of followability signals posterior capsule rupture. The correct sequence is: keep the phaco tip in the eye while LOWERING the bottle (reduces further vitreous hydration), inject dispersive viscoelastic behind the nucleus and through the side-port, then withdraw the phaco tip under viscoelastic cover to prevent AC collapse and vitreous prolapse. Triamcinolone-assisted anterior vitrectomy may follow.

3A 74-year-old woman scheduled for cataract surgery has an axial length of 23.5 mm and keratometry of 43.5 D. She has no prior refractive surgery. Which IOL power formula is most appropriate?

A.Haigis-L

B.Barrett Universal II or Kane

C.Holladay 1 with double-K method

D.Shammas no-history

Explanation: For a virgin cornea at average axial length, modern fourth-generation or AI-assisted formulas (Barrett Universal II, Kane, Hill-RBF, EVO) outperform older formulas and are preferred for routine biometry. Haigis-L, Shammas, and double-K Holladay are post-refractive formulas used when the cornea has been altered by LASIK, PRK, or RK.

4A 70-year-old with brunescent cataract, shallow anterior chamber, and zonular laxity from pseudoexfoliation syndrome is scheduled for cataract extraction. Which intraoperative adjunct is most indicated to reduce the risk of capsular bag dislocation?

A.Trypan blue capsule staining only

B.Femtosecond laser cataract surgery only

C.Capsular tension ring (CTR) placement after capsulorhexis

D.Intracameral phenylephrine/ketorolac

Explanation: Pseudoexfoliation causes progressive zonulopathy and is the leading risk factor for late in-the-bag IOL subluxation. A capsular tension ring distributes centripetal force evenly across weak zonules and stabilizes the bag intraoperatively and long-term. Trypan blue helps visualize a weak capsule but does not address zonular support. Phenylephrine/ketorolac addresses intraoperative miosis, not zonular laxity.

5A 62-year-old man on tamsulosin for BPH is undergoing cataract surgery. Intraoperatively the iris becomes floppy, billowing with fluid currents, with progressive intraoperative miosis and iris prolapse to the wound. Which strategy is most appropriate to complete the case safely?

A.Stop all irrigation and convert to extracapsular cataract extraction immediately

B.Use intracameral phenylephrine/epinephrine plus iris hooks or a Malyugin ring and lower the infusion bottle

C.Dilate the pupil with topical atropine intraoperatively

D.Perform vitrectomy before completing nucleus removal

Explanation: Intraoperative Floppy Iris Syndrome (IFIS) is strongly associated with alpha-1a antagonists (tamsulosin). Management combines pharmacologic mydriasis (intracameral phenylephrine 1.5% or epinephrine) with mechanical support (iris hooks, Malyugin ring, or B-HEX) and reduced fluidics (low bottle, low flow). Stopping tamsulosin days before surgery is NOT reliably effective because iris dilator atrophy persists.

6On postoperative day 4 after uncomplicated cataract surgery, a patient presents with hypopyon, severe pain, decreased vision to hand motions, and fibrin in the anterior chamber. What is the most appropriate immediate management?

A.Topical moxifloxacin and oral prednisone, follow up in 24 hours

B.Vitreous tap and intravitreal injection of vancomycin plus ceftazidime

C.Admission for IV ceftriaxone and observation

D.Topical fortified vancomycin/tobramycin and recheck in 48 hours

Explanation: Acute postoperative endophthalmitis (most often coagulase-negative Staphylococcus) is a surgical emergency. Per the Endophthalmitis Vitrectomy Study (EVS) and current standards, vitreous tap with intravitreal vancomycin (1 mg/0.1 mL) plus ceftazidime (2.25 mg/0.1 mL) is the correct immediate treatment. EVS supported pars plana vitrectomy only if presenting vision was light perception or worse.

7A 55-year-old diabetic undergoes uneventful phacoemulsification. Six weeks later she complains of blurred vision. Exam shows 20/60 acuity, no inflammation, and OCT reveals cystoid macular edema. Which treatment is first-line?

A.Immediate pars plana vitrectomy

B.Topical NSAID plus topical corticosteroid

C.Intravitreal bevacizumab monotherapy

D.Observation for 6 months

Explanation: Pseudophakic cystoid macular edema (Irvine-Gass syndrome) typically presents 4-12 weeks postoperatively. First-line therapy is combined topical NSAID (ketorolac, bromfenac, or nepafenac) and topical corticosteroid (prednisolone acetate). If unresponsive, sub-Tenon or intravitreal triamcinolone, or intravitreal anti-VEGF, may be considered.

8Which lens protein is most responsible for age-related nuclear sclerotic cataract color change from yellow to brown?

A.Alpha-crystallin glycation

B.Beta-crystallin cleavage

C.Gamma-crystallin aggregation and urochrome/tryptophan oxidation products

D.Vimentin cross-linking

Explanation: Age-related nuclear cataract brunescence reflects oxidative modification and aggregation of gamma-crystallins with accumulation of yellow-brown chromophores from tryptophan oxidation and glycation end-products. Alpha-crystallin acts as a chaperone; beta- and gamma-crystallins make up the bulk structural proteins. The resulting myopic shift ('second sight') is characteristic.

9Which of the following is the most common cause of unilateral congenital cataract in an otherwise healthy infant?

A.Galactosemia

B.Rubella infection

C.Idiopathic / sporadic

D.Autosomal dominant inheritance

Explanation: Most unilateral congenital cataracts are idiopathic/sporadic, often associated with persistent fetal vasculature or local lens developmental defects. Bilateral congenital cataracts are more likely hereditary (typically autosomal dominant) or due to metabolic/systemic causes. Workup for bilateral cases includes TORCH titers, urine for reducing substances (galactosemia), and metabolic labs.

10A 5-year-old undergoes unilateral congenital cataract extraction at age 6 weeks in the left eye per the Infant Aphakia Treatment Study. Based on IATS findings, which initial optical correction was associated with fewer adverse events even though visual acuity outcomes at age 5 were similar between groups?

A.Primary IOL implantation

B.Contact lens (aphakic) correction

C.Aphakic spectacles only

D.Pinhole occluder

Explanation: The Infant Aphakia Treatment Study (IATS) randomized infants 1-6 months old undergoing unilateral cataract surgery to contact lens vs primary IOL. At 5 and 10 years, visual acuity was similar between groups, but the IOL arm had significantly more adverse events and additional intraocular surgeries (visual axis opacification, glaucoma-related events). For infants under 7 months, contact lens correction is preferred.

About the ABO Ophthalmology Exam

The ABO Written Qualifying Examination (WQE) is the first of two components for primary certification by the American Board of Ophthalmology. The 250-question multiple-choice computer-based exam is administered annually at Pearson VUE test centers in a single 5-hour session consisting of two 125-question sections. The 2026 WQE is on September 19, 2026. Successful candidates must then pass the Oral Clinical Examination (OCE) to achieve full ABO certification. The exam covers nine major subject domains with the largest weights on Retina (15%), Glaucoma (14%), Lens/Cataract (13%), and Cornea (13%).

Questions

250 scored questions

Time Limit

5 hours (two 125-question sections; 4.5 hours testing plus tutorial and break)

Passing Score

Scaled score of 700 on a 200-1000 scale (criterion-referenced)

Exam Fee

$2,250 WQE exam fee (ABO 2026) (American Board of Ophthalmology (ABO); administered via Pearson VUE)

ABO Ophthalmology Exam Content Outline

15%

Retina, Vitreous, and Intraocular Tumors

Wet/dry AMD and anti-VEGF (aflibercept, ranibizumab, bevacizumab, faricimab, brolucizumab; CATT), diabetic retinopathy (Protocol S/T, DRCR.net), CRVO/BRVO/CRAO (stroke workup), rhegmatogenous RD, macular hole, ERM, retinitis pigmentosa, CSR, CMV retinitis, toxoplasmosis, choroidal melanoma (COMS), retinoblastoma (intra-arterial chemo).

14%

Glaucoma

POAG, acute angle closure and LPI, normal tension glaucoma, OHTS/LiGHT/CNTGS/EMGT, OCT RNFL/GCC, prostaglandin analogs, SLT, MIGS (iStent, Hydrus, Xen), trabeculectomy with MMC, glaucoma drainage devices, congenital glaucoma (goniotomy/trabeculotomy), aqueous misdirection, bleb leak and hypotony.

13%

Lens and Cataract

Nuclear/cortical/PSC morphology, corticosteroid-induced PSC, IOL calculation (Barrett Universal II, Kane, Haigis-L post-refractive), phacoemulsification, IFIS with tamsulosin (Malyugin ring, phenylephrine/epinephrine), posterior capsule rupture management, endophthalmitis (EVS), Irvine-Gass CME, PCO and YAG capsulotomy, pediatric cataract (IATS).

13%

Cornea, External Disease, and Anterior Segment

Bacterial keratitis (fortified vancomycin/tobramycin), HSV (HEDS trial), HZO (Hutchinson sign, oral acyclovir/valacyclovir), fungal (MUTT natamycin for Fusarium), Acanthamoeba (PHMB), corneal dystrophies (TGFBI granular, CHST6 macular, Fuchs, EBMD), keratoconus and CXL, recurrent corneal erosion, dry eye and Sjögren (anti-SSA/SSB), MGD, scleritis (phenylephrine test), PK/DSAEK/DMEK, post-LASIK ectasia (Randleman).

10%

Neuro-Ophthalmology

Optic neuritis (ONTT, MS), arteritic AION/GCA (IV methylprednisolone + TAB, tocilizumab), NAION, IIH (IIHTT, acetazolamide), chiasmal compression, myasthenia gravis (anti-AChR/MuSK, ice-pack test), CN III pupil-involving (PCom aneurysm), CN IV palsy (Parks 3-step, Bielschowsky), CN VI, Horner syndrome (cocaine, hydroxyamphetamine localization), Adie tonic pupil (dilute pilocarpine), INO from MLF lesion.

10%

Oculofacial Plastics, Lacrimal, and Orbit

Ptosis (MRD1, levator function, aponeurotic repair vs frontalis sling), eyelid malignancies (BCC most common; SCC; sebaceous carcinoma masquerade syndrome; Mohs), orbital cellulitis with SPA (IV vancomycin + ceftriaxone ± metronidazole), thyroid eye disease and teprotumumab, dacryocystitis and DCR, canalicular laceration repair, involutional ectropion (tarsal strip), pediatric rhabdomyosarcoma.

10%

Pediatric Ophthalmology and Strabismus

Amblyopia (ATS — patching 2-6 h/day, atropine penalization, critical periods through adolescence), accommodative and infantile esotropia (cross-fixation, DVD, latent nystagmus), divergence insufficiency, A/V patterns, Parks 3-step for CN IV, ophthalmia neonatorum (chlamydia oral erythromycin 14 d; gonococcal IV/IM ceftriaxone), ROP screening (BW ≤1500 g or GA ≤30 weeks; PMA 31 weeks or 4 weeks chronologic; ETROP Type 1), retinoblastoma.

Uveitis

HLA-B27 anterior uveitis (AS, reactive, IBD, psoriatic), JIA-associated uveitis screening (ANA+ pauciarticular q3 months), sarcoidosis (mutton-fat KPs, Busacca/Koeppe nodules, candle-wax drippings), VKH (bilateral panuveitis with vitiligo/poliosis/meningismus), Behçet (hypopyon with occlusive retinal vasculitis), sympathetic ophthalmia, toxoplasmosis, CMV retinitis, ARN, syphilis, IMT and biologics (adalimumab FDA-approved for noninfectious uveitis).

Optics and Refractive Management

Refractive errors and spherical equivalent, presbyopia and reading adds, retinoscopy (with vs against), vertex distance and contact lens power conversion, Prentice's rule and anisometropic prism, refractive surgery (LASIK, PRK, SMILE, phakic IOL, post-LASIK ectasia, wavefront/topography-guided enhancement), IOL formulas and effective lens position, thin-lens equation.

How to Pass the ABO Ophthalmology Exam

What You Need to Know

Passing score: Scaled score of 700 on a 200-1000 scale (criterion-referenced)
Exam length: 250 questions
Time limit: 5 hours (two 125-question sections; 4.5 hours testing plus tutorial and break)
Exam fee: $2,250 WQE exam fee (ABO 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABO Ophthalmology Study Tips from Top Performers

1Memorize the WQE content weights — Retina 15%, Glaucoma 14%, Lens/Cataract 13%, Cornea 13% comprise 55% of the exam; allocate your study time proportionally rather than spending equal time on uveitis (8%) and retina (15%)

2Know POAG target IOP reduction (>25% per OHTS) and the five OHTS risk factors (age, IOP, CCT <555 microns, cup-to-disc ratio, pattern SD); thin central cornea is the most potent modifiable-prognostic predictor

3Master the pupillary abnormality testing ladder: pupil-involving CN III → urgent CTA/MRA (PCom aneurysm); Horner cocaine confirms, hydroxyamphetamine localizes third-order lesions (carotid dissection, cavernous sinus); Adie pupil constricts to dilute pilocarpine 0.125% (denervation supersensitivity)

4Know ROP screening: BW ≤1500 g OR GA ≤30 weeks; first exam at PMA 31 weeks OR chronologic 4 weeks (whichever is LATER); Type 1 ROP (Zone I any stage with plus, Zone I stage 3 without plus, Zone II stage 2/3 with plus) triggers treatment within 48-72 hours

5Remember the acute angle closure ladder: medical IOP lowering (topical beta-blocker, alpha-agonist, CAI; oral/IV acetazolamide; mannitol) followed by definitive laser peripheral iridotomy (LPI); prophylactic LPI in fellow eye; EAGLE trial supports clear lens extraction in select cases

Frequently Asked Questions

What is the ABO Written Qualifying Examination (WQE)?

The ABO WQE is the first of two components for primary certification by the American Board of Ophthalmology. It is a 250-question computer-based multiple-choice exam delivered at Pearson VUE test centers in two 125-question sections over approximately 5 hours (4.5 hours actual testing). After passing the WQE, candidates must then pass the Oral Clinical Examination (OCE) to achieve full ABO certification. The next WQE administration is Saturday, September 19, 2026.

How many questions are on the ABO WQE and how long is the exam?

The exam consists of 250 multiple-choice questions divided into two 125-question sections with a short break in between. Total testing time is approximately 4.5 hours of actual testing plus a tutorial and break, scheduled as a 5-hour Pearson VUE appointment. Questions are single-best-answer format; some may include images (fundus photos, OCT, FA, corneal topography).

What is the passing score for the ABO WQE?

The WQE is criterion-referenced with a scaled passing score of 700 on a scale of 200 to 1000. The ABO does not publicly release the minimum raw score needed to pass because the raw-to-scaled conversion varies by exam form to account for difficulty. Score reports include performance feedback by content domain. Historical first-time pass rates have been in the 80-85% range (79.6% for 2021 per the ABO scorecard).

What is the content outline of the ABO WQE?

The 2026 ABO content outline covers nine subject domains: Retina, Vitreous, and Intraocular Tumors 15%; Glaucoma 14%; Lens and Cataract 13%; Cornea, External Disease, and Anterior Segment 13%; Neuro-Ophthalmology 10%; Oculofacial Plastics, Lacrimal, and Orbit 10%; Pediatric Ophthalmology and Strabismus 10%; Uveitis 8%; Optics and Refractive Management 8%. Each question targets presentation, diagnostic testing, management/outcomes/prognosis, or pathophysiology/basic science.

What are the eligibility requirements for the ABO WQE?

Candidates must (1) hold an MD or DO degree from an accredited medical school, (2) successfully complete an ACGME-accredited (or RCPSC-accredited for Canadian graduates) 36-month ophthalmology residency program, (3) hold an active, unrestricted medical or osteopathic license, and (4) receive satisfactory documentation from the residency program director. Registration for the 2026 WQE runs April 15-August 5, 2026.

How much does the ABO WQE cost?

The 2026 WQE registration fee is $2,250, which includes the examination fee. Late registration may incur additional fees per ABO policy. Candidates pay separately for the Oral Clinical Examination (OCE) when they advance. The exam is administered by Pearson VUE at test centers nationwide.

What are the highest-yield topics on the ABO WQE?

Retina (15%) dominates — master anti-VEGF protocols (aflibercept, ranibizumab, bevacizumab, faricimab for wet AMD and DME; Protocol T/S), CRVO/BRVO/CRAO (stroke workup), macular hole management, retinoblastoma, and choroidal melanoma (COMS). Glaucoma (14%) demands OHTS risk factors, LiGHT (SLT first-line), angle closure management (LPI), congenital glaucoma surgery, and MIGS vs trabeculectomy. Cornea/anterior segment (13%) and lens/cataract (13%) require keratitis management (bacterial fortified drops, HEDS, MUTT, PHMB for Acanthamoeba, HZO with Hutchinson sign), CXL for keratoconus, IFIS with tamsulosin, and endophthalmitis (EVS). Neuro (10%) focuses on optic neuritis (ONTT), GCA workup, pupillary abnormalities (Horner, Adie, CN III), and Parks 3-step.

How should I study for the ABO WQE?

Plan 6-12 months of focused review during PGY-4. Start with optics/refraction and anterior segment foundations (retinoscopy, IOL formulas, Prentice's rule), then cataract/cornea/glaucoma, then retina/uveitis/neuro-ophth, and finish with peds/strabismus and oculoplastics. Use the AAO BCSC series as your primary text, supplement with OKAP and WQE-focused question banks (target 3,000+ questions), and take at least two timed full-length practice exams in the last 4 weeks. Integrate current guidelines (AAO Preferred Practice Patterns, CATT, Protocol S/T, ETROP, ONTT, OHTS, LiGHT, MUTT, HEDS, IATS, IIHTT).