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Refraction Certificate


The Refraction Certificate Examination is designed to assess the following practical skills from the curriculum for ophthalmic specialty training, which can be viewed in detail at: http://curriculum.rcophth.ac.uk/:

CA2 Assess vision
PM14 To use spectacle lenses and prisms when indicated
PS2 Perform a refractive assessment and provide an optical prescription
C1 Establish a good rapport with patients and relatives
C11 Keep clinical records
BCS6 Optics and Medical Physics

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.

Candidates sitting this examination before commencing OST should note that a pass in this examination will not count towards CCT if taken out of training unless the candidate enters or re-enters the training programme within 7 years of passing.

Candidates who have entered Ophthalmic Specialist Training (OST) must have passed this examination by the end of the third year of run-through training.

Structure of the Examination

The examination will consist of an Objective Structured Clinical Examination (OSCE).

Candidates will be examined on 10 OSCE stations in five rooms (see below).  Six of these stations are retinoscopy stations during which candidates will examine three patients, performing retinoscopy upon each eye.  The time allowed will be 10 minutes for each double retinoscopy station during which time both eyes must be assessed.  Candidates are permitted to divide the 10-minute period between the eyes as they wish.

The fourth room and fifth rooms are also double stations lasting 10 minutes. The fourth room will involve the subjective refinement of a cylindrical error of a patient and the assessment of a pair of spectacles either by neutralisation or focimetry. In the fifth room the candidate will be required to carry out a subjective refinement of sphere of on each eye of a patient followed by a binocular balance/plus one blur back or duochrome test. Candidates are again permitted to divide the 10-minute period between each station as they wish.  A one-minute warning will be given before the end of each OSCE (i.e. after nine minutes).

Each double station will be timed precisely. A one-minute warning will be given before the end of each double station (room) i.e. at 9 minutes to remind the candidate to submit their answers.

The OSCE times will be strictly enforced and no further writing / data input will be allowed after the 10 minutes is up. Anything written after the end of 10 minutes will be noted but not marked. Please bear this in mind during your practice.

Candidates are advised to prepare for all of the listed OSCE stations.  One examiner will be present in rooms 4 and 5 only (stations 7 – 10) for the duration of the cycle. Rooms 1 – 3 (stations 1 – 6) will be invigilated.

Summary of OSCE Stations

The OSCE consists of a series of strictly timed assessment ‘stations’, where different areas of competence are tested using an objective marking scheme.

OSCE Stations

  • Candidates will be examined on 10 OSCE stations in 5 rooms. Six of these stations are retinoscopy stations. Candidates will perform retinoscopy on each eye of three patients.
  • Invigilators or examiners will be present throughout the examination depending upon the OSCE stations being examined.
  • Each OSCE station will be worth 15 marks – a total of 150 marks.
  • Compositions of OSCE stations and rooms are as follows:

Room 1

Station 1: Cycloplegic Retinoscopy 1    – Patient A: Right Eye

Station 2: Cycloplegic Retinoscopy 2    – Patient A: Left Eye

Room 2

Station 3: Cycloplegic Retinoscopy 3   – Patient B: Right Eye

Station 4: Cycloplegic Retinoscopy 4    – Patient B: Left Eye

Room 3

Station 5: Non-Cycloplegic Retinoscopy 1   – Patient C: Right Eye

Station 6: Non-Cycloplegic Retinoscopy 2   – Patient C: Left Eye

Room 4

Station 7: Subjective Refraction: Cylinder   – Patient D: One Eye as directed

Station 8: Lens Neutralisation with or without a focimeter

Room 5

Station 9: Subjective Refraction: Sphere   – Patient E: Both Eyes

Station 10: Further refinement / Binocular Balancing    – Patient E: Both Eyes

Detailed information on the format and conduct of the examination is available in the Refraction Certificate – Instructions to Candidates and you are strongly advised to review the Instructions prior to submitting your application.

PLEASE NOTE: The Refraction Certificate exam will become electronic later in 2020. This means that the answers will be entered by candidates into iPads and marked electronically. When this occurs all visual acuities in this exam will be tested and recorded in logMAR only. It is important that you understand logMAR acuity notation and how to test and record this as alternative vision charts or visual acuity nomenclature will not be accepted.’

Pass Mark Setting

All examinations are pass mark set.  The Refraction Certificate OSCE is pass mark set using the Hofstee method. The pass mark setting methods quoted are subject to change at any time at the discretion of the College.

Overall Result

Candidates are required to pass the OSCE.  If awarded a fail, candidates must re-sit the entire examination, even if a pass was previously achieved in any station.


Results will be released four weeks after the examination, once verified by the Senior Examiner.  Candidates are not permitted to telephone the College for examination results.  All results will be sent to candidates by first class post and the pass list will be displayed on the College website.

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 Refraction Certificate 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.

Further Information

For further information, please see the Refraction Certificate Information Packs below:
2020 Refraction Certificate Information Pack
Refraction Certificate – Instructions to Candidates – (updated July 2019)
Sample Refraction Certificate Marksheets (updated June 2019)
Policy on Allegations of Cheating and Misconduct 2018

Refraction Certificate – Frequently Asked Questions (FAQs)

To apply please click the purple box, on the right-hand side, above.