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Structure of Examination

Structure of Examination

Please note, from May 2024, the European Board of Ophthalmology have updated the comprehensive exam, to standardise the exam for onsite and online delivery.

What has changed?

Specifically, the manner in which candidates will be scored, and the passing requirement has been updated. The EBO Education Committee has developed these changes to ensure both exams require the same standard to pass.

Candidates now must score a 6 or greater in PART I (Written /MCQ section) to pass the section and also to pass the entire exam
PART I (Written/ MCQ section) will consist of 30 “traditional” EBO MCQs (Mutliple True/ False statements), and 30 SBA (Single Best Answer) type questions
There will be no negative marking in Part I
In Part II (oral exam Viva Voce / Online Clinical Cases), standardised cases will be used, and candidates will be marked based on the number of questions they answer correctly
Scores from the standardised cases will be re-scaled in line with the rescaling of the MCQ (the score equal to the average minus one standard deviation will be assigned a 6, with scores above and below this rescaled accordingly)
Exams will be delivered via the online exam platform (rather than paper-based), unless circumstances prevents this.

What has not changed?

The format of the exam: A written section followed by a series of cases based on the exam syllabus
The exam is still weighted 40% to the MCQ and 60% to the Viva Voce/ Clinical Cases
Candidates must score a 6 overall to pass
Candidates may score less than a 6 in ONE viva voce/ clinical case station, if their overall score is still above a 6

Candidates will sit the 2 parts of the exam in one day, with the results released on the next day for in person exams only.

Exams will now be taken directly via the Speedwell eSystem online exam platform. For candidates taking the online exam, they will need to ensure their laptop is compatible (a test connection will be provided in the weeks before the exam for this purpose). For onsite candidates in 2024, iPads will be provided for candidates to take the exam.

More details on the evolution of the EBO Comprehensive exam can be found in the communication issued in April 2024.

Below, we provide further information about the question types and format for each section.

Written / MCQ & SBA (Part I)

Will be composed of 30 traditional MCQs (Multiple True / False Questions) and 30 Single Best Answer questions
Negative marking will be removed
Duration will be 2 hours. If a technical problem onsite means candidates must use paper sheets to answer the MCQ section, then the duration will be increased to 2.5 hours.
It will now be mandatory to score a 6 in this section to pass the exam.

Viva Voce and Clinical Cases (Part II)

Will use standardised cases

In onsite situations, examiners will score candidates based on how well they match model answers
In online situations, examiners will review free-text input to compare candidate answers with model answers
The onsite exam will be 60 minutes to cover 8 cases (in 4 stations), whereas the online exam will be 80 minutes to cover 8 cases (in 4 stations), as candidates will need to type the answers, which naturally takes longer than talking

Part I. The Electronic Paper (MCQ & SBA Exam)

The paper is composed of 30 multiple choice questions (MCQs) and 30 Single Best Answer (SBA) questions, which cover the range of basic science, medical or surgical topics relevant to the practice of ophthalmology, particularly in the following fields:

Optics, Refraction and Contact Lenses
Paediatric Ophthalmology and Strabismus
External, Corneal and Adnexal disease
Glaucoma, Cataract and Refractive Surgery
Retina, Vitreous and Uvea
Neuro-ophthalmology
Orbital Disease and Oculoplastic Surgery
General Medicine relevant to Ophthalmology
Ophthalmic Pathology, Microbiology and Immunology
Pharmacology and Therapeutics

The MCQs consist of a stem followed by five statements, each of which needs to be judged as ‘true’ or ‘false’. Hence, 150 items will be answered in this format. The languages available are English. Answers are scored as 1 point for correct, and 0 points for incorrect or unanswered.

Examples from fields 1 through 5:

The age of onset of presbyopic symptoms: from EBOD 2004, field 1

A) Is earlier for a patient with a small amplitude of accommodation
B) Is earlier for a hyperopic patient who wears contact lenses rather than spectacles
C) Is earlier for a myopic patient who wears contact lenses rather than spectacles
D) Is earlier for a myopic than a hyperopic patient who wears spectacles with full distance correction
E) Is earlier for a short than a tall patient

Answers: A) TRUE; B) FALSE; C) TRUE; D) FALSE; E) TRUE

Regarding accommodative spasm: from EBOD 2004, field 1

A) It typically causes pseudohyperopia
B) It does not occur in truly myopic patients
C) It is suggested by an apparently small accommodative amplitude (relative to age)
D) It is confirmed by a large difference between manifest and cycloplegic refraction
E) It is managed by gradually adding minus to (or reducing plus from) the prescription

Answers: A) FALSE; B) FALSE; C) TRUE; D) TRUE; E) TRUE

Near visual acuity is disproportionately reduced compared with distance acuity in: from EBOD 2004, field 1

A) Age-related macular degeneration
B) Posterior subcapsular cataract
C) Advanced glaucomatous optic neuropathy
D) Amblyopia
E) High myopia

Answers: A) TRUE; B) FALSE; C) TRUE; D) FALSE; E) FALSE

A 5-year old boy, tall for his age with long thin fingers and hyperextensible finger joints, presents with bilaterally subluxated lenses, one down and in and the other up and out. Both parents are normal and there is no family history: from EBOD 2003, field 2

A) The most likely diagnosis is Weill-Marchesani syndrome
B) An electroretinogram is indicated
C) Visual acuity is best helped by aphakic or phakic spectacle correction based on retinoscopy and subjective refinement
D) In the differential diagnosis an autosomal recessive disease such as homocystinuria should not be considered
E) An echocardiogram should be performed

Answers: A) FALSE; B) FALSE; C) TRUE; D) FALSE; E) TRUE

In 6th cranial nerve palsy: from EBOD 2004, field 2

A) The cover test can show an esophoria for near and an esotropia for distance
B) The double vision is horizontal and the images are crossed
C) A lesion involving the 6th nerve nucleus will result in an ipsilateral horizontal gaze palsy and a lower motor neurone 7th nerve palsy
D) Additional involvement of the ipsilateral 3rd, 4th and 5th cranial nerves indicates cavernous sinus involvement
E) The choice of surgery depends on whether there is demonstrable lateral rectus function present

Answers: A) TRUE; B) FALSE; C) TRUE; D) TRUE; E) TRUE

Bullous keratopathy: from EBOD 2004, field 3

A) Is an inherited disease of the corneal epithelium
B) Is often painful
C) Is rarely associated with visual loss
D) May require penetrating keratoplasty
E) Starts in early childhood

Answers: A) FALSE; B) TRUE; C) FALSE; D) TRUE; E) FALSE

Which is/are true of keratoconus: from EBOD 2004, field 3

A) The disease is inherited as an X-linked recessive trait
B) Increasing irregular astigmatism is a common finding
C) The main progression of the disease usually occurs after the age of 40
D) Laser Assisted in situ Keratomileusis (LASIK) is a main treatment option for severe keratoconus
E) When good visual acuity is no longer achieved with glasses, rigid gas-permeable contact lenses may be an option

Answers: A) FALSE; B) TRUE; C) FALSE; D) FALSE; E) TRUE

Congenital ocular syphilis is characterised by: from EBOD 2004, field 3

A) An epaulette followed by a salmon patch in the acute phase
B) Hutchinson’s teeth and a saddle nose
C) Loss of corneal sensation
D) Superficial vascularisation of the cornea
E) Corneal steepening

Answers: A) TRUE; B) TRUE; C) FALSE; D) FALSE; E) FALSE

Patients with the exfoliation syndrome (pseudoexfoliation) are more likely to develop: from EBOD 2004, field 4

A) Chronic open-angle glaucoma
B) Hyphaemas
C) Capsular rather than zonular rupture during cataract surgery
D) Asteroid hyalosis
E) Iris pigment dispersion

Answers: A) TRUE; B) FALSE; C) FALSE; D) FALSE; E) TRUE

In the iridocorneal endothelial syndrome (ICE): from EBOD 2004, field 4

A) Iris atrophy in Chandler’s syndrome is severe
B) Peripheral anterior synechiae are commonly found
C) Glaucoma is usually bilateral
D) It is caused by proliferation of corneal endothelial cells over the iris
E) Filtering surgery usually is not effective

Answers: A) FALSE; B) TRUE; C) FALSE; D) TRUE; E) FALSE

Angioid streaks: from EBOD 2004, field 5

A) Are caused by crack-like dehiscences (breaks) in the retina
B) Are usually concentric with the optic disc
C) Are seen in sickle cell disease
D) Are associated with systemic disease in about 50% of cases
E) May be complicated by choroidal neovascularisation

Answers: A) FALSE; B) FALSE; C) TRUE; D) TRUE; E) TRUE

Retinoblastoma: from EBOD 2004, field 5

A) Is caused by mutations in a tumour suppressor gene
B) When familial is always bilateral
C) Exophytic tumours spread into the vitreous cavity
D) Trilateral disease indicates associated pituitary tumours
E) Tumours characterised by Flexner-Wintersteiner rosettes are more differentiated

Answers: A) TRUE; B) FALSE; C) FALSE; D) FALSE; E) TRUE

The Viva Voce Related Examination (The Clinical Knowledge Assessment)

The online clinical knowledge exam will use clinical cases to test candidates’ knowledge within four broad subject areas:

Optics, Refraction, Strabismus, Pediatric ophthalmology and Neuro-ophthalmology
Cornea, External Diseases, Orbit and Ocular Adnexa
Glaucoma, Cataract and Refractive Surgery
Posterior Segment, Ocular Inflammation and Uveitis

The Single Best Answer (SBA) exam requires you to identify the best response to a question or clinical scenario. Some questions will be matters of factual knowledge, others will present a clinical scenario, which you must interpret and then answer – for example, a diagnosis, appropriate treatment, knowledge of prognosis, etc.

Example SBA (Neuroophthalmology):

A 3 year old girl has been referred to the paediatric ophthalmology clinic because of unusual eye movements. The eye movements were noticed by the kindergarden staff. Parents were not aware of any problem. The child is fit and well and there is no family history of eye problems. Visual acuity is 0.9 (9/10 decimals, 0.100 LogMAR) in each eye. Anterior and posterior segment examination is normal. On examination, there is horizontal nystagmus in all positions of gaze. The frequency and amplitude of nystagmus increases significantly when the child fixes on a distance target. Eye-tracker testing shows this waveform pattern:

What is the most likely diagnosis?
a) Vestibular nystagmus
b) Pendular nystagmus
c) Manifest latent nystagmus
d) Congenital idiopathic nystagmus	X

Viva Voce (Onsite Exam) / Clinical Cases (Online Exam)

The clinical knowledge exam will cover developmental, dystrophic, degenerative, inflammatory, infectious, toxic, traumatic, neoplastic, and vascular diseases affecting the eye and its surrounding structures. In all sections, candidates should be able to identify preventive ophthalmology, medicolegal aspects of ocular disease and European contributions to ophthalmology.

This section is divided into 4 subject areas:

A: Optics, Refraction, Strabismus, Pediatric ophthalmology and Neuro-ophthalmology

B: Cornea, External Diseases, Orbit and Ocular Adnexa

C: Glaucoma, Cataract and Refractive Surgery

D: Posterior Segment, Ocular Inflammation and Uveitis

Within each subject area, you will be presented with two standardised cases, and will earn a point (or part of a point) for each correct answer provided. Onsite, an examiner will ask you questions and use a scoring grid to award your score. Online, you will enter free-text responses to questions, which will then be judged against the scoring grid.

In each section emphasis will be placed upon the following:
Data Acquisition: Recognition by the candidate in presented material of abnormalities and diseases that affect the eye, ocular adnexae and the visual pathways.

Diagnosis: The ability of the candidate to synthesize clinical, laboratory and histopathological data in order to arrive at a correct diagnosis and differential diagnosis.

Treatment: Candidates will be expected to provide a reasonable and appropriate plan for medical and surgical management of patients with the conditions depicted or described.

Detailed information about the viva voce/ clinical cases related procedure and schedule is sent to all candidates after registration for the examination.