The MCQ was fair but more technical than I expected (questions about ERG, etc).  It seems most people fail on the practical parts of the exam so I'd recommend going through the past questions on MRCOphth.com and reading Elkington & Frank but really concentrating on being slick at clinical examination and refraction. 

Here is what I was asked in the OSCE: 

1.  EYE MOVEMENTS 

• Normal VA with obvious strabismus but no diplopia in a middle aged lady who wore spectacles 
• I messed this up and am sure I failed this case 
• I asked whether I should do a cover test and they said I should.  I then 
• tested ocular motility but forgot saccades/ convergence/ etc 
• I said it was a CN IV palsy but I think it was a concomitant exotropia with suppression 
• When I said it might be a CN IV palsy they said 'what test would you do,' 
• I said Bielschowsky and they asked me to demonstrate.  It wasn't positive but I pretended it was! 
• My lesson here was to stay calm and keep cool.  It wasn't difficult but I was very nervous and messed up as a result. 
• The examiner was poker faced throughout 

2. PUPILS 

• Pupil test in a young black lady 
• She seemed to have a slight ptosis 
• I started off looking for anisocoria.  The room lighting was terrible - neither very bright with the lights on or very dim with them off.  I then did the light reflexes with my pen torch.  It was extremely difficult to see the pupils. 
• The examiner asked me what I could see and I told him I wasn't sure.  He then said how could you make things easier for yourself.  I said better room lighting and brighter test light.  He then nodded at the indirect on the table next to the patient and I tested the pupils with that.  It was then obvious that she has a RAPD. 
• Next were questions on the pathway of the pupillary light reflex and causes of RAPD. 
• At the end the examiner gave me a thumbs up! 

3. DIRECT OPHTHALMOSCOPY 

• A well-dilated and cooperative patient of retirement age 
• Bilateral pigment and drusen at the maculae 
• Asked about diagnosis (I said AMD), then about the field of view, filters (in particular about the red-free filter) and magnification on the direct 
• I was then asked to demonstrate how I would look at the superior retina 
• The examiner was friendly 

4. INDIRECT OPHTHALMOSCOPY 

• Another well-dilated cooperative patient of retirement age 
• The indirect was truely ancient and some of the dials seemed to be missing! 
• I checked it before putting it on but nothing seemed too messed up 
• I was only asked to look at one eye and was told the pathology was subtle 
• The examiner was looking from the side, I think to see that the light was passing through the pupil 
• He said that the signs were subtle but what could I see 
• I wasn't sure but said that there seemed to be macular depigmentation.  I am not at all sure that I was right but he seemed happy with my technique and that is what seemed to be the most important thing 
• Next were questions on the use of different lenses (field of view, magnification, pupil size, etc) 

5. KERATOMETRY 

• One eye of a young nurse 
• The machine was of the Javal-Shiotz type although slightly different to 
• the model I was familiar with 
• There was a pencil and paper to write on 
• Once I had the readings they asked me about the optical principles of the keratometer 
• Another friendly examiner 

6. FOCIMETRY 

• Both lenses of a pair of single vision astigmatic spectacles (no patient) 
• Again the machine was slightly different to what I was familiar with but 
• the examiner was very helpful in suggesting which dials to use 
• I was then asked to transpose the spectacle presciption and to explain the principles of the focimeter 

7. ANTERIOR SEGMENT SLIT LAMP EXAMINATION 

• Deaf old lady patient 
• I tried to introduce myself but the friendly examiner told me to hurry on as there was a lot to do! 
• The initial settings of the slit lamp (IPD, filter, magnification, etc) were all mixed up 
• The patient had a trab, PI, nuclear sclerotic and posterior subcapsular cataract 
• When I said PI, the 2nd examiner asked what the difference between peripheral iridotomy and iridectomy was (I said removal of tissue in iridectomy) 
• Next I was asked to demonstrate the different techniques for examining the cornea and describe their indications (no patient, but the examiner held his hand up in front of the slit-lamp) 

8. VISUAL FIELDS TO CONFRONTATION 

• Before examining the patients I was asked what techniques of VF testing I knew 
• I said static/ kinetic, etc.  They wanted to know about automated methods in particular and seemed pleased when I said that Humphrey was 'supra-threshold' 
• The patients was a cooperative man of retirement age 
• He had a bilateral temporal hemianopia with sparing of a small island of central field on one side 
• The examiner asked what I thought the cause was and I said bilateral occipital CVA with macular area sparing on one side 
• I was then asked about why I only used a red hatpin and if there is red desaturation, where the lesion would be 
• This examiner was also poker faced and seemed to get easily confused - the 
• 2nd examiner had to correct him at one point when I sad the lesion was on 

one side and her thought it was on the other! 

Refraction was in the Optometry department in Bradford.  The room was small and hot but well equipped.  I thin one of my examiners was an optometrist, the other an ophthalmologist (who read his newspaper throughout).  My patient was an extremely cooperative low hyperope of about 70 years of age.  She came every fortnight to be refracted by the optometry students!  I got through everything in good time, doing reading add and Maddox rod although forgetting the Maddox wing.  The form you write on is quite small so make 
sure you write neatly!