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Table of Contents
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 13

Literature consulted by Spanish-speaking candidates who passed the International Council of Ophtalmology examinations

1 Department of Ophthalmology, Hospital Universitario Austral, Pilar, Argentina; Department of Retina and Vitreous, Asociación Para Evitar La Ceguera, (APEC), CDMX, México
2 Department of Ophthalmology, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
3 Department of Ophthalmology, Hospital Universitario Austral, Pilar, Argentina

Date of Submission16-Apr-2020
Date of Acceptance17-Apr-2020
Date of Web Publication27-May-2020

Correspondence Address:
Dr. Agustina Lucia Adaniya
Malabia 2425, 7th Floor, CABA (1425), Argentina

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/PAJO.PAJO_20_20

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Context: Most ophthalmologic literature is written in English. There is a wide range of books available for the preparation of the International Council of Ophthalmology (ICO) examinations.
Aims: The aim of this study is to evaluate the assessment of the literature consulted by Spanish-speaking candidates who sat for the ICO examinations.
Settings and Design: Observational study based on a survey to candidates in Spanish-speaking countries.
Methods: Online surveys were sent to candidates residing in Latin America and Spain who passed the ICO examinations in the past 5 years. The survey asked about fluency in English, language in which the examination was studied, literature consulted in English and Spanish. Literature was classified by the language.
Statistical Analysis Used: Qualitative analysis and description of the answers.
Results: One hundred and thirty-three responses were obtained from the candidates from Argentina, Chile, Colombia, Costa Rica, Ecuador, Spain, Mexico, Peru, the Dominican Republic and Venezuela, who had passed at least one ICO examination. Seventy-eight resources were identified (14 in Spanish and 64 in English). The most widely used resource was the Basic and Clinical Science Course collection of the American Academy of Ophthalmology, English version.
Conclusions: The prevalence of English bibliography can be a challenge for Spanish-speaking candidates when taking international examinations. It would be useful to increase the number of publications and more updated literature in Spanish to encourage Hispanic candidates.

Keywords: Bibliography, International Council of Ophthalmology, knowledge examinations, Spanish-speaking candidates

How to cite this article:
Adaniya AL, Palis G, Mayorga E, Forgues RF, Aquino MP, Bazterrechea P. Literature consulted by Spanish-speaking candidates who passed the International Council of Ophtalmology examinations. Pan Am J Ophthalmol 2020;2:13

How to cite this URL:
Adaniya AL, Palis G, Mayorga E, Forgues RF, Aquino MP, Bazterrechea P. Literature consulted by Spanish-speaking candidates who passed the International Council of Ophtalmology examinations. Pan Am J Ophthalmol [serial online] 2020 [cited 2021 Nov 30];2:13. Available from: https://www.thepajo.org/text.asp?2020/2/1/13/285043

  Introduction Top

The International Council of Ophthalmology (ICO) examinations are global ophthalmology evaluations. Since 1995, the ICO offers examinations every year to help ophthalmologists to evaluate and strengthen their knowledge on basic and clinical sciences. It enables the unification of ophthalmological learning worldwide, favoring the full development of solid knowledge within professionals.

Examinations can be taken in the candidate's home country and are currently available in 83 different countries. More than 40,000 candidates have taken the examinations so far. The ICO standard examinations consist of three evaluations with a multiple-choice format: visual sciences (120 questions); optics, refraction, and instruments (60 questions); and clinical ophthalmology exam (200 questions). It is possible to take the basic science and optics, refraction and instruments examination on the same day; candidates are discouraged from sitting the clinical ophthalmology examination on the same day as the others because in the past so few have been successful. All the standard examinations are translated into Spanish, Portuguese, French, and Chinese. The foundation examination is a revision aid that is available to those who have applied for any of the standard examinations. The ICO examinations can be even more challenging once the three standard examinations have been passed: the advanced exam and the subspecialty exam, both increasing in difficulty and requirements. Anyone who wishes to be an ICO fellow must pass the advanced written exam and also an acceptable face-to-face examination.

Sometimes Hispanic candidates, for whom English is not their mother language, may experience difficulty when studying for these international exams due to the lack of adequate bibliography in Spanish. This can be a real limitation for candidates to obtain the ICO exams.

As far as we know, most of the literature available is written in English. Although there is a wide range of books at hand, this report seeks to help candidates (especially Spanish-speaking) prepare for the examinations based on the experience of previous candidates who have successfully passed them.

The objectives are to provide clear and orderly information based on a survey, to classify the bibliography used by other candidates (both in English and Spanish) and thus encourage the student to perform with greater confidence.

  Methods Top

An online survey with ten questions was sent to 1000 candidates residing in Spanish-speaking countries and who have passed at least one ICO exam between April 2015 and April 2019. The questions asked included the candidate's fluency in English, language of references used, number of exams that were passed, literature recommendations in English and in Spanish, and candidate's country of origin. If desired, the candidate could leave any comment at the end of the survey [Appendix 1].

  Results Top

The survey was completed by 134 candidates who passed at least one ICO exam. The candidates who were included resided in Spanish-speaking countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Mexico, Peru, Spain, the Dominican Republic, and Venezuela).

Seventy-eight different bibliographic resources were identified: 14 in Spanish and 64 in English.

Nearly 93.24% of the respondents stated that they were able to read English fluently. About 37.59% of the total respondents studied mainly in English and a little in Spanish, whereas 35.34% studied only in English [Figure 1] and [Figure 2].
Figure 1: Distribution of answers: How fluent are you in English?

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Figure 2: Distribution of answers: In which language did you study to prepare for the exam?

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Nearly 88.06% of the candidates passed the visual sciences examinations and 89.55% the optics, refraction and instruments section, representing 118 and 120 candidates, respectively. Meanwhile, those who passed the clinical ophthalmology examination correspond to 55.22% (74 candidates) of the surveyed. Fifteen candidates used the “Foundation” exam and only 1 took the subspecialty test [Figure 3].
Figure 3: Distribution of answers: Which International Council of Ophthalmology exams did you pass?

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The most widely used book was the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course compendium in English. It headed the list with 87 recommendations followed by the Spanish version, used by 56 candidates.[1] The book Review of Ophthalmology by Friedman, Kaiser, and Trattler was recommended as a review book, especially useful when applying to the clinical ophthalmology examination, reaching 54 recommendations.[2] The book titled Clinical Optics, by Elkington, Frank, and Greaney [3] and Basic Sciences in Ophthalmology: A self-assessment text by John Ferris,[4] are in fourth and fifth place (advised 45 and 35 times, respectively). Both written in English, they were specifically recommended when applying to the Basic Science and Optics and Refraction and Instruments Examen.

On the other hand, in regard of Spanish bibliography, the classical book titled Clinical Ophthalmology by Kanski and Bowling was recommended by 26 candidates, ranking behind the AAO in Spanish.[5] The latter is also available in English and was recommended 12 times, occupying the seventh position in the global ranking.

Another interesting and useful resource that has a practical application for trainees is the use of websites that offer multiple-choice practice simulating real ICO exams. The most popular sites among the candidates were Ophthoquestions (12 recommendations) and Eyedocs (4 recommendations). Both of them have discussion of the answers and clinical case resolutions.

  Discussion Top

There was a clear preference among the trainees toward the following learning materials. The AAO Basic and Clinical Science Course is a collection of books covering all the subspecialties with the information to cover the ICO syllabus, necessary to pass the exam. This was the most recommended book regardless of the language. Second, the Review of Ophthalmology was widely recommended, because it is a more concise text, useful to review the contents facilitating the memorization when performing multiple-choice methodology.

On the other hand, online exam platforms are a useful tool for some students, to practice multiple questions. The subscription fee put off some candidates. Many stressed the importance of relying on textbooks, and found working in study groups the most effective learning tool. Candidates also used the following textbooks: Retina by Ryan, Strabismus by Pietro-Díaz, Retina by Rojas and Col. or Cornea by Krachner, among others). The remaining recommended texts have been mentioned between 9 and 1 times by each of the trainees surveyed. The list is extensive and has been attached in the appendix in detail. Therefore, the rest of the chosen bibliography is the personal choice according to the preferences and interests of each individual.

Candidates recommended a large number of materials in English, which demonstrates that most of the Spanish-speaking students can read and understand this language satisfactorily, and therefore, prefer the original literature without translations. Once again, these data are directly correlated with the language distribution of the different resources mentioned.

As limitations to this study, we found that the data used in the analysis correspond to 13.4% of the candidates to whom the survey was sent, which implies that there might be other resources that were not considered in this study. On the other hand, our results are based on a survey, which may have bias recollection. This implies that the answers may correspond to what the subject has considered the most difficult task, or may remember those books liked the most. This information is based on the experience of each student and does not correspond to the official bibliography recommended by the ICO.

Finally, we hope that the analysis of this survey can be useful for potential candidates taking the ICO exams, and that the previous experience of other students can guide and facilitate the approach of new students.

  Conclusions Top

Given that most of the study materials are in English, it can be particularly challenging for Spanish-speaking candidates to prepare and pass the ICO examinations. Although many of the candidates understand English quite well, there are also a large number of options in Spanish. Textbooks can be complemented by a large number of multiple-choice questions available on different websites. It would be useful to increase the number of publications and updated ophthalmologic texts in Spanish, as well as to encourage medical students and residents to improve their English skills.

Financial support and sponsorship


Conflicts of interest

There are no conflict of interest.

  Appendix 1: Original Questionnaire Top

  1. How fluent are you in English?

  2. I can read and speak without problems

    I can read without problems, but I only speak a little

    I can read with some difficulty, but not speak

    I cannot read well in English and I prefer texts in Spanish

  3. When you got prepared for the exam, in what language did you study?

  4. English only

    Mainly English and some Spanish

    Some English and mainly Spanish

    All Spanish

  5. What texts or other resources IN ENGLISH would you recommend to a friend to study? List up to 5 of your favorite resources.
  6. What texts or other resources in Spanish would you recommend to a friend to study? List up to 5 of your favorite resources.
  7. What exams did you pass? Check all that apply

  8. Visual Sciences;

    Optics and refraction and instruments;

    Clinical ophthalmology.

    Foundation exam

    Subspecialty exam

  9. Name
  10. Country
  11. Email
  12. Would you allow us to contact you if we have further questions?

  13. Yes


  14. Add here any other comment you want to share with us

  References Top

American Academy of Ophthalmology. Basic and Clinical Science Course Complete Set. Section 1-13. San Francisco, CA: American Academy of Ophthalmology; 2018-2019.  Back to cited text no. 1
Friedman NJ, Kaiser PK, Trattler WB. Review of Ophthalmology. 3rd ed. Philadelphia, Pennsylvania: Elsevier; 2017.   Back to cited text no. 2
Elkington AR, Frank HJ, Greaney MJ. Clinical Optics. 3rd ed. Engelska: Wiley; 1999.   Back to cited text no. 3
Bye L, Modi N, Stanford M. Basic Sciences for Ophthalmology. Plymouth, UK.: Oxford University Press; 2013.   Back to cited text no. 4
Kanski J, Bowling B. Kanski's Clinical Ophthalmology. 8th ed. Edinburgh: Elsevier; 2015.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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