My name is Syed Hassan Raza
Jafri from Karachi, Pakistan. I am working as a Senior Registrar in Al-Ibrahim
Eye Hospital (Isra Post graduate Institute Of Ophthalmology). By the grace of
Almighty Allah I passed FRCS Glasgow from Muscat 2008. It was my first attempt.
I owe my success to my parents, my wife, my sisters, my children and all my
nears and dears who prayed for me and supported me. I would like to thank my
mentors Dr. Saleh Memon, Dr. PS Mehar, Dr. Waseem |Jafri specially for inspiring
me to go for it. Hats off to my seniors and teachers Dr Fazal Kamal and Dr.
Azizurrehman for guiding me at their best. Last but not the least my friend Dr
Fahad Feroze, who cleared it along with me, for carrying me along and sharing
his knowledge. Special thanks to Dr Chua for providing with such a wonderful and
This exam is all about keeping yourself composed. Mounds of knowledge are not
required. Basic but prompt knowledge suffices. One needs a lot of practice
regarding clinical examination skills as the time for clinicals is very short.
Only those with good practice succeed through their reflexes, otherwise itís
very usual to miss important findings which lead to failure. Also discussion
with a friend in medicine regarding emergencies is of great benefit.
I read following books
-Oxford handbook of ophthalmology (very important for viva)
- Oxford handbook of clinical medicine (for emergencies)
-American academy of ophthalmology- systemic diseases section for selected
- Chua web page is the gold mine for this examination specially MCQs, pathology
slides, investigations and viva challenge. Also past candidate experiences give
a comprehensive picture of the exam level and atmosphere.
Now my experience for exam
First, the theory paper
Q1 a 40 years old lady is seen at your clinic with a history of intermittent
pain, redness and watering in the left eye for 6 months, occurring particularly
at night. During the last attack 5 days ago, the vision in the eye had become
blurred and she had been aware of colored haloes. On examination acuities were
6/6 with refraction and both eyes were quiet with normal IOPs.
What are the possible differential diagnoses and how would you investigate and
treat this patient?
Q2 A 25 year old female patient is myopic and has always had reduced vision in
the left eye. Her best corrected is 6/6 right with -4.00 DS and 6/60 left with
-7.00DS. She usually only wears a soft contact lens in her right eye. Two days
before her wedding she is referred to your clinic with pain and redness in her
right eye and an obvious corneal opacity.
How would you investigate and manage this case?
Q3 A 75 year old lady who is a carer for her invalid husband presents with
sudden loss of vision in the right eye, with the left having been poor for many
years. On examination acuities are counting fingers left and 6/60 right and she
has a macular BRVO in the right eye. On left side there is a dense cataract.
What are the possible treatment options for this patient and how should she be
Two hours are given, its better to formulate a plan for each question before
jumping into writing the answers
MCQ paper -60 MCQs (5 stems each) in 2 hours
Try not to attempt those needing a second thought, however if in your first go,
your score is below 160, go for taking chances but only in those MCQs which are
My viva was on first day. Following were the tables and the viva topics at them
Pathology and ophthalmic surgery
Pathology of thyroid orbitopathy, various signs and their treatment
Nodular lesion on lid margin D/D and management, how to resect and reconstruct.
Picture of hyphema, identification and management, if patient having sickle cell
Slide of Fuchs endothelial dystrophy, identification, presentation, treatment,
brief discussion about keratoplasty.
Photo of unilateral lid retraction, causes, management.
Photo of CRVO, identification, workup, management and treatment options if the
patient is only eyed and needs early visual rehabilitation.
Photo of corneal abscess with history of contact lens, management, complications
Photo of severe NPDR with CSME, identification, ETDRS definitions, treatment
options. How to apply lasers for diabetic maculopathies.
Medicine and neurology
The most feared viva
Metabolic causes of cataract
Management of a young patient with bilateral cataract
Investigation and criteria for Diabetes
Causes of sudden loss of vision
Painless causes and detail in management of CRAO including cardiac and carotid
Painful causes and detail in management of GCA including steroid workup,
complications of using systemic steroids and problems regarding sudden with
drawl with management of Addisonian crisis.
I was through for the clinicals
I entered a small room with lot of patients. I was sweating and palpating
despite a dose of Inderal. The examinersí smiling faces calmed me a lot. After
that I didnít had time to think as the examiners were very fast and were trying
to present all the patients. After 30 minutes they realized that all patients
are finished so one of them went out and bring one more. But Alhamdolillah
everything went smoothly. Following were the patients and the questions asked.
1st patient had penetrating ocular trauma with corneal repair with 10/0 nylon
sutures which were loose along with iridodialysis. Asked about sequence of
events, complications and other associated areas to look for.
2nd patient on indirect ophthalmoscope had multiple hemorrhages and hard
exudates along with laser marks. Asked about possible diagnoses and treatment.
3rd patient on slit lamp had KPs on endothelium, thin cystic bleb and pale
slopping cup disc. Asked about sequence of events.
4th patient had alternating exotropia. I was asked to check ocular motility.
Deviation was equal in distance and near with no obliques abnormality. Asked
about management, possible refractive error, visual status and chances of
5th patient on 78 D, asked to look at the posterior pole. There was atrophic
maculopathy with areas of retinal thinning. Examiner showed me his high myopic
glasses and asked for a single diagnosis. Asked about other ocular associations,
complications and possible visual rehabilitation.
6th patient, I was asked to observe grossly. She was a young female having a
staring n frightening gaze. I also noticed lid retraction. I was asked about
possible diagnosis followed by a brief discussion about thyroid eye disease as
the bell rang.
Result was announced in the evening. I was entering the building with my heart
pumping out of my chest when suddenly a fellow candidate greeted me that I have
passed. My colleague Dr Fahad also cleared the exam. Thanks to Almighty Allah.
My email address is firstname.lastname@example.org.
I will be delightful if I can be of any help to anyone going for FRCS.