Daycase Cataract Surgery Audit 20 th of April, 2004. Singleton Hospital.

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Presentation transcript:

Daycase Cataract Surgery Audit 20 th of April, Singleton Hospital.

Aims To compare post-operative refraction with predicted refraction. To assess visual outcome.

Background 128 forms returned from Optometrists. Many incomplete. 104 considered for Biometry accuracy. 110 considered for visual outcome.

Demographic detail Age: mean 75 years (range ) Surgery June Jan Forms returned 46.1days (2-120).

Refractive Outcome

Refractive Outcome: Predicted <0.25 D 21% <0.5D 45% <0.75D 65% <1.00D 79% <1.50D 90% <1.75D 93% <2.00D 97%

Refraction- more detail 79% within 1 Dioptre predicted refraction. * Mean difference: +0.37D. Range : to +3.88D difference. 21 patients (21%)  1D outside predicted refraction. Most major studies 90% within 1 dioptre*. National Swedish Register range difference up to 1.19D, mean 0.9D.

Outliers >1.50D Predicted SEActual SE (Difference) (-2.22) (-2.13) (1.50) (1.58) (1.75) (1.78) (1.79 ) (1.88) (1.94) (3.88)

Outliers >1.00D Predicted SEActual SE (Difference) (-1.19) (1.05) (1.07) (1.09) (1.13) (1.13) (1.15) (1.30) (1.33) (1.45) (1.50)

Where are the outliers? 68% more +ve (71) 29% more –ve (31) 0

More Detail Outliers AL -1 patient > 24.5mm -2 patients < 22.0mm Keratometry -3 patients > 1D difference Most patients no obvious cause for inaccuracy (Only 57% files available, 12 of 21)

Method Biometry Outliers

Visual Outcome

Pre-op VA Mean : 6/30 (0.70) Range: 6/12 – 6/190 (0.25-<1.50) Post-op VA Mean : 6/9+ (0.13) Range: 6/5 -6/36 ( )

Visual Outcome 91% had VA 6/12+. No patient had VA < 6/36. National Cataract Audit :77% VA  6/12 at discharge.

Poor visual outcome Co-morbidity 100 % Amblyopia4 patients AMD5 patients POAG1 patient Myopic macular changes 1 patient 12 patients VA  6/12 – 9 files looked at.

How compare to 2003? IOL master used more %  1D - range to mean difference +0.64D

Conclusions Incomplete forms. IOL master more accurate? Use Hoffer Q etc. Personalise A constants. Can’t account fully for unexpected results.

Outliers (1) (1) O.G. AL 20.58mm OD (20.33mm OS). Ks =47.5, 48.0 Aim –0.56 (difference –1.185), 6/9ua. (2) V.E. AL 19.99mm OD (19.72mm OS). Ks 44.47, Aim /12ua (3) B.Q. AL 21.98mm OS (22.06mmOD). Ks 44.53, Aim –0.38 (difference=), 6/9ua

Outliers (2) (4) D.J. AL=24.88mm OS (24.99mm OD) (5) C.B. Ks >1D difference (43.55,45.55) (6) H.W. Ks >1D difference (43.35,45.06)

Individual Results

Consultant (1) –Visual Outcome

Consultant (2)- Visual Outcome

Consultant (3)- Visual Outcome

Consultant (4)- Visual Outcome

Consultant (1) - Accuracy Predicted Refraction

Consultant (2)- Accuracy Predicted Refraction

Consultant (3)- Accuracy Predicted Refraction

Consultant (4)- Accuracy Predicted Refraction

Consultant (5)- Accuracy Predicted Refraction

Individual Surgeon Accuracy Consultant (n=11) Consultant (n=26) Consultant (n=28) Consultant (n=4) Consultant (n=29)

Individual mean SE Consultant Consultant Consultant Consultant Consultant

To Audit office and Ophthalmology secretaries