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

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

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

4. Demographic detail Age: mean 75 years (range 45- 91) Surgery June 2003- Jan 2004. Forms returned 46.1days (2-120).

5. Refractive Outcome

7. 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%

8. Refraction- more detail 79% within 1 Dioptre predicted refraction. * Mean difference: +0.37D. Range : -2.22 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.

9. Outliers >1.50D Predicted SEActual SE (Difference) 1. -0.03 -2.25 (-2.22) 2. 0.0 -2.13 (-2.13) 3. -0.13 1.37 (1.50) 4. -0.08 1.50 (1.58) 5. 0.50 2.25 (1.75) 6. -0.40 1.38 (1.78) 7. 0.71 2.50 (1.79 ) 8. 0.0 1.88 (1.88) 9. -0.19 1.75 (1.94) 10. -2.00 1.88 (3.88)

10. Outliers >1.00D Predicted SEActual SE (Difference) 1. 0.56 -0.63 (-1.19) 2. -0.30 0.75 (1.05) 3. 0.31 1.38 (1.07) 4. 0.04 1.13 (1.09) 5. 0.0 1.13 (1.13) 6. -0.38 0.75 (1.13) 7. 0.10 1.25 (1.15) 8. -0.05 1.25 (1.30) 9. -0.20 1.13 (1.33) 10. -0.32 1.13 (1.45) 11. -1.00 0.50 (1.50)

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

12. 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)

13. Method Biometry Outliers

14. Visual Outcome

16. 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 (-0.08- 0.78)

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

18. 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.

19. How compare to 2003? IOL master used more 2004 2003- 85%  1D - range -2.42 to 1.37 - mean difference +0.64D

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

21. 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, 44.68 Aim 0.08 6/12ua (3) B.Q. AL 21.98mm OS (22.06mmOD). Ks 44.53, 45.24 Aim –0.38 (difference=), 6/9ua

22. 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)

23. Individual Results

24. Consultant (1) –Visual Outcome

25. Consultant (2)- Visual Outcome

26. Consultant (3)- Visual Outcome

27. Consultant (4)- Visual Outcome

28. Consultant (1) - Accuracy Predicted Refraction

29. Consultant (2)- Accuracy Predicted Refraction

30. Consultant (3)- Accuracy Predicted Refraction

31. Consultant (4)- Accuracy Predicted Refraction

32. Consultant (5)- Accuracy Predicted Refraction

33. Individual Surgeon Accuracy Consultant 1- +0.07 (n=11) Consultant 2- +0.50 (n=26) Consultant 3- +0.30 (n=28) Consultant 4- -0.07 (n=4) Consultant 5- +0.51 (n=29)

34. Individual mean SE Consultant 1- +0.02 Consultant 2- -0.002 Consultant 3- +0.19 Consultant 4- -0.50 Consultant 5- +0.05

35. To Audit office and Ophthalmology secretaries