ICO exam questions: a clear guide to every ICO paper in 2026

The ICO has run exams since 1995 and reports testing more than 50,000 ophthalmologists in 84 countries at 137 centers. Residents and qualified ophthalmologists take them, and the ICO says many countries use its exams in training and accreditation pathways.

Passing all three Standard exams makes you eligible to apply for the final clinical FRCS Ophthalmology exam at the Royal College of Physicians and Surgeons of Glasgow (RCPSG), whose exempting-qualifications list, published in July 2021, accepts Visual Sciences plus ORI for its Part 1 and Clinical Ophthalmology for Part 2; confirm the current rules with RCPSG.

Do not confuse the ICO with the Ophthalmology Foundation (successor to the former ICO Foundation), which runs separate computer-based Visual Sciences, ORI and Clinical Ophthalmology papers leading to FIOF, with a 160-question Clinical paper. It accepts ICO Visual Sciences and/or ORI passes up to and including 2022, and FICO up to and including 2025, as exemptions.

The ICO papers themselves follow a fixed order, with no minimum or maximum interval between them, so you can move at your own pace:

Visual Sciences, formerly Basic Science (Part A), is the ICO's basic science paper: 120 multiple-choice questions in a booklet over 3 hours, or 90 seconds per question. The ICO says it is usually taken early in residency.

For basic science preparation, pair each reading block with same-topic questions that week; anatomy, neuroanatomy and pathology reward repeated retrieval.

The ICO web page lists five topic areas, and its 2023 Terms of Use add three more. No weightings are published, so give every area real coverage:

ORI is the shortest Standard paper: 60 single-best-answer questions in 1.5 hours, again 90 seconds per question. It covers three areas: optics; refraction; and the basic design, construction and use of instruments. No weightings are published. Only a dictionary and a calculator are allowed in the room, so practice lens and vergence calculations with the calculator you plan to bring.

You can sit Visual Sciences and ORI on the same day, but the ICO advises against it: candidates who do so have lower success rates, and not every center can accommodate it. If you plan both for one sitting, check with your local coordinator first.

Clinical Ophthalmology is the longest Standard paper: 200 single-best-answer questions in 4 hours, or 72 seconds per question, the tightest pace of the three. It is open only after passes in Visual Sciences and ORI, or an exam of similar standard recognized by the ICO.

One listed area, community and public health, does not map to any of the 13 BCSC sections, so plan separate reading for it.

The current ICO web page omits glaucoma from its topic list, while the 2023 Terms of Use include it. Prepare glaucoma regardless. The full list, with no published weightings:

The Advanced exam, which the ICO labels "Advanced 115", has 115 questions in 3 hours on paper, in English only, with a clinical focus that includes extended matching questions; the current split between question types is not published. Its content list spans the clinical subspecialties plus ocular oncology, ophthalmic pathology, low vision rehabilitation, ethics and professionalism, and community eye health. Passing it, plus a local face-to-face exam, leads to FICO.

Subspecialty exams last 2 hours: 80 scenarios with four single-best-answer statements each, on paper and in English only, in cornea, glaucoma, medical and surgical retina, oculoplastics, neuro-ophthalmology, pediatrics and strabismus, uveitis and cataract. They are designed for candidates with one year's experience in the subspecialty. The ICO page lists no 2026 sitting, so check with the ICO Examinations Office.

Foundation Assessments are the ICO's online, English-only practice tests (50 Visual Sciences, 20 ORI and 50 Clinical Ophthalmology questions), free to candidates registered for the matching Standard exam who belong to an ICO member society and CHF 50 each when bought separately.

The next ICO Standard and Advanced exams are on October 19, 2026; registration and payment closed on August 17, 2026. The ICO typically holds exams twice a year, and its Terms of Use describe a March sitting (applications due in January) and an October sitting (applications due in August). No 2027 dates were published as of September 26, 2026; the ICO announces dates on its website and social media, and registration runs through its portal at ico.smartsimple.ca.

The exam is on paper: a question booklet and a machine-marked (OMR) answer sheet, at a local center. If your country has no ICO coordinator or center, the ICO Examinations Office will try to arrange one nearby. The Standard papers are taken in English.

Every Standard item has four options and one best answer, and the Advanced exam also includes extended matching questions. Wrong and blank answers score zero on every paper, so answer every question. Results are typically mailed about six weeks after the exam, and certificates show one of three pass grades: Distinction, Merit or Pass. The ICO publishes no pass rates or pass marks and does not state how it sets the standard. Failed candidates may pay for a manual re-check, refunded if the result changes to a pass; appeals are due within 24 hours of the exam or 5 working days of results.

The ICO does not publish fee amounts. Fees are tiered by World Bank country income group, with further discounts for members of ICO member societies. The fee that applies to you appears when you select your home country in the ICO portal, and it must be paid in full by the registration deadline, by credit or debit card online or by bank transfer.

Withdrawing before the closing date gets you either a 12-month deferral or a refund minus a CHF 100 administration charge. After it, there is no refund except in exceptional circumstances; you get a 12-month deferral instead, with a CHF 100 charge when you reapply.

Before registering, ask whether your national society is an ICO member: it affects both your fee and whether you get the Foundation Assessments free.

Match the exam's conditions: four options, one best answer, no negative marking, and 90 seconds per question for Visual Sciences and ORI or 72 for Clinical Ophthalmology. Learn each section with untimed topic sets and read every explanation. From about six weeks out, switch to timed mixed blocks, revisit misses and lucky guesses a few days later, and mark some mocks on a paper answer sheet.

OphthoMentor is one option: an independent question bank, not affiliated with or endorsed by the ICO. Its free public library at ophthomentor.com/ophthalmology-questions is organized by the 13 BCSC sections, which overlap with many ICO topic areas. A free account (no card; the free tier does not expire) gives access to all 713 published questions as of September 26, 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 every oral case station.

These are original questions, not ICO items, and the ICO publishes no pass marks, so treat any bank's score as a trend, not a prediction of your ICO result. If you have access, finish with the ICO's Foundation Assessments as a check on the official style.