This page is for candidates preparing for the COST exam, which the International Joint Commission on Allied Health Personnel in Ophthalmology administers under the Ophthalmic Surgical Assisting (OSA) name. It sets out the format, fee and retake rules, then offers free practice sets, worked questions and a study plan. Practice questions here are written with AI tools and are not real exam questions.
The COST has 80 questions, takes about 60 minutes and costs $145[1][2] (International Joint Commission on Allied Health Personnel in Ophthalmology, verified Oct 22, 2026).
Numbers in brackets link to the official sources listed under Sources & last verified. Dates that have passed are removed automatically.
| Item | Detail | Source · Verified |
|---|---|---|
| Number of questions | 80 questions[1] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Time limit | 60 minutes[1] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Passing score | Criterion-referenced (modified Angoff); cut score not released[3] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Exam fee | $145 initial exam[2] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Retake fee | $95 per retest[2] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Retake policy | Up to 2 retests within 12 months, then a 12-month wait and a new application[3] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Validity | 36 months (3 years), synced to the core credential[3] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Delivery | Pearson VUE test centers only (OnVUE online not offered for OSA)[4] | pearsonvue.com · Oct 22, 2026 |
| Eligibility | Core COA, COT or COMT certification plus a surgical pathway (SA1–SA4)[1] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Score release | Official results mailed 2–4 weeks after the exam[3] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
| Testing window | 90-day eligibility period after the confirmation letter[2] | International Joint Commission on Allied Health Personnel in Ophthalmology · Oct 22, 2026 |
According to International Joint Commission on Allied Health Personnel in Ophthalmology, “A modified Angoff procedure is used to establish each passing score. In this commonly accepted psychometric procedure, content experts estimate the probability of each question being answered correctly by a person who meets the minimum eligibility requirements. Passing scores are not released.”[3]
The COST credential is awarded through the International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO). The exam details below come from its Ophthalmic Surgical Assisting (OSA) pages, so confirm that the credential name on your application matches before relying on them.
Eligibility starts with a core COA, COT or COMT certification in good standing, plus a surgical pathway (SA1–SA4). Check the official page for the requirements of your route. The initial exam fee is $145. The exam has 80 questions and a 60-minute limit. It is given at Pearson VUE test centers only; OnVUE online testing is not offered for this exam. Once your confirmation letter arrives, you have a 90-day eligibility period to sit the exam.
Scoring is criterion-referenced. A modified Angoff procedure sets the passing score, and the cut score is not released, so a practice percentage cannot tell you whether you would pass. Official results are mailed 2–4 weeks after the exam.
If you do not pass, a retest costs $95. You may apply for up to 2 retests within 12 months of your initial test date. After that, a 12-month wait and a new application apply. The certification is valid for 36 months (3 years), synced to your core credential.
The content areas below are copied from the official COST content outline published by International Joint Commission on Allied Health Personnel in Ophthalmology, with the share of the exam each area carries. The right-hand column shows which of our practice sets covers it.
| Official content area | Weight | Practice on this site |
|---|---|---|
| Aseptic Technique[5] | 20% | COST Aseptic Techniques & Infection Control Practise sterile field rules, what counts as a break in sterility, and the right response when one happens. |
| Instruments[5] | 25% | Mixed practice tests above We have no set built for this area, so use the official outline and learn each instrument by name, purpose and handling. |
| Minor Surgery[5] | 5% | Mixed practice tests above We have no set built for this area, so work from the official outline and review setup and common supplies for minor procedures. |
| Ophthalmic Anesthesia[5] | 5% | COST Anesthesia and Medications in Ophthal... Practise comparing anesthesia routes and agents, and what the surgical technologist monitors and prepares. |
| Ophthalmic Surgical Pharmacology[5] | 10% | COST Pharmacology Basics Practise matching each drug class to its purpose, such as dilating, numbing or preventing infection, and to its main cautions. |
| Pre-Operative Preparation of the Patient[5] | 5% | COST Patient Safety Protocols Practise patient identification, site verification and the checks that happen before the patient enters the room. |
| Surgical Complications[5] | 3% | COST Ocular Pathology & Disease Recognition Practise recognising warning signs and knowing which problems need the surgeon immediately. |
| Surgical Procedures[5] | 27% | COST Ocular Anatomy and Physiology Use the anatomy set to support this area, then learn the steps, instruments and supplies for each procedure from official material. |
Prepare for the COST - Certified Ophthalmic Surgical Technologist exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.
Question: Which ethical principle is most directly applicable to patient safety protocols?
Answer: B. Beneficence — acting in the patient's best interest
Explanation:
The answer is beneficence. It means acting in the patient's best interest, which is the reason patient safety protocols exist: each check is there to prevent harm to the person on the table.
Maximizing facility revenue is wrong because it puts the organisation's finances ahead of the patient. Following the most convenient protocol is wrong because convenience for staff is not a safety standard. Prioritizing speed over thoroughness is wrong because skipped steps are where errors get through.
The rule to remember: when an ethics question sets patient interest against revenue, convenience or speed, choose the option centred on the patient's wellbeing and harm prevention.
Question: Which viscoelastic material property is most important for protecting the corneal endothelium during cataract surgery?
Answer: A. High viscosity and coating ability (cohesive OVD)
Explanation:
The answer is high viscosity and coating ability. The corneal endothelium has limited ability to recover from damage, so the material placed in the eye should form a physical barrier between the endothelium and instruments, fluid flow and ultrasonic energy. The question points to a cohesive ophthalmic viscosurgical device (OVD) with these properties.
Low viscosity for easy removal is wrong because easy cleanup is a convenience, not protection. Antibiotic properties are wrong because an OVD is a protective and space-maintaining material, not an antimicrobial. A mydriatic effect is wrong because pupil dilation comes from dilating drops, not from the viscoelastic.
The rule to remember: match the property to the stated goal. Here the goal is protection, so choose the property that physically shields tissue.
Question: The aqueous humor is produced by which ocular structure?
Answer: B. Ciliary body
Explanation:
The answer is the ciliary body. Its non-pigmented epithelium actively secretes aqueous humor, which then fills the anterior and posterior chambers.
The choroid is wrong because it is a vascular layer that supplies the outer retina; it does not make aqueous. The iris is wrong because it controls how much light enters through the pupil and sits in the path of aqueous flow rather than producing it. The trabecular meshwork is wrong because it is a drainage structure that carries aqueous out of the eye, which is the opposite direction.
The rule to remember: separate production from drainage. The ciliary body makes aqueous, and the trabecular meshwork helps remove it.
Start with the official outline from IJCAHPO and note which content areas carry the most weight. Spend the most time on the heavier areas, and use the table above to see which of our sets cover each one. Some of our sets, such as documentation or patient communication, cover topics outside the official outline, so treat them as background rather than priority.
Start with Aseptic Techniques & Infection Control and Pharmacology Basics. Remember that our questions are written by us with AI tools and are not real exam questions.
No. According to the Pearson VUE page for IJCAHPO, the exam is given at Pearson VUE test centers only. OnVUE online testing is listed as available for the COA and CRT exams only, and it is not offered for the Ophthalmic Surgical Assisting exam.
The initial exam fee is $145 and each retest is $95. You may apply for up to 2 retests within 12 months of your initial test date. If you do not pass the second retest, a 12-month wait and a new application are required.
The exam has 80 questions and a 60-minute limit. Once you receive your confirmation letter, you have a 90-day eligibility period to take it, so schedule your seat at a Pearson VUE test center early in that window.
IJCAHPO does not release the cut score. It uses a modified Angoff procedure, a criterion-referenced method in which a panel estimates how a minimally qualified person would do on each question. Because the number is not published, treat practice scores as a guide to weak areas, not a prediction.
Official results are mailed by IJCAHPO 2–4 weeks after you finish the exam. They are sent by mail only, not by email or fax, so make sure your mailing address on file is current.
You need a core COA, COT or COMT certification in good standing, plus a surgical pathway (SA1–SA4). Check the official page for your route. The certification is valid for 36 months (3 years), synced to your core credential.
How we verify: editorial & fact-checking policy. Report an error: contact us.