My personal tips for cracking the competitive Royal College of Ophthalmology (practical) refraction certificate examination in the first attempt

Dear Editor,

For the first time since its commencement, the Royal College of Ophthalmology (RCOphth) has conducted the refraction certificate exam in India, making it accessible to aspiring candidates. We had the privilege of taking part in that exam and clearing it on the first attempt. We are sharing our experience regarding the preparation involved to crack this exam in the first attempt.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the examination pattern had been changed and it was conducted only using a trainer eye model (Heine model). It consisted of five stations; the first four had two retinoscopy each and the fifth station had one retinoscopy and one lens neutralization.[1] Also, each station should be completed within 10 minutes.

It is a known fact that it is challenging to crack these competitive exams without a strategy. So, during the preparation phase, we practiced on trainer eye models (in addition to real patients), as sometimes those reflections might throw you off in the exam if not exposed to them before. We used the demo version of the exam available on the RCOphth website (https://ripleyhosting.co.uk/fmi/webd/RCOphth_Web?homeurl = https://ripleyhosting.co.uk/RCOphth/). It helped us with time management and familiarized us with data entry without manual errors. The exam page will close after the allotted time runs out; so, if you have not entered your data in the iPad before that, you will lose marks. Hence, it is imperative to enter your data before time runs out. This comes only with practice, and it is nearly impossible to do this for the first time in the exam hall, due to familiarity issues.

It is essential to set up the station optimally during the exam to perform smoothly. In the time given for orientation, adjust the room lighting and the height of the ophthalmic chair, shift the lens tray to the ophthalmic chair, and place the rough paper, pencil, and iPad next to you [Fig. 1]. We would suggest not using a trial frame, as it was not comfortable to use over the model head and caused time delay due to physical friction while inserting and taking the lens from the trial frame every time. Once you start with retinoscopy, the first thing to look for will be the axis, which can be confirmed using the protractor image on the wall behind the model eye [Fig. 2]. Then, input the axis in the iPad and make a cross in the rough sheet [Fig. 3]. Now go about neutralizing the power. Now use the rough sheet to do your distance correction and write down the prescription value. Then, enter the data into the iPad to avoid trivial errors [Fig. 4]. For shorter candidates, it was comfortable to stand and do retinoscopy, considering the model is mounted on the headrest of the ophthalmic chair. With this pattern, we were able to complete each station with several minutes to spare. Also, for the lens neutralization station, we suggest writing down your findings in the rough sheet and then transferring them to the iPad to reduce calculation errors.

Figure 1.

Photograph of arrangement of lens tray for optimal performance, by isolating the whole numbers separately (green arrows), for ease of use

Figure 2.

(a) Photograph of a Heine retinoscope trainer eye model with retinoscopy depicting oblique axis. (b) Photograph showing confirmation of retinoscopy axis on the protractor printout

Figure 3.

(a) Screenshot of iPad showing the aligning of axis according to retinoscopy. (b) Photograph of the rough sheet showing marking down of the identified axis

Figure 4.

(a and b) Photograph of a (sample) final workup done on the rough sheet followed by the screenshot showing the transferred data, respectively

Though the Royal College of Ophthalmology refraction examination patterns are ever-evolving, it is easy to get through them with proper planning and good strategizing. In this manuscript, we have shared our personal experience and certain important tips and tricks on how we cracked this competitive exam in our first attempt, which incidentally took place for the first time in India.

Acknowledgments and sincerely thank Mr. Akshay Surendran (Optometrist, Department of Optometry and Research) of Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India for his help and support, while preparing for this competitive exam.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.