COA, COT, and COMT Certification

JCAHPO (Joint Commission on Allied Health Personnel in Ophthalmology) first came into existence in 1969 as a means of providing continuing education for allied health professionals. That led to the development of various certifications for ophthalmic assistants and technicians. This has become a recognized organization providing industry standards of excellence in both the United States and Canada.

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Certification Exam Requirements

There are different levels of certification for those seeking out a career in ophthalmology. Those certifications must be earned incrementally. They also require a passing score on the respective exams administered by the JCAHPO. Here is a look at what is required to take each of the following certification exams.

Certified Ophthalmic Assistant (COA)

Those looking to take the COA examination do not need any prior work experience in the field of ophthalmology. Test takers do not need any previous education, but must pass an accredited training program offered through the International Council of Accreditation. There are three different levels of COA certification and that depends upon an individual’s work history. For example, to be considered a COA-A2, there is a 500-hour work requirement, in addition to the previous requirements. The third level (COA-A3) requires 1,000 hours of work experience along with the completion of an independent study course.

Certified Ophthalmic Technician (COT)

No work experience is required to take the COT certification exam. There is no college or high school education required. However, eligibility for this test requires the completion of an accredited training program through the International Council of Accreditation. There are three more levels of certifications.

  • COT-T2: The accumulation of 2,000 work hours while holding a COA certification.
  • COT-T3: The accumulation of 2,000 more work hours while holding a COA certification.
  • COT-T4: The accumulation of 6,000 work hours while holding a COA certification. 

Certified Ophthalmic Medical Technician (COMT)

Those looking to take beginning COMT examination to do not need any prior work experience in the field of ophthalmology. This exam is known as the COMT certification exam. However, there is an education requirement. Test takers must have completed two years (minimum of 60 credits) of post-secondary school as well as an accredited training program through the International Council of Accreditation. Here is a look at the levels of COMT certifications that accompany a passing score on the certification exam:

  • COMT-TG2: 4,000 hours of work under an ophthalmologist’s supervision.
  • COMT-TG3: 6,000 hours of work as a COT.
  • COMT-TG4: 4,000 hours of work with a certification.
  • COMT-TG5: 3,000 hours of work as a COT and 6,000 non-certified work hours.

Exam Structure

The structure of each of these exams are slightly different in that the COA variety does not include a skills portion. Each exam takes three hours to complete and the COA and COT are made up of 200 questions while the COMT exam features 190 questions. Each exam is divided up into the following categories:

  • Assisting with Interventions and Procedures
  • Corrective Lenses
  • Imaging
  • Office and Clinical Skills

Skill Areas

The COT examination has a skill evaluation portion that requires test takers to demonstrate their abilities in various areas. This portion includes visual field tests, lensometry, the ability to detect a phoria through cover tests, keratometry, retinoscopy, tonometry and refinement. 

The COMT has a similar portion in its certification exam that requires test takers to show their ability to conduct cover and prism tests. It also tests their ability to perform manual lensometry and fundus photography. The evaluation of pupil function is also included in this section.


Each certification comes with a non-refundable payment. Here is a look at the costs to take each of the following exams:

  • Certified Ophthalmic Assistant (COA) – $300
  • Certified Ophthalmic Technician (COT) – $325
  • Certified Ophthalmic Medical Technician (COMT) – $340

The COA exam requires an initial $150 fee while another $150 is required before receiving the certification. In the event that a retest is necessary for any of these certification exams, there will be a $50 deduction from each of the fees which will need to be paid in full. Exams are offered at a test center and can be scheduled through the year.

COA, COM and COMT Certification Exam Topics

All three of the certification exams (COA, COM, COMT) focus on five distinct areas, which are Ocular, Medical, Medication, Social, Family. The COA certification is considered to be the basic level while the COT moves on to the intermediate level while the COMT is the advanced level. Earning these certifications is a progression as each level builds on the prior knowledge and skill accumulated with each certification. Each of the certifications includes sections on the following topics:

  • History and Documentation
  • Visual Assessment
  • Visual Field Testing
  • Tonometry
  • Pupil Assessment
  • Lensometry
  • Ocular Motility Testing
  • Refraction, Retinoscopy and Refinement
  • Biometry
  • Pharmacology
  • Surgical Assistant
  • Ophthalmic Patient Services
  • Optics and Sales
  • Ethics and Legal Issues
  • Videography and Photography
  • Equipment Maintenance

Certification Renewal

A recertification is required every three years and that applies to COA, COT and COMT certifications. Certification is valid for a period of three years during which time continuing education credits are required. There are different requirements for each distinction and those credits are grouped into two groups. The first (Group A) includes credits earned from attending workshops, lectures and online courses. The second (Group B) includes attendance in grand rounds or courses approved by the American Medical Association. For every two hours attended, it counts as one hour for COTs and COAs. Every hour attended by a CMOT counts as one credit. Here is a look at the credit hours required for each certification:

COA – 18 (minimum of 12 Group A)

COT – 27 (minimum of 27 Group A)

COMT – 36 (Minimum of 18 Group A)

There is a $115 fee required for recertification. There is the option of paying an additional $50 to put a rush on the recertification and there is also a $75 late fee charge. Those who intend to appeal a recertification denial are required to pay a fee of $50.