Syed Husain

Introduction

Having fortunately passed the FRCOphth part 1 in my first attempt, the aim herein is to detail exactly how I used one of the main foundational texts- ‘Clinical Optics’ by Elkington and Frank.

Out of 174 multiple choice questions (6 questions removed post-exam) in the April 2022 FRCOphth Part 1 exam, 47 questions were dedicated to Optics; comprising the most number of questions of any topic. Optics generally has formed the majority of questions in previous sittings too, although since its conversion to a pure MCQ exam, there appears to be increasing emphasis in this area.

Moreover, optics can often be the most challenging component of the exam as, arguably; it does not test rote knowledge like anatomy, but the understanding of the complex physics underlying ophthalmic examinations and investigations. The consensus is ‘Clinical Optics by Elkington’ is a must read to attain the breadth and depth of knowledge required.

Elkington Outline

• ~250 pages long
• 17 chapters
• Very text-heavy, detailed sketches
• Contains all the detail that is required of the part 1 exam

My Approach

I aimed to read it cover to cover at least 2x prior to the exam, with more focused chapter repetition after identifying weak areas in my knowledge with practice questions closer to the exam.

The first few chapters are relatively light and can be read through quickly. I’d advise committing the different numerical values e.g. spectra of wavelengths, to memory. Similarly, the clinical application of concepts mentioned e.g. the use of destructive interference in sunglasses and the corneal stroma, are often tested in the MCQs. In this first reading, as well as trying to memorise as much as possible, the aim should be to complete the text as quickly as possible to have an exposure to all the content.

Highlight the pages/sentences which are unclear and don’t spend too long trying to understand one line/paragraph at this point. The secret of this text is that the latter chapters often explain earlier topics in more detail to make sense. Use Connie Koklanis’ YouTube channel alongside American Academy of Ophthalmology PowerPoint sets to help.

The second full reading is to consolidate your knowledge, and to pay more attention to the denser chapters as mentioned above. A key point here is when coming across lens transpositions and power crosses, to find some practice questions online related to these specific areas. Once you are able to perform these calculations, it is easy marks in the exam.

Once you are already half-way through the text on the second reading, use this link to access chapter specific MCQs: This will highlight any obvious weak areas from earlier chapters and again help to consolidate your knowledge.

One benefit of the conversion to pure MCQs is that you won’t need to draw out any ray diagrams. However, you will still be expected to recognise the ray diagrams e.g. that of a Galilean vs Keplerian telescope system.

There is some crossover between ‘investigation interpretation’ and ‘optics’ questions in the exam. For example, in interpreting the outcome of the Maddox rod test or Worth 4 dot test. In these cases, it is a must to watch videos on these being performed or even better spending time with the Orthoptists who carry out these examinations. The questions in the exam are not too intricate and are easy marks to achieve with relatively little effort.

Summary

Optics is a core component of the exam. Plan how you wish to cover the content and leave enough time. Use Elkington as your base text, and supplement with other resources. Self-test questions are vital to test understanding and consolidate your knowledge. Ultimately, as with any fellowship exam, preparation requires discipline and working smartly through the content by identifying the high yield topics to focus on.  

Good Luck!