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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 three Committees 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.

From 1 August 2013, candidates are permitted a maximum of six attempts in which to pass this examination. Examination attempts prior to August 2013 do not count towards the number of attempts available.

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

CertLRS Syllabus

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

For a detailed syllabus please see CertLRS Syllabus 20170510


The written component will consist of 100 MCQ questions, single best answer from four.  The examination is of the open-book format. The question bank has been created in conjunction with Ulster University (UU). The Ebel method will be used to pass mark set the written component and to determine a pass mark.  This is the same pass mark setting method as that used by the College for Part 1 and Part 2 FRCOphth MCQ examinations.

MCQ Online Delivery

From September 2021, the CertLRS MCQ examination will be taken as an Online Examination, where the candidate will sit the exam at their home or their workplace, without the need to travel to a testing centre or examination venue. The examination will be taken online by being delivered over the internet to the candidate’s computer at a pre-agreed examination date and time.

Candidates are recommended to thoroughly read and familiarise themselves with the Important-Information-for-CertLRS-online-MCQ-Examination

Candidates are also advised to read the CertLRS-MCQ-Online-Written-Exam-FAQs

MCQ Exemption

  1. Candidates holding the PGDip CRS (theory) dated 2016 or later will be granted exemption from the MCQ component of the CertLRS for one sitting.
  2. This exemption will be valid for 5 years from the date of being awarded the PGDip CRS by Ulster University (specifically the date of the UU exam board meeting).
  3. Should such a candidate fail the viva component, and hence the CertLRS, they will not be exempt the MCQ component if they choose to re-sit the examination.

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 pass mark set using the Angoff method.  This approach to pass mark setting is widely used, is approved by the GMC, and is a significant advancement on the previous criteria applied to pass the exam.

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 evidence of substantive experience in ophthalmology:

i. FRCOphth OR
ii. MRCOphth as awarded from 1 January 1997 to 31 December 2008 OR
iii. FRCSEd(Ophth)  OR
iv. FRCSI(Ophth)  OR
v. FRCSGlas (Ophth) OR
vii. FICO OR

Applicants will be asked to provide a certified copy of their relevant post-graduate certificate to demonstrate their eligibility.

Policy on Allegations of Cheating and Misconduct May 2016

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.

Additional Examination Attempts

GMC policy states: “No candidate will normally be allowed more than six attempts at an examination.”

“After six failed attempts, a candidate must provide evidence of additional educational experience to the royal college or faculty for each re-sit.”

The GMC have confirmed that the expectations around national professional examinations allow flexibility for colleges to make exceptions to the guidelines or to apply more stringent rules if they see fit, meaning they are permitted to implement their own limit to the number of additional exam attempts permitted.

The RCOphth will allow only ONE additional attempt after the limit on previous attempts has been reached.

NB: For the CertLRS examination, the maximum number of attempts is 6.

For RCOphth examinations, candidates who have had the maximum number of attempts will not be eligible to attempt an examination again unless evidence of additional educational experience is provided. To be considered for a maximum of one additional attempt only, please read the following Additional Examination Attempt Information Pack and complete the Additional Examination Attempt Application Form only if you have exhausted your maximum number of exam attempts.