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Exam Review

Key Facts: NCLE Advanced Exam

125

Exam Questions

A portion may not be scored

3 hrs

Time Limit

Computer-based exam

42%

Pass Rate (2024)

ABO-NCLE

$275

Exam Fee

Non-refundable

3 yrs

Certified Before Testing

One NCLE renewal period (or opticianry degree)

195

Currently Certified

NCLE-AC holders (ABO-NCLE, Nov 1, 2026)

The NCLEAC exam has 125 questions, a portion of which may not be scored, with a 3-hour time limit. Passing is based on a criterion-referenced scaled score. The 2024 pass rate was 42%. Prerequisites include active basic NCLE certification plus one completed 3-year recertification period. The exam fee is $275 (non-refundable). Testing is at Prometric centers or by ProProctor remote testing; anyone testing for a state license must first confirm that the state board accepts a remotely proctored exam.

Sample NCLE Advanced Practice Questions

Try these sample questions to review concepts for the NCLE Advanced exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 130+ question experience with AI tutoring.

1A patient presents with a history of penetrating keratoplasty (corneal transplant) performed 18 months ago. Which contact lens type is MOST appropriate as a first-line option for visual rehabilitation?

A.Standard soft spherical lens

B.Large-diameter scleral lens

C.Daily disposable toric lens

D.Conventional RGP corneal lens

Explanation: Large-diameter scleral lenses are the preferred first-line option for post-penetrating keratoplasty patients because they vault completely over the irregular corneal surface and graft-host junction, providing a smooth optical surface with a fluid reservoir. Standard soft lenses cannot mask the irregular astigmatism. Daily disposable torics only correct regular astigmatism. Conventional RGP corneal lenses may bear on the graft-host junction and risk graft rejection or discomfort.

2During a scleral lens fitting, the practitioner observes central bearing (touch) on the cornea after lens settling. What is the MOST appropriate modification?

A.Decrease the overall diameter

B.Increase the sagittal depth

C.Flatten the base curve

D.Reduce the haptic landing zone

Explanation: Central bearing indicates insufficient vault over the cornea. Increasing the sagittal depth provides more clearance between the lens back surface and the corneal apex, eliminating the touch. Decreasing diameter would reduce vault. Flattening the base curve would also reduce central vault. Reducing the haptic landing zone would affect peripheral fit but not resolve central bearing.

3What is the primary mechanism by which orthokeratology (ortho-K) lenses reduce myopia?

A.Permanent stromal reshaping from overnight wear

B.Temporary central epithelial flattening from hydraulic forces

C.Increased tear-film refractive index under the lens

D.Reduced anterior chamber depth from lens pressure

Explanation: Orthokeratology works by using reverse-geometry lens design to create hydraulic forces under the lens that redistribute the central corneal epithelium, temporarily flattening the central cornea and steepening the mid-periphery. This reduces myopic refractive error. The effect is on the epithelium, not the stroma, and it is reversible — not permanent. The tear film and anterior chamber are not the mechanisms of action.

4A keratoconus patient has a steep K reading of 52.00 D and a flat K of 46.00 D. What grade of keratoconus does this MOST likely represent?

A.Forme fruste (subclinical)

B.Mild keratoconus

C.Moderate keratoconus

D.Advanced (severe) keratoconus

Explanation: Moderate keratoconus is typically characterized by K readings between 45.00 and 52.00 D with visible corneal thinning and Vogt's striae. The steep K of 52.00 D with 6.00 D of corneal astigmatism places this in the moderate category. Forme fruste has K readings below 45.00 D with no clinical signs. Mild keratoconus typically has K readings of 45-48 D. Advanced keratoconus typically shows K readings exceeding 55 D with Munson's sign or corneal scarring.

5Which tear film layer is MOST critical to evaluate before fitting a scleral lens?

A.The lipid layer produced by meibomian glands

B.The aqueous layer produced by the lacrimal gland

C.The mucin layer produced by goblet cells

D.The glycocalyx produced by corneal epithelial cells

Explanation: The aqueous layer is most critical for scleral lens fitting because scleral lenses rely on a fluid reservoir (tear pool) between the lens and cornea. Adequate aqueous tear production ensures the post-lens tear reservoir remains filled and provides oxygen transport to the cornea. Patients with severe aqueous deficiency may experience corneal desiccation under the lens. While the lipid layer, mucin layer, and glycocalyx are all important for overall tear function, the aqueous component directly affects the scleral lens fluid reservoir.

6In a reverse-geometry orthokeratology lens design, the secondary (reverse) curve is:

A.Flatter than the base curve to create a bearing zone

B.Steeper than the base curve to create a tear reservoir

C.The same radius as the base curve for uniform pressure

D.Aspheric to match the corneal eccentricity

Explanation: In a reverse-geometry ortho-K lens, the secondary (reverse) curve is significantly steeper than the flat base curve, creating a deep tear reservoir zone between the central treatment (base curve) zone and the alignment zone. This reverse curve generates the hydraulic forces needed to redistribute the corneal epithelium. The base curve is fitted flatter than the flattest K to create the central flattening effect, while the steep reverse curve creates negative pressure (suction) that aids epithelial redistribution.

7A prosthetic contact lens is indicated for all of the following conditions EXCEPT:

A.Iris coloboma with disabling photophobia

B.Corneal scar causing cosmetic disfigurement

C.Active bacterial keratitis with mucopurulent discharge

D.Aniridia with glare sensitivity

Explanation: Active bacterial keratitis with mucopurulent discharge is a contraindication for any contact lens wear, including prosthetic lenses, because the lens could trap infectious material against the cornea and worsen the infection. Prosthetic lenses are indicated for iris coloboma (to reduce photophobia by creating an artificial pupil), corneal scars (to improve cosmetic appearance), and aniridia (to reduce glare by providing an artificial iris). The infection must be fully resolved before considering any lens fitting.

8When evaluating a scleral lens fit using anterior segment OCT, what is the IDEAL central corneal clearance immediately after lens insertion?

A.50-100 micrometers

B.200-300 micrometers

C.400-600 micrometers

D.800-1000 micrometers

Explanation: The ideal initial central corneal clearance for a scleral lens immediately after insertion is approximately 200-300 micrometers. This allows for the expected settling (typically 50-100 micrometers over 4-8 hours) while maintaining adequate clearance at the end of the wearing period (approximately 100-200 micrometers). Less than 100 micrometers risks corneal touch. More than 600 micrometers can cause lens fogging (midday fogging), reduced oxygen transmissibility, and fluid reservoir stagnation.

9Which corneal topography pattern is MOST characteristic of keratoconus?

A.Symmetric bow-tie pattern

B.Inferior steepening with a displaced apex

C.Central island of flattening

D.Uniform spherical curvature

Explanation: Keratoconus characteristically shows inferior steepening with a displaced corneal apex on topography, often described as an asymmetric inferior bow-tie or skewed radial axis pattern. The I-S value (inferior minus superior dioptric power difference) is a key diagnostic metric. A symmetric bow-tie indicates regular astigmatism (with-the-rule or against-the-rule). Central flattening would suggest post-refractive surgery or ortho-K wear. Uniform spherical curvature indicates a normal cornea.

10A patient wearing a piggyback lens system (RGP over soft lens) reports fluctuating vision. What is the MOST likely cause?

A.The RGP lens is decentering on the soft carrier lens

B.The soft lens base curve is too steep

C.The patient has accommodative spasm

D.The RGP lens has protein deposits

Explanation: In a piggyback system, the most common cause of fluctuating vision is the RGP lens decentering or moving excessively on the soft carrier lens. The soft lens provides a smoother, more comfortable platform but may allow the RGP to slide if the soft lens fit or surface characteristics do not provide adequate stability. A steep soft lens would cause tightness rather than decentration. Accommodative spasm is unlikely in an established wearer. While deposits can reduce vision, they cause consistent blur rather than fluctuation.

About the NCLE Advanced Exam

The NCLE Advanced Certification (NCLE-AC) validates advanced-level knowledge and skills for contact lens technicians working with specialty lenses and patients with complex ocular conditions. Administered by ABO-NCLE, the NCLEAC outline names piggyback, custom soft, hybrid, scleral, and irregular-cornea lens designs, along with lens modifications and triage of acute contact lens complications.

Exam sponsor: ABO-NCLE (American Board of Opticianry & National Contact Lens Examiners). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

125 questions

Time Limit

3 hours

Passing Score

Scaled (criterion-referenced)

Exam / Certification Fees

$275

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Prefit, Preparation, and Evaluation

Complex ocular history documentation, specialty lens candidacy assessment, keratometry and topography interpretation, tear film evaluation, and patient needs analysis

30%

Design, Fit and Dispense Standard and Specialty Lenses

Lens material and design selection (e.g., piggyback, custom soft, hybrid, scleral, lenses for irregular cornea), diagnostic lens evaluation for the initial fit, and ordering specialty and customized lenses

15%

Patient Instruction and Delivery Procedures

Specialty lens insertion and removal training, scleral lens filling solutions, wear and care instructions, and follow-up scheduling

25%

Routine and Emergency Follow-up Visits

Evaluating complex lens fit and performance, lens modification strategies, compliance review, acute complication recognition, and triage protocols

Administrative Procedures

Contact lens environment safety, professional and ethical compliance, HIPAA and legal guidelines, patient record maintenance

Preparing for the NCLE Advanced Exam

What You Need to Know

Passing score: Scaled (criterion-referenced)
Exam length: 125 questions
Time limit: 3 hours
Exam / certification fees: $275 Official sources

Using Our Practice Resources

Work through all 130 available questions
Review every answer and explanation
Track weak areas and revisit them
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NCLE Advanced: Suggested Study Strategy

1Focus on lens selection and diagnostic fitting: tasks 2.1 and 2.2 (piggyback, custom soft, hybrid, scleral, and irregular-cornea designs) carry 25% of the exam

2Master the SOAP documentation method (Subjective, Objective, Assessment, Plan) for complex patient case management

3Study keratoconus grading scales, corneal topography maps, and how they guide specialty lens selection

4Know the differences between piggyback, hybrid, and scleral lens systems and when each is indicated

5Review orthokeratology lens design principles, patient selection criteria, and monitoring protocols

6Practice identifying acute contact lens complications and proper triage protocols — this carries 6% of the exam weight alone

Frequently Asked Questions

What is the NCLE Advanced (NCLE-AC) certification?

NCLE Advanced Certification (NCLE-AC or NCLEAC) is an advanced credential from the American Board of Opticianry & National Contact Lens Examiners (ABO-NCLE) for contact lens technicians. Its outline covers specialty lens care for patients with complex ocular conditions and names piggyback, custom soft, hybrid, scleral, and irregular-cornea lens designs. On November 1, 2026, ABO-NCLE's Advanced Exam page counted 195 current NCLE-AC holders.

What are the prerequisites for the NCLE Advanced exam?

You must hold an active basic NCLE certification (CLRE) and have completed at least one full 3-year recertification period. Alternatively, candidates with an opticianry degree can take the advanced exam any time after passing the basic NCLE exam. Some state licensing boards may have additional requirements.

How many questions are on the NCLE Advanced exam?

The NCLEAC exam contains 125 multiple-choice questions. A portion may not be scored and are pretested for future exams. You cannot identify which questions are pretest, so treat every question seriously. The exam covers 5 domains; the largest is Design, Fit and Dispense Standard and Specialty Lenses (30%), and Prefit, Preparation, and Evaluation and Routine and Emergency Follow-up Visits are 25% each.

What is the passing score for the NCLE Advanced exam?

The NCLEAC uses a criterion-referenced scaled scoring system rather than a fixed percentage. The passing score is determined through a psychometric standard-setting process. In 2024, the NCLE Advanced pass rate was 42.0% (ABO Advanced: 52.0%). Results are reported as soon as you finish, and an emailed exam report follows within a couple of hours.

What topics are covered on the NCLE Advanced exam?

The NCLEAC covers 5 domains: Prefit, Preparation, and Evaluation (25%), including patients with complex conditions; Design, Fit and Dispense Standard and Specialty Lenses (30%), with examples such as piggyback, custom soft, hybrid, scleral, and lenses for irregular cornea; Patient Instruction and Delivery Procedures (15%); Routine and Emergency Follow-up Visits (25%), including triage of acute complications; and Administrative Procedures (5%).

How much does the NCLE Advanced exam cost?

The NCLEAC exam registration fee is $275, which is non-refundable once payment is submitted. This covers one exam attempt at a Prometric testing center or via remote proctor. If you need to retake the exam, you must register and pay the full $275 fee again; you may retest 14 days after your exam date, and after a third unsuccessful retake you must wait 90 days.

How is the NCLE Advanced exam administered?

The NCLEAC is a computer-based exam administered at Prometric testing centers or via Prometric's ProProctor remote proctoring system. Testing windows are quarterly (January-March, April-June, July-September, October-December); registration closes on March 15, June 15, September 15 and November 15, with no late registration. If you are testing for a state license, confirm with your state board that a remotely proctored exam is accepted before you schedule one.

How long should I study for the NCLE Advanced exam?

ABO-NCLE publishes no study-time figure. Its Advanced Exam page notes that candidates with 2-3 years of hands-on experience or an optical school education have higher success rates, and the 2024 NCLE Advanced pass rate was 42.0%. Focus on the outline: specialty lens designs (piggyback, custom soft, hybrid, scleral, irregular cornea), patients with complex ocular conditions, lens modifications, and triage of acute complications.

What is the difference between NCLE Basic and NCLE Advanced?

The basic NCLE (CLRE) tests entry-level contact lens knowledge including standard soft and RGP fitting. The NCLE Advanced (NCLEAC) outline covers patients with complex ocular conditions and names piggyback, custom soft, hybrid, scleral, and irregular-cornea lens designs. It had a 42.0% pass rate in 2024 and requires NCLE certification held for one complete three-year renewal period (or an opticianry degree and a passed Basic exam).