The examination registration form and payment is due in the ACVO office by 5pm MT, June 15, 2013. Call the ACVO office (208-466-7624) for the physical address if you wish to use a courier service.

The 2013 Image Recognition and Written examinations will be administered at regional testing centers on July 22 and 23, respectively. Practical examination portions will be held on July 30-August 3, 2013 at the Veterinary Teaching Hospital at North Carolina State University, Raleigh, NC. No major changes in format are expected for the 2013 examination. These dates are also found in the resident section of the ACVO web site.

The online address to help you locate a testing center near you is: http://www.isoqualitytesting.com/locations.aspx. Contact the chair of the Examination Committee, Dr. Ian Herring at , with any questions or concerns.

NATURE AND SCOPE OF THE ACVO EXAMINATION

The ACVO Certification Examination is given annually to candidates who have successfully completed all requirements dictated by the ACVO Residency and Credentials Committees. The examination process consists of three separate sections: 1) the Image Recognition examination, 2) the Written examination, and 3) the Practical examination. The Image Recognition and Written examinations are given in late July to early August at regional testing centers. The Practical examination is held approximately 1-2 weeks later, usually at a veterinary medical teaching institution. The specific dates for this year’s examinations are listed below under “Schedule for the 2013 Examination”. 

The separate portions of the examination are constructed to evaluate the candidate's proficiency and knowledge of items considered relevant and important to a veterinary ophthalmologist. The Image Recognition examination is designed to evaluate ability to identify, assess, and problem solve (assimilate) clinical material. The Written examination is designed to evaluate knowledge of the current scientific literature and basic sciences relevant to veterinary ophthalmology. The Practical examination portions are designed to evaluate proficiency in ophthalmic examination techniques and surgical techniques.

ACVO EXAMINATION SAMPLE QUESTIONS

Examples of questions for the Written and Image Recognition portions of the ACVO certifying examination may be found at the following links:

Sample IR questions

Sample Written questions

These examples are provided to familiarize the candidate with the type and format of questions that may be asked and do not reflect the content distribution of the actual exam, as outlined by the ACVO Examination Blueprint.  Also note that the list of acceptable responses listed for the Image Recognition questions is not necessarily comprehensive. They are simply examples of acceptable responses appropriate to the phrasing of the questions posed. It is advisable to review the “Components of the Examination, Image Recognition Examination” section below before proceeding to the sample questions.

COMPONENTS OF THE EXAMINATION

I. Image Recognition Examination

The Image Recognition examination is conducted on-line at regional testing centers and consists of a series of images and corresponding questions in three sections of the eye and related structures: 1) Orbit and Adnexa, 2) Anterior Segment, and 3) Lens and Posterior Segment.

The major demands of the Image Recognition examination include identification, assessment, and problem solving (assimilation) of the appearance and information presented on a photographic image. During the exam, candidates are asked to respond to structured questions with a short answer response while viewing the image. The candidates are given approximately 2 to 2.5 hours to complete each section of the exam. The candidates are generally asked to give several answers for each image.

The images used in this part of the examination include clinical photographs of the eye or patient, fundus photographs, goniophotographs, photographs of imaging techniques, special diagnostic techniques, slit lamp photographs, cytologic specimens, and gross and microscopic (photomicrographs) pathology specimens. Questions on surgical techniques, principles, equipment and complications are also covered in each of these three areas. Questions typically include such items as listing lesions or abnormalities, developing a differential considerations list for the specific disease process, citing the most likely etiologic diagnosis(es) or pathogenesis, listing a morphologic diagnosis, listing appropriate therapy for the specific condition, identifying species on the image, identifying the surgical technique being performed, surgical instrument, or surgical principle relevant to the image, or surgical complication. The phrasing of questions on the Image Recognition examination follows the guidelines outlined in the terminology description below.

As this exam is designed to evaluate recognition and assimilation of clinical material, the candidate can best prepare for this portion during the residency by seeing a full and diverse caseload and developing sound problem solving skills. Preparation for this portion of the exam is also facilitated by reviewing images of the subject content listed above and interpreting the images according to the questions likely to be asked.  Working familiarity with the terms and phrases outlined below is highly recommended.

Distribution of Image Recognition Questions

The image recognition portion of the examination is administered in 3 parts, each of which is constructed by anatomic region of the eye, as outlined below.   See the ACVO Exam Blueprint for the approximate distribution of questions according to species and region of the eye.

PART I. ORBIT AND ADNEXA

PART II. ANTERIOR SEGMENT

PART III. LENS AND POSTERIOR SEGMENT

Appropriate Terminology for Answers to Image Recognition Examination Section

The following list of terms has been approved by the Examination Committee for use in questions on the ACVO Image Recognition examination. The candidates should familiarize themselves with this list in preparation for the certification examination. Though there may be differences of opinion with regard to the correct usage some of these terms, this is the terminology the Committee has determined to use on the Image Recognition exam. The term to be used on the examination is listed first, followed by synonyms with which the term is often used (these synonyms will not generally be used on the exam), followed by examples of what the term represents:

Note that abnormality can refer to clinical findings, histopathologic or cytologic findings, and findings in ancillary tests such as gonioscopy, fluorescein angiography, radiography or other imaging techniques, laboratory tests, etc. The question may be stated as, list the "clinical abnormality" or list the "histopathologic abnormality," etc. If asked for an abnormality, the candidates should list what they see, not the interpretation of what they see, and the abnormality should be described in as much detail and to the highest level possible from what is shown on the image. For example, the image may depict corneal edema, and if the examiners felt the image adequately depicted this lesion, the candidate would be expected to list this as an abnormality, not "corneal cloudiness" or "white area in the cornea." Note that with a fundus photograph, which clearly shows a retinal detachment, the abnormality would be listed as a "retinal detachment." However, with an ultrasound the abnormality should be listed as "hyperechoic lines radiating from optic disc and extending into vitreous".  In the latter example, retinal detachment would be a DIAGNOSIS. The examiners take these types of terminology overlap into consideration when formulating the questions and assessing the candidate's answers. Do not assume that if the question asks for any abnormalities that one is necessarily present. If no abnormality is present, the candidate would be expected to write "normal" or "no abnormality." Likewise, the question may ask for “the most significant abnormalities” with a number of correct responses accepted. However, if a lens luxation and retinal detachment are present, listing conjunctival hyperemia instead will not be accepted.

Diagnosis refers to an interpretation of the abnormalities or findings. The question may be qualified to ask for a "histopathologic diagnosis," "morphologic diagnosis," "clinical diagnosis," an "ultrasonographic diagnosis," etc. Again, the diagnosis should be listed in the most specific terms possible from the findings on the image and the information given in the question. Diagnosis will generally not be used to refer to a specific cause/etiology.

Etiologic diagnosis refers to a specific cause for the abnormalities or diagnosis. The question may be qualified and ask for an "etiologic factor," "etiologic agent," a "noninfectious etiologic agent," etc. An etiologic diagnosis is more specific than a clinical diagnosis.

Pathogenesis will be used to refer to the cellular events and reactions or other pathologic mechanisms occurring in the development of a disease. It is distinguished from "etiologic diagnosis" by being more specific and referring to mechanism (often cellular) rather than cause (such as a microbe, trauma, etc.).

MISCELLANEOUS TERMINOLOGY:
The following terms are also used on the image exam and are usually qualified in some fashion in terms of the specific answer requested:

Pathogenesis will be used to refer to the cellular events and reactions or other pathologic mechanisms occurring in the development of a disease. It is distinguished from "etiologic diagnosis" by being more specific and referring to mechanism (often cellular) rather than cause (such as a microbe, trauma, etc.).

MISCELLANEOUS TERMINOLOGY:
The following terms are also used on the image exam and are usually qualified in some fashion in terms of the specific answer requested:

EXAMPLE 2: An image shows a horse with a typical "melting" corneal ulcer. The question could ask for:

EXAMPLE 3: An image shows a dog with a dense, black pigmented mass in the posterior chamber, apparently arising from the ciliary body. Questions could include:

II. Written Examination

The Written examination consists of 250 multiple-choice questions in eight disciplines: anatomy/embryology, physiology, neuro-ophthalmology, surgery, pharmacology, pathology, medical ophthalmology, and diagnostics. The test is designed to evaluate the candidate's knowledge of both current literature and basic science information relevant to veterinary ophthalmology. The content distribution of Written Exam questions approximates the ACVO Exam Blueprint (available on the ACVO website), which details discipline, animal species, and eye region. The exam is given in two sections, 125 questions apiece, and the candidates are allowed 3.5 hours/section to complete the exam.

A suggested reading list from which examination questions are composed is provided (see Suggested Resource Material 2013 ACVO Exam). Appropriate chapters in veterinary medical, surgical, and anatomical, etc., texts should also be consulted. Questions from journal articles are from articles published in the 7 years preceding the year the examination is administered and the candidates should concentrate their study efforts on this more recent scientific literature. However, some articles that are considered "classic" articles (i.e., those that provided a major advancement in the knowledge of that particular condition) and are older than seven years should also be reviewed. A supplemental list of such articles is provided. Much of the information from these articles has made its way into contemporary veterinary ophthalmic texts (e.g., Gelatt's textbook), and this information can to some extent be gleaned from these sources; however, the candidates are strongly encouraged to also review the original manuscripts.

Note that articles in veterinary journals should be reviewed for any disease, condition, or situation that involves ocular, periocular, or neuro-ophthalmic structures of systemic conditions directly relevant to ocular disease in animals. Review of basic science texts and human clinical journals should be limited to those chapters or articles dealing with situations or diseases directly applicable to veterinary ophthalmology, or to those where a common domestic animals is used as an animal model. Review of human clinical conditions or basic science articles or texts unrelated to veterinary ophthalmology is not necessary for exam preparation. Additionally, beginning with literature published in January 2010 or later, no questions on the Written Examination will be derived from articles involving single cases (i.e. single case reports). 

III. Practical Examination

The Practical examination consists of three separate stations that are designed to evaluate a candidate's proficiency in animal examination techniques and surgical techniques. The individual stations and associated time limits are described below.

Animal Examination (100 points total/50 points per animal)
The candidate has 40 minutes to examine both eyes of 2 clinical patients (i.e.  20 minutes per patient): a large animal (such as a horse, cow, llama, alpaca or pig) and a small animal (such as a dog, cat, rabbit, rat, or guinea pig).  Additionally, the candidate is given up to 5 minutes per patient to set up or adjust any equipment.  Time in transit between patients is not included in the total time allotted to the candidate.  All eyes are dilated with a mydriatic drug and the large animals are sedated and have auriculopalpebral nerve blocks performed prior to the candidate’s arrival. Only an ophthalmic examination is performed, not additional diagnostic testing (such as tonometry, tear testing, or fluorescein dye application).  Three examiners are in the examination room to record the candidate’s findings (as described verbally) and critique the candidate’s examination methods and use of instrumentation.  The candidate is not allowed to ask the examiners questions about the animals.
 
The candidate will be provided with a slit lamp biomicroscope (Kowa SL15 or SL2), direct ophthalmoscope, indirect ophthalmoscopic headset, condensing lenses, and a Finhoff transilluminator. The candidate may use his/her own equipment if desired, but setup time is limited as described above. If an instrument fails during the examination, the candidate is responsible for notifying an examiner.  The problem will be corrected and the candidate will be given additional time equal to that required to correct the problem.

Station time limits are strictly enforced.  Once the candidate finishes with a particular animal, he/she cannot go back to that animal for re-examination, even if additional time remains.  When the candidate is notified that his/her time is up, no additional comments will be recorded by the examiners.
 
The candidate is asked to describe all clinical findings, normal and abnormal, to the examiners. It is the candidate’s responsibility to accurately describe all lesions (i.e. give its specific depth, size, shape, location in a specific ocular tissue, color, orientation, texture, etc.), and clearly note in which eye the lesion exists.  A morphological or differential diagnosis is not required – only a clear verbal description of findings.  However, unequivocal diagnoses may be stated (i.e., ‘corneal vascularization’ rather than ‘linear red structures within the cornea’ or ‘cataract’ rather than ‘lens opacity’), provided the depth, size, location, etc. are properly described.  Identifying lesions NOT present, OR failing to note that a normal structure is normal, will result in subtraction of points.  Appropriate use of instrumentation is also evaluated.
 
It will be at the examiners’ discretion, not the candidate’s, to determine if an animal is overly active preventing adequate ocular examination. 

LACK OF FAMILIARITY WITH EQUIPMENT WILL NOT BE ACCEPTABLE GROUNDS FOR APPEAL OR EXTENSION OF TIME LIMITS.
 
The candidate should prepare for the animal examination portion of the examination by developing sound examination techniques and practicing verbalizing accurate and succinct descriptions of observed lesions to their mentors.
 
Surgery Stations (Extraocular and Intraocular)
The two surgery stations (extraocular surgery and intraocular surgery) involve surgical exercises on cadaver (calf, pig, rabbit or other appropriate species) eyes. The candidate is asked to perform one extraocular procedure (either adnexal or corneal/conjunctival) and an intraocular procedure. The candidate supplies all necessary instruments, irrigating solution, suture material, blades, gloves, head loupes (if desired), etc. An operating microscope for the intraocular surgery section and stands for organizing the instruments will be available.

FAILURE TO BRING NECESSARY SUPPLIES MAY RESULT IN FAILURE. THE EXAMINERS WILL NOT OFFER ANY SUPPLIES INCLUDING DISPOSABLE MATERIALS.
 
 
Extraocular surgery (100 points) – The candidate will be given 50 minutes to set up and perform either an adnexal OR corneal/conjunctival surgery. The specific surgery to be performed will be declared at the time of examination.  An operating microscope will not be available for this procedure. The candidate should describe what magnification he/she would normally use and is advised to bring a portable source of magnification (head loupe), if desired.

The required surgical procedure will be derived from the following list, although the required procedure may encompass a combination of those listed (e.g. lamellar keratectomy and conjunctival bridge flap):
Corneoconjunctival
Lamellar keratectomy
Corneoconjunctival transposition
Conjunctival flap/graft (any type of conjunctival flap/graft may be required)
Autologous lamellar keratoplasty

Adnexal
H-plasty
Medial canthoplasty (Roberts-Jensen pocket technique)
Modified Kuhnt-Szymanowski (Munger-Carter modification)
Stades procedure
Bigelbach lateral canthoplasty 

Intraocular surgery (100 points) – The candidate will be given 50 minutes to setup and perform an extracapsular cataract extraction. An operating microscope will be available and the candidate will be given orientation to its use. The candidate is expected to demonstrate currently acceptable techniques of intraocular surgery and should use techniques with which he/she is familiar.  The candidate will be asked perform a two-step clear corneal incision, continuous curvilinear capsulorrhexis and extracapsular extraction. Demonstrate cortical removal, if needed, by manual techniques. Closure method is the candidate’s choice. The candidate will be asked to describe the procedure while performing it. It is recognized that this demonstration differs from a clinical situation and the candidate will be asked to discuss these differences and how his/her technique and results differ from a clinical situation. Observation of sterile technique is not expected. One of the examiners will function as a surgical assistant but will act only upon the candidate’s specific instructions. As cadaver eyes are soft, the candidate may wish to inflate the globe to a more normal tension by intraocular injection of saline (provided).  Although this is not a commonly performed surgical procedure, it contains a number of technical elements which are absolutely necessary in the execution of successful intraocular surgery.
 
Candidates are evaluated on components of the procedure and are primarily evaluated on surgical technique. Knowledge of and experience with proper surgical technique and the common ophthalmic surgical techniques (especially those above) should prepare the candidate for this portion of the exam. The candidate is also strongly urged to carefully prepare and to practice all the possible surgical techniques on porcine cadaver eyes in preparation for this examination. As correct (currently accepted) instrumentation, use of instruments, and appropriate suture material will be evaluated, the candidate should bring equipment and supplies as would be used on a client-owned animal (although sterility of the supplies is not required).

All sections of the practical examination must be passed to successfully complete the examination. Only failed sections must be repeated.

GRADING OF THE EXAMINATION AND DETERMINATION OF PASSING POINT

The Written examination is computer scored and a total score for all 250 questions is generated. Each section of the Image Recognition examination is scored independently by three examination committee members in a masked fashion (without knowledge of candidate identity) and their scores averaged. The score for all three sections is used for the final score. The surgery and animal examination stations are evaluated by judges observing and independently scoring the surgical and examination technique of the candidate on separate components of the procedure, including appropriate instrumentation and proficiency in the technique itself. The candidate is asked to explain what is being done during the surgeries and some questions may be asked.

The passing point for the Written and Image Recognition examinations are determined through a criterion referenced method as modified by Angoff. This technique is considered by most experts as one of the most reliable and defensible methods available of setting passing points. It relies on the pooled judgments of content experts. For example, in this approach, a group of experts is asked to judge each item on the test. The criterion used is formed into a question: "what is the probability that a `minimally acceptable' candidate will answer this item correctly?". This question prompts the judges to consider a group of minimally acceptable candidates and what proportion of that group will answer each item correctly. The average of the proportions, or probabilities, is multiplied by the total number of questions in the test. The result then represents the minimally acceptable score. The final passing score for the examination is based on this pooled judgment and includes a statistical adjustment for testing error. This adjustment is provided to give the benefit of the doubt to examinees that score just below the level judged by the content experts to be the minimal passing point. Since the ACVO exams are revised regularly, with some items being replaced by newly developed ones, the content and difficulty level of the examination changes. These changes usually affect the score necessary to pass. As a result, the passing point for each examination is unique. Since the criterion reference method is not feasible to the practical examination grading, the passing point for each of the three stations has been established at 70%.

CANDIDATE PLEDGE

The candidates taking the examination are not to discuss the any portion of the examination, either during or following the examination, with other or future ACVO examination candidates. Any evidence of discussion of the examination during the examination will lead to disqualification of the candidate and initiate a report to the ACVO Professional Practice, Disciplinary, and Appeals (PPDA) Committee.
 
Immediately prior to the examination, the candidates will be required to sign that they have read and agree to the following:

“I hereby acknowledge that the American College of Veterinary Ophthalmologists certification examination is a secure examination duly copyrighted under the laws of the United States of America.  I further acknowledge that any reproduction or transmission in any form or by any means of the contents of the questions contained in the examination is strictly prohibited.  I understand that reproduction or transmission of the contents of these questions contained in this examination may jeopardize membership in the American College of Veterinary Ophthalmologists.  I will not reproduce or transmit any part of this examination without the prior written consent of the American College of Veterinary Ophthalmologists, Board of Regents. On my honor, I have neither given nor received unauthorized aid, directly or indirectly, on the certification examination.  I have not observed other candidates receiving unauthorized aid on this examination which has not been reported in writing by me to a Proctor.”

APPLICATION PROCEDURE FOR EXAMINATION ACCOMMODATIONS

In compliance with the Americans with Disabilities Act (ADA), the American College of Veterinary Ophthalmologists (ACVO) offers its exams in manner that accommodate individuals with disabilities, including persons with learning disabilities.

A candidate who has a disability, but has completed the credentialing requirements of the ACVO, may request accommodations in taking the Written and Image Recognition portions of the ACVO certifying examination.  Due to the nature of the Practical portions of the certifying examination (which include the Intraocular Surgery, Extraocular Surgery and Animal Examination stations), accommodations in the form of time extension or altered setting are not provided for these portions of the exam.

For specific information regarding the process for accommodations requests and submission of documentation, please contact the ACVO at 1-208-466-7624 or by e-mail at office13@acvo.org.

CANDIDATE NOTIFICATION AND REEXAMINATION PROCEDURES

The candidates for the certification examination are notified by the examination committee chairperson by certified mail within 8 weeks of the end of the Practical examination.  DO NOT EMAIL OR CALL the Examination Committee Chair regarding exam results.  Exam results WILL NOT be given over the phone or email to you, your mentor, or anyone else – YOU MUST WAIT FOR THE OFFICIAL CERTIFIED MAIL. The candidates are informed of their specific scores and minimum passing point on the each section of the examination.

A candidate need only retake that portion of the examination for which an unsuccessful score was rendered. The portions of the practical examination are considered separate sections as related to reexamination (i.e. only unsuccessful stations need be repeated, not the entire practical examination).

The candidate has four calendar years from the time his/her credentials are initially approved to pass all portions of the exam regardless of the number of attempts made to pass the exam (i.e.-if for whatever reason a candidate does not take the exam in consecutive years, the four year “clock” continues to run). After that time, the candidate must take all portions of the certifying examination. Re-application to begin a new four calendar year cycle is not permitted until the cycle initiated by the candidate’s initial credentials application has expired.

PROCEDURE FOR REAPPLICATION TO REPEAT THE EXAMINATION
Reapplicants must comply with all requirements as outlined by the Credentials Committee in order to repeat any portion(s) of the certification examination.  Previous satisfaction of Credential Committee requirements does not insure successful reapplication.

APPEAL PROCEDURES

Candidate appeal of failing scores on the certification exam can be made to the ACVO Professional Practice, Disciplinary, and Appeals (PPDA) Committee within 90 days of the notification of the results by providing written notification to this group.  Appeals should be mailed to the Executive Director of the ACVO along with an explanation of the grounds for appeal.  The Executive Director will then forward all materials to the Chair of the PPDA Committee.  The PPDA Committee reviews the appeal at either their next scheduled meeting, or by telephone conference, if deemed necessary. Proper policy and procedure for the certification examination by the Examination Committee are the predominant criteria used by the PPDA Committee in their deliberation of appeals by candidates and not the specific questions and answers on the examination. The unsuccessful candidate has as a secondary means of restitution, appeal to the American Board of Veterinary Specialists.

If you have questions regarding the logistics of the written, image, or practical examinations, you may contact the examination committee chairpersons: