CERTIFIED OPHTHALMIC ASSISTANT
(COA) (Latest 2026/2027 Update)
Questions & Answers
,
, Section 1: History Taking & Documentation
1. When taking an ocular history, which of the following is considered a "red flag"
symptom requiring immediate ophthalmic attention?
A) Intermittent floaters for several years
B) Gradual blurring of vision over several months
C) Sudden onset of flashing lights and a curtain over vision
D) Mild foreign body sensation that resolves with blinking
Answer: C) Sudden onset of flashing lights and a curtain over vision
Sudden flashing lights accompanied by a "curtain" or shadow over vision are classic
symptoms of retinal detachment, a sight-threatening emergency requiring immediate
evaluation .
2. When documenting the chief complaint, which of the following is the most
comprehensive approach?
A) "Patient states their eyes are red."
B) "Patient states their vision is blurry."
C) "Patient states they have a headache."
D) Onset, duration, severity, and associated symptoms
Answer: D) Onset, duration, severity, and associated symptoms
A thorough chief complaint should be documented using the OLDCART mnemonic: Onset,
Location, Duration, Character, Aggravating/Alleviating factors, Radiation, and Timing .
3. A patient reports that their vision is "perfectly clear except when I try to read,
then everything is blurry." This history is most consistent with:
A) Myopia
B) Presbyopia
C) Astigmatism
D) Hyperopia
Answer: B) Presbyopia
Presbyopia is the age-related loss of accommodation that typically becomes symptomatic
around age 40, causing difficulty with near tasks .
4. Which of the following medications, when used systemically, is known to cause
ocular side effects that should be documented in the patient's history?
, A) Hydrochlorothiazide
B) Hydroxychloroquine (Plaquenil)
C) Lisinopril
D) Levothyroxine
Answer: B) Hydroxychloroquine (Plaquenil)
Hydroxychloroquine is known to cause retinal toxicity. It is an essential part of the
medication history to document its use for conditions like rheumatoid arthritis and lupus .
5. Which of the following is the most appropriate initial step when a patient
reports a sudden onset of new floaters?
A) Reassure the patient that this is a normal part of aging
B) Document the symptom and schedule a routine exam in 6 months
C) Escalate the finding to the ophthalmologist immediately
D) Advise the patient to take over-the-counter eye drops
Answer: C) Escalate the finding to the ophthalmologist immediately
New floaters, especially with flashes or a visual field defect, can indicate a posterior
vitreous detachment or retinal tear, requiring immediate dilated fundus examination .
👁️ Section 2: Ocular Anatomy & Physiology
6. The clear, avascular structure that provides two-thirds of the eye's refractive
power is the:
A) Lens
B) Cornea
C) Aqueous humor
D) Vitreous humor
Answer: B) Cornea
The cornea contributes approximately 43 diopters (about 2/3 of total refractive power).
The lens provides the remaining 1/3 and accommodates .
7. The optic disc is located approximately how many degrees nasal to the fovea?
A) 5 degrees
B) 10 degrees
(COA) (Latest 2026/2027 Update)
Questions & Answers
,
, Section 1: History Taking & Documentation
1. When taking an ocular history, which of the following is considered a "red flag"
symptom requiring immediate ophthalmic attention?
A) Intermittent floaters for several years
B) Gradual blurring of vision over several months
C) Sudden onset of flashing lights and a curtain over vision
D) Mild foreign body sensation that resolves with blinking
Answer: C) Sudden onset of flashing lights and a curtain over vision
Sudden flashing lights accompanied by a "curtain" or shadow over vision are classic
symptoms of retinal detachment, a sight-threatening emergency requiring immediate
evaluation .
2. When documenting the chief complaint, which of the following is the most
comprehensive approach?
A) "Patient states their eyes are red."
B) "Patient states their vision is blurry."
C) "Patient states they have a headache."
D) Onset, duration, severity, and associated symptoms
Answer: D) Onset, duration, severity, and associated symptoms
A thorough chief complaint should be documented using the OLDCART mnemonic: Onset,
Location, Duration, Character, Aggravating/Alleviating factors, Radiation, and Timing .
3. A patient reports that their vision is "perfectly clear except when I try to read,
then everything is blurry." This history is most consistent with:
A) Myopia
B) Presbyopia
C) Astigmatism
D) Hyperopia
Answer: B) Presbyopia
Presbyopia is the age-related loss of accommodation that typically becomes symptomatic
around age 40, causing difficulty with near tasks .
4. Which of the following medications, when used systemically, is known to cause
ocular side effects that should be documented in the patient's history?
, A) Hydrochlorothiazide
B) Hydroxychloroquine (Plaquenil)
C) Lisinopril
D) Levothyroxine
Answer: B) Hydroxychloroquine (Plaquenil)
Hydroxychloroquine is known to cause retinal toxicity. It is an essential part of the
medication history to document its use for conditions like rheumatoid arthritis and lupus .
5. Which of the following is the most appropriate initial step when a patient
reports a sudden onset of new floaters?
A) Reassure the patient that this is a normal part of aging
B) Document the symptom and schedule a routine exam in 6 months
C) Escalate the finding to the ophthalmologist immediately
D) Advise the patient to take over-the-counter eye drops
Answer: C) Escalate the finding to the ophthalmologist immediately
New floaters, especially with flashes or a visual field defect, can indicate a posterior
vitreous detachment or retinal tear, requiring immediate dilated fundus examination .
👁️ Section 2: Ocular Anatomy & Physiology
6. The clear, avascular structure that provides two-thirds of the eye's refractive
power is the:
A) Lens
B) Cornea
C) Aqueous humor
D) Vitreous humor
Answer: B) Cornea
The cornea contributes approximately 43 diopters (about 2/3 of total refractive power).
The lens provides the remaining 1/3 and accommodates .
7. The optic disc is located approximately how many degrees nasal to the fovea?
A) 5 degrees
B) 10 degrees
