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systematic review examined geographical temporal trends medical school ophthalmology education relationship course student outcomes evidence suggesting decline ophthalmology teaching medical schools increasing raising concern adequacy eye knowledge across rest medical profession systematic review embase scopus inclusion studies containing data medical school ophthalmic course length 1 outcome measures student ophthalmology knowledge skills selfevaluation knowledge skills student course appraisal systematic review registered prospectively international prospective register systematic reviews identifier crd42022323865 results aggregated outcome subgroup analysis description relationship geographical temporal trends descriptive statistics including nonparametric correlations used analyze data trends systematic review yielded 4596 publication titles 52 included analysis data 19 countries average course length ranged 125 2087 hours significant continental disparity among mean course lengths africa reported longest average course length 1033 hours north america reported shortest 364 hours average course lengths declining last 2 decades average overall course length 929 hours 2000s 529 hours 2020s mean student selfevaluation skills 513 mean student selfevaluation knowledge 554 objective mean assessment mark skills 575 knowledge 717 compared average pass mark 667 average 264 students felt confident ophthalmology knowledge 345 felt confident skills evidence describes declining length courses devoted ophthalmology last 20 years significant student dissatisfaction courses content suboptimal knowledge confidence proprietary commercial disclosure may found footnotes disclosures end article