Introduction to the ABO/NCLE Sight Testing Examination Program

The Sight Testing Examination, jointly developed and administered by the American Board of Opticianry and National Contact Lens Examiners, has been specifically designed to test the knowledge, skills and ability of ophthalmic personnel at an advanced level. The contents of this examination relate to the procedures used in determining refractive error and other ocular and vision anomalies. This examination was psychometrically developed for ophthalmic professionals who have had courses in refraction education or who are actively engaged in sight testing.
A panel of ophthalmic professionals including certified ophthalmic technicians, opticians, contact lens practitioners and others identified as having advanced sight-testing skills designed this examination. Additionally, Professional Examination Service (PES – the leading national health care related testing organization) was instrumental in the construction, and will administer the examination nationally.
The questions have been developed to test a candidate’s ability to recall knowledge and apply that knowledge to specific sight testing situations. Candidates should be well versed in the anatomy and physiology of the eye, therapeutic topical and systematic medications, diagnostic pharmaceuticals, pathology that may affect visual acuity, vision testing procedures, history taking, instrumentation, optics and methods of correction.
Potential certificants should refer to the examination content outline to identify specific topical areas covered in the examination.
While Sight Testing certification is a valuable advanced credential, it does not confer the legal permission to engage in these activities in any state or province. Rather, it is a confirmation of your advanced knowledge of the procedures used in vision testing and correction.

ELIGIBILITY REQUIREMENTS

• Graduates of a two-year optical program
• JCAHPO COTs and COMTs
  
• Graduates of OAA 100-Hour Refractometry Course
  
• Verification of at least 2,000 hours of sight testing related skills
  (submit original notarized affidavit from supervising O.D. or M.D employer

Sight Testing Content Outline

Case History 17%
Task:
Interview patient regarding chief complaint, visual demands and efficiency, family/health history
Document the case history
Refer patient if appropriate
Knowledge and Skills:
Knowledge of
Pharmacology regarding the effects on the eye and/or visual functioning; allergic reaction or
toxicity; method of delivery.
Systemic diseases that may affect the eye and/or visual function (e.g., diabetic retinopathy
cataract, glaucoma, and macular degeneration
Normal and abnormal anatomy and physiology of the eye (e.g., lens, chamber, vitreous, retina, disc, nerve, optic chiasma, visual cortex, visual pathway)
Ocular adnexa (e.g., eyelids, lacrimal system, orbit)
Patient education procedures
Procedures to maintain confidentiality
Legalities of documentation (e.g., using the patients’ own words)
Appropriate content of chart notes
Acceptable abbreviations used in medical charting
Skill in establishing professional relationship with patient
Preliminary / Initial Evaluation 17%
Task:
Observe patient for head posture, ptosis, ocular adnexa, and asymmetry
Measure visual acuity at distance and near, with and without correction
Observe papillary responses
Test
Ocular motility (including versions and vergences)
for stereopsis
for ocular alignment (phorias and tropias)
Conduct visual (confrontational) field test
Conduct color vision test
Determine whether or not visual acuity can be improved
Refer patient, if appropriate
Document the results of preliminary/initial evaluation
Knowledge and Skills:
Knowledge of:
Normal and abnormal cranial anatomy as it relates to the eye and/or visual function
Normal and abnormal ocular anatomy and physiology
Ocular pathology
Pharmacology regarding the effects on the eye and/or visual functioning; allergic
reaction or toxicity; method of delivery
Types of acuity testing for distance vision and for near vision
Types of papillary response tests
Stereopsis
Low vision
Strabismus
Types of ocular motility tests
Manual and automated visual field tests
Normal and abnormal limits of the visual field
Types of condensed and detailed versions of color testing (e.g., Ishihara D15,
Farnsworth)
Illumination requirements for acuity and color testing
Impact of patient’s age, health, visual status, medication, culture and occupational
needs on selection and administration of tests
Specific chart types and nomenclature
Procedures to maintain confidentiality
Procedures to document and record findings (e.g., using the patients’ own words)
Patient orientation, instruction and/or evaluation
Synthesizing results of preliminary/initial evaluation
Identifying course of action based on findings (e.g., refer vs. continue assessment)
Modifying procedures for patient needs

Refraction 40%
Task:
Perform autorefraction
Perform retinoscopy
Manually determine the refractive state of the eye and neutralize any existing refractive error (i.e.
retinoscopy)
Measure corneal curvature (e.g., keratometer, corneal topography)
Estimate visual acuity for patients with visual opacities (e.g., laser retinometry, potential visual
activity meter [PVAM, PAM])
Neutralize eyeglasses/contact lenses
Determine by subjective means the refractive state of the eye and the combination of spherical
and cylindrical and prismatic lenses needed or required to neutralize any existing refractive
error (e.g., phoropter, trial frame) at distance and near
Determine contrast sensitivity, brightness acuity testing
Refine cylinder power and axis (Jackson Cross Cylinder)
Verify refractive findings (e.g., duochrome, binocular balancing)
Evaluate the amount of accommodation
Balance phorias and tropias (by using dissociating prisms)
Record final measurements for refraction
Recheck visual acuity
Place trial frame with trial lenses on the patient’s face to determine the accuracy and acceptance
of the final phoropter findings
Document end results
Refer patient, if appropriate
Knowledge and Skills:
Knowledge of:
Operation of autorefractor
Patient orientation, instruction and/or education
Streak retinoscopy
Spot retinoscopy
Keratometer operation/readings (e.g., flat vs. steep vs. average; with the rules vs. against the
rule)
Corneal topography readings (e.g. astigmatism, irregularity)
Impact of visual opacities (e.g., cornea, lens, vitreous, retina)
Amblyopia, strabismus, anisometropia
Keratoconus and other pathologies which may affect acuity and/or refraction
Operation of lensometer to neutralize corrective lenses
Phoropter and components (e.g., polarized lens, red lens)
Ophthalmic lenses (e.g., spherical and cylindrical, axis settings)
Lenticular vs. residual astigmatism (e.g., simple, Compound, mixed)
Trial frame and lens usage
Jackson Cross Cylinder (plus and minus cylinder, cylinder axis, cylinder power)
Rotating cylinder axis
Duochrome test (e.g., red-green)
Binocular balancing (e.g., prism balancing, fogging)
Procedures to test accommodation (e.g., push-up method [Donder Table for
Age-Reference Accommodation], near point accommodation [NPA])
Procedures to calculate the range of clear vision
Procedures to test for phorias and tropias (e.g. cross cover tests, dissociation prisms, prism
rack/bar, Maddox rod)
Procedures to document and record findings
Impact of patient’s age, health, visual status, medication, culture and occupational needs on
selection and administration of tests
Modifying procedures for patient needs
Skill in:
Modifying procedures for patient needs
Synthesizing results to obtain MPMVA (e.g., maximum plus to maximum visual acuity)
Synthesizing results of objective, subjective, auxiliary and/or ancillary acuity
Identifying course of action based on findings (e.g., refer vs. continue assessment)

Ancillary Testing 9%
Task:
Evaluate corneal integrity using slit lamp
Detect anomalies through use of slit lamp (including estimating angle)
Determine tear quality and quantity - Schirmer
Measure intraocular pressure with and without contact tonometry
Detect central visual field distortions and defects using Amsler grid
Instill drops to dilate pupil and/or anesthetize the eye under the supervision of an O.D. or M.D.
Observe the anterior segment prior to dilation
Document results of findings
Refer patient, if appropriate
Knowledge and Skills:
Knowledge of:
Procedures to use slit lamp
Procedures to instill drops
Procedures to perform tonometry
Tear tests
Use of Amsler grid
Patient orientation, instruction and/or education
Procedures to document and record findings
Impact of patient’s age, health, visual status, medication, culture and occupational needs on
selection and administration of tests
Modifying procedures for patient needs

Instrumentation 17%
Task:
Use:
Lensometer to determine lens power
Autorefractor to estimate refractive error of the eye
Phoropter and/or trial lenses to measure the refractive status of the eye.
Retinoscope to measure refractive error of the eye objectively.
Keratometer to measure corneal curvature to determine if astigmatism exists.
Biomicroscrope (i.e., slit lamp) to observe the structures of the eye
Air puff to administer noncontact tonometry
Tonometer to perform contact tonometry (e.g., Titmus test, VA test)
Administer test to measure stereopsis (e.g., Titmus test, Landolt broken-ring test)
Knowledge and Skills:
Knowledge of:
Phoropter
Autorefractor
Tonometer
Trial frames and lenses
Lensometer
Keratometer/corneal topography
Slit lamp biomicroscope
Ophthalmoscope
Chart/projector for assessing visual acuity
Refracting rack (e.g., retinoscopy rack or lens rack)
Use of YAG/Argon laser
Use of fluoroscein angiography
Use of A-Scan and B-Scan
Use of pachometry
Potential visual acuity meter (PVAM, PAM)
Brightness visual acuity test (BVAT)
Contrast sensitivity testing
Patient orientation, instruction and/or education
Procedures to record and document findings
Skill in modifying procedures for patient needs

REGISTRATION AND FEE

The exam is three hours long, and there are 100 multiple-choice questions.
The registration fee is $150, payable to ABO/NCLE with a cashiers or company check, money order or Visa, MasterCard or American Express.
Contact ABO/NCLE at 800/296-1379 or 703/719-5800 for registration information, dates and other materials.