CERTIFIED OPHTHALMIC TECHNICIAN
(COT) EXAM NEWEST 2026 ACTUAL
EXAM TEST BANK| CERTIFIED
OPHTHALMIC TECHNICIAN
CERTIFICATION EXAM WITH COMPLETE
450 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (BRAND NEW!!)
1. A patient presents with a best-corrected visual acuity of 20/200 in
the right eye using a Snellen chart at 20 feet. When tested at 10 feet,
the patient can read the 20/100 line. What is the correct method for
recording this acuity?
A. 10/100
B. 20/200
C. 20/400
D. 5/200
Rationale: The correct answer is C. 20/400. Visual acuity must always be
recorded as a Snellen fraction based on the standard testing distance of
20 feet. If a patient is moved closer to the chart to read larger letters, you
must convert the measurement. The formula is: (Testing Distance / Line
Read) x Denominator of Line Read. Here: (10 ft / 20 ft) x 200 = (0.5) x 200
= 400. Thus, the acuity is 20/400. Recording it as 10/100 is incorrect
,because it doesn't use the standard denominator. This tests your
knowledge of Visual Acuity Testing procedures and conversion.
2. When performing Goldmann applanation tonometry, the technician
sees a semicircular mire that is too wide. Which adjustment should be
made?
A. Increase the applanation force.
B. Decrease the applanation force.
C. Add more fluorescein dye.
D. Use a smaller mire setting.
Rationale: The correct answer is B. Decrease the applanation force. In
Goldmann tonometry, the ideal endpoint is when the inner edges of the
two semicircular fluorescein mires just touch (or slightly overlap). A mire
that is too wide indicates over-applanation (too much force is being
applied, flattening too large an area of the cornea). The technician should
gently dial back the force knob until the mires are of the correct size.
Adding more fluorescein (C) would make the mires brighter but not
change their width. This question tests core competency in Tonometry.
3. Which of the following findings during pupil assessment is MOST
suggestive of a relative afferent pupillary defect (RAPD)?
A. Both pupils are dilated and non-reactive to light.
B. Both pupils constrict consensually but not directly.
C. During the swinging flashlight test, the pupil dilates when light is swung
to it.
D. One pupil is noticeably smaller than the other in room light.
Rationale: The correct answer is C. During the swinging flashlight test,
the pupil dilates when light is swung to it. A RAPD (Marcus Gunn pupil) is
a sign of optic nerve or severe retinal disease. The key diagnostic
maneuver is the swinging flashlight test. In a normal eye, both pupils
constrict equally when light is shown directly. In an eye with an RAPD,
when light is swung from the normal eye to the affected eye, the affected
,pupil will paradoxically dilate because the perceived light stimulus is
weaker. Option A suggests pharmacological dilation or third nerve issues.
Option B describes an abnormal direct reflex. Option D describes simple
anisocoria. This tests knowledge of Pupil Assessment and neuro-
ophthalmic signs.
4. A technician is performing lensometry on a patient's spectacles. The
lensometer target is clear and focused when the power drums read:
Sphere +2.00, Cylinder -1.50, Axis 090. How should this prescription be
recorded in plus-cylinder form?
A. +2.00 -1.50 x 090
B. +0.50 +1.50 x 180
C. +3.50 -1.50 x 090
D. +0.50 -1.50 x 180
Rationale: The correct answer is B. +0.50 +1.50 x 180. This question
tests transposition skills, essential for Lensometry. The lensometer
initially reads in minus-cylinder form: +2.00 -1.50 x 090. To convert to
plus-cylinder form:
1. Algebraic Sum: Add the sphere and cylinder powers: +2.00 + (-1.50)
= +0.50 (New Sphere).
2. Change Cylinder Sign: Change the sign of the cylinder: -1.50
becomes +1.50 (New Cylinder).
3. Change Axis by 90°: 090° + 90° = 180° (New Axis).
Thus, the plus-cylinder form is +0.50 +1.50 x 180.
5. When administering topical ophthalmic medications, which
sequence is MOST appropriate for a patient who is to receive a gel, a
drop, and an ointment?
A. Ointment, gel, drop.
B. Drop, gel, ointment.
C. Gel, drop, ointment.
D. Drop, ointment, gel.
, Rationale: The correct answer is B. Drop, gel, ointment. The general rule
for instilling multiple ocular medications is: Least viscous (aqueous
drops) first, then more viscous (gels/suspensions), and ointments last.
This sequence allows each medication optimal contact time with the
ocular surface without being washed away or blocked by a thicker agent.
Wait at least 3-5 minutes between different medications. This tests
knowledge of Ocular Pharmacology and Administration.
6. During manual lensometry of a bifocal lens, the technician finds two
distinct optical centers with different powers. The more powerful
reading add is found by:
A. Focusing the target through the distance portion and noting the power.
B. Focusing the target through the near segment and noting the power.
C. Subtracting the distance sphere power from the near sphere power.
D. Adding the sphere and cylinder powers in the near segment.
Rationale: The correct answer is C. Subtracting the distance sphere
power from the near sphere power. A bifocal add power is the additional
plus power required for near vision, over and above the distance
correction. The lensometer allows you to measure the sphere power in the
distance portion (e.g., +1.00) and then in the near segment (e.g., +2.50).
The add power is the difference: +2.50 - (+1.00) = +1.50 Add. Simply
noting the near power (B) gives the total power, not the additive power.
This tests Advanced Lensometry for multifocals.
7. A patient is undergoing automated perimetry (visual field testing).
The technician should instruct the patient to:
A. Move their eyes to follow the blinking lights.
B. Blink normally whenever they feel the need.
C. Press the button whenever they see any light, including the central
fixation light.
(COT) EXAM NEWEST 2026 ACTUAL
EXAM TEST BANK| CERTIFIED
OPHTHALMIC TECHNICIAN
CERTIFICATION EXAM WITH COMPLETE
450 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (BRAND NEW!!)
1. A patient presents with a best-corrected visual acuity of 20/200 in
the right eye using a Snellen chart at 20 feet. When tested at 10 feet,
the patient can read the 20/100 line. What is the correct method for
recording this acuity?
A. 10/100
B. 20/200
C. 20/400
D. 5/200
Rationale: The correct answer is C. 20/400. Visual acuity must always be
recorded as a Snellen fraction based on the standard testing distance of
20 feet. If a patient is moved closer to the chart to read larger letters, you
must convert the measurement. The formula is: (Testing Distance / Line
Read) x Denominator of Line Read. Here: (10 ft / 20 ft) x 200 = (0.5) x 200
= 400. Thus, the acuity is 20/400. Recording it as 10/100 is incorrect
,because it doesn't use the standard denominator. This tests your
knowledge of Visual Acuity Testing procedures and conversion.
2. When performing Goldmann applanation tonometry, the technician
sees a semicircular mire that is too wide. Which adjustment should be
made?
A. Increase the applanation force.
B. Decrease the applanation force.
C. Add more fluorescein dye.
D. Use a smaller mire setting.
Rationale: The correct answer is B. Decrease the applanation force. In
Goldmann tonometry, the ideal endpoint is when the inner edges of the
two semicircular fluorescein mires just touch (or slightly overlap). A mire
that is too wide indicates over-applanation (too much force is being
applied, flattening too large an area of the cornea). The technician should
gently dial back the force knob until the mires are of the correct size.
Adding more fluorescein (C) would make the mires brighter but not
change their width. This question tests core competency in Tonometry.
3. Which of the following findings during pupil assessment is MOST
suggestive of a relative afferent pupillary defect (RAPD)?
A. Both pupils are dilated and non-reactive to light.
B. Both pupils constrict consensually but not directly.
C. During the swinging flashlight test, the pupil dilates when light is swung
to it.
D. One pupil is noticeably smaller than the other in room light.
Rationale: The correct answer is C. During the swinging flashlight test,
the pupil dilates when light is swung to it. A RAPD (Marcus Gunn pupil) is
a sign of optic nerve or severe retinal disease. The key diagnostic
maneuver is the swinging flashlight test. In a normal eye, both pupils
constrict equally when light is shown directly. In an eye with an RAPD,
when light is swung from the normal eye to the affected eye, the affected
,pupil will paradoxically dilate because the perceived light stimulus is
weaker. Option A suggests pharmacological dilation or third nerve issues.
Option B describes an abnormal direct reflex. Option D describes simple
anisocoria. This tests knowledge of Pupil Assessment and neuro-
ophthalmic signs.
4. A technician is performing lensometry on a patient's spectacles. The
lensometer target is clear and focused when the power drums read:
Sphere +2.00, Cylinder -1.50, Axis 090. How should this prescription be
recorded in plus-cylinder form?
A. +2.00 -1.50 x 090
B. +0.50 +1.50 x 180
C. +3.50 -1.50 x 090
D. +0.50 -1.50 x 180
Rationale: The correct answer is B. +0.50 +1.50 x 180. This question
tests transposition skills, essential for Lensometry. The lensometer
initially reads in minus-cylinder form: +2.00 -1.50 x 090. To convert to
plus-cylinder form:
1. Algebraic Sum: Add the sphere and cylinder powers: +2.00 + (-1.50)
= +0.50 (New Sphere).
2. Change Cylinder Sign: Change the sign of the cylinder: -1.50
becomes +1.50 (New Cylinder).
3. Change Axis by 90°: 090° + 90° = 180° (New Axis).
Thus, the plus-cylinder form is +0.50 +1.50 x 180.
5. When administering topical ophthalmic medications, which
sequence is MOST appropriate for a patient who is to receive a gel, a
drop, and an ointment?
A. Ointment, gel, drop.
B. Drop, gel, ointment.
C. Gel, drop, ointment.
D. Drop, ointment, gel.
, Rationale: The correct answer is B. Drop, gel, ointment. The general rule
for instilling multiple ocular medications is: Least viscous (aqueous
drops) first, then more viscous (gels/suspensions), and ointments last.
This sequence allows each medication optimal contact time with the
ocular surface without being washed away or blocked by a thicker agent.
Wait at least 3-5 minutes between different medications. This tests
knowledge of Ocular Pharmacology and Administration.
6. During manual lensometry of a bifocal lens, the technician finds two
distinct optical centers with different powers. The more powerful
reading add is found by:
A. Focusing the target through the distance portion and noting the power.
B. Focusing the target through the near segment and noting the power.
C. Subtracting the distance sphere power from the near sphere power.
D. Adding the sphere and cylinder powers in the near segment.
Rationale: The correct answer is C. Subtracting the distance sphere
power from the near sphere power. A bifocal add power is the additional
plus power required for near vision, over and above the distance
correction. The lensometer allows you to measure the sphere power in the
distance portion (e.g., +1.00) and then in the near segment (e.g., +2.50).
The add power is the difference: +2.50 - (+1.00) = +1.50 Add. Simply
noting the near power (B) gives the total power, not the additive power.
This tests Advanced Lensometry for multifocals.
7. A patient is undergoing automated perimetry (visual field testing).
The technician should instruct the patient to:
A. Move their eyes to follow the blinking lights.
B. Blink normally whenever they feel the need.
C. Press the button whenever they see any light, including the central
fixation light.
