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ACMO® Background

In 2005, the National Board of Examiners in Optometry offered ACMO® as the first examination to assess advanced competence in medical optometry, which was developed at the request of the National Association of VA Optometrists (NAVAO Taking the ACMO® examination provides an opportunity for Doctors of Optometry to achieve the same formal recognition and status that other VA health care professionals receive following completion of residency programs.

Although the ACMO® exam was originally designed for Doctors of Optometry who have completed, or are in the process of completing, an ACOE-accredited VA residency, eligibility has been expanded to include individuals who meet the following criteria:

  • Completed or will complete an ACOE-accredited VA residency program by June 30, 2020, or
  • Completed an ACOE-accredited residency program, or
  • Actively involved in the training and education of optometry residents, or
  • Clinically privileged to provide optometric patient care services to patients at federal facilities,


  • Active licensure with therapeutic privileges as of March 12, 2020 (3 months prior to the test administration), and
  • No licensure sanctions or active state board investigations.

NAVAO strongly encourages all eligible individuals to sit for this important examination, which has already gained stature as an important and valuable credential for VA residency-trained Doctors of Optometry. The American Board of Certification in Medical Optometry (ABCMO) uses the passing of ACMO® in its Board Certification process.

Description of Examination

ACMO® is a computer-administered examination consisting of 40 simulated patient cases related to ocular disease and associated systemic conditions. Each case begins with a scenario in which the patient history and clinical data are presented. The cases place considerable emphasis on the interpretation of visuals. Each scenario includes at least one clinically related visual, and the vast majority of cases contain two or more clinically related visuals. Visuals including, but not limited to, the following may be presented.

  • Color ophthalmic photographs
  • Laboratory analysis
  • Radiologic imaging
  • NFL analysis
  • Optic nerve topography
  • OCT
  • Visual fields
  • Fluorescein angiography
  • A- and B- scan ultrasonography
  • Ultrasound biomicroscopy
  • Red free, infrared and autofluorescence imaging

Every scenario is followed by 4 multiple-choice test items, each of which may contain as many as 10 options. The combination of one scenario and the 4 accompanying test items comprises a patient case. Thus, the 40 cases contain 160 test items. The items in most patient cases are presented in the following sequence:

Question #
Question Focus


Diagnosis follow-up, including clinical correlations, pathophysiology, and/or systemic issues



Treatment/Management follow-up, including prognosis, patient education, systemic issues, medication side effects, and/or further patient assessment


The vast majority of items on the ACMO® exam have only 1 correct answer but approximately 5-10% of the items will be multiple-response (MR) items. MR items may have up to 3 correct answers, and candidates must select all the correct answers to get credit for answering the item correctly; there is no partial credit. For all MR items, the stem of the item indicates how many correct answers should be selected. For example, if there are 3 correct options, the phrase "(Select 3 answer options)" will appear at the end of the stem.

The second item on the second sample case (see the link that immediately follows below) is an example of an MR item.

To download the ACMO® Tutorial, click here.

Although the format for ACMO® is similar to that of the Part II - PAM® (Patient Assessment and Management) examination, ACMO® has a different content focus that is beyond the entry level clinical knowledge tested in PAM®, and covers exclusively ocular disease and associated systemic conditions. As this blend of content and difficulty is designed for the advanced level of competence that VA residencies provide, it is anticipated that VA residents will be fully familiar with the nature of the examination content.

Most of the cases test the ability to diagnose and manage ocular disease. Many of these cases also include a test item assessing clinical knowledge of a related systemic issue. Some cases focus on systemic conditions. Overall, 25%-35% of the test items cover systemic conditions, while 65%-75% cover ocular disease. Within ocular disease, there is a high emphasis on glaucoma, anterior segment disease, and posterior segment disease. Trauma and post-operative conditions have a minimal emphasis, and neuro-ophthalmologic conditions have a moderate emphasis. While zoom capability is not yet available when reviewing the case visuals, some of the photographs and/or figures include low and high magnification versions when appropriate.

Similar to clinical care notation, abbreviations are used liberally throughout the examination text. An alphabetized list of clinical and lab abbreviations will be electronically linked to the examination and may be used as a resource throughout the test. In addition, a drug list of generic drugs and trade name equivalents will be electronically linked to the examination and may be used as a resource throughout the test.

As with all other National Board exams, candidates will have an opportunity to type in a comment about any test item during the examination.

Exam Administration

The National Board has contracted with Pearson VUE for computerized testing services. Pearson's extensive network of more than 200 test centers provides relatively easy access for all candidates to sit for the exam.

The ACMO® examination will be administered in a single 4 1/2-hour session. Before the exam begins, candidates are given a brief tutorial so that they are familiar with the computerized presentation and mechanics of the test. Candidates can click here to download the ACMO tutorial.

In addition, before the exam begins, candidates will be asked to read and endorse a non-disclosure agreement (NDA) concerning the Candidate Exam Conduct and Exam Security Agreement. Immediately following the exam, a 9-item survey will be displayed requesting candidate feedback to various aspects of the exam. The overall length of the test session is 5 hours, which includes 4 1/2 hours for the test and 30 minutes for these administrative details.

The ACMO® examination has a 2-tiered fee structure. The standard exam fee is $780; however, there is a reduced fee of $480 for current residents who sit for the test during the residency-year in which they complete their residency program.

All ACMO® candidates are encouraged to consult their tax advisor regarding the potential tax deductibility of the examination fee.

For more information about the ACMO® exam, please click here to view the 2020 ACMO® brochure.

Click here to register for the 2020 ACMO® Examination.

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