Just to clear things up, a stress ECG is only required if you are over 50 and applying for an International licence, as I understand it, you dont require one every year, just for the first time. For the Manx only a National licence is required so this doesnt apply. The ACU changed their rules a few years ago, when you reached the age of 55 you were required to have a medical every year, now all you have to do is sign a medical declaration that you havent had any of the problems that they list, if you have you have to give details, in my case I have to say yes and give details to one of them, even thought Im fully recovered now. Under the age of 55 an eyesight test is required evey 3 years, I think. In my case, because Im over 55 I have to have an eyesight test every year, but they can also tell other things from this, for instance, my mate discovered that he had high blood pressure after having an eyesight test, because he had ruptured blood vessels in his eyes.