National biometry audit

Eye (Lond). 2004 Jan;18(1):63-6. doi: 10.1038/sj.eye.6700550.


Purpose: To determine compliance with the Royal College of Ophthalmologists' (RCOphth) biometry guidelines.

Method: A structured telephone questionnaire of individuals who perform biometry in all eye departments in the United Kingdom (UK).

Results: A biometrist was interviewed in 107 of the UK's 178 eye departments. Nurses alone run the biometry service in 58% of departments, orthoptists alone in 13%, junior doctors alone in 6%, optometrists alone in 3%, and a combination of staff in 20%. Of the staff interviewed, 37% had been on external biometry training courses. One intraocular lens (IOL) calculation formula was used for all eyes in 61% of departments with 17% using the obsolete SRK II formula, 36% of departments used two or more formulae and only 4% adhered to the RCOphth guidelines to use Hoffer Q in eyes with axial lengths <22.0 mm, an average of all three formulae in eyes between 22.0 and 24.5 mm, Holladay in eyes between 24.6 and 26.0 mm, and SRK/T in eyes >26.0 mm. Audit of refractive results was claimed by 71% of units but in only 17 (16%) did the biometrist know the percentage of eyes with a prediction error <or=1 D.

Conclusion: This study demonstrates poor awareness and/or implementation of the RCOphth biometry guidelines and indicates that audits are either not highlighting poor results or are not resulting in a change in practice. The guidelines should be updated to emphasise the importance of customising A constants and to set benchmark standards for prediction error.

MeSH terms

  • Biometry / methods*
  • Cataract Extraction
  • Education, Continuing / statistics & numerical data
  • Guideline Adherence / statistics & numerical data*
  • Health Care Surveys
  • Humans
  • Lenses, Intraocular*
  • Medical Audit
  • Ophthalmology / education
  • Practice Guidelines as Topic*
  • Preoperative Care / standards
  • Refraction, Ocular*
  • Societies, Medical
  • United Kingdom