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The Duke-Elder exam is a specialist ophthalmology exam intended for medical students to sit during medical school. It is named after Sir Stewart Duke-Elder, a pioneering Scottish ophthalmologist who was active in the first half of the 20th Century by writing several textbooks, most notably the multiple editions of System of Ophthalmology. His contribution to the field of ophthalmology led him to lecture internationally and receive several medals for his work [1].

The exam now ran by the Royal College of Ophthalmologists is one of two ophthalmology awards which can be obtained during medical school (The Patrick Trever-Roper Undergraduate Travel Award being the other prize) [2]. Being successful at the Duke-Elder offers different prizes, for instance ranking in top 60% allocates 1 point and ranking in the top 10% allocates 2 points towards ophthalmology specialty training post applications. Students who rank in the top 20 candidates in the country will receive a special commendation in the form of a signed letter from the college, and the top candidate will receive either a monetary prize of £400 or an opportunity to visit St John’s Eye Hospital in Jerusalem. Students can sit the exam on multiple years during medical school with the aim to try better their score and achieve these awards [3].



The Duke-Elder exam is a notoriously competitive and difficult exam to sit during medical school. Each year students can register for the exam before December and the exam is held in early March. Traditionally, the exam is held in person, but this year uniquely due to the restrictions of the COVID-19 pandemic, the exam was held remotely using an online proctored examination software. Two hours is allocated to answer ninety multiple choice questions which no negative marking. The standard of some of questions that students encounter is beyond those of the undergraduate ophthalmology curriculum experienced during medical school. It consists of questions from the different sub-specialties within ophthalmology: cornea and external eye disease, cataract, glaucoma, medical retina and vitreoretinal surgery, strabismus and paediatric ophthalmology, neuro-ophthalmology, ocular adnexal and orbital disease, refractive errors and optics. In addition to these clinical based questions, other areas of ophthalmology can be examined, for instance, ocular anatomy, physiology and pathology, as well as the socio-economic aspects key to ophthalmology [3].

The Royal College of Ophthalmologists offers guidance and recommended reading resources for candidates interested in the sitting the exam (see below) [3]. Sitting this exam is a great start in pursuing a career in ophthalmology, which is a competitive specialty with minimal exposure during medical school, therefore early preparation and practise is key to success.


Recommended reading resources provided by the Royal College of Ophthalmologists [3]:
  • Forrester JV, Dick AD, McMenamin P, Roberts F. The Eye: Basic Sciences and Practice. WB Saunders, Elsevier; 2007. ISBN-10: 070202841X. ISBN-13: 978- 0702028410
  • Galloway PH, Forrester JV, Dick AD, Lee WR. MCQ companion to the Eye. Basic Sciences in Practice. WB Saunders; 2001. ISBN-10: 0702025666. ISBN-13: 978-0702025662
  • Elkington AR, Frank HJ, Greaney MJ. Clinical Optics. John Wiley & Sons, Blackwell Science; 1999. ISBN: 0632049898/9780632049899
  • Snell RS, Lemp MA. Clinical Anatomy of the Eye. Blackwell Scientific Publications; 1998. ISBN: 063204344X
  • Kanski JJ, Bowling B. Clinical Ophthalmology: A Systematic Approach. Butterworth-Heinemann, Elsevier; 2011. ISBN-10: 0702040932. ISBN-13: 978- 0702040931
  • Kanski JJ, Trzaska AK. Clinical Ophthalmology: A Self-Assessment Companion. Elsevier; 2007. ISBN-10: 0750675381. ISBN-13: 978- 0750675383
  • Chiam P. EMQs And MCQs For The FRCOphth Part 2 [Paperback]. Lulu Marketplace; 2011. ISBN 9781447806615



1. Henkind P. Sir Stewart Duke-Elder, FRS 1898-1978. Arch Ophthalmol 1978;96(7):1169-71.
2. Awards and Prizes. The Royal College of Ophthalmologists. 2021:

(Last accessed August 2021).
3. Duke Elder Undergraduate Prize Examination. The Royal College of Ophthalmologists. 2021:

(Last accessed August 2021).



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Neel Vyas

University of Leeds, UK.

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