Daycase Cataract Surgery Audit

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Daycase Cataract Surgery Audit

• 20th of April, 2004.
• Singleton Hospital.

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Aims

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

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Background

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

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Demographic detail

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

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Refractive Outcome
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Refractive Outcome
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Refractive Outcome Predicted
lt0.25 D 21
lt0.5D 45
lt0.75D 65
lt1.00D 79
lt1.50D 90
lt1.75D 93
lt2.00D 97
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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.

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Outliers gt1.50D
Predicted SE Actual 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)
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Outliers gt1.00D
Predicted SE Actual 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)
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Where are the outliers?

• 68 more ve (71)
• 29 more ve (31)

0
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More Detail Outliers

• AL -1 patient gt 24.5mm -2 patients lt
  22.0mm
• Keratometry -3 patients gt 1D difference
• Most patients no obvious cause for inaccuracy
• (Only 57 files available, 12 of 21)

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Method Biometry Outliers
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Visual Outcome
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Visual Outcome
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Visual Outcome

• Pre-op VA
• Mean 6/30 (0.70)
• Range 6/12 6/190 (0.25-lt1.50)
• Post-op VA
• Mean 6/9 (0.13)
• Range 6/5 -6/36 (-0.08- 0.78)

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Visual Outcome

• 91 had VA 6/12.
• No patient had VA lt 6/36 .
• National Cataract Audit 77 VA? 6/12 at
  discharge.

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Poor visual outcome
Co-morbidity 100

Amblyopia 4 patients
AMD 5 patients
POAG 1 patient
Myopic macular changes 1 patient
12 patients VA ?6/12 9 files looked at.
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How compare to 2003?

• IOL master used more 2004
• 2003- 85 ? 1D - range -2.42 to
  1.37 - mean difference 0.64D

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Conclusions

• Incomplete forms.
• IOL master more accurate?
• Use Hoffer Q etc.
• Personalise A constants.
• Cant account fully for unexpected results.

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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

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Outliers (2)

• (4) D.J.
• AL24.88mm OS (24.99mm OD)
• (5) C.B.
• Ks gt1D difference (43.55,45.55)
• (6) H.W.
• Ks gt1D difference (43.35,45.06)

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Individual Results
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Consultant (1) Visual Outcome
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Consultant (2)- Visual Outcome
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Consultant (3)- Visual Outcome
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Consultant (4)- Visual Outcome
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Consultant (1) - Accuracy Predicted Refraction
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Consultant (2)- Accuracy Predicted Refraction
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Consultant (3)- Accuracy Predicted Refraction
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Consultant (4)- Accuracy Predicted Refraction
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Consultant (5)- Accuracy Predicted Refraction
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Individual Surgeon Accuracy

• Consultant 1- 0.07 (n11)
• Consultant 2- 0.50 (n26)
• Consultant 3- 0.30 (n28)
• Consultant 4- -0.07 (n4)
• Consultant 5- 0.51 (n29)

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Individual mean SE

• Consultant 1- 0.02
• Consultant 2- -0.002
• Consultant 3- 0.19
• Consultant 4- -0.50
• Consultant 5- 0.05

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To Audit office and Ophthalmology secretaries
Thank You