California Optometrist Licensing Practice Exam
Questions And Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
1. A 25-year-old emmetrope complains of sudden onset of floaters and a
curtain over the visual field in one eye. The most likely diagnosis is:
A. Central retinal artery occlusion
B. Optic neuritis
C. Retinal detachment
D. Acute macular degeneration
Rationale: Floaters with a “curtain” or shadow are classic for
rhegmatogenous retinal detachment; prompt retinal evaluation is
required.
2. The near point of convergence (NPC) is abnormal when it is:
A. 5 cm in a 20-year-old
B. 10 cm in a 60-year-old
C. 10 cm in a 20-year-old
D. 2 cm in a 10-year-old
Rationale: NPC ~6 cm or less is normal for young adults; 10 cm in a 20-
year-old suggests convergence insufficiency.
3. Which lens power changes the focal length most significantly per diopter?
A. +1.00 D to +2.00 D change at the spectacle plane
B. Higher power lenses produce larger image magnification changes per
diopter
C. Low power lenses have greater effect per diopter
D. Diopter change effect is identical across powers
Rationale: Effect on effective power and magnification depends on base
power — changes in higher power lenses produce larger optical effects at
the spectacle plane.
4. First-line topical agent to lower IOP in open-angle glaucoma with few
systemic side effects:
, A. Oral acetazolamide
B. Pilocarpine
C. Topical prostaglandin analog (e.g., latanoprost)
D. Topical beta-blocker (timolol)
Rationale: Prostaglandin analogs are first-line for OAG because they are
effective once daily with minimal systemic effects.
5. Amblyopia is best treated by:
A. Refractive surgery in adulthood
B. Correct refractive error and occlusion therapy during childhood
C. Reading glasses only
D. Pharmacologic miotics
Rationale: Early correction of refractive error and patching (occlusion) of
the better eye during the critical period is most effective.
6. The most common cause of bacterial keratitis in contact lens wearers is:
A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Moraxella species
Rationale: Pseudomonas is highly associated with contact lens-related
corneal infections and can be aggressive.
7. A relative afferent pupillary defect (RAPD) indicates:
A. Optic nerve or extensive retinal disease in one eye
B. Cerebral cortex lesion
C. Asymmetric optic nerve or severe retinal pathology
D. Normal variant
Rationale: RAPD (Marcus Gunn pupil) reflects decreased afferent input
from one eye due to optic nerve/retinal disease.
8. The Holladay formula is used to:
A. Calculate spectacle prescription
B. Predict IOL power after cataract extraction
C. Determine glaucoma risk
D. Measure corneal thickness
, Rationale: Holladay and other formulas estimate intraocular lens (IOL)
power for cataract surgery.
9. In diabetic retinopathy, the earliest microvascular change seen on fundus
exam is:
A. Neovascularization
B. Microaneurysms
C. Cotton-wool spots
D. Macular edema
Rationale: Microaneurysms are among the earliest ophthalmoscopic signs
of nonproliferative DR.
10.The Hering-Breuer reflex primarily affects:
A. Pupil size
B. Tear production
C. Respiratory rate (not directly ocular — distractor)
D. Accommodation
Rationale: Hering-Breuer is a respiratory reflex — included to test
recognition of non-ocular physiology.
11.A positive Seidel test after cataract surgery indicates:
A. Endophthalmitis
B. Wound leak (aqueous leakage)
C. Elevated IOP
D. Posterior capsule rupture
Rationale: Seidel tests for aqueous leakage from the globe surface using
fluorescein dye.
12.The Goldmann applanation tonometer measures IOP by:
A. Indentation of cornea
B. Measuring corneal thickness
C. Applanating (flattening) a known area of cornea and measuring force
D. Transpalpebral pressure sensing
Rationale: Goldmann uses force required to flatten a 3.06 mm diameter
corneal area; influenced by corneal thickness.
13.Which Vitamin deficiency is linked to night blindness and xerosis?
A. Vitamin C
Questions And Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
1. A 25-year-old emmetrope complains of sudden onset of floaters and a
curtain over the visual field in one eye. The most likely diagnosis is:
A. Central retinal artery occlusion
B. Optic neuritis
C. Retinal detachment
D. Acute macular degeneration
Rationale: Floaters with a “curtain” or shadow are classic for
rhegmatogenous retinal detachment; prompt retinal evaluation is
required.
2. The near point of convergence (NPC) is abnormal when it is:
A. 5 cm in a 20-year-old
B. 10 cm in a 60-year-old
C. 10 cm in a 20-year-old
D. 2 cm in a 10-year-old
Rationale: NPC ~6 cm or less is normal for young adults; 10 cm in a 20-
year-old suggests convergence insufficiency.
3. Which lens power changes the focal length most significantly per diopter?
A. +1.00 D to +2.00 D change at the spectacle plane
B. Higher power lenses produce larger image magnification changes per
diopter
C. Low power lenses have greater effect per diopter
D. Diopter change effect is identical across powers
Rationale: Effect on effective power and magnification depends on base
power — changes in higher power lenses produce larger optical effects at
the spectacle plane.
4. First-line topical agent to lower IOP in open-angle glaucoma with few
systemic side effects:
, A. Oral acetazolamide
B. Pilocarpine
C. Topical prostaglandin analog (e.g., latanoprost)
D. Topical beta-blocker (timolol)
Rationale: Prostaglandin analogs are first-line for OAG because they are
effective once daily with minimal systemic effects.
5. Amblyopia is best treated by:
A. Refractive surgery in adulthood
B. Correct refractive error and occlusion therapy during childhood
C. Reading glasses only
D. Pharmacologic miotics
Rationale: Early correction of refractive error and patching (occlusion) of
the better eye during the critical period is most effective.
6. The most common cause of bacterial keratitis in contact lens wearers is:
A. Streptococcus pneumoniae
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Moraxella species
Rationale: Pseudomonas is highly associated with contact lens-related
corneal infections and can be aggressive.
7. A relative afferent pupillary defect (RAPD) indicates:
A. Optic nerve or extensive retinal disease in one eye
B. Cerebral cortex lesion
C. Asymmetric optic nerve or severe retinal pathology
D. Normal variant
Rationale: RAPD (Marcus Gunn pupil) reflects decreased afferent input
from one eye due to optic nerve/retinal disease.
8. The Holladay formula is used to:
A. Calculate spectacle prescription
B. Predict IOL power after cataract extraction
C. Determine glaucoma risk
D. Measure corneal thickness
, Rationale: Holladay and other formulas estimate intraocular lens (IOL)
power for cataract surgery.
9. In diabetic retinopathy, the earliest microvascular change seen on fundus
exam is:
A. Neovascularization
B. Microaneurysms
C. Cotton-wool spots
D. Macular edema
Rationale: Microaneurysms are among the earliest ophthalmoscopic signs
of nonproliferative DR.
10.The Hering-Breuer reflex primarily affects:
A. Pupil size
B. Tear production
C. Respiratory rate (not directly ocular — distractor)
D. Accommodation
Rationale: Hering-Breuer is a respiratory reflex — included to test
recognition of non-ocular physiology.
11.A positive Seidel test after cataract surgery indicates:
A. Endophthalmitis
B. Wound leak (aqueous leakage)
C. Elevated IOP
D. Posterior capsule rupture
Rationale: Seidel tests for aqueous leakage from the globe surface using
fluorescein dye.
12.The Goldmann applanation tonometer measures IOP by:
A. Indentation of cornea
B. Measuring corneal thickness
C. Applanating (flattening) a known area of cornea and measuring force
D. Transpalpebral pressure sensing
Rationale: Goldmann uses force required to flatten a 3.06 mm diameter
corneal area; influenced by corneal thickness.
13.Which Vitamin deficiency is linked to night blindness and xerosis?
A. Vitamin C
