Certification Guide for Ophthalmic Technicians and Assistants

“So… are you a nurse? Are you studying to become a doctor? Did you go to school for this?” – The Typical Question to an Ophthalmic Technician

These are the standard questions I get on a daily basis from patients, and if you work in ophthalmology, I’m sure you do too.

I don’t blame them for being curious; ophthalmology is one of the few medical fields that requires almost a year of experience before you can even test for certification.

The levels of certification can be confusing, to the average person, they all sound roughly the same;

  • Assistant
  • Technician
  • Medical Technologist

Here are the differences between the various ophthalmic certifications:

Certified Ophthalmic Assistant (COA):

Becoming a COA is the first step in certification.

Most hospitals and medical groups will require that a technician has their COA, or sign paperwork saying they will obtain their COA within a year of employment.

Many optometric and ophthalmology private practice assistants defer becoming certified either because it is not a requirement of the job or they feel they know the skills. Therefore, the cost, both financially and sheer hours involved, of obtaining certification seems meaningless.

All certifications require you to recertify every three years, which consists of getting a doctor to recommend your certification, submitting Continuing Education Credits, and of course, paying JCAHPO a recertification fee.

By the way, The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO), was established as a not-for-profit organization in 1969 to offer certification and continuing education opportunities to ophthalmic allied health personnel. Currently, more than 25,000 people in the U.S., Canada, and around the world hold a JCAHPO certification. 

So then why Certify?

Despite the cost involved, anyone who has been practicing under an ophthalmologist for over a year should go through the steps to become certified.

Certified assistants make more money than non-certified (if this isn’t the case for you, please have a conversation with your office manager), and being able to prove you know your skills has value, both to your doctor and patients. Make your qualifications more than just, “I’ve been doing this a long time.”. People tend to like that.

A Certified Ophthalmic Assistant assist doctors in a variety of ways.

They take histories, evaluate chief complaints, administer ancillary tests, maintain equipment, and assist in minor procedures.

To pass the test, assistants will take a 200 question computerized multiple-choice test in which they will need to show a basic understanding of the anatomy of the eye and brain, basic pharmaceutical knowledge, and problem-solving skills.

Even assistants who have been working in ophthalmology for years should review the test format before taking the test, and do not rely on the advice of others in what the test includes, as there are multiple versions.

For example, when I took the test, I was told by multiple people that it was all about visual fields, really intense, in-depth requirements for understanding and interpreting. And maybe the test they got was, but mine was not. I was grossly underprepared (but I still passed!).


Certified Ophthalmic Technician (COT):

The next level in certification is a Certified Ophthalmic Technician.

The COT exam has two major parts, first, similar to the COA, there is a multiple choice exam consisting of 19 categories, after passing the exam, you then have up to 24 months to complete the skills portion of the certification.

Unlike the computerized exam, the Skills portion of the exam is hands-on, testing your knowledge of seven distinct categories. It’s daunting, but if you pass some, but fail others, you only need to retake the skills portions that you failed.

Acquiring your COT shows that you have an advanced knowledge of ophthalmic testing, and looks particularly good when applying for a job at a new office.

The majority of Certified Ophthalmic Assistants do not go on to become Certified Ophthalmic Technicians, but if you are looking at Ophthalmology as a career, then it is a surefire way to make yourself indispensable in any practice.

Certified Ophthalmic Medical Technologist (COMT):

Before I go into an explanation of what a Certified Ophthalmic Medical Technologist is, I feel it’s important to note that currently the test is only being administered at the JCAHPO headquarters in St. Paul, Minnesota. I am not entirely sure why, because it is a computer-based test, so, in theory, could be administered at any testing location.

Regardless of why they chose to keep the testing in St. Paul, the on-site testing lends itself to exclusivity and makes the COMT the most difficult to achieve for more reasons than just skill. Acquiring a COMT shows that you have the highest level of knowledge and dedication in your field.

Candidates for the COMT are required to have no less than three years working as a COT before taking the COMT Exam. The COMT exam is not it’s own exam, as much as it is a continuation of the COT exam I described earlier.

The additional portion of the exam is referred to as a Performance Test and consists of five sections. If you complete the Skills portion of the COT exam, they do not require you to repeat the for the COMT. Also similar to the COT exam, you are only required to retest on the areas of the Performance test that you failed.

Ophthalmic Surgical Assisting (OSA):

OSA is a sub-specialty that can be earned in conjunction with your certification. It is particularly useful for ophthalmic technicians who are most interested in assisting with in-office procedures and want to advertise their proven skills.

The OSA is a one-hour computerized exam consisting of 75 multiple choice questions, where technicians will be required to show their knowledge of instruments used during procedures, as well as the procedures themselves.

It is important to note that many ophthalmologists operate in hospitals, which require their surgical staff to, at a minimum, be a registered nurse, and so obtaining the OSA certification is most valuable for technicians who want to work in private practice.

The bottom line is to get certified.

Certified technicians certainly have a higher education level, and in my experience, tend to be much more dedicated the field of eyecare. The level of certification you strive for really depends on what you want to get out of your career.

There’s nothing wrong with obtaining the base-level COA certification and not pursuing beyond that level but it may limit how far you can go in ophthalmology. After all, some levels of certification take years to achieve, so if you’re new to the field, you have plenty of time to decide how far you want to go.

Let’s chat more in the comments. Feel free to ask questions and I can expand on this article!


About Kim Martel

Kim Martel
I'm a Certified Ophthalmic Assistant, comedian, and journalist at CovalentCareers!


  1. what’s the difference between an ophthalmic certified Medical Assistant (CMA) vs a certified ophthalmic assistant (COA)?

    • Kim Martel

      Hey! Good question. JCAHPO does not have a specific “ophthalmic medical assistant” delineation, so if you’re seeing that title in a job description, the employer is probably using the term “medical assistant” and “ophthalmic assistant” interchangeably. “Medical Assistant” is a separate, more generalized certification. Often, ophthalmic assistants will enter the field with a medical assistant certification, and then become more specialized after completing the required hours as an ophthalmic assistant. I hope that helps. -Kim

  2. I heard that I don’t need to go to school to become a “COA.” Is this the case? If so, what programs and what can I do I need to know?

    • Kimberly Martel
      Kimberly Martel

      Well it is true that you dont have to go to school to take the test, it does require experience. A COA requires training in an office, under supervision by an ophthalmologist, for a year prior to taking the test to become certified. I strongly recommend buying one of the many COA test books prior, so you have a complete scope of what you need to know.

  3. I am 53 years old and looking for a new profession. I am too old to pursue this field. I would like this to carry me through to retirement, mid 70’s.

    • Kimberly Martel
      Kimberly Martel

      I would encourage you to pursue ophthalmology, and here’s why: It only takes a year of training, so the time investment for someone starting a new career is pretty small. Secondly, for the most part, the patient demographic is older; the average age of patients at the office I work at is about 75, so you’re still young! Finally, its not a job that requires heavy lifting or lots of running around (I run sometimes, but it’s not required), so it ages well. Two of the best techs I’ve ever known were in their 70s.
      I hope that helps. Good luck!

      • Thank you so much for this post. 20 years ago I was a certified ophthalmic assistant and performed fluorescein angiographies for a very large practice. Then,Marriage and 4 children happened. Our youngest is now a senior in high school and I will be looking for work in this field again. Do you have any suggestions? I have a refresher book on assisting however , this may not be enough as technology has changed and even treatments have changed drastically since I was in the field. Looking to get my feet back in the work force but I will be competing with a younger tech savey crowd. Help!

        • Kimberly Martel
          Kimberly Martel

          Oh boy! First may I just say: welcome back! I suggest you go in with confidence and a sense of humor, and the rest will come with time. For everything that may have changed since you were in the field, a lot is the same. Much of our job is patient management, and patients have the same anxieties and issues they always have. The only difference is you may have more in common with a prebsyopic patient than you did as a 21-year-old, so use that to your advantage. Good luck in your pursuit, and dont be afraid to reach out for help.

  4. hey, i want to become an opthalmology and am very confused where to begin my career, if i take all the exams of coa, cot and comt, will i be able to become full ophthalmologist and how many years do all these three exmas take? Thanks

    • Antonio Chirumbolo

      To become an ophthalmologist – you will need to take on an undergraduate degree in some sort of concentration (science is the easiest way to meet all prerequisites) and then take the MCAT and apply to medical school. After you get through medical school, you can then apply for a residency in ophthalmology. It is a long hard road, best of luck!

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