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Is refractive outcome post cataract surgery an effective measure of individual surgical skill?

Poster Details

First Author: F.Allen UK

Co Author(s):    M. Rahman   E. Thompson   A. Chandra              

Abstract Details


The Royal College of Ophthalmologists requires all trainees completing training to present an audit of 50 consecutive cases including the percentage of eyes within 0.5D and also 1D of predictive refractive outcome. This information is presented alongside complication rates and final visual acuity for these cases. This study aims to clarify whether refractive outcome is related to surgical competence and therefore whether it should be included as a key outcome when auditing an individual surgeon.


This work was completed by the ophthalmology department at Southend University Hospital NHS Foundation Trust.


All cataract operations performed during January and February of 2017 were retrospectively audited. Post operative refraction was taken from autorefraction data performed at a 3 week post operative visit. The spherical equivalent of this was compared to the target post operative outcome predicted by the preoperative biometry. The variation from the aimed post operative refraction was compared between groups of surgeons with varying surgical experience; trainee, specialty, fellow and consultant surgeons.


There were 550 operations audited over this period. 195 operations were performed by consultant surgeons, 247 by Specialty grade doctors, 73 by fellows and 35 by trainees. The mean distance from target post operative refraction was 0.75D from target refraction for trainee doctors, 0.87D for fellows, 0.75D for staff grades and 0.78D for consultants. 56% of postoperative refractions were within 0.5D of target refraction for consultant surgeons compared to 50% for specialty doctors, 41% for fellows and 49% for trainees. There was no statistically significant variation between postoperative refraction for the difference surgical groups (p=0.76, one way ANOVA test).


Our results indicate that post operative refraction is a poor indicator of surgical competence given no statistical difference between surgeons of greatly varying experience. It seems more likely that this is a measure of biometry accuracy and skill which in the NHS setting is generally performed by a nurse. Post operative refraction should continue to be audited on a departmental scale to ensure the accuracy of biometry within a department however it is perhaps unsuitable as a key measure of individual surgical competence.

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