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100+ Free ICO Advanced Practice Questions

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2026 Statistics

Key Facts: ICO Advanced Exam

10 EMQs + 75 SBAs

Written Advanced paper has 10 extended matching and 75 single-best-answer questions

International Council of Ophthalmology - Advanced Examination

3 hours

Duration of the booklet-format written Advanced Examination

International Council of Ophthalmology - Advanced Examination

FICO

Passing plus a local face-to-face exam confers the Fellow of the ICO post-nominal

International Council of Ophthalmology - Advanced Examination

3 Standard exams first

Candidates must pass Visual Sciences, Optics-Refraction and Clinical Ophthalmology before sitting

International Council of Ophthalmology - ICO Examinations

No negative marking

Correct answers score positively and wrong or blank answers are not penalised

International Council of Ophthalmology - Advanced Examination

Approx. CHF 610

Advanced Examination fee, varying by country and collaboration status

International Council of Ophthalmology examination courses

English only

The Advanced Examination is conducted in English at worldwide test centres

International Council of Ophthalmology - Advanced Examination

100

Free original exit-level practice questions provided here

OpenExamPrep

The ICO Advanced (FICO) Examination is the International Council of Ophthalmology's exit-level written paper for experienced ophthalmologists who have already passed the three ICO Standard Examinations. The 3-hour booklet paper contains 10 extended matching questions and 75 context-setting single-best-answer items focused on clinical ophthalmology, with no penalty for wrong or blank answers. It examines subspecialty depth and independent decision making across retina, glaucoma, cornea, cataract, neuro-ophthalmology, paediatrics, oculoplastics, uveitis, ocular oncology and pathology, plus low vision, ethics and community eye health. The fee is about CHF 610, varying by country, and results are graded Pass with Distinction, Merit or Pass. This 100-question bank provides original exit-level single-best-answer practice across every Advanced subject; the separate local face-to-face component is excluded from scope.

Sample ICO Advanced Practice Questions

Try these sample questions to test your ICO Advanced exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old with type 2 diabetes has scattered microaneurysms, fewer than 20 intraretinal haemorrhages in each quadrant, and no venous beading or IRMA. Using the International Clinical Diabetic Retinopathy scale, this best corresponds to:
A.No apparent retinopathy
B.Mild non-proliferative diabetic retinopathy
C.Severe non-proliferative diabetic retinopathy
D.Proliferative diabetic retinopathy
Explanation: Mild non-proliferative diabetic retinopathy is defined by microaneurysms only. The picture described, with only a few haemorrhages and no severe features, is at the mild end; the absence of the 4-2-1 features and neovascularisation excludes severe NPDR and PDR.
2According to the ETDRS, clinically significant macular oedema is defined by any of several criteria. Which finding alone meets the definition?
A.Any hard exudate anywhere in the macula
B.Retinal thickening within 500 microns of the foveal centre
C.A single microaneurysm in the temporal macula
D.Drusen within 1 disc diameter of the fovea
Explanation: CSME (ETDRS) includes retinal thickening within 500 microns of the foveal centre, hard exudates within 500 microns of the centre if associated with adjacent thickening, or a zone of thickening one disc area or larger within one disc diameter of the centre. Thickening within 500 microns of the centre meets the definition.
3A 70-year-old presents with sudden painless visual loss. Fundus shows a cherry-red spot at the macula with retinal whitening. The most likely diagnosis is:
A.Central retinal vein occlusion
B.Central retinal artery occlusion
C.Anterior ischaemic optic neuropathy
D.Acute angle-closure glaucoma
Explanation: A cherry-red spot with surrounding retinal opacification reflects inner retinal ischaemia from central retinal artery occlusion; the fovea appears red because it is supplied by the choroid and lacks an overlying opacified inner retina. CRAO causes sudden, painless, profound visual loss.
4In neovascular age-related macular degeneration, the principal molecular target of first-line intravitreal therapy is:
A.Tumour necrosis factor alpha
B.Vascular endothelial growth factor
C.Interleukin-6
D.Complement factor H
Explanation: Anti-VEGF agents (such as ranibizumab, aflibercept and bevacizumab) are first-line for neovascular AMD because VEGF drives choroidal neovascularisation and vascular permeability. Blocking VEGF reduces leakage and induces regression of the neovascular complex.
5A 65-year-old presents with a sudden onset of floaters and a curtain over the upper field. Examination shows a bullous inferior retinal detachment with a horseshoe tear at 6 o'clock. The most appropriate definitive treatment is:
A.Observation with repeat review in 6 weeks
B.Intravitreal anti-VEGF injection
C.Retinal detachment repair by vitrectomy or scleral buckle
D.Topical carbonic anhydrase inhibitor
Explanation: A macula-threatening rhegmatogenous retinal detachment requires prompt surgical repair, either pars plana vitrectomy or scleral buckling (sometimes with pneumatic retinopexy in selected cases). The break must be closed and the retina reattached to restore and preserve vision.
6On OCT, a full-thickness macular hole is best distinguished from a pseudohole by:
A.The presence of an epiretinal membrane
B.A full-thickness defect of all retinal layers at the fovea
C.Increased macular thickness
D.Loss of the foveal pit only
Explanation: A true full-thickness macular hole shows a defect spanning all neurosensory retinal layers at the fovea on OCT, often with cuff oedema and operculum. A pseudohole, by contrast, results from an epiretinal membrane steepening the foveal contour without an actual retinal dehiscence.
7A premature infant born at 25 weeks develops stage 3 retinopathy of prematurity in zone I with plus disease. According to current evidence (including the BEAT-ROP findings), an accepted treatment option is:
A.Immediate scleral buckle
B.Laser photocoagulation or intravitreal anti-VEGF
C.Observation until 60 weeks postmenstrual age
D.Systemic corticosteroids
Explanation: Type 1 ROP (including zone I, stage 3 with plus disease) is treated to prevent progression to retinal detachment. Laser photocoagulation of the avascular retina is standard, and intravitreal anti-VEGF is an accepted alternative, particularly effective for posterior zone I disease as shown in BEAT-ROP.
8A patient with a branch retinal vein occlusion develops macular oedema reducing vision to 6/24. The best-supported first-line treatment to improve vision is:
A.Grid laser to the fovea
B.Intravitreal anti-VEGF therapy
C.Oral acetazolamide
D.Pars plana vitrectomy
Explanation: Macular oedema from BRVO causing reduced vision is treated first-line with intravitreal anti-VEGF, supported by trials such as BRAVO and VIBRANT. It improves vision more reliably than older grid laser, which is no longer first-line for vision loss from BRVO oedema.
9Retinitis pigmentosa classically presents with which combination of findings?
A.Central scotoma with normal peripheral fields
B.Nyctalopia, ring scotoma, bone-spicule pigmentation and an attenuated ERG
C.Sudden painful red eye with raised IOP
D.Bilateral disc swelling with enlarged blind spots
Explanation: Retinitis pigmentosa is a rod-cone dystrophy presenting with night blindness, progressive peripheral and ring field loss, mid-peripheral bone-spicule pigment, waxy disc pallor, arteriolar attenuation and a markedly reduced or extinguished electroretinogram.
10During pars plana vitrectomy, the standard entry sites are placed through the pars plana at a distance from the limbus that avoids the lens and retina. In an adult phakic eye, this distance is approximately:
A.1.0 mm
B.3.5 to 4.0 mm
C.7.0 mm
D.9.0 mm
Explanation: Sclerotomies for pars plana vitrectomy are placed about 3.5 to 4.0 mm posterior to the limbus in phakic eyes (around 3.0 to 3.5 mm in pseudophakic/aphakic eyes). This positions entry through the pars plana, anterior to the retina and posterior to the lens, minimising the risk of lens or retinal damage.

About the ICO Advanced Exam

The ICO Advanced Examination is the exit-level written paper of the International Council of Ophthalmology, designed for experienced ophthalmologists who have already passed the three ICO Standard Examinations (Visual Sciences; Optics, Refraction and Instruments; and Clinical Ophthalmology). The 3-hour booklet paper focuses on clinical ophthalmology and comprises 10 extended matching questions and 75 context-setting single-best-answer items drawing on written, visual and graphical stems. It assesses up-to-date subspecialty knowledge and independent clinical decision making across vitreoretinal disease, glaucoma, cornea and refractive surgery, lens and cataract, neuro-ophthalmology, paediatric ophthalmology and strabismus, oculoplastics and orbit, uveitis, ocular oncology and pathology, and low vision, ethics and community eye health. Passing the written Advanced Examination together with a local face-to-face ophthalmology examination entitles the candidate to use the post-nominal FICO.

Assessment

The written paper comprises 10 extended matching questions (EMQs) and 75 context-setting single-best-answer questions. Each item presents written, visual or graphical material and four options requiring one best answer, scored positively with no penalty for wrong or blank answers.

Time Limit

3 hours for the written booklet paper, conducted in English only at ICO test centres worldwide.

Passing Score

No fixed percentage pass mark is published. A criterion standard is set by the examination committee; a positive mark is awarded for each correct answer and none is deducted for incorrect or blank answers. Outcomes are reported as Pass with Distinction, Pass with Merit or Pass.

Exam Fee

Approximately CHF 610 (Swiss francs) for the written Advanced Examination, with reduced fees where the national ophthalmology society collaborates with the ICO; candidates confirm the exact local fee through their country coordinator. (International Council of Ophthalmology (ICO))

ICO Advanced Exam Content Outline

14%

Vitreoretinal Diseases

Medical and surgical retina: diabetic retinopathy classification and treatment, neovascular and atrophic AMD, retinal vein and artery occlusions, rhegmatogenous and tractional detachment, inherited retinal dystrophies, and interpretation of OCT, fundus and angiographic imaging.

12%

Glaucoma

Primary open-angle and angle-closure disease, secondary and childhood glaucoma, IOP and optic disc assessment, visual field defect interpretation, and medical, laser and incisional surgical management including trabeculectomy and tube shunts.

12%

Cornea, External Disease and Refractive Surgery

Microbial, herpetic and immune keratitis, ocular surface and dry eye disease, dystrophies, keratoconus and ectasia, lamellar and penetrating keratoplasty, and refractive surgery principles and complications.

10%

Lens and Cataract

Cataract morphology, biometry and IOL power calculation, phacoemulsification principles, and recognition and management of posterior capsule rupture, dropped nucleus, endophthalmitis and refractive surprise.

10%

Neuro-ophthalmology

Optic neuritis and ischaemic, compressive and hereditary optic neuropathies, afferent and efferent pupillary disorders, cranial nerve palsies, nystagmus, visual field localisation and neuro-imaging correlation.

10%

Paediatric Ophthalmology and Strabismus

Amblyopia diagnosis and treatment, comitant and incomitant strabismus and its surgery, retinopathy of prematurity screening and treatment, congenital cataract and glaucoma, and developmental anomalies.

8%

Oculoplastic Surgery and Orbit

Entropion, ectropion and ptosis, eyelid and lacrimal tumours, nasolacrimal obstruction, thyroid eye disease, orbital cellulitis and inflammation, orbital trauma and tumours, and socket reconstruction.

8%

Uveitis and Ocular Inflammation

Anterior, intermediate, posterior and panuveitis, infectious causes such as toxoplasmosis, tuberculosis and herpetic disease, systemic associations including HLA-B27, sarcoidosis and Behçet disease, and corticosteroid, immunomodulatory and biologic therapy.

10%

Ocular Oncology and Ophthalmic Pathology

Uveal melanoma, retinoblastoma, ocular surface squamous neoplasia, adnexal and eyelid malignancies, primary vitreoretinal lymphoma, and the histopathological correlation of common ocular specimens.

6%

Low Vision, Ethics and Community Eye Health

Low vision assessment and rehabilitation aids, medical ethics, consent and professionalism, and the epidemiology of avoidable blindness and global eye-health and prevention programmes.

How to Pass the ICO Advanced Exam

What You Need to Know

  • Passing score: No fixed percentage pass mark is published. A criterion standard is set by the examination committee; a positive mark is awarded for each correct answer and none is deducted for incorrect or blank answers. Outcomes are reported as Pass with Distinction, Pass with Merit or Pass.
  • Assessment: The written paper comprises 10 extended matching questions (EMQs) and 75 context-setting single-best-answer questions. Each item presents written, visual or graphical material and four options requiring one best answer, scored positively with no penalty for wrong or blank answers.
  • Time limit: 3 hours for the written booklet paper, conducted in English only at ICO test centres worldwide.
  • Exam fee: Approximately CHF 610 (Swiss francs) for the written Advanced Examination, with reduced fees where the national ophthalmology society collaborates with the ICO; candidates confirm the exact local fee through their country coordinator.

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

ICO Advanced Study Tips from Top Performers

1Build directly on your ICO Clinical Ophthalmology preparation; the Advanced paper assumes that knowledge and tests deeper subspecialty reasoning and management decisions.
2Use the AAO Basic and Clinical Science Course (BCSC) sections together with focused subspecialty texts, and read each topic to the level of recognising and managing complications.
3Practise extended matching questions specifically: list the option set first, then match each stem, because EMQs reward pattern recognition across a single subspecialty.
4Train on image-based stems such as OCT, fundus photographs, visual fields and angiograms, since many context questions are built around interpreting an image.
5Because there is no negative marking, answer every question and flag uncertain ones to revisit; never leave a stem blank.
6Revise evidence-based management thresholds, for example diabetic retinopathy and AMD treatment criteria and glaucoma target IOP, so you can choose the single best next step.

Frequently Asked Questions

What is the format of the ICO Advanced Examination?

The written Advanced paper is a 3-hour booklet examination of 10 extended matching questions (EMQs) and 75 context-setting single-best-answer questions, each presenting written, visual or graphical material with four options and one best answer.

Is the ICO Advanced Examination multiple choice?

Yes. The scored written component is entirely single-best-answer and extended matching multiple choice, computer-marked. A separate local face-to-face clinical examination is required for FICO but is run by national bodies, not by the ICO written paper.

Who is eligible to sit the Advanced Examination?

Candidates must hold a primary medical qualification and have already passed all three ICO Standard Examinations: Visual Sciences; Optics, Refraction and Instruments; and Clinical Ophthalmology.

How is the Advanced Examination scored?

A positive mark is awarded for each correct answer, with no marks deducted for incorrect or blank answers, so candidates should answer every question. Results are reported as Pass with Distinction, Pass with Merit or Pass.

How much does the ICO Advanced Examination cost?

The fee is approximately CHF 610 (Swiss francs), but it varies by country and is reduced where the national ophthalmology society collaborates with the ICO. Candidates confirm the local fee through their country coordinator.

What does passing the Advanced Examination allow?

Passing the written Advanced Examination together with a local face-to-face ophthalmology examination entitles the candidate to use the post-nominal FICO, Fellow of the International Council of Ophthalmology.