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What are ICO International Examinations?

The ICO started to run examinations (at first called “Assessments”) in 1995 and almost each year more and more ophthalmologists take the examination. In 2019 over six thousand, five hundred examinations were taken in 137 test centres in 83 countries.

The International Council of Ophthalmology (ICO) represents and serves professional associations of ophthalmologists throughout the world. One of its objectives is to promote excellence in eye care worldwide by encouraging individuals to acquire and maintain the highest standard of knowledge for the practice of Ophthalmology. The International Visual Science Examination, Optics, Refraction, and Instruments, and the Clinical Ophthalmology Examinations are part of that initiative.

The examinations are tests of knowledge to a very high international standard in Optics, Refraction, and Instruments, Visual Science as applied to ophthalmology and Clinical ophthalmology. The standards are equivalent to those set by such bodies as the Royal Colleges or the American Academy of Ophthalmology.

Candidates who pass any of the sections of the examination will have a knowledge base relating to that section, which equips them to practise ophthalmology leading toward consultant practice. The Examinations do not test competency in clinical or basic sciences or research, purely knowledge and they are thus not a licence to practise.

The Advanced (FICO) examination tests up-to-date knowledge and a high level of "common sense" decision making and has a unique marking system that encourages precision and accuracy which are essential characteristics of competent ophthalmologists. The areas covered include current clinically relevant basic sciences, theoretical optics & refraction and clinical sciences, international ethics and the ICO guidelines.

Why should an ophthalmologist take the ICO examinations?

  1. The ICO Examinations give ophthalmologists in every country an opportunity to take an international ophthalmology exam of a standard that is at least equivalent to any Regional and National examinations.
  2. Passing the examinations demonstrates a level of knowledge, in the relevant areas of ophthalmology, which is needed for a trainee to apply what they learn in the clinic.
  3. The examinations are not a test of competence or a license to practise but its presence has encouraged several countries to have their own face-to-face exams tests of competence to practise. Some countries use the ICO Examinations as an entry to their licensing procedures.
  4. They have raised the standard of ophthalmology in many countries to the benefit of the population as a whole.
  5. The successful candidates use the qualification to prove a level of knowledge and for advancing their career.
  6. Passing the examinations may exempt candidates from some parts of other examinations.
  7. Candidates who obtain a Distinction (top 0.1%) or Merit (top 0.5%) are assured of national and international recognition that they have achieved the highest standards.
  8. Successful candidates have an increased chance of getting one of the 80 or so ICO Fellowships each year.

What are the costs?

The exams are supplied at a cost that is on a sliding scale depending on the country’s Gross National Income Per Capita (GNIPC). This gives the figures for individuals in a country so whilst a country may be high in the list of GNI, with GNIPC a populous country may rank well outside. Thus it is possible to make the exam affordable by every ophthalmologist wherever he/she lives as long as the application for the exams is made through a co-ordinator: individual bookings come at the full price.

Bursaries may help individual candidates in difficult financial circumstances: applications are made directly with the Examinations Office and need the written support of a co-ordinator or the candidates tutor.

In order to use the examination to best help ophthalmologists and their patients in the 80 countries where the ICO exam is taken, we prefer it if the “senior” Ophthalmological Society (“senior” is usually defined as the one that pays the ICO dues) is involved. The society itself does not have to run the exam: that is done by the co-ordinator. It is, however, best if the society is involved as this disseminates the exam and may lead to the formation of a national or regional face-to-face or other examination of competence.

The fees for the exams in 2020, where a candidate applies for the exam individually are:

  1. Visual Science + Optics, Refraction, and Instruments: 745 Swiss Francs.
  2. Visual Science: 595 Swiss Francs
  3. Optics, Refraction, and Instruments: 445 Swiss Francs
  4. Clinical Ophthalmology: 1015 Swiss Francs
  5. Advanced: 650 Swiss Francs

Contact your local coordinator or the ICO exams office to obtain a substantial fee reduction.

No refund is given to candidates who enroll for both papers but only complete part of the Examination.

Who are the Examinations Co-ordinators?

The International Council of Ophthalmology Examinations Co-ordinators are appointed by the ICO Examinations committee as they are prominent, senior ophthalmologists. They play a vital role in the dissemination, organisation and invigilation of the examinations for which they do not get paid: they mostly fulfil this role as a service to their community.

You can find a co-ordinator here.

Who writes and sets the questions?

The questions are written by a panel of senior clinical ophthalmologists and basic scientists from many countries. The questions are proof-read and modified by the director of the Examinations Committee and, if good enough, added to the question database.

Well before the examinations the Examinations Committee, which consists of ophthalmologists who represent the major areas of the world, has a question setting meeting where the questions are scrutinised in detail and, if necessary modified or rejected.

After the exams the performance of each question is recorded in the question database so that it can be modified if used again.

Security of the examinations

Security is very important in order to retain the credibility of the examinations and of those who will and have already passed them. This security is preserved in a number of ways, including the following:

  1. Few questions are used twice in exactly the same form in order to prevent groups building up a bank of previously asked questions.
  2. There is a high percentage of new questions each year.
  3. The delivery of the questions to the centres where the examinations are taken and their return is by secure courier or by personal delivery by a member of our team.
  4. Centres may be visited by the ICO Examinations team without notice.
  5. Our co-ordinators who organise and invigilate are chosen because of their prominence in their community, their honesty and helpfulness. They are regularly reviewed.
  6. There are severe penalties for cheating in the examinations: candidates proven to have cheated are always disbarred from the current examination and their paper is not marked, they may be disbarred for up to 5 years and they may be reported to their co-ordinator, local Ophthalmological Society or Ministry of Health.
  7. The question marking is scrutinised by software which detects abnormal grouping of answers.
  8. Other confidential methods.

The responsibilities of the Candidates

Candidates are responsible themselves for their preparation for the examinations by reading, attending teaching courses, seminars, demonstrations etc. They may be helped by reading the Educational Technology and Reading lists which the ICO Examinations supplies (available here). They have to come to the examinations appropriately equipped and they should have read in the instructions to candidates (also available here).

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