How to Achieve Top 10% in the Duke Elder Exam
The Duke Elder Undergraduate Prize Examination in Ophthalmology is one of the best opportunities for medical students interested in ophthalmology. Not only does it strengthen your ophthalmology knowledge far beyond the undergraduate curriculum, but it also gives valuable insight into what a career in ophthalmology entails.
From a portfolio perspective, performing well can also contribute to applications for ophthalmology specialty training (https://www.severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-26/evidence-folder-lib):
3 points for achieving 1st place
2 points for placing in the top 10%
1 point for placing in the top 20%
I achieved 4th place in the 2025 Duke Elder examination, and in this article I’ll share the strategies and resources that helped me succeed.
1. Establish a Solid Knowledge Base
Before diving into MCQs, it is important to build a solid foundation.
Two great starting textbooks are:
Ophthalmology: Lecture Notes by A. Bron, Bruce James, and Chris Chew
The Duke Elder Exam of Ophthalmology: A Comprehensive Guide for Success — Mostafa Khalil and Omar Kouli
They are concise, easy to understand, and cover the core concepts needed for the exam. Early on, focus on understanding common pathologies, anatomy, examination techniques, and key management principles rather than memorising isolated facts. Kanski's Clinical Ophthalmology is an outstanding reference textbook, but it can feel overwhelming if used as a primary revision resource. Use it sparingly for clarifying difficult topics or uncommon conditions.
2. Use Multiple Question Banks
Question practice is essential for the Duke Elder, but each resource has different strengths.
The EyeAcademy Question bank was undoubtedly the most useful overall resource. These questions are written by previous top scorers, and reviewed by Ophthalmologists before publishing. Their questions are the most up-to-date and include explanations, with a focus on the more holistic/general medicine concepts increasingly appearing in the exam.
PrepDukeElder is a useful question bank, particularly for strengthening factual recall, and its online textbook can help consolidate core knowledge, although it is less focused on applied clinical reasoning. EyeDocs is more challenging in this regard and covers a broader range of topics, although I found some of the content to be slightly outdated.
Overall, the Duke Elder exam has shifted away from pure memorisation towards greater emphasis on clinical reasoning and a wider understanding of ophthalmology. In practice, I found that all of these resources complemented each other well, but if I had to prioritise, I would choose EyeAcademy and EyeDocs.
3. Attend Tutorials and Webinar Series
Some ophthalmology concepts are difficult to grasp from textbooks alone, so tutorials are very helpful for simplifying content and focusing on high-yield topics. The EyeAcademy webinar series is useful for structured revision and clear explanations, while the Moorfields Duke Elder Preparatory Course offers in-depth coverage of difficult but relevant material for those aiming higher than a pass.
University ophthalmology society sessions are also an underrated resource. I found these through Instagram, and hearing different speakers explain topics helped reinforce understanding. Particularly useful were sessions from Cardiff, Sheffield, and Cambridge, as well as the National Ophthalmology Training Series (NOTS).
4. Practise With MCQ Books
Once you have a strong foundation, focus on applying your knowledge through MCQs.
The following books were particularly useful:
300 MCQs for the Duke Elder Ophthalmology Exam — Anmol Patel and Peng Yong Sim
Success in the Duke Elder Examination: 180 MCQs — Anna Song
180 MCQs for the Duke Elder Examination — Benjamin Blackburn, Mumta Kanda, Lina Sprogyte
80 MCQs for the Duke Elder Exam — Aneeta Kumar and Ameeta Kumar
The mock papers at the end of The Duke Elder Exam of Ophthalmology: A Comprehensive Guide for Success were particularly thorough, and tested areas different to the above whilst still being relevant.
If you have extra time: attempt FRCOphth questions. These are post-graduate ophthalmology exams so don’t worry if you find them a lot harder! These questions are significantly harder than Duke Elder level, but useful if aiming for the very top marks.
Towards the end of revision, I also looked at:
FRCOphth Part 1: 400 SBAs and CRQs — H. Nikki Hall and Robert G. Peden
The Royal College of Ophthalmologists sample questions from the candidate duke elder pack were also helpful, as well as the FRCOphth part 2 sample questions linked below:
5. Learn Beyond the Standard Curriculum
The highest-scoring candidates often know more than just textbook ophthalmology. Read about current clinical trials and become familiar with landmark trials and their outcomes. It is also important to understand global eye health, including initiatives such as the World Health Organization SPECS 2030 programme, as well as major causes of visual impairment and current public health strategies aimed at addressing them.
6. Master Ophthalmic Imaging
Image interpretation is key, and you should be comfortable recognising common pathology such as retinal detachment and tears, diabetic and hypertensive retinopathy, retinopathy of prematurity, retinal tumours, macular holes, epiretinal membranes, and OCT findings like drusen and layer changes.
Useful resources include websites such as EyeGuru, which is excellent for OCT interpretation, MCQ-style image questions, and pattern recognition, and EyeWiki, which provides strong retinal imaging alongside detailed epidemiology and pathophysiology.
I would also recommend becoming familiar with common ophthalmic instruments such as the slit lamp, indirect ophthalmoscope, B-scan ultrasound, and gonioscopy lenses, including their appearance and clinical uses.
Final Thoughts
The Duke Elder can initially feel overwhelming due to the visual and detail-heavy nature of ophthalmology. However, with consistent preparation, regular question practice, and strong image interpretation skills, achieving a top score is very achievable. It is best to start early, ideally around four months before the exam, doing a small amount each day and gradually increasing the workload as the exam approaches.
Most importantly, try to enjoy the process. Beyond portfolio points, it is a great opportunity to explore ophthalmology in depth and see whether it could be the right career path for you. I hope these tips are helpful, and best of luck with your preparation!
