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Certificate in Laser and Refractive Surgery

The College first introduced a Certificate in Laser Refractive Surgery in 2007. This examination in Laser Refractive Surgery, if successful, leads to the conferment of ‘The Certificate in Laser Refractive Surgery’ and subject to the GMC requirement for satisfactory annual appraisal as part of the revalidation process, permits the use of the post-nominals ‘CertLRS’. This certificate applied only to refractive procedures performed by laser.

The existing Certificate in Laser Refractive Surgery has now been extensively revised and its scope widened to include lens based refractive surgery, and also to improve the strength and validity of the assessment.  The information below should be read in conjunction with publications by other committees.

Certification and Standard Setting in refractive surgery is now covered by threeCommittees at the Royal College of Ophthalmologists:

  • Refractive Surgery Standards Working Group (Subcommittee of Professional Standards)
  • Refractive Surgery Examinations Subcommittee (Subcommittee of Examinations)
  • Refractive Surgery Curriculum Subcommittee (Subcommittee of Training)

Following revision of the College’s Standards, the examination is now set as an entry requirement to independent practice in the field.  The format has been changed to include 100 MCQs and five structured vivas. The latter are constructed in a similar manner to vivas for other RCOphth examinations that meet GMC assessment standards, and are a complete overhaul to those preformed previously in Cert LRS.

The portfolio element of the CertLRS has been removed and candidates will no longer have to submit audits or case reports. The new examination will continue to assess the principles of audit as they apply to refractive surgery in the MCQ and vivas.  Surgeons will need to demonstrate their knowledge of both laser and non-laser approaches, on the basis that they need to appropriately advise and select patients for surgery.

A detailed curriculum will shortly be published on the College’s website by the Curriculum Committee.

Overview of the syllabus which will be covered by the assessment:

  • Basic anatomy, physiology and optics
  • Pre-op Assessment for Cataract and Refractive Surgery
  • Theory of Laser Refractive Surgery
  • Refractive surgery for keratoconus
  • Technology and theory of lens based refractive surgery
  • Cataract / Lens surgery and intra-operative complications
  • Correction of Regular and Irregular Astigmatism
  • Phakic IOLs
  • Presbyopia
  • High Ametropia
  • Post operative complications of lens based refractive surgery
  • Post operative complications of laser refractive surgery
  • Retreatments
  • Good Medical Practice
  • Audit


The written component will consist of 100 MCQ questions, single best answer from four.  The question bank has been created in conjunction with Ulster University (UU) and candidates holding the PGDip CRS (theory) dated 2016 or later will be granted exemption from the written component.

The Ebel method will be used to standard set the written component and to determine a pass mark.  This is the same standard setting method as that used by the College for Part 1 and Part 2 FRCOphth MCQ examinations.

Structured vivas

There will be five structured vivas each lasting 10 minutes.  There will no longer be a Portfolio assessment. The viva stations are as follows:

  1. Good Medical Practice/audit
  2. Pre-op assessment
  3. Laser treatments
  4. Non-laser procedures
  5. Post-op assessment/ complications

Vivas will be of the same structure as those used in the College’s Part 2 FRCOphth and are intended to allow in depth discussion on a wide variety of topics, with the opportunity for examiners to explore candidates answers, seek further clarification, and assess their analytical skills in ways which are often not possible in MCQs.  Each will be marked independently by two examiners working from pre-defined scripted questions and structured into 4 marking points with a clear marking guide.  Viva questions and required answers will be written and agreed in advance by experts in the field.

The structured viva component will be standard set using the Angoff method.  This approach to standard setting is widely used, is approved by the GMC, and is a significant advancement on the previous criteria applied to pass the exam.

The first sitting of the new Certificate in Laser and Refractive Surgery will be held on 26 – 28 June 2017.

The fee to enter the assessment is £1,310.00 and applications can be made online from 20 February 2017.  The closing date for applications is 18 April 2017.

Candidate eligibility

There are two routes of eligibility to take the assessment:

1.Applicant is on the GMC’s Specialist Register for Ophthalmology.
2. Those without specialist registration in ophthalmology must have:
a. Evidence of substantive experience:
i. work in hospitals and training in ophthalmology for a minimum of four years full time equivalent OR
ii. FRCS, FRCOphth or MRCOphth as awarded from 1st January 1997 to 31 December 2008 OR
iii. DO (but not DRCOphth or the pre-1997 MRCOphth)
b. Minimum two years full time equivalent in refractive surgery

Applicants will be asked to email their CV to exams@rcophth.ac.uk to demonstrate their eligibility.

Policy on Allegations of Cheating and Misconduct May 2016

The existing Laser Refractive Surgery Curriculum is presented in an interactive PDF file, for ease of use and of distribution, and is available here: 079_Laser_Refractive_Surgery_Curriculum.  This document is currently under review, and a revised and extended curriculum will be published in Spring 2017.

All doctors are subject to undertaking Continued Professional Development (CPD) and annual appraisal as set out by the General Medical Council (GMC) as part of a system of revalidation.  Their appraisal should provide evidence to their employer, and if required by the GMC, to include all aspect of their practice including surgery in terms of Audit and Outcomes thus showing their competency to continue in practice.