10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The NCLE-AC exam has 125 questions and runs 3 hours.
These 10 free NCLE-AC questions are organized by exam domain, so you can see how each part of the National Contact Lens Examiners Advanced Certification blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Prefit, Preparation and Evaluation 25% of exam
Question 1
A four-month-old infant has undergone unilateral cataract extraction without an intraocular lens. The fellow eye has a clear crystalline lens. The pediatric ophthalmologist recommends contact-lens correction, and the caregivers can demonstrate safe handling. What is the principal optical advantage over a high-plus spectacle lens for the operated eye?
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Correct answer: D - It reduces image-size disparity between the eyes compared with a unilateral high-plus spectacle lens.
Question 2
Pre-fitting assessment records an OSDI-6 score of 9 out of 24, non-invasive tear breakup times of 6 and 7 seconds, tear osmolarities of 302 and 305 mOsm/L, and no appreciable surface staining. Common mimicking conditions have been excluded by the examining clinician. Under TFOS DEWS III, which conclusion is supported?
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Correct answer: A - Dry eye is supported, but its subtype remains undetermined.
Question 3
A 53-year-old dental technician is being assessed for a first contact-lens prescription. A monovision trial using the preferred distance eye provides clear distance and near acuity, but fine depth judgments become unreliable during a simulated work task. Stereoacuity returns to baseline when both eyes receive full distance correction. The patient wants useful distance and near vision without switching spectacles. Which alternative most directly addresses the binocular tradeoff?
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Correct answer: D - Binocular multifocals, assessed for stereopsis and contrast during the actual work task.
Domain 2: Design, Fit and Dispense Standard and Specialty Lenses 30% of exam
Question 4
A scleral diagnostic lens gives 20/20 vision with a plano spherical over-refraction. After four hours, central and limbal clearance remain adequate. The spherical landing zone causes nasal and temporal vessel blanching, while its superior and inferior edges lift away from the conjunctiva. Which redesign addresses this pattern without adding an unnecessary optical correction?
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Correct answer: C - Use a toric landing zone and retain spherical optics.
Question 5
The spectacle refraction for a custom soft toric fitting is -8.00 / -2.00 x 180, measured at a 12 mm vertex distance. Select the initial corneal-plane power estimate, before on-eye refinement. Convert both principal meridians and round each to the nearest 0.25 D before expressing the result in minus-cylinder form.
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Correct answer: B - -7.25 / -1.75 x 180
Question 6
A soft toric diagnostic lens covers the cornea but produces blink-dependent blur. After settling, its reference mark alternates between 15 degrees to the examiner's left and 10 degrees to the examiner's right; the same variability recurs after several blink sequences. An axis-compensated reorder has been proposed. The next fitting step should instead be to:
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Correct answer: A - Improve rotational stability with a different fit or stabilization design.
Domain 3: Patient Instruction and Delivery Procedures 15% of exam
Question 7
A patient calls before applying reusable soft lenses that have soaked in CLEAR CARE PLUS for six hours. The patient used an ordinary flat storage case because the supplied basket case was left at home. The lenses have not touched the eyes. Which instruction makes this pair ready for safe wear?
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Correct answer: B - Restart the full six-hour cycle with fresh solution in the supplied neutralizing case.
Question 8
Before dispensing a custom toric lens, the order lists back vertex power as -3.00 / -1.50 x 180. The laboratory verification report lists -4.50 / +1.50 x 090 for the same eye. Material, geometry, lens identity, and on-eye acceptance checks all match the order. What disposition is justified by the two power notations?
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Correct answer: C - Complete dispensing; the two power notations are optically equivalent.
Domain 4: Routine and Emergency Follow-up Visits 25% of exam
Question 9
During a blurred-vision follow-up, keratometry over a spherical corneal GP lens repeatedly detects 1.25 D of front-surface toricity. Verification before application and after removal confirms that the lens has spherical front and back surfaces. Its position is stable, but the cylindrical over-refraction varies during wear. What accounts for the difference between the on-eye and off-eye findings?
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Correct answer: A - Reversible flexure of the lens during wear.
Question 10
A soft-lens wearer who slept in the lenses develops rapidly worsening unilateral pain, photophobia, and reduced vision. After lens removal, acuity is 20/80 rather than the usual 20/20, and examination shows a paracentral stromal infiltrate with an overlying epithelial defect. The fitter is not authorized to prescribe medication. How should the patient be directed?
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Correct answer: C - Keep the lens out and arrange immediate same-day ophthalmic assessment.