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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
CA7 Perform a cover test and assess ocular motility
PM1 To formulate and agree with the patient a management plan based upon clinical assessment and investigations, with reference to established protocols and guidelines
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 12 OSCE stations in four rooms (see below).  Six of these stations are retinoscopy stations during which candidates will examine three patients, performing retinoscopy on each eye.  The time allowed will be ten minutes for each double retinoscopy station during which time both eyes must be assessed.  Candidates are permitted to divide the ten minute period between the eyes as they wish.  After ten minutes there will be a one minute change over period.  A five minute OSCE station will then follow.  Each station will be timed precisely.  A one minute warning will be given before the end of each OSCE (after nine minutes for the double OSCE and after four minutes for the single OSCE).

The fourth room will also start with a double OSCE lasting ten minutes. This will also be an examination on one patient and again the candidate will be allowed to use the time flexibly.  The candidate will be required to carry out the sphere refinement of subjective refraction on each eye of a patient followed by a binocular balance/plus one blur back or duochrome test.  Following completion of the double OSCE, there will be a one minute change over period, followed by the final, five minute OSCE station.  Similarly a one minute warning will be given before the end of each station (after nine minutes for the double OSCE and four minutes for the single OSCE).

The OSCE times will be strictly enforced and no further writing is allowed after the end of the OSCE.  Please bear this in mind during your practice.

Candidates will be examined on 12 OSCE stations.  Each station will be timed for precise periods of five minutes.  Candidates are advised to prepare for all of the listed OSCE stations.  One examiner will be present in each station for the duration of the cycle.

Summary of OSCE Stations

The composition of OSCE stations and rooms are as follows:

Room 1
Station 1: Cycloplegic Retinoscopy 1 – Patient A: First Eye
Station 2: Cycloplegic Retinoscopy 2 – Patient A: Second Eye
Station 3: Subjective Refraction: Cylinder – Patient B: One Eye, as directed by examiner 

Room 2
Station 4: Cycloplegic Retinoscopy 3 – Patient C: First Eye
Station 5: Cycloplegic Retinoscopy 4 – Patient C: Second Eye
Station 6: Lens Neutralisation with or without a focimeter

Room 3
Station 7: Non-Cycloplegic Retinoscopy 1 – Patient D: First Eye
Station 8: Non-Cycloplegic Retinoscopy 2 – Patient D: Second Eye
Station 9: Visual Acuity and Trial Frame Fitting – Patient E

Room 4
Station 10: Subjective Refraction: Sphere – Patient F: Both Eyes
Station 11: Subjective Refraction: Binocular Balance – Patient F: Both Eyes
Station 12: Near Addition: Patient G

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.

Pass Mark Setting

All examinations are pass mark set.  The Refraction Certificate OSCE is pass mark set using the Hofstee method.  All questions are reviewed in the light of performance and modified accordingly. All examinations are pass mark set. 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.

Further Information

For further information, please see the Refraction Certificate Information Packs below:
2018 Refraction Certificate Information Pack
Refraction Certificate – Instructions for Candidates (updated February 2019)
Sample Refraction Certificate Marksheets (updated September 2017)
Policy on Allegations of Cheating and Misconduct 2017
Refraction Certificate – Frequently Asked Questions (FAQs)

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