EXAMINATION STRUCTURE

1) Eligibility of Candidates

A medically qualified candidate will be eligible to sit the examination provided that he/she

a) holds a medical qualification approved by the General Medical Council for the purpose of registration;

b) has passed the Part 1 Membership Examination OR Part 1 Fellowship Examination;

c) has completed one year's full-time training (or equivalent) in ophthalmology.

2) Examination content

a) Applied visual optics and theory and practice of refraction

b) Clinical methods of examination

3) Form of Examination

a) A multiple choice question paper of 60 questions
Duration: 2 hours
The questions will relate to optics, refraction and clinical methods

b) An Objectively Structured Examination (OSE) in clinical methods including optics.
There will be 8 stations with 5 minutes allocated to each station

c) A practical examination in refraction
Duration: 30 minutes
Candidates will spend 30 minutes with the patient in the company of the examiners, 2 clinical ophthalmologists.

d) An Objectively Structured Clinical Examination (OSCE) in clinical methods including optics in which patients will be involved. There will be 8 stations with 5 minutes allocated to each station. The purpose of the clinical examination is to elicit signs, candidates must appreciate the signs they have found and may be asked, if time permits, to form a differential diagnosis. Discussion of pathology and management is beyond the scope of this examination.

CANDIDATES ARE UNLIKELY TO PASS THIS EXAMINATION UNLESS THEY HAVE HAD EXPERIENCE IN PRACTICAL REFRACTION. THE PRACTICAL REFRACTION AND THE OBJECTIVELY STRUCTURED CLINICAL EXAMINATION MUST BE PASSED.

4) Resit Procedure

There will be no limit on the number of times a candidate will be permitted to resit the examination.

Examination syllabus
PHYSICAL OPTICS

Properties of light
Electromagnetic spectrum
Wave theory
Particle theory
Diffraction
Interference
Resolution
Polarisation
Scattering
Transmission and absorption
Photometry
Lasers 

GEOMETRIC OPTICS

Reflection
Laws of reflection
Reflection at a plane surface
Reflection at curved surfaces

Refraction
Laws of refraction (Snell's Law)
Refraction at a plane surface
Refraction at curved surfaces
Critical angle and total internal reflection

Prisms
Definition
Notation of prisms
Uses in ophthalmology (diagnostic and therapeutic)
Types of prism

Spherical lenses
Cardinal points
Thin lens formula
Thick lens formula
Formation of the image
Vergence power (dioptric power)
Magnification
Spherical decentration and prism power
Lens form

Astigmatic lenses
Cylindrical lenses
Maddox rod
Toric lensesConoid of SturmJackson's cross cylinderNotation of lensesSpectacle prescribing
Simple transposition
Toric transposition

Identification of unknown lenses
Neutralisation
Focimeter
Geneva lens measure

Aberrations of lenses
Correction of aberrations relevant to the eye
Duochrome test

CLINICAL OPTICS

Optics of the eye
Transmittance of light by the optic media
Schematic and reduced eye
Pupillary response and its effect on the resolution of the optical system (Stiles-Crawford Effect)
Visual acuity
Contrast sensitivity
Catoptric images
Emmetropia
Accommodation
Purkinje shift
Pinhole

Ametropia
Myopia
Hypermetropia
Astigmatism
Anisometropia
Aniseikonia
Aphakia

Accommodative problems
Insufficiency
Excess
AC/A ratio

Refractive errors
Prevalence
Inheritance
Changes with age
Surgically induced

Correction of ametropia
Spectacle lenses
Contact lenses
Intraocular lenses
Principles of refractive surgery

Problems of spectacles in aphakia
Effect of spectacles and contact lens correction on accommodation and convergence
Effective power of lenses
Back vertex distance
Spectacle magnification
Calculation of intraocular lens power
Presbyopia

Low visual aids
High reading addition
Magnifying lenses
Telescopic aids - Galilean telescope

CLINICAL REFRACTION

Retinoscopy
Subjective refraction
Measurement of BVD
Muscle balance tests
Accommodative power
Measurement of IPD
Decentration of lenses and prismatic effect
Best form lens
Prescribing multifocal lenses
Prescribing for children
Cycloplegic refraction

INSTRUMENTS

Direct ophthalmoscope
Indirect ophthalmoscope
Retinoscope
Focimeter
Simple magnifying glass (Loupe)
Lensmeter
Automated refractor
Slit-lamp microscope - including methods of examination
Stereo-tests
Keratometer
Applanation tonometer
Specular microscope
Operating microscope
Zoom lens principle
Corneal pachometer
Lees screen/Hess chart
Synoptophore
Goldman perimeter
Humphrey perimeter
Lenses used for fundus biomicroscopy (panfunduscope, Goldmann lens, Hruby lens, 90D lens, etc.)Fundus cameraGonioscope

OSE

Focimetry
Lens identification
Lens transposition
Calculations - focal length lens decentration
Ray diagrams
Prescribing for children
Contact lens fitting
Interpupillary distance
Fluorescein angiography
CT/MRI scans, plain X-rays etc
Ultrasound scans (A and B scans)
Electrodiagnosis
Hess charts/orthoptic reports
Interpretation of laboratory reports
Corneal topography
Biometry
Colour vision
Visual fields
Interpretation of Goldmann or Humphrey field testing

OSCE CLINICAL METHODS

Pupil reactions
Visual field testing/interpretation **
Ocular motility (including ptosis, nystagmus, cover test + prism bar)
Exophthalmometry
Ophthalmoscopy - direct and indirect
Use of slit lamp and lenses
Retinoscopy (model eye)

NOTE: ALTHOUGH THIS SYLLABUS IS REASONABLY EXHAUSTIVE, CANDIDATES MAY BE ASKED ABOUT TOPICS OF RELEVANCE TO OPTICS AND REFRACTION AND TO CLINICAL METHODS OF EXAMINATION WHICH ARE NOT LISTED.

** Candidates should note they may be asked to perform either a Goldmann or Humphrey visual field and should be familiar with the apparatus. They should also be prepared to interpret visual fields from this equipment.