ICO Board Exam Review in Ethiopia

By Barb Erny, MD

ASCRS Foundation Medical Liaison for International Programs


Imagine the Wills Eye Ophthalmology Review Course, but in Ethiopia. There were a lot of similarities, such as being held at a hotel. However, rather than gathering at a big chain like the Sheraton, residents came to a locally owned establishment, the Ras Amba Hotel in Addis Ababa.  The lecture halls were smaller, so the residents didn’t have to show up an hour early every morning to stake out front row seats like I remember doing.

Another positive difference were the provided meals; no running out for a Philly cheesesteak sandwich from a truck! Huge buffets with injera (the staple local bread), sublime vegetable dishes, and meats (for those who were not being vegan during Lent) supplied not only sustenance but a time to relax and socialize.

The Himalayan Cataract Project was instrumental in planning and funding the three day course, which was also supported by a grant from Emory University and by The ASCRS Foundation.Every resident in Ethiopia eligible for the ICO Board exams was invited to come and had their expenses paid.  Unlike the ABO, the ICO gives three sets of written board exams to be taken by residents:  Visual science, optics refraction and instruments, and clinical ophthalmology. (There is also an advanced clinical exam for practicing ophthalmologists.) The course had two lecture halls running simultaneously, one with the clinical curriculum for the senior residents, and the other with visual science lectures followed by optics.


The first time the course was given was in 2018 and was taught mostly by the Emory and Stanford Global Fellows, Fran Wu and Neda Nikpor, who did the groundbreaking work. In an effort to have the Ethiopian professors gradually take over running the course, this year many subjects were taught by university attendings, local practitioners, and optometry professors.  Keri Allen, the Emory Fellow who spent the year in Addis Ababa, did an amazing job pulling together Ethiopian and US doctors to teach all of the different subject matter, along with securing the venue and dealing with all of the logistics. Since there is not a single neuro-ophthalmologist in Ethiopia, Dr. Wayne Cornblath from University of Michigan taught that section of the clinical review course.  He had such great nystagmus videos that I got dizzy just watching! His colleague Dr. Christine Nelson also participated, lecturing on her specialty, oculoplastics.  Allison Jarstad, the global fellow from Stanford helped Keri plan and execute the course.  They fulfilled the arduous task of teaching most of the visual science, which few practicing ophthalmologists can teach, much less remember.

Keri and Allison dealt with power outages, no-show speakers, equipment failures and doors that wouldn’t stay closed, with calm grace (and some old bricks.)  These expected hassles were trivial in comparison to the tragedy that occurred on the last morning of the course. Dr. Yared Assefa, the residency director from Gondar University who was scheduled to speak, passed away suddenly. Several Gondar residents left early, too upset to continue, and the mood of the rest of us was quite solemn.

Despite these obstacles, the reviews of the course were extremely positive, both from the residents and the speakers. Personally, I enjoyed lecturing on cataract/lens, socializing with the residents and seeing them work together to review the subject matter. The real evidence of success, however, came later when we received the results of the exams. In one year, the pass rate in Ethiopia for optics, refraction and instruments increased by 25%, for visual science by 13% and for clinical ophthalmology by 15%. Compared to the total number of test takers in approximately 80 countries, the Ethiopian residents performed better than average in all three sections and blew it out of the water with an 87% pass rate in visual science compared to 57% worldwide!

The ASCRS Foundation is committed to working with our NGO partners and in- country ophthalmologists to provide quality training. In just a few years Ethiopia has grown to have five residency programs and every sub-specialty (except neuro-ophthalmology), and next year will start to offer fellowships. Your contributions are not only used to directly help impoverished patients, but also go toward ophthalmology education. Helping residents pass their board exams provides the foundation for sustainable, locally sourced eye care.