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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:
2According to the ETDRS, clinically significant macular oedema is defined by any of several criteria. Which finding alone 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:
4In neovascular age-related macular degeneration, the principal molecular target of first-line intravitreal therapy is:
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:
6On OCT, a full-thickness macular hole is best distinguished from a pseudohole by:
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:
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:
9Retinitis pigmentosa classically presents with which combination of findings?
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:
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.