The paper is composed of 52 multiple choice questions (MCQs) which cover any basic science, medical or surgical topic relevant to the practice of ophthalmology, particularly in the following fields:

1. Optics, Refraction and Contact Lenses
2. Paediatric Ophthalmology and Strabismus
3. External, Corneal and Adnexal disease
4. Glaucoma, Cataract and Refractive Surgery
5. Retina, Vitreous and Uvea
6. Neuro-ophthalmology
7. Orbital Disease and Oculoplastic Surgery
8. General Medicine relevant to Ophthalmology
9. Ophthalmic Pathology, Microbiology and Immunology
10. Pharmacology and Therapeutics

The MCQs consist of a stem followed by five statements, each of which is either ‘true’ or ‘false’. Hence, 260 answers will be required. The languages available are English, French and German - only one for each candidate, according to request on application form. Each correct answer credits one point.

Examples from fields 1 through 5:

1. The age of onset of presbyopic symptoms: from EBOD 2004, field 1

Is earlier for a patient with a small amplitude of accommodation Is earlier for a hyperopic patient who wears contact lenses rather than spectacles Is earlier for a myopic patient who wears contact lenses rather than spectacles Is earlier for a myopic than a hyperopic patient who wears spectacles with full distance correction Is earlier for a short than a tall patient

2. Regarding accommodative spasm: from EBOD 2004, field 1

It typically causes pseudohyperopia It does not occur in truly myopic patients It is suggested by an apparently small accommodative amplitude (relative to age)   It is confirmed by a large difference between manifest and cycloplegic refraction It is managed by gradually adding minus to (or reducing plus from) the prescription

3. Near visual acuity is disproportionately reduced compared with distance acuity in: from EBOD 2004, field 1

Age-related macular degeneration Posterior subcapsular cataract Advanced glaucomatous optic neuropathy Amblyopia High myopia

4. A 5-year old boy, tall for his age with long thin fingers and hyperextensible finger joints, presents with bilaterally subluxated lenses, one down and in and the other up and out. Both parents are normal and there is no family history: from EBOD 2003, field 2

The most likely diagnosis is Weill-Marchesani syndrome An electroretinogram is indicated Visual acuity is best helped by aphakic or phakic spectacle correction based on retinoscopy and subjective refinement In the differential diagnosis an autosomal recessive disease such as homocystinuria should not be considered An echocardiogram should be performed

5. In 6th cranial nerve palsy: from EBOD 2004, field 2

The cover test can show an esophoria for near and an esotropia for distance The double vision is horizontal and the images are crossed A lesion involving the 6th nerve nucleus will result in an ipsilateral horizontal gaze palsy and a lower motor neurone 7th nerve palsy Additional involvement of the ipsilateral 3rd, 4th and 5th cranial nerves indicates cavernous sinus involvement The choice of surgery depends on whether there is demonstrable lateral rectus function present

6. Bullous keratopathy: from EBOD 2004, field 3

Is an inherited disease of the corneal epithelium Is often painful Is rarely associated with visual loss May require penetrating keratoplasty Starts in early childhood

7. Which is/are true of keratoconus: from EBOD 2004, field 3

The disease is inherited as an X-linked recessive trait Increasing irregular astigmatism is a common finding The main progression of the disease usually occurs after the age of 40 Laser Assisted in situ Keratomileusis (LASIK) is a main treatment option for severe keratoconus When good visual acuity is no longer achieved with glasses, rigid gas-permeable contact lenses may be an option

8. Congenital ocular syphilis is characterised by: from EBOD 2004, field 3

An epaulette followed by a salmon patch in the acute phase Hutchinson’s teeth and a saddle nose Loss of corneal sensation Superficial vascularisation of the cornea Corneal steepening

9. Patients with the exfoliation syndrome (pseudoexfoliation) are more likely to develop: from EBOD 2004, field 4

Chronic open-angle glaucoma Hyphaemas Capsular rather than zonular rupture during cataract surgery Asteroid hyalosis Iris pigment dispersion

10. In the iridocorneal endothelial syndrome (ICE): from EBOD 2004, field 4

Iris atrophy in Chandler’s syndrome is severe Peripheral anterior synechiae are commonly found Glaucoma is usually bilateral It is caused by proliferation of corneal endothelial cells over the iris Filtering surgery usually is not effective

11. Angioid streaks: from EBOD 2004, field 5

Are caused by crack-like dehiscences (breaks) in the retina Are usually concentric with the optic disc Are seen in sickle cell disease Are associated with systemic disease in about 50% of cases May be complicated by choroidal neovascularisation

12. Retinoblastoma: from EBOD 2004, field 5

Is caused by mutations in a tumour suppressor gene When familial is always bilateral Exophytic tumours spread into the vitreous cavity Trilateral disease indicates associated pituitary tumours Tumours characterised by Flexner-Wintersteiner rosettes are more differentiated

Answers to the example MCQ

Upon completion of the Written Paper, applicants proceed to the Oral Examination.

Four separate vivas of 15 min each will be conducted by four panels of two examiners. Language is English but, whenever possible, at least one examiner in each pair will be chosen to speak and understand, in case of difficulty, the Candidate’s native tongue.

The viva voce panels are:

1. Optics, Refraction, Strabismus and Neuro-ophthalmology
2. Cornea, External Diseases, Orbit and Ocular Adnexa
3. Glaucoma, Cataract and Refractive Surgery
4. Posterior Segment, Ocular Inflammation and Uveitis

The vivas will cover developmental, dystrophic, degenerative, inflammatory, infectious, toxic, traumatic, neoplastic, and vascular diseases affecting the eye and its surrounding structures. In all panels candidates should be able to discuss preventive ophthalmology, medicolegal aspects of ocular disease and European contributions to ophthalmology.

In each panels emphasis will be placed upon the following:

1. Data Acquisition: Recognition by the candidate in presented material of abnormalities and diseases that affect the eye, ocular adnexae and the visual pathways.
2. Diagnosis: The ability of the candidate to synthesize clinical, laboratory and histopathological data in order to arrive at a correct diagnosis and differential diagnosis.
3. Treatment: Candidates will be expected to provide a reasonable and appropriate plan for medical and surgical management of patients with the conditions depicted or described.

Detailed information about the viva voce procedure and schedule is sent to all candidates after registration for the examination.

After the examination, the successful candidates that also hold a valid certificate of Specialist in Ophthalmology in any country of the European Union, Norway, or Switzerland may add the title Fellow of the European Board of Ophthalmology (FEBO) after his or her name.