COA Exam 2025 Outline: What Changed, the 3 Eligibility Routes and the Practice Exam

Written & reviewed by Quibank Editor · Last reviewed 2026-10-21 · Editorial standards

The Certified Ophthalmic Assistant exam is 200 multiple-choice questions in 180 minutes, and since August 1, 2025 it has been weighted toward the hands-on clinical workup rather than general knowledge. Under IJCAHPO's new content outline, general medical knowledge and patient services dropped from 14% of the exam each to 8% each, while history, pupils, tonometry and pharmacology all roughly doubled.

That matters because the handbook IJCAHPO still links from its COA page is the 2019 second edition, which carries the old weights, and so does much of the study material written against it. This article lays out what moved, what it means for how you spend study hours, and the eligibility, fee and timing rules that decide when and how cheaply you can sit the exam.

The August 2025 outline, against the 2019 one

Both outlines split the COA into 22 content areas. The 2019 handbook groups the clinical measurements (history, acuity, fields, pupils, tonometry, keratometry, motility, lensometry, refraction, biometry and supplemental testing) under Patient Evaluation, and those areas added up to 42% of the exam. In the outline effective 8/1/2025, the same areas add up to 56%. The biggest individual moves:

History and Documentation: 5% → 9%, now the single largest area.
Pupil Assessment: 3% → 7%.
Tonometry: 4% → 7%.
Pharmacology: 3% → 6%.
Visual Field Testing: 4% → 6%.
General Medical Knowledge: 14% → 8%.
Ophthalmic Patient Services and Education: 14% → 8%.
Imaging: the 2019 split of Ophthalmic Imaging 5% plus Photography and Videography 5% became Ophthalmic Imaging 5% plus a new Diagnostic Ultrasound line at 2%.

Several areas did not move at all: keratometry 2%, motility 4%, lensometry 3%, biometry 3%, supplemental testing 3%, optics 2%, contact lenses 2%, equipment maintenance 2% and ethics 4%. Microbiology slipped from 3% to 2% and surgical assisting from 4% to 3%.

Read the new list as a description of the job. An assistant who can take a clean history, run a swinging-flashlight test, get a trustworthy pressure reading and set up a field is now the person the exam is built around. The two broad knowledge areas still carry 16% between them, so they cannot be skipped, but together they now carry less than history, pupils and tonometry combined, at 23%.

How to re-plan your study hours

If your prep book or course tells you general medical knowledge and patient education are the two biggest blocks on the exam, it is quoting the 2019 weights. Check the edition date, and rebalance rather than throw it away: the content is still on the test, just at about half the share.

Spend the recovered time where the outline added it. History at 9% is not just a list of what to ask; it is documentation, so practise recording the ocular, medical, medication, social and family history in a form the physician can act on. Pupils at 7% includes the relative afferent pupillary defect, so know which eye a positive swinging-flashlight test points to, not just the steps. Tonometry at 7% covers the hand-held applanator, applanation tonometry and the non-contact tonometer, and IJCAHPO's detailed COA task list also names cleaning and disinfecting the tonometer. Pharmacology at 6% is, at COA level, drug delivery methods, the parts of a prescription, instilling drops and ointments correctly, and the indications and side effects of mydriatics and cycloplegics.

On Quibank, the Visual Acuity, Pupils & Motility and Tonometry, Visual Fields & Biometry pools cover most of the areas that grew, and the Pharmacology, Microbiology & Surgical Assisting pool covers the drug questions.

The passing score is confidential, and 10 questions do not count

IJCAHPO does not publish a COA pass mark. Its Procedures and Policies document says the passing score is set by the certification committee with a psychometrician using a modified Angoff method, that passing scores are confidential, and that the mark is neither a straight percentage nor a curve, so other candidates' results do not affect yours. Any specific cut score you see quoted online did not come from IJCAHPO. (IJCAHPO's COA page lists 200 questions and 180 minutes.)

The same document says each examination includes 10 unscored questions that may be used on future forms, and you will not know which ones they are. Its practical advice is blunt: answer every question. There is no reason to leave one blank, and a question that feels strangely unfamiliar may be one of the ten.

Which of the three eligibility routes you are on

IJCAHPO's COA page lists three categories, and each has its own clock:

COA-A1, clinical training program graduates: an ICA-accredited program at the Clinical Assistant level, with no work hours required. If you graduated more than 12 months before applying, you owe 18 IJCAHPO CE credits for each year since graduation, earned within the 36 months before you apply.
COA-A2, non-clinical training program graduates (distance learning included): the same 12-month and CE rule, plus 500 hours under the supervision of an ophthalmologist within the 12 months before you apply.
COA-A3, work experience: a high school diploma or equivalent, an approved independent study course (the JCAHPO Career Advancement Tool or the AAO Ophthalmic Medical Assisting course), and 1,000 hours under an ophthalmologist's supervision within the 12 months before you apply. If the course is more than 36 months old, you repeat it or add 18 CE credits for each year past that point.

Two details catch people. The hours on A2 and A3 are a rolling 12-month window, so a long gap between jobs can erase hours you already worked. And program students can apply up to two months before graduation, but IJCAHPO holds the result until it receives official notice that you graduated.

Why the $150 practice exam is the cheaper first attempt

IJCAHPO's fee schedule lists the standard COA exam at $300, a first retest at $250 and a second retest at $150. It also offers a COA Practice Examination to anyone who meets an eligibility route: $150 to sit it, and if you pass, another $150 within 30 days of your official results to receive the certificate. A failed practice exam is not counted as a formal attempt, and you then apply for the regular exam at the $300 initial fee within 12 months of the practice date.

Work through the cases from those published fees. Pass first time: $300 either way. Fail first, pass second: $300 plus $250, or $550, on the standard route, against $150 plus $300, or $450, through the practice exam. The catch is the deadlines: 30 days to pay for the certificate after a pass, and 12 months to sit the regular exam after a fail.

The clocks after you apply

Your confirmation letter opens a 90-day eligibility period to test at a Pearson VUE center. One 30-day extension is allowed, for $50, requested inside that period.
Rescheduling with Pearson VUE is free 30 or more business days out, $25 at 5 to 29 business days, and cancelling inside 5 business days counts as a no-show, which is $85.
If you fail, you have 12 months from your initial test date to submit two retest applications. Fail both and you wait until 12 months after the initial date, then reapply from scratch with full documentation and fees.
Once certified, the COA is valid for 36 months, and recertifying by CE takes 18 credits per cycle, at least 12 of them IJCAHPO credits.

The fastest way to find out whether you are ready is one run across every area at once. The full COA mock exam draws from all seven Quibank pools, so a weak area shows up in the breakdown rather than hiding behind a strong one.

Try the free COA practice test →