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Daycase Cataract Surgery Audit

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

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Daycase Cataract Surgery Audit

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  1. Daycase Cataract Surgery Audit 20th 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

  6. Refractive Outcome

  7. Refractive Outcome: Predicted

  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

  10. Outliers >1.00D

  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

  15. Visual Outcome

  16. 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 (-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 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 Thank You

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