100+ Free NBEO Part II Practice Questions

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What is the role of MIGS (minimally invasive glaucoma surgery) in the current glaucoma treatment paradigm, and what are the main categories?

MIGS is the same as trabeculectomy

MIGS can only be performed with cataract surgery

MIGS procedures offer a safer surgical option with moderate IOP reduction, positioned between medical therapy and traditional filtering surgery; categories include trabecular bypass (iStent), Schlemm's canal devices (Hydrus), subconjunctival filtration (Xen gel stent), and suprachoroidal shunts

MIGS has replaced all traditional glaucoma surgeries

to track

2026 Statistics

Key Facts: NBEO Part II Exam

~300

Exam Questions

Two 3-hour sessions

6 hrs

Total Test Time

Full day exam

$575

Exam Fee

NBEO

~90-95%

First-Time Pass Rate

Estimated

Year 4

Typically Taken

4th year of OD program

NBEO Part II has approximately 300 questions in two 3-hour sessions. It covers ocular disease diagnosis and management (30%), clinical optometry procedures (25%), contact lenses (15%), binocular vision and pediatrics (15%), and systemic disease with ocular manifestations (15%). Typically taken in the fourth year of optometry school. Required for optometry licensure in all U.S. states.

Sample NBEO Part II Practice Questions

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

1A patient presents with acute painless vision loss in one eye. Fundoscopy reveals a pale retina with a cherry-red spot at the macula. What is the most likely diagnosis?

A.Central retinal vein occlusion

B.Central retinal artery occlusion

C.Optic neuritis

D.Vitreous hemorrhage

Explanation: Central retinal artery occlusion (CRAO) presents with sudden, painless vision loss. The retina appears pale/edematous due to ischemia of the inner retinal layers, while the fovea appears as a cherry-red spot because the thin foveal retina allows the underlying choroidal circulation to show through. This is an ophthalmic emergency requiring urgent evaluation for embolic sources (carotid, cardiac).

2What is the standard method for measuring intraocular pressure (IOP) in clinical optometry?

A.Schiotz tonometry

B.Goldmann applanation tonometry

C.Digital palpation

D.Pneumotonometry

Explanation: Goldmann applanation tonometry (GAT) is the gold standard for measuring IOP. It applies the Imbert-Fick principle: the force required to flatten (applanate) a 3.06 mm diameter area of the cornea equals the IOP. This standardized area minimizes the effects of corneal rigidity and surface tension. Central corneal thickness (CCT) can affect readings — thinner corneas may underestimate and thicker corneas may overestimate true IOP.

3A contact lens patient presents with a painful red eye, photophobia, and a white corneal infiltrate. What is the most important initial step?

A.Prescribe a topical steroid

B.Obtain corneal cultures and initiate empirical broad-spectrum topical antibiotic therapy

C.Refit the contact lens

D.Observe for 48 hours

Explanation: A white corneal infiltrate with pain, redness, and photophobia in a contact lens wearer suggests microbial keratitis until proven otherwise. The most important initial step is to obtain corneal scrapings for culture and sensitivity (Gram stain, blood agar, chocolate agar, Sabouraud's agar) before starting empirical therapy. Empirical treatment typically includes fortified antibiotics (e.g., fortified tobramycin + fortified cefazolin) or a fluoroquinolone for smaller ulcers. Contact lens wear must be discontinued.

4What is the cover test used to assess in a binocular vision examination?

A.Visual acuity

B.The presence and magnitude of strabismus (tropia) and phoria

C.Color vision

D.Stereoacuity

Explanation: The cover test is the primary clinical test for detecting and measuring ocular alignment disorders. The unilateral cover test detects manifest deviations (tropias): covering one eye and observing movement of the uncovered eye. The alternating cover test reveals the total deviation (tropia + phoria) by dissociating the eyes. The direction and magnitude of the movement indicate the type (eso, exo, hyper) and size of the deviation. Prism can be added to measure the deviation (prism cover test).

5A patient with type 2 diabetes presents for an eye exam. What is the recommended dilated fundus examination frequency for a patient with no diabetic retinopathy?

A.Every 5 years

B.Annually

C.Every 6 months

D.Monthly

Explanation: The American Diabetes Association and American Optometric Association recommend annual comprehensive dilated eye examinations for patients with type 2 diabetes starting at the time of diagnosis. If no retinopathy is found on initial exam and blood glucose is well controlled, the interval may be extended to every 1-2 years per the treating clinician's judgment. For type 1 diabetes, screening begins 5 years after diagnosis. More frequent examinations are needed when retinopathy is present.

6Which type of cataract is most commonly associated with aging?

A.Anterior subcapsular cataract

B.Posterior subcapsular cataract

C.Nuclear sclerotic cataract

D.Cortical cataract

Explanation: Nuclear sclerotic cataract is the most common type associated with aging. It involves progressive hardening and yellowing of the central lens nucleus due to protein aggregation and accumulation of urochrome pigment. This can cause a myopic shift (increased lens refractive index), which temporarily improves near vision ('second sight'). Other age-related types include cortical cataracts (spoke-like opacities) and posterior subcapsular cataracts (associated with steroids and diabetes).

7What is the minimum acceptable base curve selection method when fitting a spherical soft contact lens?

A.Always use the flattest lens available

B.Select the base curve based on keratometry readings, with the goal of achieving good centration, movement (0.25-0.50 mm on blink), and comfort

C.Use the steepest lens to ensure tight fit

D.Base curve does not matter for soft lenses

Explanation: Soft contact lens base curve selection should produce an appropriate lens-cornea fitting relationship: adequate centration, smooth movement of approximately 0.25-0.50 mm with each blink (ensuring tear exchange beneath the lens), and patient comfort. Keratometry readings and corneal diameter help guide initial trial lens selection. A lens that is too flat will decenter and move excessively; too steep will result in inadequate movement, reduced tear exchange, and potential hypoxia.

8A 6-year-old child presents with an inward turning eye. The deviation is constant and measures 30 prism diopters at distance and near. What is the most likely diagnosis?

A.Intermittent exotropia

B.Accommodative esotropia

C.Infantile (congenital) esotropia

D.Duane syndrome

Explanation: A constant, large-angle esotropia (typically >30 PD) presenting in early childhood with approximately equal deviation at distance and near suggests infantile (congenital) esotropia. It typically manifests before 6 months of age. Accommodative esotropia usually has a significant hyperopic refractive error, responds to plus lenses, and the distance/near deviation may differ. Treatment for infantile esotropia is surgical, with the goal of achieving alignment and enabling development of binocular vision.

9Which visual field defect is most commonly associated with glaucoma?

A.Central scotoma

B.Arcuate (Bjerrum) scotoma

C.Bitemporal hemianopia

D.Homonymous hemianopia

Explanation: The arcuate (Bjerrum) scotoma is the most characteristic visual field defect in glaucoma. It follows the arcuate pattern of retinal nerve fiber bundles curving around the fovea from the optic disc. Other classic glaucomatous field defects include nasal step (Roenne), paracentral scotoma, and generalized depression. These defects correspond to damage of retinal ganglion cell axons at the optic nerve head. Central vision is typically preserved until advanced stages.

10A patient with thyroid eye disease (Graves ophthalmopathy) presents with proptosis, lid retraction, and restriction of upgaze. Which extraocular muscle is most commonly affected?

A.Lateral rectus

B.Superior rectus

C.Inferior rectus

D.Medial rectus

Explanation: In thyroid eye disease (Graves ophthalmopathy), the inferior rectus is the most commonly affected extraocular muscle, followed by the medial rectus. The muscles undergo lymphocytic infiltration, edema, and eventually fibrosis, causing restrictive strabismus. The fibrotic inferior rectus restricts upgaze, which is one of the earliest motility findings. Unlike a superior rectus palsy (which would cause a deficit in upgaze with full downgaze), a restrictive inferior rectus shows limited upgaze with positive forced duction testing.

About the NBEO Part II Exam

NBEO Part II Patient Assessment and Management (PAM) tests clinical optometry knowledge including ocular disease diagnosis and management, clinical procedures, contact lens fitting, binocular vision disorders, pediatric optometry, low vision, and ocular manifestations of systemic disease.

Questions

100 scored questions

Time Limit

6 hours (two 3-hour sessions)

Passing Score

Criterion-referenced scaled score

Exam Fee

$575 (NBEO (National Board of Examiners in Optometry))

NBEO Part II Exam Content Outline

30%

Ocular Disease Diagnosis & Management

Anterior and posterior segment disease, glaucoma, retinal conditions, neuro-ophthalmic disorders, and emergency management

25%

Clinical Optometry

Refraction techniques, diagnostic testing, imaging interpretation (OCT, visual fields), low vision rehabilitation

15%

Contact Lenses

Soft, RGP, scleral, toric, multifocal, and specialty lens fitting, complications, and patient management

15%

Binocular Vision & Pediatrics

Strabismus classification and management, amblyopia treatment, vision therapy, and pediatric vision screening

15%

Systemic Disease & Ocular Manifestations

Diabetic retinopathy, hypertensive retinopathy, thyroid eye disease, autoimmune conditions, and drug toxicities

How to Pass the NBEO Part II Exam

What You Need to Know

Passing score: Criterion-referenced scaled score
Exam length: 100 questions
Time limit: 6 hours (two 3-hour sessions)
Exam fee: $575

Keys to Passing

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

NBEO Part II Study Tips from Top Performers

1Focus on ocular disease — it's 30% of the exam. Know the differential diagnosis, workup, and management for common conditions like glaucoma, AMD, diabetic retinopathy, and uveitis

2Practice interpreting clinical images: OCT scans, visual fields, corneal topography, and fundus photographs are frequently tested

3Master contact lens fitting for keratoconus (RGP/scleral), presbyopia (multifocal), and post-surgical patients — know Dk/t requirements and complication management

4Study the three-step test for cranial nerve palsies, amblyopia treatment protocols (PEDIG studies), and convergence insufficiency management (CITT evidence)

5Review systemic disease ocular manifestations — diabetic retinopathy grading, hypertensive retinopathy staging, thyroid eye disease, and drug toxicity screening protocols

Frequently Asked Questions

What is NBEO Part II?

NBEO Part II, also called Patient Assessment and Management (PAM), tests clinical knowledge and decision-making skills for optometry practice. It covers ocular disease diagnosis and management, clinical procedures, contact lens fitting, binocular vision disorders, and systemic disease with ocular manifestations. It is typically taken in the fourth year of the OD program and is required for optometry licensure.

How many questions are on NBEO Part II?

NBEO Part II contains approximately 300 multiple-choice questions administered in two 3-hour sessions. The content covers ocular disease (30%), clinical optometry (25%), contact lenses (15%), binocular vision and pediatrics (15%), and systemic disease (15%). Questions are clinical case-based, testing your ability to diagnose, manage, and refer appropriately.

How does NBEO Part II differ from Part I?

Part I (ABS) tests foundational basic science knowledge (anatomy, optics, pharmacology), while Part II (PAM) tests clinical application and patient management skills. Part II questions are more clinically oriented, presenting patient scenarios that require diagnosis, treatment planning, and management decisions. Part II is typically taken 2 years after Part I, during the fourth year of optometry school when clinical rotations are completed.

How should I study for NBEO Part II?

Effective NBEO Part II preparation includes: studying ocular disease diagnosis and management protocols (30% of exam), reviewing clinical cases with diagnostic images (OCT, visual fields, fundus photos), practicing contact lens fitting scenarios, studying binocular vision assessment and amblyopia treatment, and reviewing systemic diseases with ocular manifestations. Clinical rotation experience is essential preparation. Most students study 4-6 months alongside rotations.