How It Fits into the FRCOphth Timeline

The Refraction Certificate is a mandatory component of the Fellowship of the Royal College of Ophthalmologists (FRCOphth) pathway. It is designed to ensure that ophthalmology trainees and candidates demonstrate safe and competent clinical refraction skills before completing their final examinations.

This exam is often misunderstood or underestimated — yet it is an essential hurdle that must be cleared before attempting the FRCOphth Part 2 Oral examinations.

Where Does It Fit in the FRCOphth Pathway?

The FRCOphth pathway typically follows this sequence:

1. FRCOphth Part 1 – Basic sciences, no clinical experience required
2. Refraction Certificate – Practical exam in retinoscopy and subjective refraction
3. FRCOphth Part 2 Written – Clinical ophthalmology and patient management
4. FRCOphth Part 2 Oral (Viva + OSCE) – Final stage of assessment

To sit for the FRCOphth Part 2 Oral, candidates must first have passed both the Part 2 Written exam and the Refraction Certificate.
Importantly, candidates must also have passed FRCOphth Part 1 to be eligible to apply for the Refraction Certificate. This makes the Refraction exam not just a skill checkpoint, but a critical milestone within the FRCOphth journey.

Booking, Exam Content, and Preparation

The Refraction Certificate is a practical exam testing your skills in objective and subjective refraction using retinoscopy and other manual techniques.

Booking and Availability

• Offered: 3 times annually (usually March, July, November)
• Application Window: Opens ~12 weeks before the exam date
• Exam Centres: Primarily held at RCOphth’s designated testing sites in the UK
• Booking Platform: RCOphth Examinations Page

Due to limited slots and hands-on testing logistics, this exam can fill up quickly. Candidates are advised to check booking windows regularly and register early.

Exam Format and Duration

The exam typically runs for 90–120 minutes, depending on the number of stations and candidates per batch. It includes:

1. Objective Refraction

• Retinoscopy at various working distances
• Cylinder axis estimation
• Sphere and cylinder power estimation

2. Subjective Refraction

• Fogging techniques
• Jackson cross cylinder (JCC)
• Determining best corrected visual acuity (BCVA)

3. Clinical Judgement and Accuracy

• Final prescription formulation
• Documentation and communication of refraction findings

Key Elements:

• Each station is timed, usually around 10 minutes
• Real or model eyes are used in some stations
• Examiners assess accuracy, methodology, communication, and safety

Full guidance is available on the official Refraction Certificate syllabus published by the Royal College of Ophthalmologists.

Preparation Strategy

Unlike written exams that rely heavily on textbook knowledge, the Refraction Certificate focuses on applied skills. Hence, the preparation style must reflect this practical orientation.

Here is a structured preparation strategy to guide your journey:

Week 1–2: Understand the Syllabus

• Study the Refraction Certificate syllabus from RCOphth
• Watch official RCOphth videos (if available)
• Read chapters from:
  • Clinical Optics by Elkington
  • Optics Made Easy for FRCOphth candidates
• Familiarise yourself with:
  • Retinoscopy theory (spherical and cylindrical)
  • Visual acuity measurement standards
  • Subjective refraction techniques

Week 3–5: Hands-On Practice

• Practice daily using retinoscopes and trial lenses
• Partner with colleagues to simulate exams
• Time yourself for each step: reflex detection, JCC use, finalisation

Week 6–7: Mock Scenarios and Simulation

• Complete full-length mock exams in real conditions
• Get feedback on technique, timing, and prescription accuracy
• Focus on consistency and confidence under exam conditions

Daily Micro-Practice

• 15 minutes of reflex movement identification
• Trial lens ordering and communication script
• Error spotting (e.g. over-minusing or axis misjudgement)

For many international doctors or early trainees, mastering retinoscopy and subjective refraction without daily clinic access can be a challenge. This is where focused mentorship and structured simulation can be a game-changer.

PrepMedico offers:

• Personalised guidance from FRCOphth-qualified mentors
• One-on-one technical drills for retinoscopy and JCC
• Mock station walkthroughs with exam-style timing
• Structured feedback on lens choice, communication, and workflow

This kind of targeted training ensures that candidates don’t just memorise techniques, but build real confidence with real cases or simulated patient models. This approach also fits especially well for those preparing while working full-time or outside UK teaching hospitals.

You can explore our offerings here: PrepMedico FRCOphth Support

For full exam details, booking updates, and resources, explore: RCOphth Refraction Certificate Exam Page

Frequently Asked Questions (FAQs)

Why is the Refraction Certificate required separately?

Refraction is a core skill in ophthalmology and is too technical to be assessed adequately in written exams. The Royal College separates this assessment to ensure that all FRCOphth candidates demonstrate practical competence in refraction, which is central to daily clinical care.

Do I need to pass it before Part 2 orals?

Yes. You cannot appear for the FRCOphth Part 2 oral exams (viva or OSCE) unless you have passed the Refraction Certificate. It’s advisable to schedule the certificate early enough, so that it doesn’t delay your Part 2 progression.

How is the Refraction Certificate assessed?

It is a practical, OSCE-style exam with multiple stations testing:

• Retinoscopy technique and accuracy
• Subjective refinement using JCC
• Prescription accuracy and communication

Examiners assess your methods, clinical judgement, and final prescription, not just the result. Every step counts.

Can PrepMedico help with Refraction Certificate prep?

Yes. While PrepMedico does not position itself as a formal training provider, it offers mentorship-driven prep, including:

• One-on-one refraction coaching
• Retinoscopy drills and timing
• Common station walkthroughs
• Feedback on positioning, accuracy, and prescription errors

The programme is especially helpful for overseas doctors who may not have access to hands-on refraction training in their home country.

When is the best time to attempt Refraction?

Most candidates take the Refraction Certificate 6–12 months after passing Part 1 and before starting their Part 2 written prep. This timing:

• Ensures sufficient practical experience
• Prevents backlog or last-minute delays in Part 2 progression
• Allows time to retake if necessary. Historically, pass rates have varied across sittings and are typically moderate.

Check available slots on the RCOphth Refraction Exam Page.