Acing the ICO Exam

Dr. Rajat Kapoor, MBBS, DO, DNB, FLVPEI, FICO, FRCS
  • Dr. Rajat Kapoor completed his basic medical training from Krishna Institute of Medical Sciences, Maharashtra affiliated to MUHS, Nashik. He did his Diploma in Ophthalmology from Joseph eye hospital in Trichy where he won the gold medal followed by D.N.B in Ophthalmology from Sankara Eye Hospital in Coimbatore.
  • He went on to do a fellowship in Paediatric/Neuro-ophthalmology and Strabismus from LV Prasad eye institute, Hyderabad.  Currently, he is a senior faculty and leading the paediatric/Neuro-ophthalmology and Strabismus services at Pushpagiri eye institute, Hyderabad.
  • He is a Fellow of the International Council of Ophthalmology (F.I.C.O) London and also a Fellow of Royal College of Surgeons of Glasgow (F.R.C.S). He has an experience of over 11 years in the field of ophthalmology.
1. Brief description about the ICO?

ICO (International council of ophthalmology) is an organization with headquarters in Geneva, Switzerland. The goal of the organization is to standardize the quality of ophthalmic care across the globe. The ICO exams are conducted world-wide to help ophthalmologists, evaluate their knowledge in basic and clinical sciences. The ICO has fellowships which are designed to support young ophthalmologists to improve their clinical skills and also broaden their horizon by visiting and observing experts at various top institutions across the globe which aids them to deliver high-quality eye care to their patients.

Currently the ICO conducts its exams in various steps which I am highlighting below:

  • Step A (Visual sciences): 120 MCQ’s in 3 hours, single best answer, no negative marking, covers the following subjects;
    • Anatomy of the Eye, the Orbit and related structures
    • Neuro-Anatomy
    • Vision, Ocular Physiology, Biochemistry and Cell Biology
    • Epidemiology and Statistics
    • Pathology and Micro-biology
  • Step B (Optics, Refraction and instruments): 60 MCQ’s in 1.2 hours, single best answer, no negative marking, covers the following subjects;
    • Optics
    • Refraction and Instruments
    • Instruments used in Ophthalmology
  • Step A+B combined: Separate exams on the similar pattern as mentioned above can be done on the same day one after the other.
  • Step C (Clinical ophthalmology): can be given only after clearing step A and B. 200 MCQ’s in 4 hours, single best answer, no negative marking, covers the following subjects;
    • General Medicine related to Ophthalmology
    • Community and Public Health
    • Ophthalmic Pathology and Tumours
    • Neuro-ophthalmology
    • Paediatric Ophthalmology and Strabismus
    • Orbit, Eyelids and Lacrimal Disease
    • External Diseases and Cornea
    • Intraocular Inflammation and Uveitis
    • Lens and Cataract
    • Retina and Vitreous
  • Advanced 115: can be given only after clearing steps A, B and C. Duration Is 3 hours, it mainly tests clinical acumen, application of knowledge, common sense and decision making. You may have to prepare all subjects covered in previous steps for this exam.
  • ICO sub-speciality exams: offered for ophthalmologists who have completed a minimum f one year training in their chosen speciality. The Examination will comprise of 80 context setting description (written, visual or graphical) each with 4 associated statements which require a single best answer response. The examinations will be offered in the following subjects:
    • Cornea & External Eye Disease
    • Glaucoma
    • Medical & Surgical Retina
    • Oculoplastic
    • Neuro-Ophthalmology
    • Paediatrics & Strabismus
    • Uveitis

More information is available on ICO Website 🔗 

2. Why should I prepare for the ICO exam?

The standard of education, patient care and training is very variable across the globe. Certain institutes give their trainees great exposure with respect to sub-specialty care, surgical skills. On the other hand, there are many institutes where doing a residency is merely a formality to get MD/MS post nominals. There is lack of access to basic ophthalmic equipment and teaching faculty. Such residents/fellows are left high and dry, but for those who are keen to improve, applying for the ICO exams gives them motivation to study and learn more and that too in a standardized way.

Personally, I started with the ICO exams as there was a trend of giving it during post-graduation in our institute. All of my seniors and colleagues were doing it, so I too gave it a shot thinking it can only make me better.

3. What’s the best time to apply for the ICO exam?

Its best to start early. 

  • I would suggest one to give step A and B during the first year of residency if you are doing a DO, or during second year of residency if you are doing MD/MD/DNB. 
  • For step C, it is better to plan immediately after completing your residency as at that stage we have anyways extensively read for our post graduate exams. 
  • Advanced exam can also be given immediately or within an year of completing residency. 

I personally feel delaying the exams after residency can be counter-productive as later we tend to get busy with fellowships (focusing on a single speciality) or practice and get out of touch with academics and at that stage preparing for basic sciences exams may be a touch painful.

4. How to apply for the ICO exam?

Application for the exam can be submitted online ICO Examination Registration Site 🔗 after creating an account and registering yourself. The application process is straightforward and simple. Exam fee can also be paid online via wire transfer. For any query, we can mail the ICO team, they are very responsive and usually get back within a day. Previously, the ICO used to offer a group discount on exam fee for people from low-middle income countries (>3 candidates applying together or applying through a local ICO exam coordinator). Recently I heard that they have stopped this process, however interested candidates may write to them directly to know more.

I recommend to attempt step A and B simultaneously. The exams are conducted every 6 months and all information with respect to dates etc. can be accessed online.

5. What books and online resources (step-wise) to read and how to prepare for the ICO exam?

There are many online resources, books and telegram channels available nowadays but I feel it’s better to keep it simple. The standard of post graduate exam in India is quite similar to what is required for clearing the ICO exam and thus, we can just follow the books which we routinely study during our post-graduation.

However, I will list a few of them for everyone’s benefit:

  • Step A (Basic sciences): Khurana Anatomy and Physiology, Basic sciences in ophthalmology by John Ferris, Basic sciences in practice by John Forrester.
  • Step B (ORI): Optics and refraction by Khurana, Elkington clinical optics
  • Step C (Clinical sciences and Advanced exam): Any of the basic textbooks which we may follow for our post-graduate exam (Kanski, Zia Choudary, Yanoff, Wills eye manual ,Parson’s, AAO series, DOS articles). MCQ based books such as (Massachusetts eye and ear infirmary review manual of ophthalmology, Review questions in ophthalmology by Kenneth Chern, Provision).

Again, it is not mandatory to read all these books. It is important to read, understand and apply basic textbooks and have a good base. Application of subject is more important than mugging MCQ’s. Personally I read only a few of these but had all of them on my I-pad, hence mentioned.

6. Pros & Cons of the ICO Exam.

ICO exams are optional and for people who are already doing their residency/fellowship from good institutes, they can give it a miss as it does not add much to their repertoire apart from an additional postnominal. However it is a personal choice, like everything in life we can discuss its pros and cons;

Pros :

  • Internationally recognized postnominal (FICO).
  • Exemption from Step 1, Step 2A and step 2B for FRCS Glasgow.
  • MRCS Ed – direct entry after clearing on application.
  • Opportunity to pursue short term(3 months) and long term (1 year) sponsored fellowships abroad. Clearing ICO exams is not mandatory to apply for these fellowships.
  • Exposure to different working styles abroad.
  • Reading and revision of subjects in a systematic way.
  • Testing yourself (joy of giving exams).
  • Better future opportunities (adding an internationally recognized qualification definitely improves your CV and may help you in getting preference in fellowship/job interviews).

Cons :

  • Financial impact : the exams are expensive as you end up paying in swiss franks. With remuneration being quite low in our country during post-graduation and fellowships, paying for these exams may add to our financial burden.
  • No surgical work during fellowships , they are merely an observership.
  • FICO is not a licensing exam and contrary to the belief of many it directly does not allow us to work in foreign countries like UK, Australia and UAE.
  • Lack of exclusivity: FICO has now become very common and many people complete this exam. FRCS exams in that way carry more exclusivity and weightage as they are harder to crack.
Quick Links 🔗