Study guide · OKAP
How to study for the OKAP: a year-by-year plan for 2027
A practical plan for the March 11-14, 2027 OKAP that pairs the AAO BCSC reading schedule with question practice, adjusted for your year of residency.
Last reviewed · Independent · Not affiliated with AAO, ABO, EBO, FEBO, ICO, RANZCO, RCPSC, or the Royal College of Ophthalmologists
OKAP study plan at a glance
| Next exam | March 11-14, 2027; programs may use more than one of those days[1] |
|---|---|
| Questions | 260 multiple-choice items[1] |
| Content split | Equal share across the 13 BCSC sections, each scored as a subtest[1],[2] |
| Question types | Recall, interpretation, and decision making and clinical management[2] |
| Timing | 4 hours 30 minutes of testing plus an optional 10-minute break[1] |
| Where | Online at your own institution, with a program-supplied proctor[1] |
| Arrival | At least 10 minutes early; the timer keeps running during technical problems[3] |
| Passing score | None; scores are norm-referenced[2] |
| Score scale | Total mean 500 (SD 100), subtest mean 50 (SD 10), anchored to 2017[2] |
| Results | Late April; disputes within 7 days[1] |
| Official reading plan | AAO 2026-2027 BCSC reading schedule, July 2026 to March 2027[4] |
To study for the OKAP, read the BCSC on a fixed weekly schedule through the academic year, answer practice questions on each section in the same week you read it, and give the final 8 to 12 weeks to timed mixed question blocks and your weakest sections. The exam's 260 multiple-choice questions are spread equally across the 13 BCSC sections, so every section carries the same weight, and the next US sitting runs March 11-14, 2027.
How hard you push depends on your year. The OKAP has no passing score: your percentile compares you only with residents in the same year of ophthalmology training, and AAO notes that the biggest jump in scores usually comes between the first and second years. Below are a section-by-section map, plans for PGY-2 to PGY-4, the exam-day rules, and a countdown you can start this week.
How the 13 BCSC sections map to the OKAP
AAO says the 260 questions are spread equally at random across the 13 BCSC sections, and each section is scored as its own subtest. That implies about 20 questions per section, but AAO does not publish an exact count. Section titles are from the 2026-2027 BCSC.
| Feature | BCSC section | Share of the OKAP | 2026-2027 edition | Free topic page on OphthoMentor |
|---|---|---|---|---|
| Section 1[5],[1],[2] | Update on General Medicine | Equal (1/13) | - | General medicine |
| Section 2[5],[1],[2] | Fundamentals and Principles of Ophthalmology | Equal (1/13) | - | Fundamentals |
| Section 3[5],[1],[2] | Clinical Optics and Vision Rehabilitation | Equal (1/13) | Major revision | Clinical optics |
| Section 4[5],[1],[2] | Ophthalmic Pathology and Intraocular Tumors | Equal (1/13) | - | Pathology and tumors |
| Section 5[5],[1],[2] | Neuro-Ophthalmology | Equal (1/13) | - | Neuro-ophthalmology |
| Section 6[5],[1],[2] | Pediatric Ophthalmology and Strabismus | Equal (1/13) | Major revision | Pediatrics and strabismus |
| Section 7[5],[1],[2] | Oculofacial Plastic and Orbital Surgery | Equal (1/13) | - | Oculoplastics |
| Section 8[5],[1],[2] | External Disease and Cornea | Equal (1/13) | - | Cornea and external disease |
| Section 9[5],[1],[2] | Uveitis and Ocular Inflammation | Equal (1/13) | - | Uveitis |
| Section 10[5],[1],[2] | Glaucoma | Equal (1/13) | - | Glaucoma |
| Section 11[5],[1],[2] | Lens and Cataract | Equal (1/13) | - | Lens and cataract |
| Section 12[5],[1],[2] | Retina and Vitreous | Equal (1/13) | Major revision | Retina and vitreous |
| Section 13[5],[1],[2] | Refractive Surgery | Equal (1/13) | - | Refractive surgery |
Sources: AAO's 2026-2027 BCSC listing, OKAP page and 2026 OKAP User's Guide, checked 26 September 2026. Topic pages are in OphthoMentor's free library at ophthomentor.com/ophthalmology-questions; OphthoMentor is independent of AAO.
How is the OKAP structured and scored?
The OKAP is a 260-item multiple-choice exam that the American Academy of Ophthalmology (AAO) gives to ophthalmology residents in each year of training in the US and Canada. Items are written from a Content Outline that closely matches the BCSC, and each sits at one of three cognitive levels: recall, interpretation, or decision making and clinical management. Items at the higher levels ask you to interpret findings or choose the next step, not just recall a fact.
Scores are norm-referenced, with a scaled score and a percentile rank for the total and for each of the 13 subtests. The total scale has a mean of 500 (SD 100) and each subtest a mean of 50 (SD 10), anchored to the 2017 examinees, so 500 means the 2017 average. The scaled score compares you with every examinee; the percentile compares you only with residents at your training level.
On the March 2026 exam, mean total scaled scores were 403.17 in year 1, 506.07 in year 2, 533.61 in year 3 and 605.60 in year 4. So a first-year score well below 500 is normal. AAO also advises reading subtest scores with caution because they are less reliable than the total, so one low subtest deserves a closer look but is not proof of a weakness.
OKAP vs BCSC: how do they fit together?
The BCSC (Basic and Clinical Science Course) is AAO's 13-section textbook series, and the 13 OKAP subtests parallel its 13 volumes, as the table above shows. In the 2026-2027 edition, Sections 3, 6 and 12 are major revisions, so read the current edition of those three.
AAO says the BCSC is not exhaustive and that preparation should also draw on textbooks and journals. A workable division of labor: the BCSC to learn each topic, questions to find what you did not retain, and a subspecialty text for the topics your misses keep exposing.
Reading builds the framework; questions test whether you can apply it at the interpretation and management levels the OKAP uses. AAO's own BCSC Self-Assessment Program lists more than 4,500 questions tied to BCSC content and an annual member price of $299 (as listed on 26 September 2026); independent banks, including OphthoMentor, are another option.
How do you follow an OKAP reading schedule for the BCSC?
If your program does not give you a reading schedule, AAO publishes one. The 2026-2027 schedule runs from July 2026 to March 2027 in consecutive seven-day blocks, each with a pages-per-day target. Its last reading block is Section 3, Clinical Optics and Vision Rehabilitation, Chapters 7-10, on February 20-26, 2027; February 27 to March 10, 2027 is set aside for reviewing all volumes.
Four adjustments make it work better for the OKAP:
- Join at the current week. Starting in late September 2026, pick up this week's block and cover the sections you missed with questions rather than going back to the July start.
- Pair each reading week with questions on the same section, and read every explanation, including those for items you got right.
- Keep a miss log by section and topic; it becomes your review list for the final weeks.
- Protect one catch-up day a week. When a heavy rotation knocks you off schedule, skim the chapter headings to stay in sequence.
How should your OKAP study plan change by PGY year?
ACGME requires programs to give a national objective test such as the OKAP every year from PGY-2 to PGY-4, and says results must not be the only criterion for promotion or graduation. AAO ranks you by year of ophthalmology residency, not PGY year, so here PGY-2 to PGY-4 mean ophthalmology years 1 to 3. Check that your program enters the right year, because AAO does not recalculate reports.
The plans differ mainly in the balance between first-pass reading and questions:
- PGY-2 (ophthalmology year 1): one complete pass through all 13 sections, even if some are light. You are ranked only against other first-years, so aim for coverage and habits. Do questions on each section as you read it, and start optics problems early instead of waiting for Section 3 to come up in the schedule.
- PGY-3 (ophthalmology year 2): a question-led second pass. Start from last year's Keyword Report and lowest subtests, read those sections in full, skim the rest, and add timed mixed blocks from about 12 weeks out.
- PGY-4 (ophthalmology year 3): a rehearsal for the ABO Written Qualifying Examination (WQE). AAO calls the OKAP good preparation for the WQE, and in a national study of 1,597 residents, PGY-4 OKAP scores were among the best predictors of passing it. Make questions your main activity from January.
How do you use a question bank to study for the OKAP?
Use questions for retrieval, not in place of reading. Early in the year, do untimed sets on the section you just read and treat the explanations as a second read. From about 12 weeks out, switch to timed mixed blocks across all 13 sections: the exam allows 270 minutes of testing for 260 items, a little over a minute per question. Revisit every miss and lucky guess a few days later.
OphthoMentor is one option: an independent question bank, not affiliated with or endorsed by AAO or ABO. Its free public library at ophthomentor.com/ophthalmology-questions uses the same 13 BCSC sections, so each reading week maps to a topic page. A free account (no card, no expiry) opens all 713 published questions as of 26 September 2026. The site offers explanations with decision flowcharts, timed mock exams, weak-topic drills, a spaced-repetition review queue and a readiness dashboard.
Premium (299 SEK a year) adds spaced-repetition review on every question and unlocks all oral case stations. OphthoMentor's items are original questions (single-best-answer plus some EBO-style true/false), not OKAP items, so treat any bank's scores as a trend within that bank, not a predicted OKAP percentile.
OKAP tips for the final 8-12 weeks
From mid-December 2026 to early March 2027, shift the balance from reading to questions and review. Each section is an equal share of the exam, so a strong section cannot carry a neglected one very far.
Then rehearse the real conditions:
- 12 weeks out: sit a timed mixed baseline block and rank the 13 sections from weakest to strongest.
- Practice in halves. The break is offered once 2 hours 15 minutes pass or 130 items are answered, so 130 questions in 135 minutes matches each half.
- 8 to 4 weeks out: drill your three or four weakest sections and re-read only the chapters your misses point to.
- Calculators are prohibited, so work optics problems by hand on scratch paper.
- About 2 weeks out: take one full-length 260-question mock at the start of AAO's review window (February 27 to March 10, 2027), then spend the rest of it on your miss log.
- Final days: no new material, normal sleep, and a check of your laptop, browser and AAO login.
What happens on OKAP exam day?
The US OKAP is taken online at your own institution, supervised in person by a proctor your program provides. In 2027 there are five start times a day, on the hour from 8:00 am to 12:00 pm Eastern Time, and you must start in your scheduled hour. Arrive at least 10 minutes early; the proctor must log in and accept an attestation before you can begin.
Testing lasts 4 hours 30 minutes plus the optional 10-minute break, during which you may not talk to anyone, use electronic devices or consult references. You can enlarge images, skip and mark items, and open a summary of marked or unanswered ones; Submit appears only when all 260 are answered or time runs out. Answers save in real time, but the timer keeps running during technical problems.
- You need a laptop or desktop with one screen, a power cord and a stable internet connection, running Chrome or Firefox, plus a working AAO login.
- Earplugs, drinks and snacks are allowed.
- No books, notes or calculators; one clean sheet of scratch paper, which the proctor destroys afterwards.
- Phones, smartwatches and tablets must be switched off and handed to the proctor.
OKAP study schedule: countdown to March 11-14, 2027
Start from the row that matches today's date. Weeks count back from March 11, 2027; your program may schedule you on a later day.
- Now (late September 2026)Join AAO's BCSC reading schedule at the current week and set a weekly question target for the section you are reading.
- October to mid-December 2026Read each week's section and do untimed questions on it, logging misses by topic. Programs must register residents by December 31, 2026; confirm yours enters your correct training year.
- 12 weeks out (mid-December 2026)Take a timed mixed baseline block, rank the 13 sections, and start spaced review of your misses.
- 12 to 8 weeks out (mid-December 2026 to mid-January 2027)Keep reading, but give at least half your study time to mixed question blocks, including optics by hand.
- 8 weeks out to February 26, 2027Timed blocks of 130 questions in 135 minutes, plus drills and targeted re-reading for your weakest sections, while you finish AAO's last reading blocks.
- February 27 to March 10, 2027AAO's review-all-volumes window: one full-length 260-question mock at the start, then your miss log. Check your laptop, browser and AAO login.
- Exam day (March 11-14, 2027)Arrive at least 10 minutes early, start in your scheduled hour, and mark hard items to return to.
- Late April 2027Read your score report and Keyword Report, raise any dispute within 7 days, and plan next year with your program director.
OKAP study plan FAQ
When should I start studying for the OKAP?
AAO's BCSC reading schedule runs from July to March, so the natural start is July, when that schedule begins. If you start later, join the schedule at the current week and use questions to cover what you missed. Save the heaviest timed practice for the final 8 to 12 weeks.
Is reading the BCSC enough for the OKAP?
The BCSC is the closest match, because OKAP items are written from a Content Outline that closely matches BCSC topic areas. AAO also says the BCSC is not exhaustive and recommends textbooks and journals as well. Pair your reading with questions to practice the interpretation and management items the exam uses.
How many OKAP questions come from each BCSC section?
About 20: AAO says the 260 questions are spread equally at random across the 13 BCSC sections, but it does not publish an exact count per section. Each section is scored as its own subtest.
Is there a passing score on the OKAP?
No. The OKAP is norm-referenced, and your percentile is the share of residents at your training level who scored lower, not the percentage of questions you answered correctly. ACGME says the results must not be the only criterion for promotion or graduation.
What is a good OKAP score?
Because scaled scores are anchored to 2017, 500 is the 2017 average; in 2026 the mean total scaled scores were 403.17 in year 1, 506.07 in year 2 and 533.61 in year 3. Your percentile, which ranks you within your training year, is the fairer comparison. In a 2025 JAMA Ophthalmology study's model, a PGY-4 scaled score of 500 corresponded to 84% of candidates passing the WQE, 550 to 94% and 600 to 98%, although the authors caution that these thresholds can shift from year to year.
Do OKAP scores matter for fellowship applications?
AAO does not condone using OKAP scores in fellowship selection and does not send them to fellowship programs. A program director may release only your overall score, and only with your signed permission naming the program. AAO's EyeNet notes that scores have still been used in fellowship selection in practice.
Does studying for the OKAP help with the WQE?
AAO calls the OKAP good preparation for the ABO's Written Qualifying Examination, and the two organizations still write and review items for both exams jointly. The exams have used entirely different questions since 1993, and the 250-item WQE does not use the OKAP's 13-section structure.
What should I do with my OKAP score report?
Scores arrive in late April, and disputes must be raised within 7 days of scores becoming available. The Keyword Report lists every topic you missed, grouped by BCSC book, but the report does not show percent correct. AAO suggests ranking your subtests, grouping subtest scaled scores as below 40, 40-60 or above 60, using the Keyword Report and BCSC headings to set learning objectives, and reviewing the plan with your program director.
Sources
- OKAP Exam — American Academy of Ophthalmology
- OKAP User's Guide 2026 — American Academy of Ophthalmology
- OKAP Exam Day Information and Guide for Residents — American Academy of Ophthalmology
- Your 2026-2027 BCSC Reading Schedule — American Academy of Ophthalmology
- Complete Set: 2026-2027 Basic and Clinical Science Course (BCSC) — American Academy of Ophthalmology
- Board Prep Resources — American Academy of Ophthalmology
- ACGME Program Requirements for Graduate Medical Education in Ophthalmology — Accreditation Council for Graduate Medical Education
- Ophthalmic Knowledge Assessment Program Scores and Written Qualifying Examination Performance — JAMA Ophthalmology (via PubMed Central)
- Can OKAP Scores Predict Performance on the WQE? — American Academy of Ophthalmology (EyeNet)