Optometrist Prometric exam questions with answers

1. Question 1Anterior Segment Diseasemedium

   A soft contact lens wearer who sleeps in her lenses has a painful red eye, photophobia and a 3 mm white corneal infiltrate with an overlying epithelial defect and anterior chamber cells. What is the most appropriate action?

   1. ALubricants and review in one week
   2. BTopical steroid and antibiotic combination
   3. CSame-day referral for scraping and intensive antibiotics
   4. DResume lens wear with a new lens type
   Show answer and explanation▾

   Answer: C. Same-day referral for scraping and intensive antibiotics

   A central infiltrate with an epithelial defect and anterior chamber reaction in a contact lens wearer suggests microbial keratitis, often due to Pseudomonas. This needs same-day ophthalmology referral for corneal scraping and intensive topical antibiotics. Steroids before antibiotic control can worsen infection.

2. Question 2Binocular Vision and Orthopticshard

   At near, a patient has 6 prism dioptres esophoria. Through +1.00 DS added binocularly, the near phoria becomes 2 prism dioptres esophoria. What is the gradient AC/A ratio?

   1. A2 prism dioptres per dioptre
   2. B6 prism dioptres per dioptre
   3. C8 prism dioptres per dioptre
   4. D4 prism dioptres per dioptre
   Show answer and explanation▾

   Answer: D. 4 prism dioptres per dioptre

   The gradient AC/A ratio is the change in phoria divided by the change in lens power: (6 - 2) / 1.00 = 4 prism dioptres per dioptre. This is within the usual range. A high ratio suggests that a near addition will reduce near esophoria effectively.

3. Question 3Binocular Vision and Orthopticsmedium

   A 5-year-old has a refraction of +1.00 DS in the right eye and +4.50 DS in the left, with left visual acuity of 6/24 and no strabismus. What is the first step in management?

   1. AFull-time occlusion of the right eye immediately
   2. BAtropine to the left eye daily
   3. CObserve and recheck in a year
   4. DFull spectacle correction worn consistently
   Show answer and explanation▾

   Answer: D. Full spectacle correction worn consistently

   In anisometropic amblyopia, wearing full optical correction alone improves acuity substantially in many children over several weeks. Occlusion or atropine to the better eye is added if improvement stops. Atropine is placed in the better eye, not the amblyopic eye.

4. Question 4Contact Lensesmedium

   A monthly soft lens wearer has itching, mucus and lens decentration. Eversion of the upper lid shows papillae over 1 mm in diameter. What is the most appropriate management?

   1. AIncrease wearing time to adapt
   2. BSwitch to extended wear lenses
   3. CUse a thicker lens with a larger diameter
   4. DReduce wear and change to daily disposables
   Show answer and explanation▾

   Answer: D. Reduce wear and change to daily disposables

   Giant papillary conjunctivitis is a reaction to lens deposits and mechanical irritation. Reducing or stopping wear, then refitting with daily disposable lenses and treating with mast cell stabilisers, is effective. Extended wear and thicker lenses increase deposits and irritation.

5. Question 5Posterior Segment and Neuro-ophthalmologyeasy

   A 58-year-old myope reports new flashes and floaters in the left eye for 2 days and now a dark shadow rising from below. What is the correct referral urgency?

   1. ARoutine referral within 4 weeks
   2. BRecheck at the next annual visit
   3. CEmergency referral the same day
   4. DSoon referral within 2 weeks
   Show answer and explanation▾

   Answer: C. Emergency referral the same day

   Flashes and floaters followed by a field shadow suggest rhegmatogenous retinal detachment, which needs same-day emergency referral to preserve macular function. Delay risks macular involvement and permanent loss of central vision. Myopia increases the risk.

6. Question 6Glaucomamedium

   Optic disc assessment in a glaucoma suspect shows the neuroretinal rim is thinnest at the inferior pole. How does this relate to the ISNT rule?

   1. AIt breaks the rule, which suggests glaucoma
   2. BIt follows the rule, which is normal
   3. CThe rule only applies to small discs
   4. DThe rule only describes cup colour
   Show answer and explanation▾

   Answer: A. It breaks the rule, which suggests glaucoma

   In most healthy discs the rim is thickest inferiorly, then superiorly, nasally and thinnest temporally. A rim thinnest at the inferior pole breaks this pattern and suggests glaucomatous damage, which often affects the inferior and superior poles first. The rule describes rim width, not cup colour.

7. Question 7Refraction and Clinical Opticshard

   A 52-year-old emmetrope has an amplitude of accommodation of 2.00 D and wants to read at 40 cm. Keeping half of the amplitude in reserve, what reading addition is needed?

   1. A+1.00 DS
   2. B+2.00 DS
   3. C+1.50 DS
   4. D+2.50 DS
   Show answer and explanation▾

   Answer: C. +1.50 DS

   Reading at 40 cm needs 2.50 D of focus. Using half the amplitude (1.00 D) comfortably, the addition must supply 2.50 - 1.00 = +1.50 DS. Giving the full +2.50 would leave the near point too close and reduce the range of clear vision.

8. Question 8Refraction and Clinical Opticseasy

   A patient's refraction is -2.00 / -1.50 x 180. What is the spherical equivalent?

   1. A-3.50 DS
   2. B-2.00 DS
   3. C-1.25 DS
   4. D-2.75 DS
   Show answer and explanation▾

   Answer: D. -2.75 DS

   The spherical equivalent is the sphere plus half the cylinder: -2.00 + (-0.75) = -2.75 DS. It places the circle of least confusion on the retina. Adding the whole cylinder (-3.50) is a common error.

9. Question 9Ocular Anatomy, Physiology and Pharmacologymedium

   A patient using topical dexamethasone four times daily for 4 weeks after a corneal problem is found to have an IOP of 32 mmHg, compared with 16 mmHg before. What is the most likely cause?

   1. AAcute angle closure from mydriasis
   2. BSteroid response reducing outflow
   3. CMeasurement error from corneal oedema
   4. DPupillary block from posterior synechiae
   Show answer and explanation▾

   Answer: B. Steroid response reducing outflow

   Corticosteroids can reduce trabecular outflow and raise IOP in susceptible people, usually after a few weeks of use. Patients on topical steroids need IOP monitoring, and the steroid should be reviewed by the prescriber. Corneal oedema tends to cause underestimation rather than such a rise.

10. Question 10Paediatric Optometry and Low Visionmedium

    Parents of an 8-year-old whose myopia increased by -0.75 D in the past year ask how to slow progression. Which option has good evidence of benefit?

    1. ADeliberate undercorrection of the myopia
    2. BLow-dose atropine eye drops
    3. CPinhole spectacles for near work
    4. DDaily eye movement exercises
    Show answer and explanation▾

    Answer: B. Low-dose atropine eye drops

    Low-dose atropine has been shown in randomised trials to slow myopia progression, as have myopia control spectacle lenses, soft multifocal lenses and orthokeratology. Undercorrection does not slow progression and may speed it. Time outdoors also helps reduce onset.

11. Question 11Posterior Segment and Neuro-ophthalmologymedium

    A 74-year-old has sudden painless loss of vision in the right eye to hand movements. The retina is pale with a cherry-red spot at the macula. Besides urgent referral, which question is most important to ask?

    1. ARecent history of eye rubbing
    2. BUse of contact lenses overnight
    3. CFamily history of glaucoma
    4. DJaw claudication and scalp tenderness
    Show answer and explanation▾

    Answer: D. Jaw claudication and scalp tenderness

    A pale retina with a cherry-red spot indicates central retinal artery occlusion. In patients over about 50, giant cell arteritis must be considered, so symptoms such as jaw claudication, scalp tenderness and malaise must be asked about, as urgent steroids protect the other eye. Patients also need urgent stroke assessment.

12. Question 12Posterior Segment and Neuro-ophthalmologymedium

    A 76-year-old reports that straight lines in door frames have looked wavy in the right eye for 1 week. Acuity has fallen from 6/9 to 6/18, and there is a small macular haemorrhage. What is the most appropriate action?

    1. ARoutine referral and AREDS supplements
    2. BAdvise an Amsler grid check in 6 months
    3. CUpdate spectacles and review in a year
    4. DFast-track referral for possible anti-VEGF treatment
    Show answer and explanation▾

    Answer: D. Fast-track referral for possible anti-VEGF treatment

    New distortion, reduced acuity and macular haemorrhage suggest neovascular AMD, which needs rapid referral because outcomes with anti-VEGF injections are better when treatment starts early. Supplements are for intermediate dry AMD, not active neovascular disease. Delaying referral risks permanent scarring.

13. Question 13Professional Practice, Ethics and Infection Controlmedium

    A patient with suspected adenoviral conjunctivitis needs contact tonometry. What is the best way to prevent cross-infection?

    1. AWipe the prism with a dry tissue
    2. BRinse the prism under tap water
    3. CUse a single-use disposable prism
    4. DSoak the prism in saline for 1 minute
    Show answer and explanation▾

    Answer: C. Use a single-use disposable prism

    Adenovirus is highly contagious and survives on surfaces, so single-use disposable tonometer prisms or covers are the safest option. Dry wiping and water rinsing do not reliably remove the virus. Hand hygiene and surface disinfection after the visit are also needed.

14. Question 14Professional Practice, Ethics and Infection Controlmedium

    A patient with advanced glaucoma has a binocular field defect that falls below the driving standard. He says he will keep driving. What is the most appropriate first step?

    1. ATell his employer immediately
    2. BInform the police without telling him
    3. CDo nothing because of confidentiality
    4. DAdvise him to stop driving and record the advice
    Show answer and explanation▾

    Answer: D. Advise him to stop driving and record the advice

    The practitioner must explain that he does not meet the standard, advise him to stop driving and to inform the licensing authority, and document this. If he continues to drive and puts others at risk, disclosure to the authority may then be justified in the public interest, after telling him. Contacting his employer is not appropriate.

15. Question 15Refraction and Clinical Opticsmedium

    During subjective refraction of a myopic adult, letters on the red side of the duochrome chart look clearer than those on the green side. What change should be made?

    1. AAdd -0.25 DS
    2. BAdd +0.25 DS
    3. CChange the cylinder axis by 10 degrees
    4. DReduce the cylinder by -0.25 DC
    Show answer and explanation▾

    Answer: A. Add -0.25 DS

    Red light focuses further back than green, so if red is clearer the image lies in front of the retina and the eye is under-corrected for myopia. Adding -0.25 DS moves the focus back until both sides look equal. The duochrome tests the sphere, not the cylinder.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.