Background: Development of a national ophthalmology review course for the education of residents and use of a standardized international exam as a metric of resident knowledge and education.Methods: A 3 day review course for all Ethiopian ophthalmology residents, taught by visiting and local faculty, in preparation for the International Council of Ophthalmology (ICO) exam. The ICO exam serves as an external and standardizing measurement of residency curriculum and preparedness for clinical practice. The course and exam was provided free of cost to residents. Baseline knowledge was assessed with the ICO exam in 2017 and results compared with performance each year after the introduction of the review course. Results: Over 2 years of implementation, the resident passage rates of the basic sciences and optics and refraction exams increased by 10% and 28% and a 15% improvement in passage rate of the clinical sciences exam. These scores were significantly higher than international averages. Additionally, increasing numbers of residents were able to sit for the advanced exam with a passage rate of 67% in 2019 compared to the international passage rate of 56%.Conclusions: The implementation of a national review course is feasible and effective in enhacing the education of ophthalmology residents in Ethiopia. The review course and ICO exam serves as a key metric in the education of Ethiopian residents and their knowledge as it compares to their peers in other countries.