ABO Ophthalmology Practice Test PDF (Free Printable 2026 October)

The American Board of Ophthalmology (ABO) Written Qualifying Examination is a high-stakes milestone for ophthalmology residents. Administered after the third year of residency, the exam tests comprehensive clinical knowledge across the full breadth of the specialty — from cornea and anterior segment diseases to retinal disorders, glaucoma, neuro-ophthalmology, and pediatric eye conditions. Passing the Written QE is required before candidates can advance to the Oral Examination and achieve board certification.

Preparing with printed materials allows candidates to study systematically in clinical settings where screens are impractical. This page provides a free ABO practice test PDF covering high-yield topics from each major domain, along with detailed study guidance and a checklist to structure a focused board review schedule.

Anterior Segment and Cornea

Anterior segment disease is one of the highest-yield areas of the ABO Written QE because it encompasses conditions that every comprehensive ophthalmologist encounters in daily practice. Corneal anatomy — from Bowman's layer through Descemet's membrane and the endothelium — anchors understanding of dystrophies such as Fuchs', map-dot-fingerprint, and lattice. Candidates must be able to distinguish these conditions by slit-lamp findings, inheritance patterns, and clinical course.

Infectious keratitis testing focuses on bacterial, viral, fungal, and Acanthamoeba etiologies. Herpes simplex keratitis questions require knowledge of dendritic ulcers on fluorescein staining, the role of topical antivirals, and the risk of steroid use in active epithelial disease. Fungal keratitis, especially after vegetative trauma, tests knowledge of natamycin and voriconazole as first-line agents. Cataract surgery complications — posterior capsule rupture, Descemet's membrane detachment, retained nuclear fragment — are reliably tested because they represent judgment calls every surgeon faces.

The anterior segment domain also includes uveitis, specifically anterior uveitis associated with HLA-B27 conditions such as ankylosing spondylitis and reactive arthritis, as well as granulomatous uveitis from sarcoidosis and tuberculosis. Questions often test the difference between mutton-fat keratic precipitates (granulomatous) and fine KPs (non-granulomatous) and the appropriate workup for each presentation.

Retina and Posterior Segment

The retina domain is extensive and demands both clinical recognition and pathophysiologic reasoning. Age-related macular degeneration questions span drusen classification, geographic atrophy, and choroidal neovascularization management with anti-VEGF agents. Candidates should know the landmark clinical trials — MARINA, ANCHOR, and CATT — and their implications for ranibizumab, bevacizumab, and aflibercept treatment intervals.

Diabetic retinopathy remains one of the most tested topics. The Diabetic Retinopathy Study and Early Treatment Diabetic Retinopathy Study established the indications for panretinal photocoagulation and focal/grid laser, and the ABO regularly tests those criteria. The addition of anti-VEGF therapy for center-involving diabetic macular edema, supported by RIDE/RISE and PROTOCOL T data, is now standard board content.

Retinal detachment — rhegmatogenous, tractional, and exudative — tests both diagnosis and repair strategy. Candidates must know when to use pneumatic retinopexy versus scleral buckle versus pars plana vitrectomy, and which breaks are amenable to each approach. Inherited retinal diseases, including retinitis pigmentosa, Stargardt disease, Best disease, and choroideremia, appear regularly and test knowledge of inheritance patterns, ERG findings, and genetic counseling principles. Ocular oncology — choroidal melanoma staging, retinoblastoma (Reese-Ellsworth and International Classification), and choroidal metastases — rounds out the posterior segment domain.

Glaucoma and Optic Nerve

Glaucoma questions on the ABO test both the science and the clinical management decisions that separate competent practitioners from those who are merely familiar with the disease. Primary open-angle glaucoma testing covers aqueous humor dynamics, the trabecular meshwork's role in outflow resistance, and the pharmacology of each drug class: prostaglandin analogs (first-line), beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, and Rho-kinase inhibitors. Systemic contraindications — beta-blockers in reactive airway disease and heart block, alpha-2 agonists in infants — are common question stems.

Normal-tension glaucoma, angle-closure glaucoma, and secondary glaucomas (pigmentary, pseudoexfoliative, neovascular, uveitic) each have distinctive pathophysiology and management protocols. The Ocular Hypertension Treatment Study and Collaborative Normal-Tension Glaucoma Study are heavily tested because they defined treatment thresholds that still govern clinical practice.

Optic nerve disease extends beyond glaucoma to include ischemic optic neuropathy (arteritic versus non-arteritic), optic neuritis and its relationship to multiple sclerosis, compressive optic neuropathy from orbital masses, and toxic/nutritional optic neuropathies. Papilledema from elevated intracranial pressure requires candidates to know the workup, the role of lumbar puncture, and visual field patterns that distinguish it from other causes of disc edema.

Neuro-ophthalmology and Pediatrics

Neuro-ophthalmology is high-yield and requires a strong foundation in neuroanatomy. Pupils are a classic ABO topic: Horner syndrome (ptosis, miosis, anhidrosis, and the cocaine/apraclonidine test for confirmation) must be distinguished from a third-nerve palsy (mydriasis, ptosis, and exotropia). The relative afferent pupillary defect (RAPD) — its detection with the swinging flashlight test and its significance as a marker of optic nerve or extensive retinal disease — is tested repeatedly.

Visual field defects and their localization form another core area. Bitemporal hemianopia points to the optic chiasm, homonymous hemianopia to retrochiasmal lesions, and the congruity of the defect narrows localization further. Candidates must trace the visual pathway from retinal ganglion cells through the lateral geniculate nucleus to the striate cortex and associate each segment with its corresponding vascular supply.

Pediatric ophthalmology tests amblyopia (its critical period, detection with crowded optotypes, and treatment hierarchy from patching to atropine penalization), congenital cataracts and the urgency of early surgery to prevent deprivation amblyopia, retinopathy of prematurity (Zone I/II/III, Stage 1–5, and treatment thresholds from ETROP), and strabismus surgery planning. Pediatric glaucoma, nasolacrimal duct obstruction, and genetic syndromes with ocular manifestations — Marfan, Down, and Turner syndromes — complete the pediatric domain and appear frequently in case-based question formats.

Consistent, systematic study across all domains is the most reliable path to passing the ABO Written QE. Use this PDF to identify knowledge gaps early, then return to primary sources to fill them before exam day. For additional scored practice with immediate answer explanations, the ABO ophthalmology practice test on this site offers interactive questions organized by clinical domain.

Sample ABO - American Board of Ophthalmology Practice Questions

Try these questions from our free ABO - American Board of Ophthalmology practice tests. The correct answer and an explanation follow each question.

1. When interpreting a Humphrey Visual Field (HVF) 24-2 test for a glaucoma suspect, which of the following patterns is most characteristic of early glaucomatous damage?

   • A. A central scotoma
   • B. A bitemporal hemianopsia
   • C. A nasal step respecting the horizontal midline
   • D. An enlarged blind spot

Answer: C. A nasal step respecting the horizontal midline

Early glaucomatous visual field defects typically correspond to the pattern of nerve fiber layer loss. A nasal step, which is a scotoma just above or below the horizontal midline in the nasal field, is a classic early sign. This occurs due to damage to the arcuate nerve fibers. A central scotoma is more typical of macular disease or advanced glaucoma. Bitemporal hemianopsia suggests a chiasmal lesion. An enlarged blind spot can be seen in glaucoma but is less specific than a nasal step.

Answer: D. Bitemporal hemianopia

A lesion compressing the optic chiasm, where the nasal retinal fibers from each eye cross, characteristically damages these crossing fibers first. [7] Since the nasal retinal fibers perceive the temporal visual field, this damage results in a bitemporal hemianopia (loss of vision in the temporal half of the visual field for both eyes). [6, 7] This pattern is a classic sign of chiasmal compression. [6]

Answer: B. Pterygium

A pterygium is a fibrovascular growth of the conjunctiva that crosses the limbus and encroaches onto the cornea, often in a triangular shape. It is strongly associated with chronic ultraviolet light exposure. A pinguecula, in contrast, is a degenerative lesion that is confined to the conjunctiva and does not cross onto the cornea.

Answer: C. Acute post-operative endophthalmitis

Acute post-operative endophthalmitis is a devastating intraocular infection that can occur after any intraocular surgery. It typically presents within the first week with severe pain, vision loss, and signs of intense inflammation like a hypopyon. It is an ophthalmologic emergency requiring immediate intervention.

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