How to Work in the U.S. As a Foreign-Educated Optometrist

In this guide, we will answer the following questions:

Beginning Your Optometry Career in the United States

If you completed your optometry education abroad and want to begin practicing in the United States, the licensing process can seem complex at first. However, many internationally trained optometrists successfully become licensed once they understand the key steps involved.

In most cases, the pathway includes enrolling in an accredited academic program or securing a sponsor, passing the national optometry examinations, and meeting any additional state requirements. Although the process may appear extensive, it is entirely achievable with the proper guidance. Once licensed, you can pursue a wide range of career opportunities, including private practice, vision therapy, ocular disease management, and advanced clinical care.

Optometry also offers a strong earning potential. According to the Bureau of Labor Statistics, the median annual wage for optometrists was over $134,000 in 2024, and employment in the field is projected to grow by 8 percent from 2024 to 2034, which is significantly faster than the average for most professions. This means the future of eye care presents meaningful opportunities for new practitioners entering the field.

This guide outlines the essential steps to becoming licensed as a foreign-trained optometrist in the United States. It provides resources to help you navigate state boards, examination preparation, and other requirements as you move forward in your career.

Understanding Who Grants Optometry Licenses in the United States

National organizations support optometrists, but state boards issue licenses.

One of the first things to understand is which organization is responsible for issuing your optometry license in the United States. Because optometrists play a key role in preserving and improving patients’ vision and eye health, the licensing process involves a thorough review of your education, training, and qualifications.

While national organizations such as the American Optometric Association (AOA) support the profession, your license will be issued by the state in which you plan to practice. For instance, if you intend to work in California, your license will come from the California State Board of Optometry. The AOA provides a helpful directory that lists the optometry board for every state, making it easier to locate the appropriate authority.

Once you identify the state board you will be working with, you can continue to the next step of the licensing process.

When and Why You May Need a Credential Evaluation

As a foreign-trained optometrist, you may need to have your academic and professional credentials evaluated by a recognized credentialing service. This evaluation helps determine how your education and experience compare to U.S. standards.

There are two primary reasons you might need a credential evaluation. The most common is sponsorship, which will be explained more fully later. Since foreign optometry programs are not accredited by the Accreditation Council on Optometric Education (ACOE), many internationally trained optometrists seek sponsorship to qualify for the national optometry exams. In these cases, most state licensing boards or U.S. academic programs require a credential evaluation before agreeing to sponsor an applicant.

The second reason is the possibility of transferring coursework into a U.S. optometry program. This is far less common, as most foreign-trained optometrists begin a U.S. program from the start. However, an evaluation can still help schools review your academic background and determine whether any credits may be transferable.

State boards and academic institutions may have specific preferences regarding which credentialing services they accept, so verify their requirements before selecting a provider. Evaluations range from basic summaries to detailed course-by-course reports. Most internationally trained optometrists opt for a comprehensive assessment because it provides the most complete review of coursework and clinical experience.

These evaluations typically cost between $200 and $400 and may take from a few days up to four weeks to complete. Expedited processing is usually available for an additional fee of $80 to $150.

You will need to submit essential documents such as diplomas, transcripts, and clinical records. After the evaluation is finished, the agency will either send the report directly to the state board or to the academic program, or provide it to you in a sealed envelope, depending on the board’s instructions. If your documents are not in English, certified translations will almost always be required.

Certified Translations for Your Licensing and Immigration Documents

Certified translations are often required to submit official documents for optometry licensure in the U.S.

As you move through the licensing process, you may be required to submit certified translations of certain personal and professional documents. State boards, academic programs, and federal agencies often request certified translations to verify your identity, education, and eligibility for licensure. Understanding what this means and how to prepare can help you avoid delays in your application.

A certified translation is a complete, accurate translation of a document accompanied by a signed statement from the translator or translation company confirming that the translation is true and correct to the best of their knowledge. In the United States, certified translations must meet strict standards because they are used for official and legal purposes.

Most optometry candidates need certified translations for documents such as diplomas, transcripts, birth certificates, marriage certificates, name-change documents, and any academic or clinical records issued in a language other than English. Some boards also require sealed copies or direct submissions from the translation provider, so always verify the requirements of the state where you plan to apply.

When selecting a translation provider, make sure the service explicitly offers certified translations that comply with U.S. Citizenship and Immigration Services (USCIS) and state licensing board requirements. A reliable provider will deliver a signed certificate of accuracy, maintain consistent formatting that mirrors your original document, and return your files promptly so you can stay on schedule.

If you are unsure which documents require translation or want guidance on preparing your materials, we can help. Our certified translation services are designed to meet state and federal standards, ensuring your documentation is accurate, complete, and ready for submission.

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Understanding the NBEO Exam Requirements

Passing all three NBEO exam parts is required for optometry licensure in the U.S.

To become a licensed optometrist in the United States, you must pass all three parts of the National Board of Examiners in Optometry (NBEO) exam. These exams are often referred to collectively as “the boards.”

Part I, Applied Basic Science, focuses on the foundational sciences that support optometric practice. Part II, Patient Assessment and Management, evaluates your ability to assess patients and make informed clinical decisions. Part III, Patient Encounters and Performance Skills, tests your hands-on abilities in clinical scenarios.

Some additional exams exist, such as the Injections Skill Exam and the Laser and Surgical Procedures Exam, but most candidates will not need them. These specialized exams are required only in states that permit optometrists to perform therapeutic injections or laser procedures. For most applicants, the three core NBEO sections are the primary requirements.

The first two NBEO parts are administered through Pearson VUE, which operates testing centers throughout the United States. These exams must be taken in person, and you can locate your nearest center using Pearson VUE’s Find a Test Center tool. After registering for an exam on the NBEO website and paying the associated fee, you will receive instructions on creating a Pearson VUE account to schedule your test.

Each NBEO part has its own fee, so it is important to plan accordingly. Before test day, review Pearson VUE’s tutorials that explain the testing environment and computer-based exam format to help you feel prepared.

The third part of the exam is administered directly by the NBEO, and guidance on preparing for it will be covered later in this guide.

With the core structure of the NBEO exam in mind, the next section will explore each part in

more detail.

What to Expect from Part I: Applied Basic Science

PART I ABS Exam Content Outline

Applied Basic Science is the first section of the NBEO exam and focuses on the core scientific foundation needed for optometric practice. For a complete breakdown of every topic included in this section, the NBEO Content Matrix and Content Outline are available online as PDFs. Below is an overview of the most important details to help you prepare.

If you enroll in an accredited U.S. optometry program, you will typically take Part I during your third year. If you are not enrolled in an ACOE-recognized program, you must be sponsored to sit for the exam. In this case, a state licensure board or an accredited Doctor of Optometry program must send a sponsorship letter directly to the NBEO. Once your sponsorship is approved, you become eligible to register.

Part I is offered twice each year, usually in March and August. Exact dates are published annually in a PDF on the NBEO website. Registration is completed online, and the exam fee is $1,445.

This section assesses knowledge of anatomy, optics, and the biological sciences that informs everyday clinical decisions. The exam is divided into two four-hour sessions, each containing 185 questions. After the morning session, you may take an optional 45-minute break before beginning the afternoon session. In total, you will answer 350 scored questions.

An additional 20 unscored pre-test questions are included throughout the exam. These items are blended with the scored questions, and you will not be able to identify them. Because they are indistinguishable from scored items, treat every question as if it contributes to your final result.

Most questions require selecting one correct answer, but approximately 10 to 15 percent are multiple-response items. These require choosing two, three, or four correct answers as instructed. Full credit is awarded only when all correct options are selected.

Scores are typically released within five to seven weeks. You will receive an email once your results are posted, and the NBEO will also publish an announcement on its homepage. If you do not pass, you cannot register for a retake until your failing score is officially posted. Candidates are allowed up to six attempts, and each attempt counts once you begin the exam, regardless of whether you complete it. The full exam fee applies to every attempt, so thorough preparation is essential.

To prepare effectively, begin with the NBEO’s free Sample Test Items. This set includes 49 questions written by the NBEO and provides a reliable sense of the exam’s style and difficulty. For more comprehensive practice, the NBEO offers the Part I Practice Items Databank through a platform called Test Run. This resource includes a large pool of practice questions, detailed score reports, and the option to practice by topic or simulate a full exam session. A one-month subscription costs $199 and includes unlimited access to all questions. Renewals are available for $149 per additional month.

Private study courses are also available, though many of them cover all three NBEO sections together. These will be discussed later in this guide. For now, let’s continue to the second part of the exam.

What to Expect from Part II: Patient Assessment and Management (PAM)

Part Two of the NBEO exam focuses on patient assessment and management.

Part Two of the NBEO exam is called Patient Assessment and Management, or PAM. For a full breakdown of every topic included in this section, the NBEO Part Two Content Matrix and Content Outline are available online. The summary below covers the essential information you need to understand how the exam works and what it tests.

A major component of Part Two is TMOD, or Treatment and Management of Ocular Disease. TMOD used to be a separate exam, but it is now fully integrated into Part Two. You will not take it as a standalone test. Instead, TMOD questions are embedded throughout the exam, and your performance on them is scored separately.

As with Part One, Part Two is administered through Pearson VUE. Pearson VUE provides a free online tutorial to help you become familiar with the exam format and computer interface. The exam fee is $1,445. After registering and paying through the NBEO website, you will schedule your testing appointment through your Pearson VUE account.

Most students take Part Two in the middle of their fourth year or any time afterward. The exam is offered twice per year, typically in early April and early December. Registration for the April session usually opens in late January, while registration for the December session opens in early June.

Part Two includes 350 questions, approximately 120 of which fall under the TMOD category. The exam is completed in two sessions on the same day. Each session contains 175 items and lasts three and a half hours. The morning session includes a 15-minute tutorial and non disclosure agreement. You may take an optional 45-minute break before the afternoon session begins.

Part Two is entirely case-based. Each case begins with a patient scenario that includes demographic details, symptoms, medical and ocular history, and clinical findings. Every case includes at least one image, often more. The full patient scenario and all images appear on the left side of the screen. On the right, you will answer three to six questions about the case. Questions appear one at a time, but the patient information remains visible throughout.

Drug names follow a standardized format. Each medication is listed by either its generic or trade name, but not both. During the exam, you will have access to a searchable drug list and a searchable list of abbreviations. Sample versions of both lists are available online for practice, and during the exam, you can open them from any page by selecting the tabs at the top of the screen.

Part Two covers two main categories. The first, Disease and Trauma, represents about 60 to 70 percent of the exam. It focuses on common ocular conditions, injuries, infections, emergencies, postoperative care, and systemic health issues that affect the eyes. The second section, Refractive, Sensory, and Oculomotor content, makes up roughly 30 to 40 percent of the exam and includes topics such as refractive error, contact lenses, color vision, binocular vision, visual development, accommodation, and eye movement disorders.

Scores are usually released five to seven weeks after the exam. You will receive an email when your score is available, and the NBEO will also post an announcement on its homepage. If you do not pass, you may retake the exam up to six times in total. Each attempt requires paying the full $1,445 fee.

Preparation is key to passing on your first attempt. A strong place to begin is the NBEO Practice Databank, hosted through TestRun. A one-month subscription costs $199, and renewals are $149 permonth.

Private companies also offer more comprehensive study programs, which we will discuss after we cover Part Three of the exam.

What to Expect from Part III: Patient Encounters and Performance Skills (PEPS)

Part Three of the NBEO exam is called Patient Encounters and Performance Skills, or PEPS. This final section of the core NBEO exams evaluates your ability to analyze clinical cases, make sound decisions, and demonstrate essential hands-on skills in a simulated patient environment.

You will register for the PEPS exam through your NBEO online account, using the same login information from Parts One and Two. The exam fee is $1,445 and is paid during online registration.

Unlike the first two parts, Part Three is not administered at a Pearson VUE center. Instead, it is held exclusively at the NBEO’s testing facility in Charlotte, North Carolina. This facility, known as the National Center of Clinical Testing in Optometry (NCCTO), is specifically designed to ensure that every candidate is evaluated in an identical, standardized setting. Because of this requirement, all examinees must travel to Charlotte, regardless of where they live or study.

For a complete overview of the exam, the NBEO provides a detailed Candidate Guide PDF. Below is a summary of the key information to help you understand what to expect.

Traveling to North Carolina is a significant logistical step for many candidates, and the NBEO provides resources to make this process easier. They offer a PDF guide that includes photos of the testing center, the candidate entrance, and nearby roads such as Arrowood Road and Microsoft Way. The guide also explains how to navigate the building and includes a list of nearby hotels that offer corporate rates for NBEO test-takers. Among the recommended options are the Hilton Garden Inn and Homewood Suites, both located close to the testing center. You are free to choose any accommodations you prefer, but these two hotels are the only ones offering NBEO-specific discounts.

What Happens on Exam Day at the PEPS Testing Center

Now let’s take a closer look at what you can expect during the Part Three exam itself. Your visit to the testing center will last about seven hours, including check-in, orientation, the exam, and check-out.

On the morning of your exam, you must bring two valid forms of identification that match the name you used during registration. One must be a government-issued photo ID such as a passport, driver’s license, or military ID. The second can be a student ID, a credit or debit card, or any other card that displays your name and signature.

After your identification is verified, you will move forward with the exam process.

The exam is organized into five competency domains, or subject areas. Clinical Interpretation and Assessment evaluates how well you interpret and apply patient information. Management and Documentation focuses on creating appropriate treatment plans and documenting them clearly. Skills assess your hands-on clinical procedures. Patient Education measures how effectively you explain information to patients, and Communication and Professionalism evaluates how you interact with patients and staff.

The testing center provides all required equipment, so there is no need to bring your own instruments. Before the exam begins, you will participate in an orientation session to get familiar with the laptop, headset, slit lamp, and other tools used during the assessment. You are expected to wear professional attire and a white lab coat.

During the exam, you will rotate through 12 stations, each staffed by a standardized patient. These individuals are trained to present cases consistently, ensuring that every candidate is evaluated under the same conditions.

Ten of the stations involve full clinical scenarios. In these, you gather patient information, review findings, and explain your next steps. The remaining two stations focus solely on performing specific clinical techniques rather than working through an entire case.

Each station follows a standard timeline. You will have three minutes to review the station overview, followed by 15 minutes for the encounter or skills task. After each station, you will have a four-minute break in the hallway. When the final station is complete, candidates remain seated until staff signal that it is time to exit.

Throughout the exam, standardized patients evaluate your communication, professionalism, and ability to gather information. Examiners observe and score your clinical and technical skills, and your notes entered on the laptop are also reviewed. These combined assessments determine your performance across all competency areas.

After completing the final station, you will step out of the testing room and wait in a designated area until staff let you know you are free to leave.

Part III – Patient Encounters and Performance Skills (PEPS) Candidate Guide

Understanding Your Part III Results and Score Reporting

After completing Part Three of the exam, your scores will be released following the schedule posted on the NBEO website. Results are typically available within about two months. For example, candidates who test in August can expect scores in October, while those who test in February usually receive results in April. The NBEO will email you once your score is ready, and you can view it in the same online portal used for registration.

Scores range from 100 to 900, with 300 set as the passing mark. Your score report will provide a clear overview of your performance. If you selected the option during registration, your results can also be sent directly to your optometry school or to the state licensing authority where you plan to practice.

The PEPS exam is not graded on a curve or compared to other candidates. Instead, it uses a criterion-referenced scoring system, which means your score is evaluated against a fixed standard of competence required for safe, entry-level practice. Your performance is assessed solely on your own work, not on how others performed.

As with the first two NBEO sections, you may attempt Part Three up to six times if needed, though most candidates do not come close to that limit. Your best chance of passing on the first attempt comes from using the detailed preparation materials offered by the NBEO.

Study Materials and Resources for Preparing for Part III

Preparing for the PEPS exam is much easier when you take full advantage of the free resources available on the NBEO website. The PEPS webpage includes several important tools, and the best way to begin is to work through each one.

Start with the interactive tutorial, which walks you through the PEPS exam software and shows you exactly what the interface looks like on exam day. You will also find a 21-minute orientation video that explains what happens at each station and demonstrates how the equipment is used.

The website also includes Evaluation Forms that outline the specific skills you must demonstrate. Beyond that, you will find an equipment list, a station experience video, and a detailed content outline. Reviewing all of these materials is one of the most effective ways to prepare.

boards.kmkoptometry.com

Many students choose to supplement these free resources with paid study programs. One widely used provider is KMK Optometry, which offers a single bundle covering all three NBEO parts. Their package includes textbooks, video libraries, guided study plans, practice questions, mock exams, flashcards, and simulated clinical skills rooms. Materials are accessible through their Apple and Android apps, making it easy to study on the go. KMK’s AllBoards bundle can be purchased for $205 per month or for a one-time payment of $3,980.

Another well-known option is OptoPrep. Their program provides question banks, case-based learning tools, video lessons, virtual exam rooms, and interactive patient scenarios for all three NBEO sections. OptoPrep is also available on Apple and Android apps. Their full bundle costs $1,599, with an optional financing plan of $100 per month.

optoprep.com

In addition to formal study programs, online communities can be a valuable source of support. The subreddit r/OptometrySchool receives more than 4,000 weekly visitors and is a helpful place to ask questions and see how others are preparing. There is also a Facebook group called Students of Optometry with more than 17,000 members, where students share advice and study resources daily.

Jurisprudence Exams and License Renewal Requirements by State

After passing your NBEO exams, many states require an additional jurisprudence exam before you can obtain your license. Beyond the initial licensing process, you will also need to maintain your license throughout your career. Most states require renewal every one to three years, along with a set number of continuing education hours.

Below are the requirements for seven states that are especially popular among internationally trained optometrists. Even if you plan to practice elsewhere, this overview offers a valuable sense of what licensing and renewal standards look like across the country.

California

Maintaining your optometrist license in California

To get licensed, you must pass the California Laws and Regulations Exam. Renewal requires 50 hours of continuing education every two years, and the renewal fee is $500.

Florida

Maintaining your optometrist license in Florida

Florida requires candidates to pass the Florida Laws and Rules Examination before applying for licensure. Optometrists must complete 30 hours of continuing education every two years and pay a renewal fee of $305.

Illinois

Maintaining your optometrist license in Illinois

In Illinois, optometrists must complete 30 hours of continuing education during each two-year renewal period. The renewal fee is $400.

Massachusetts

Maintaining your optometrist license in Massachusetts

Licensure requires passing a 25-question jurisprudence exam. The license is valid for one year and can be renewed for $100 after completing 18 hours of continuing education.

New Jersey

Maintaining your optometrist license in New Jersey

Applicants must pass a jurisprudence exam to receive their initial license. Renewal requires 50 continuing education credits every two years and a $250 renewal fee.

New York

Maintaining your optometrist license in New York

Optometrists must complete 36 hours of continuing education during each three-year licensing cycle. The renewal fee is $242.

Texas

Maintaining your optometrist license in Texas

Candidates must pass the Texas Jurisprudence Exam to become licensed. Renewal requires 32 hours of continuing education every two years, and the current renewal fee is $432.72.

Understanding these requirements early on can help you plan effectively as you prepare to begin your optometry career in the United States.In addition to formal study programs, online communities can be a valuable source of support. The subreddit r/OptometrySchool receives more than 4,000 weekly visitors and is a helpful place to ask questions and see how others are preparing. There is also a Facebook group called Students of optometry with more than 17,000 members, where students share advice and study resources daily.

Final Thoughts and Next Steps for Your Optometry Journey in the United States

This guide brings us to the end of the licensing process overview for internationally trained optometrists seeking to build their careers in the United States. Although each state and academic program has its own requirements, many of the steps follow a similar structure, which should give you a clear sense of what to expect as you move forward.

As you prepare for this transition, it is encouraging to remember that your training and skills have the potential to make a meaningful impact on patients’ lives. Beginning a new chapter in the U.S. can be exciting, but it often involves substantial paperwork. In addition to professional requirements such as credential evaluations, transcripts, and clinical records, you may also need translations of personal documents like birth certificates or marriage certificates, depending on your situation and the state where you plan to live.

If you are unsure which documents require translation or how to begin the process, we are here to help. Our team can guide you through each step and make sure you are prepared as you pursue your optometry career in the United States.

Author: Aaron Randolph | LinkedIn