OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
OPHTHALMIC SURGICAL
ASSISTANT
ACTUAL EXAM 2026/2027
Questions and Answers | Expert-Level Certification Preparation
130 COMPREHENSIVE QUESTIONS
Covering All Major Certification Domains
EXAM DOMAIN DISTRIBUTION
Section 1: Intra-operative Assistance: 25% (33 Questions)
Section 2: Ocular Anatomy and Physiology: 20% (26 Questions)
Section 3: Pre-operative Procedures: 15% (19 Questions)
Section 4: Post-operative Care: 15% (20 Questions)
Section 5: Surgical Instrumentation: 15% (20 Questions)
Section 6: Sterile Technique & Infection Control: 10% (12 Questions)
Time Allowed: 3 Hours | Passing Score: 75% | Total Questions: 130
Expert-Level Certification Preparation | Page 1
,OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
SECTION 1: INTRA-OPERATIVE ASSISTANCE (Questions 1–33)
Phacoemulsification, Surgical Assistance, Intraoperative Complications & Advanced
Techniques
Q1. During phacoemulsification cataract surgery, the surgeon is about to perform capsulorhexis
and requests an instrument to create a continuous circular tear in the anterior capsule. Which
instrument should the surgical assistant pass?
A. Keratome
B. Cystotome or bent needle
C. Phaco handpiece
D. Lens loop
Correct Answer: B [CORRECT] Cystotome or bent needle is the correct instrument for capsulorhexis.
Rationale: Capsulorhexis requires a sharp, controlled instrument for anterior capsule tearing. Option B
(cystotome/bent needle) is specifically designed for this purpose. Option A (keratome) creates the corneal
entry incision — incorrect at this stage. Option C (phaco handpiece) is used for nucleus emulsification, not
capsule tearing. Option D (lens loop) is used in ECCE to deliver the nucleus, not during phaco capsulorhexis.
Q2. During phacoemulsification, the surgeon notes the anterior chamber suddenly shallows and
the pupil dilates unevenly. What is the MOST likely complication and the assistant's priority
action?
A. Posterior capsule rupture; prepare vitrectomy instrumentation
B. Expulsive hemorrhage; dim the room lights
C. Wound leak; apply pressure to the wound
D. Zonular dialysis; prepare a capsular tension ring
Correct Answer: D [CORRECT] Zonular dialysis; prepare a capsular tension ring
Rationale: Sudden anterior chamber shallowing with uneven pupil dilation during phaco is a classic sign of
zonular dialysis (weakened zonules). Option D is correct — a capsular tension ring (CTR) stabilizes the
capsular bag by distributing forces when zonules are compromised. Option A (posterior capsule rupture)
typically presents with sudden deepening of the chamber and vitreous prolapse. Option B (expulsive
hemorrhage) is a catastrophic choroidal bleed requiring wound closure. Option C (wound leak) would cause
AC shallowing but not uneven pupil dilation.
Q3. The surgeon requests a second instrument to facilitate nuclear rotation during divide-and-
conquer phacoemulsification. Which instrument is the assistant most likely to pass?
A. Sinskey hook or second instrument (Kuglen hook)
B. Capsulotomy scissors
C. McPherson forceps
D. Irrigating cannula
Correct Answer: A [CORRECT] Sinskey hook or Kuglen hook for nuclear rotation
Rationale: Nuclear rotation and manipulation during divide-and-conquer phacoemulsification requires a fine
hook instrument. Option A is correct — the Sinskey or Kuglen hook provides leverage for nuclear rotation
while the phaco tip is inserted. Option B (capsulotomy scissors) is used for anterior capsulotomy, not nuclear
manipulation. Option C (McPherson forceps) handles sutures and delicate tissues, not nuclear rotation.
Option D (irrigating cannula) maintains AC depth but is not used for nuclear rotation.
Expert-Level Certification Preparation | Page 2
,OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
Q4. During femtosecond laser-assisted cataract surgery (FLACS), the assistant is setting up the
patient interface. What is the primary purpose of the patient interface docking system?
A. To measure intraocular pressure during surgery
B. To couple the laser delivery system to the eye and maintain stable fixation
C. To provide irrigation during the laser phase
D. To dilate the pupil mechanically
Correct Answer: B [CORRECT] The patient interface couples the laser to the eye for stable fixation.
Rationale: FLACS requires precise laser delivery to the cornea and lens. Option B is correct — the patient
interface docks to the eye, immobilizes it, and creates a clear optical path for the femtosecond laser. Option A
is incorrect; IOP may rise with docking but measurement is not its purpose. Option C is incorrect; the laser
phase does not use irrigation. Option D is incorrect; pupil dilation is pharmacological, not mechanical via the
interface.
Q5. The surgeon is performing a trabeculectomy and requests a releasable suture technique.
Which suture material and configuration is most appropriate for the assistant to prepare?
A. 10-0 nylon in a slip-knot configuration for the scleral flap
B. 8-0 Vicryl in simple interrupted sutures
C. 6-0 polypropylene for wound closure
D. 9-0 nylon for corneal sutures
Correct Answer: A [CORRECT] 10-0 nylon in a slip-knot configuration for the scleral flap
Rationale: Releasable sutures in trabeculectomy allow post-operative adjustment of aqueous outflow. Option
A is correct — 10-0 nylon with a slip-knot on the scleral flap can be removed post-op to titrate filtration. Option
B (8-0 Vicryl) is absorbable and cannot be released selectively. Option C (6-0 polypropylene) is too heavy for
delicate scleral flap suturing. Option D (9-0 nylon for corneal sutures) is used in corneal surgery, not
trabeculectomy.
Q6. During pars plana vitrectomy, the surgeon calls for endophotocoagulation. What does the
assistant need to immediately prepare?
A. The endolaser probe and laser console settings
B. The phaco handpiece at low vacuum settings
C. A fresh viscoelastic cartridge
D. BSS Plus irrigation solution
Correct Answer: A [CORRECT] Endolaser probe and laser console settings for photocoagulation.
Rationale: Endophotocoagulation during vitrectomy treats retinal breaks, proliferative retinopathy, or
tamponade around breaks. Option A is correct — the assistant must prepare the endolaser probe and verify
the laser is set at appropriate power (typically 200–400 mW for retinal photocoagulation). Option B (phaco
handpiece) is used in anterior segment surgery. Option C (viscoelastic) is used in anterior segment and IOL
procedures. Option D (BSS) is always present but not the specific preparation needed for endolaser.
Q7. A patient undergoing MIGS (Minimally Invasive Glaucoma Surgery) iStent inject procedure
requires visualization of the trabecular meshwork. Which intraoperative positioning adjustment
is essential?
A. Tilt the microscope 30–45 degrees temporally and tilt the patient's head nasally
B. Position the patient in steep Trendelenburg
C. Rotate the patient 90 degrees to a lateral decubitus position
Expert-Level Certification Preparation | Page 3
, OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
D. Elevate the head of the bed to 45 degrees
Correct Answer: A [CORRECT] Tilt the microscope 30-45 degrees with nasal head tilt for trabecular
meshwork visualization.
Rationale: MIGS procedures requiring gonioscopic view of the trabecular meshwork need oblique
visualization. Option A is correct — the microscope is tilted 30–45° temporally and the patient's head is tilted
nasally to allow the surgeon a direct gonioscopic view of the angle. Option B (Trendelenburg) would worsen
IOP and is not used for angle surgery. Option C (lateral decubitus) is not standard for iStent procedures.
Option D (head elevation) does not provide the necessary angle view.
Q8. Immediately after IOL insertion during phacoemulsification, the surgeon requests removal
of ophthalmic viscosurgical device (OVD). What action should the assistant anticipate?
A. Pass the irrigation-aspiration handpiece and prepare BSS irrigation
B. Refill the anterior chamber with more OVD
C. Apply a pressure patch to the eye
D. Prepare the phaco handpiece at high vacuum
Correct Answer: A [CORRECT] Pass the I/A handpiece and prepare BSS to remove residual OVD.
Rationale: Retained OVD post-IOL insertion causes transient IOP spikes. Option A is correct — the
irrigation/aspiration (I/A) handpiece is used to remove OVD from behind and in front of the IOL using
balanced salt solution. Option B (adding more OVD) would worsen IOP problems. Option C (pressure patch)
is post-operative, not intraoperative. Option D (high-vacuum phaco) risks engaging and damaging the IOL.
Q9. During strabismus surgery, the surgeon is performing a recession of the medial rectus
muscle. The assistant notices the surgeon is using a muscle hook. What is the purpose of the
muscle hook at this stage?
A. To cut the muscle from its insertion
B. To isolate and expose the muscle belly away from surrounding tissue
C. To measure the recession distance on the sclera
D. To perform forced duction testing
Correct Answer: B [CORRECT] The muscle hook isolates the muscle belly from surrounding tissue.
Rationale: Recession surgery requires careful muscle isolation before any cutting or suturing. Option B is
correct — the muscle hook (e.g., Von Graefe or Stevens hook) passes behind the muscle to isolate it away
from surrounding connective tissue and Tenon's capsule. Option A (cutting) occurs after isolation, not during
hooking. Option C (measuring recession distance) uses calipers, not the muscle hook. Option D (forced
duction testing) uses a forceps at the limbus, not a muscle hook.
Q10. The surgeon is performing Descemet membrane endothelial keratoplasty (DMEK) and is
about to unfold the graft. Which instrument or technique should the assistant be prepared to
assist with?
A. Air injection through a paracentesis to float and unfold the graft
B. Suture the graft to the recipient cornea with 10-0 nylon
C. Apply topical mitomycin C to the graft bed
D. Pass a corneal trephine for final sizing
Correct Answer: A [CORRECT] Air injection to unfold the DMEK graft.
Rationale: DMEK grafts are extremely thin and scroll naturally. Option A is correct — filtered air or gas (SF6)
is injected through a paracentesis to unfold and attach the graft to the recipient Descemet bed. Option B
(sutures) is used in DALK and PKP, not DMEK, which is sutureless. Option C (mitomycin C) is used in
Expert-Level Certification Preparation | Page 4
OPHTHALMIC SURGICAL
ASSISTANT
ACTUAL EXAM 2026/2027
Questions and Answers | Expert-Level Certification Preparation
130 COMPREHENSIVE QUESTIONS
Covering All Major Certification Domains
EXAM DOMAIN DISTRIBUTION
Section 1: Intra-operative Assistance: 25% (33 Questions)
Section 2: Ocular Anatomy and Physiology: 20% (26 Questions)
Section 3: Pre-operative Procedures: 15% (19 Questions)
Section 4: Post-operative Care: 15% (20 Questions)
Section 5: Surgical Instrumentation: 15% (20 Questions)
Section 6: Sterile Technique & Infection Control: 10% (12 Questions)
Time Allowed: 3 Hours | Passing Score: 75% | Total Questions: 130
Expert-Level Certification Preparation | Page 1
,OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
SECTION 1: INTRA-OPERATIVE ASSISTANCE (Questions 1–33)
Phacoemulsification, Surgical Assistance, Intraoperative Complications & Advanced
Techniques
Q1. During phacoemulsification cataract surgery, the surgeon is about to perform capsulorhexis
and requests an instrument to create a continuous circular tear in the anterior capsule. Which
instrument should the surgical assistant pass?
A. Keratome
B. Cystotome or bent needle
C. Phaco handpiece
D. Lens loop
Correct Answer: B [CORRECT] Cystotome or bent needle is the correct instrument for capsulorhexis.
Rationale: Capsulorhexis requires a sharp, controlled instrument for anterior capsule tearing. Option B
(cystotome/bent needle) is specifically designed for this purpose. Option A (keratome) creates the corneal
entry incision — incorrect at this stage. Option C (phaco handpiece) is used for nucleus emulsification, not
capsule tearing. Option D (lens loop) is used in ECCE to deliver the nucleus, not during phaco capsulorhexis.
Q2. During phacoemulsification, the surgeon notes the anterior chamber suddenly shallows and
the pupil dilates unevenly. What is the MOST likely complication and the assistant's priority
action?
A. Posterior capsule rupture; prepare vitrectomy instrumentation
B. Expulsive hemorrhage; dim the room lights
C. Wound leak; apply pressure to the wound
D. Zonular dialysis; prepare a capsular tension ring
Correct Answer: D [CORRECT] Zonular dialysis; prepare a capsular tension ring
Rationale: Sudden anterior chamber shallowing with uneven pupil dilation during phaco is a classic sign of
zonular dialysis (weakened zonules). Option D is correct — a capsular tension ring (CTR) stabilizes the
capsular bag by distributing forces when zonules are compromised. Option A (posterior capsule rupture)
typically presents with sudden deepening of the chamber and vitreous prolapse. Option B (expulsive
hemorrhage) is a catastrophic choroidal bleed requiring wound closure. Option C (wound leak) would cause
AC shallowing but not uneven pupil dilation.
Q3. The surgeon requests a second instrument to facilitate nuclear rotation during divide-and-
conquer phacoemulsification. Which instrument is the assistant most likely to pass?
A. Sinskey hook or second instrument (Kuglen hook)
B. Capsulotomy scissors
C. McPherson forceps
D. Irrigating cannula
Correct Answer: A [CORRECT] Sinskey hook or Kuglen hook for nuclear rotation
Rationale: Nuclear rotation and manipulation during divide-and-conquer phacoemulsification requires a fine
hook instrument. Option A is correct — the Sinskey or Kuglen hook provides leverage for nuclear rotation
while the phaco tip is inserted. Option B (capsulotomy scissors) is used for anterior capsulotomy, not nuclear
manipulation. Option C (McPherson forceps) handles sutures and delicate tissues, not nuclear rotation.
Option D (irrigating cannula) maintains AC depth but is not used for nuclear rotation.
Expert-Level Certification Preparation | Page 2
,OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
Q4. During femtosecond laser-assisted cataract surgery (FLACS), the assistant is setting up the
patient interface. What is the primary purpose of the patient interface docking system?
A. To measure intraocular pressure during surgery
B. To couple the laser delivery system to the eye and maintain stable fixation
C. To provide irrigation during the laser phase
D. To dilate the pupil mechanically
Correct Answer: B [CORRECT] The patient interface couples the laser to the eye for stable fixation.
Rationale: FLACS requires precise laser delivery to the cornea and lens. Option B is correct — the patient
interface docks to the eye, immobilizes it, and creates a clear optical path for the femtosecond laser. Option A
is incorrect; IOP may rise with docking but measurement is not its purpose. Option C is incorrect; the laser
phase does not use irrigation. Option D is incorrect; pupil dilation is pharmacological, not mechanical via the
interface.
Q5. The surgeon is performing a trabeculectomy and requests a releasable suture technique.
Which suture material and configuration is most appropriate for the assistant to prepare?
A. 10-0 nylon in a slip-knot configuration for the scleral flap
B. 8-0 Vicryl in simple interrupted sutures
C. 6-0 polypropylene for wound closure
D. 9-0 nylon for corneal sutures
Correct Answer: A [CORRECT] 10-0 nylon in a slip-knot configuration for the scleral flap
Rationale: Releasable sutures in trabeculectomy allow post-operative adjustment of aqueous outflow. Option
A is correct — 10-0 nylon with a slip-knot on the scleral flap can be removed post-op to titrate filtration. Option
B (8-0 Vicryl) is absorbable and cannot be released selectively. Option C (6-0 polypropylene) is too heavy for
delicate scleral flap suturing. Option D (9-0 nylon for corneal sutures) is used in corneal surgery, not
trabeculectomy.
Q6. During pars plana vitrectomy, the surgeon calls for endophotocoagulation. What does the
assistant need to immediately prepare?
A. The endolaser probe and laser console settings
B. The phaco handpiece at low vacuum settings
C. A fresh viscoelastic cartridge
D. BSS Plus irrigation solution
Correct Answer: A [CORRECT] Endolaser probe and laser console settings for photocoagulation.
Rationale: Endophotocoagulation during vitrectomy treats retinal breaks, proliferative retinopathy, or
tamponade around breaks. Option A is correct — the assistant must prepare the endolaser probe and verify
the laser is set at appropriate power (typically 200–400 mW for retinal photocoagulation). Option B (phaco
handpiece) is used in anterior segment surgery. Option C (viscoelastic) is used in anterior segment and IOL
procedures. Option D (BSS) is always present but not the specific preparation needed for endolaser.
Q7. A patient undergoing MIGS (Minimally Invasive Glaucoma Surgery) iStent inject procedure
requires visualization of the trabecular meshwork. Which intraoperative positioning adjustment
is essential?
A. Tilt the microscope 30–45 degrees temporally and tilt the patient's head nasally
B. Position the patient in steep Trendelenburg
C. Rotate the patient 90 degrees to a lateral decubitus position
Expert-Level Certification Preparation | Page 3
, OPHTHALMIC SURGICAL ASSISTANT ACTUAL EXAM 2026/2027
D. Elevate the head of the bed to 45 degrees
Correct Answer: A [CORRECT] Tilt the microscope 30-45 degrees with nasal head tilt for trabecular
meshwork visualization.
Rationale: MIGS procedures requiring gonioscopic view of the trabecular meshwork need oblique
visualization. Option A is correct — the microscope is tilted 30–45° temporally and the patient's head is tilted
nasally to allow the surgeon a direct gonioscopic view of the angle. Option B (Trendelenburg) would worsen
IOP and is not used for angle surgery. Option C (lateral decubitus) is not standard for iStent procedures.
Option D (head elevation) does not provide the necessary angle view.
Q8. Immediately after IOL insertion during phacoemulsification, the surgeon requests removal
of ophthalmic viscosurgical device (OVD). What action should the assistant anticipate?
A. Pass the irrigation-aspiration handpiece and prepare BSS irrigation
B. Refill the anterior chamber with more OVD
C. Apply a pressure patch to the eye
D. Prepare the phaco handpiece at high vacuum
Correct Answer: A [CORRECT] Pass the I/A handpiece and prepare BSS to remove residual OVD.
Rationale: Retained OVD post-IOL insertion causes transient IOP spikes. Option A is correct — the
irrigation/aspiration (I/A) handpiece is used to remove OVD from behind and in front of the IOL using
balanced salt solution. Option B (adding more OVD) would worsen IOP problems. Option C (pressure patch)
is post-operative, not intraoperative. Option D (high-vacuum phaco) risks engaging and damaging the IOL.
Q9. During strabismus surgery, the surgeon is performing a recession of the medial rectus
muscle. The assistant notices the surgeon is using a muscle hook. What is the purpose of the
muscle hook at this stage?
A. To cut the muscle from its insertion
B. To isolate and expose the muscle belly away from surrounding tissue
C. To measure the recession distance on the sclera
D. To perform forced duction testing
Correct Answer: B [CORRECT] The muscle hook isolates the muscle belly from surrounding tissue.
Rationale: Recession surgery requires careful muscle isolation before any cutting or suturing. Option B is
correct — the muscle hook (e.g., Von Graefe or Stevens hook) passes behind the muscle to isolate it away
from surrounding connective tissue and Tenon's capsule. Option A (cutting) occurs after isolation, not during
hooking. Option C (measuring recession distance) uses calipers, not the muscle hook. Option D (forced
duction testing) uses a forceps at the limbus, not a muscle hook.
Q10. The surgeon is performing Descemet membrane endothelial keratoplasty (DMEK) and is
about to unfold the graft. Which instrument or technique should the assistant be prepared to
assist with?
A. Air injection through a paracentesis to float and unfold the graft
B. Suture the graft to the recipient cornea with 10-0 nylon
C. Apply topical mitomycin C to the graft bed
D. Pass a corneal trephine for final sizing
Correct Answer: A [CORRECT] Air injection to unfold the DMEK graft.
Rationale: DMEK grafts are extremely thin and scroll naturally. Option A is correct — filtered air or gas (SF6)
is injected through a paracentesis to unfold and attach the graft to the recipient Descemet bed. Option B
(sutures) is used in DALK and PKP, not DMEK, which is sutureless. Option C (mitomycin C) is used in
Expert-Level Certification Preparation | Page 4
