Certified Ophthalmic Technician (COT) Exam: Everything You Need to Know

Table of Contents

Certification Requirements

Before Taking the Test

The Written Exam

The COT Skills Evaluation

Eye Tech Training's COT Exam Prep Course

Up-to-date as of August 2018 * 


Hi there and welcome! My name is Sharon Alamalhodaei and in this article I will introduce you to the basics of the certification process for Certified Ophthalmic Technician (COT). This is the next level of certification for ophthalmic techs after Certified Ophthalmic Assistant (COA). I wrote a similar introductory article for the COA certification, which you can find here or in the sidebar. If you’re new to the profession, it might be best to start there. This post covers the ins-and-outs of the COT exam, including information about the upcoming exam changes that will come into effect on August 1, 2018. 

Many techs who become COAs do not go on to take the COT exam. But that just makes the COT certification even more prestigious, and the group of people who pass even more elite.

You’ve probably heard about Eye Tech Training’s live and online COA exam prep courses, which include a COT study guide and a COT practice test. If you’re ready to start studying for the exam, click on the image below. Otherwise, keep reading to learn about taking and passing the COT exam!

Certification Requirements

The COA exam and the COT exam are similar in many ways. For starters, both the COA exam and the COT exam are administered by JCAHPO (Joint Commission on Allied Health Personnel in Ophthalmology). Both exams require a high school diploma or its equivalent. Both exams include a written component. Both require an application, signed by an ophthalmologist to confirm that you’ve met the prerequisites. And with both, you become eligible for the exam either through graduating from an accredited college or via working on the job. But there are many key differences. The COT certification is a significant step up both in your career and in the level of skills you are expected to possess, so the examination content is also more advanced. Find more specific information from JCAHPO here. You can also contact them at 800-284-3937.

Unless you received a degree from an accredited college or institution, you must have been working as a COA for 2,000 hours, or one full year of full-time work within 24 months of submitting your application. If you’re interested in an accredited program, rather than on the job experience, you can find a link of qualifying programs here, on the International Council of Accreditation website. According to JCAHPO’s comprehensive “Certification and Recertification” PDF document, you also need 12 hours of JCAHPO credits. You can earn these in a number of ways. For instance, my online COT exam prep course includes 8 JCAHPO Group A credits.

Before Taking the Test

Again, this process is very similar to the COA exam. Before taking the exam, you must submit your Application for Examination. This is something that everyone must do and it must be signed by a sponsoring ophthalmologist. In addition, you must pay $325. For the skills evaluation portion of the exam, if you pay $85 you are allowed to take a practice test. 

If you do not pass the skills examination, you will be sent a retest application along with your results. For a short period of time after receiving the results, you can retest for a discounted price.

The Written Exam

This is the first stage of the exam and you will not be allowed to take the COT skills evaluation if you don’t pass. If you’ve taken the COA exam, you’ll find this portion of the test familiar. For example, all the questions are multiple-choice and like the COA exam, you will have three hours to complete the test.


The content areas covered by the questions is the same, but the proportion of questions about each area differs between tests. For example, while the content area "Ophthalmic Patient Services and Education” accounts for 16% of questions on the COA exam, this section only comprises 7% of the COT exam questions. On the other hand, “Ophthalmic Imaging” comprises 3% of the questions in the COA, but 7% in the COT. These changes are important and will help determine how you study, so be sure to check them out in detail. Refer to page 10 of JCAHPO’s “Certification and Recertification” PDF document for full information.

The 2018 exam includes two new sub-content sections: Communications Skills and Administrative Duties. You can find a full description of the content areas on page 15 of their PDF document “Certification and Recertification,” which is published by JCAHPO and is fully up-to-date. This is also where you will find the application to take the exam.

The COT Skills Evaluation

The skills evaluation is conducted on a computer. According to the “Certification and Recertification” document, It covers the following areas:

  • “Lensometry – Demonstrate the ability to perform non-automated lensometry to determine the strength of the distance correction and the bifocal or trifocal add. The task may be perform in plus (+) or minus (-) cylinder.  

  • Visual Fields – Demonstrate the ability to perform an automated visual field on a specified automated visual field test as determined by JCAHPO.  

  • Ocular Motility – Demonstrate the ability to detect a phoria or tropia, and identify the direction of the deviation using appropriate cover tests.  

  • Keratometry – Demonstrate the ability to perform keratometry.  

  • Retinoscopy – Demonstrate the ability to perform retinoscopy. The task may be performed in plus(+) or minus (-) cylinder.  

  • Refinement – Demonstrate the ability to perform refinement. The task may be performed in plus(+) or minus (-) cylinder.  

  • Tonometry – Demonstrate the ability to perform applanation tonometry.”

This section of the exam takes 2 hours. Each skill is measured according to "accuracy of results" and "technique." Further more, this part of the examination is measured on a pass/conditional/fail system - meaning that you will receive a mark of either “satisfactory” or “non-satisfactory” for each skill. You MUST pass all seven skills in order to pass the exam as a whole. If you receive a "conditional" result, this means that you only passed some of the sections, but not all. Luckily, a "conditional" result lets you retest the portions of the exam that you failed, without having to retest the skills exam as a whole.

If you feel unsure about this portion of the test, have no fear. Skills test tutoring is included for my COT exam prep course students and for those who have not taken my COT exam prep course, I offer COT skills tutoring for a nominal charge. The tutoring is conducted over phone, email, or Skype, the benefit being that it is completely customizable to you. You lead the discussion.  

CLick here to purchase Skills Test Tutoring

Eye Tech Training's COT Exam Prep Course

The most comprehensive resource available to you is Eye Tech Training's COT exam prep course. Eye Tech Training offers both live and online COT exam prep courses. If we're not coming to your city anytime soon, you have the option of purchasing the online course.

Watch the video below for a FREE sneak peek into my online COT course. 

You'll join thousands (yes, thousands) of other techs who have taken the Eye Tech Training prep course... and passed.

Click here for more information about Eye Tech Training's COA Exam Prep Course and How to Buy

I hope this guide has helped and inspired you. Although the COT exam can seem quite daunting, anyone with enough grit and determination can pass it. Including you. Now get out there and get after it!