NBEO Part III
NBEO Part III: Clinical Skills Examination
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ExploreAbout this exam
Part III of the NBEO series is the Clinical Skills Examination (CSE), the performance-based stage of optometric licensure in the United States. Where the earlier computer-based parts test knowledge, Part III asks you to demonstrate it: you rotate through timed stations and perform procedures on standardized patients, instruments, and clinical models while examiners score your technique, sequencing, and communication. It is intended for candidates who have completed the didactic and clinical coursework required by their program and are moving toward licensure; state boards look to the full NBEO sequence, so confirm your jurisdiction's requirements. The stations span the clinical domains you use daily: history taking, acuity and refraction, binocular and motility testing, slit lamp and anterior segment evaluation, fundoscopy, tonometry and glaucoma assessment, visual fields, contact lens fitting and evaluation, lensometry and optics, pharmacology, and professionalism and safety. Preparation is largely procedural. Practice each skill aloud in the exact sequence you will perform it, with a partner timing you and calling out omissions; drill the hand-washing, patient-identification, and documentation habits that examiners score automatically. Build a checklist for every station and rehearse until the checklist runs without prompting. Because the CSE rewards clean, safe, reproducible routine over speed, the candidates who struggle are usually those who never practiced under observation. The official body publishes current administrative details, so verify logistics on its site rather than relying on secondhand reports.
What you'll study
About NBEO Part III preparation
What actually happens on exam day?
You move through a series of timed stations, each with a prompt, a standardized patient or instrument setup, and an examiner or recording capturing your performance. You read the instructions, perform the procedure, and sometimes document findings. Stations are short, so transition discipline matters as much as clinical knowledge.
How is Part III different from Parts I and II?
Parts I and II are computer-based and test knowledge and clinical reasoning through questions. Part III tests whether your hands and voice actually execute the routine. You are scored on observable behavior: hand hygiene, patient identification, explanation, instrument handling, measurement technique, and clean-up.
How long is the exam and what does it cost?
The National Board of Examiners in Optometry publishes the current schedule, station timing, and fees on its official website, and these change between administrations. Check the site directly before you register or book travel, and do not rely on figures quoted by classmates from a previous cycle.
What score do I need to pass, and can I retake it?
Passing standards and retake rules are set and published by the National Board of Examiners in Optometry, including any waiting periods or limits on attempts. Consult the official site and your state board, since licensure rules can be stricter than the examination's own policies.
How difficult is it, really?
Most candidates find the content familiar and the format stressful. The failure modes are procedural, not intellectual: skipping hand hygiene, forgetting to identify the patient, poor illumination during slit lamp work, or narrating nothing while you work. If you can perform each skill cleanly while explaining it, difficulty drops sharply.
In what order should I study the domains?
Start with the stations that carry the most weight and the most automatic-fail habits: history taking, acuity and refraction, slit lamp, and professionalism and safety. Then add binocular and motility testing, fundoscopy, and tonometry. Layer in visual fields, contact lenses, lensometry, and pharmacology last, since these are narrower routines.
What are the most common mistakes candidates make?
Rushing. Candidates skip patient identification, forget to explain the procedure, contaminate equipment, or leave the patient without a summary. Others know the technique but freeze when the examiner watches. Rehearse aloud with a partner who scores you against a checklist so the routine survives scrutiny.
Do I need to bring my own equipment?
The exam provides the instruments and materials used at each station, and instructions specify what is available. Read the station prompt carefully so you use the supplied equipment correctly. The official site lists any candidate-supplied items and prohibited items; verify that list before exam day.
How should I practice in the final weeks?
Run full mock circuits under time pressure with a partner acting as patient and examiner. Score yourself against written checklists, then repeat only the stations where you lost points. Video yourself for slit lamp and fundoscopy stations, where illumination, focus, and hand position are hard to self-assess in real time.