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Undertaking and Performing Biometry Registered Practitioners Competency Assessment Central Index Number: C0986 Version 2 of 20

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Undertaking and Performing Biometry

Registered Practitioners Competency Assessment

Division

Surgery

Department

Ophthalmology

Year

2018

Version Number

Version 2

Central Index Number

C0986

Ratifying Committee

Nursing & Midwifery Advisory Group

Date Ratified

Approval Committee

Ophthalmology CMT

Date Approved

Author Name and Job Title

Emma Bell, Senior staff nurse Ophthalmology PDT Hinchingbrooke Ophthalmology Department- amalgamated policies 2018.

Key Words (for search purposes)

Registered Practitioner; Biometry competency

Date Published on Document Library

Review Date

July 2021

Target Audience

Registered Practitioners in Ophthalmology at all NWAFT sites



DOCUMENT VERSION CONTROL SCHEDULE

Year and Version Number

Author Date Published

on Document

Library

Revisions from previous issue

Ratifying Committee

Date of Ratification

2015 Version 1

Emma Bell

26/05/2015 New assessment


26/03/2015

2018 Version 2

Emma Bell and Hinchingbrooke Ophthalmology

Staff

XXX Amalgamated policy

cross site.




Summary of key points in this document

This competency assessment is for a Registered Practitioner to undertake biometry including using the IOL master, A-scan and Hand Held Keratometer.

This competency assessment is for all Registered Practitioners undertaking biometry.

The member of staff will need to complete 10 observed IOL master measurements, 10 observed A-scans and 10 Hand Held Keratometers prior to being assessed.

The purpose of this assessment is to make sure staff are competent to undertake biometry correctly.

This is a one off assessment unless there is an incident regarding a member of staff’s competence, or in the absence of an incident, if a staff member feels they require further training in any aspect of testing



Contents

Section Page

Number

1 Introduction 5

2 Purpose 5

3 Scope 5

4 Definitions 5

5 Assessment 7

6 Monitoring 7

7 Ratification 7

8 Distribution 7

9 References 8

Appendices

1 – Undertaking Biometry measurements on the IOL Master 10

2 – Undertaking Biometry measurements with an A-scan 13

3 – Undertaking Biometry measurements with a Hand Held Keratometer

16

4 – Assessment: Undertaking Biometry measurements on a IOL Master, A-scan and hand held Keratometer: Statement of competence

18

5 – Quality Assurance Checklist 19

The latest version of this document is on The Document Library. Any printed copies must be checked against the Document Library version to ensure that the latest version is being used.



Undertaking and Performing Biometry Registered Practitioners Competency Assessment

1. Introduction 1.1 Biometry involves the measurement of the various dimensions of the eye

including the axial length and the corneal curvature which is then used to calculate the lens strength needed to put in the patients eye when a cataract is removed.

1.2 It is important for staff to undertake this assessment to ensure the correct

measurements of the eye are taken, so the correct strength of the lens is inserted into the patient eye, giving the patient the best optimal outcome.

1.3 Biometry is undertaken on all patients prior to undergoing cataract surgery and

is an important part of our pre-assessment service. It enables us to make sure we have the correct strength lens in stock

2. Purpose

To ensure a Registered Practitioner is competent in undertaking biometry on various equipment such as the IOL master, A-scan and hand held keratometer.

3. Scope This competency assessment applies to all Registered Practitioners undertaking biometry.

4. Definitions 4.1 Registered Practitioner is a Registered Nurse (RN), Operating Department

Practitioner (ODP), or Orthoptist 4.2 Biometry: is the measurement of the various dimensions of the eye including

the axial length and the corneal curvature. 4.3 Hand Held Keratometer: is an optical instrument for measuring the radius of

the curvature of the cornea. 4.4 IOL Master: is a combined biometry instrument which measures parameters of

the human eye needed for intraocular lens calculation. It measures quickly and precisely the following eye parameters:

Axial length (distance between tear film and retina).

Corneal curvature – called K readings.

Anterior chamber depth – depth of chamber in the eye between the cornea and the iris.



4.5 Focimeter: An optical instrument for determining the vertex power, axis

direction and optical centre of an ophthalmic lens. 4.6 A-scan: A technique utilising high-frequency ultrasound waves (greater than

18000 Hz) emitted by a transducer (probe) placed on the eye. This technique is used to make biometric measurements such as the axial length of the eye, the depth of the anterior chamber, the thickness of the lens and cornea, the distance between the back of the lens and the retina. These measurements are recorded as peaks in a graph as the ultrasound wave travels through the different layers in the eye as diagram below shows.

4.7 Myopia: Refractive condition of the eye in which the images of distant objects

are focused in front of the retina when the accommodation is relaxed. 4.8 Myopic Shift: Also known as myopia lenticular which is attributed to an

increase in the index of refraction of the lens. This causes an increase in refractive power and it usually accompanies the development of some cataracts. This type of myopia can also accompany or follows an increase in blood sugar level and is normally transient in nature. The power of the crystalline lens diminishes after blood sugar returns to normal.

4.9 Emmetropia: The refractive state of the eye in which, with accommodation

relaxed, the conjugate focus of the retina is at infinity. The retina lies in the plane of the posterior principal focus of the eye and the distant objects are sharply focused on the retina. This is the ideal refractive state of the eye.

4.10 Hypermetropia (far sight): Refractive condition of the eye in which distant

objects are focused behind the retina when the accommodation is relaxed and vision is blurred. In hypermetropia, the point conjugate with the retina that is the far point of the eye is located behind the eye.



4.11 Astigmatism: A refractive condition where the cornea curves more in one direction than in the other (like a rugby ball). This results in blurred vision for both distance and near objects. It is often combined with myopia and hypermetropia.

4.12 Presbyopia:

A refractive condition in which the accommodative ability of the eye is insufficient for near vision work, due to ageing. This is due to a hardening of the lens and a reduction of the elasticity of its capsule. It causes blurred vision at a working distance.

4.13 Amblyopia: A condition characterised by reduced visual acuity, without any

latent or manifest disease of the eye or proven disorder in the visual pathway and is not correctable by spectacles or contact lenses.

4.14 Kereatoconus: Steep curvature of the cornea. 4.14 Lasik surgery: Surgery undertaken on the cornea to affect refractive outcome. 5. Assessment 5.1 The Registered Practitioner will be observed by a clinician undertaking 10 IOL

Master readings (see Appendix 1), perform 10 A-scan readings (see Appendix 2) and perform 10 Hand Held Keratometer readings (Appendix 3) and will require a competent assessed person to sign for these patients scans.

5.2 Once the Registered Practitioner has been observed undertaking 10 of each

measurement, the competency can be completed unless the competent clinician decided that the Registered Practitioner needs further training.

6. Monitoring

If there is a problem with the biometry measurements including IOL master, A-scan or Hand Held Keratometer, a doctor will identify this to the member of staff who undertook the biometry and the senior person in charge. Consideration will be given to reassessment.

7. Ratification This competency assessment will be approved by the Ophthalmology CMT and/ or the Surgery Divisional Governance forum & ratified by the Nursing & Midwifery Advisory Group.

8. Distribution



This competency assessment will be available on SharePoint. Once competency assessment completed a copy will be held on the practitioner’s personal file.

9. References Benjamin L (2000) IOL Formulae & Factors Involved with IOL Selection for Routine Surgery. October Biometry 2000, Oxford British National Formulary, British Medical Association and Royal Pharmaceutical Society of Great Britain Chell P.B (2003) Refractive targeting in cataract surgery, Focus Update 28 Royal College of Ophthalmologists Clark I H, Shah S & Ilango B (2001) Intraocular Lens power Calculations After Myopic Keratorefractive Procedures. Eyenews Oct/Nov; Vol 8 No 3 Collins L (2000) Measure for Measure An introduction to biometry. October, Biometry 2000 Oxford. Chopdar A (sponsored by Alcon) Understanding Macular Degeneration. Netherne Printing Services, Dorking Dalton L (2002) Biometry. October Ophthalmic Study Day Cheltenham Department of Health (2001) 12 Key Points on Consent: the Law In England Huber M J E, Reacher M H (1991) Clinical Tests Ophthalmology. Wolfe Medical Publications Ltd Scotland IOLMaster Gebrauchsanweisung User’s Manual Zeiss Window 95 Ilango B, Shah S & Clark I (2001) A Review of Biometry Techniques, Eyenews Oct/Nov; Vol 8 No 3 Millodot M, Laby D M (2002) Dictionary of Ophthalmology, Butterworth -Heinemann, Oxford Martindale 31st Edition (1996) Nidek Auto Keratometer Model KM-500 Operators’s Manual Nidek Co ltd



NMC Guidelines for the Administration of Medicines. Nursing & Midwifery Council. April 2002 NMC Guidelines for Records and Record Keeping. Nursing & Midwifery Council. April 2002 NMC Code of Professional Conduct. Nursing & Midwifery Council. April 2002 Millodot M, Laby D M (2002) Dictionary of Ophthalmology, Butterworth -Heinemann, Oxford Martindale 31st Edition (1996) Rosen P (2000) Complex Refractive Challenges, October Biometry 2000, Oxford Royal Collage of Ophthalmology Cataract Guidelines (2001) Biometry. February Chap 5.0 –5.12 Simcock P (2001) Patient Pictures Ophthalmology. Health Press Limited Oxford Spicer D (2000) Structure and Function of the Eye as an Optical Instrument, October, Biometry 2000, Oxford Swaye T (2002) Clinical Governance Nursing Standard Essential Guide. RCN Publishing Company February 2002 Tomey Operator Manual Bio & Pachy Meter AL-2000 Website www.eyetec.net (2005) Module 2 Advanced A –scan Biometry. Section 1, 2 & 3.



Appendix 1 Undertaking Biometry measurements on the IOL Master:

Supervised Practice The Registered Practitioner must perform a minimum of 10 supervised measurements on the IOL Master undertaking K readings, axial lengths and anterior chamber depths as per competency requirements below. When the Registered Practitioner and assessor agree the Registered Practitioner is confident and competent then the competency assessment must be completed prior to unsupervised practice.

Date Registered Practitioner

Signature Assessor Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.



Undertaking Biometry measurements on the IOL Master by a Registered Practitioner: Competency Assessment

The Registered Practitioner will be able to: Pass Fail

1. Perform hand washing prior to commencing procedure and disinfection of chin rest.

2. Log on and set up IOL Master.

3. Be able to calibrate IOL Master and change printer cartridge.

4. Log onto medisoft on PC.

5. Confirm the patient’s identity prior to commencing procedure and obtain consent. Action any discrepancies with a doctor.

6. Enter patient data correctly.

7. Explain the procedure to the patient, ensuring they understands the reason for biometry and what this entails.

8. To eExplain the effect previous surgery has on biometry measurement and outcome.

9. Explain the effect of contact lens wear and the effect it has on biometry measurements.

10. Explain the eye structures (e.g. cornea, lens, iris, pupil and retina) in relation to what they do, and how they affect the biometry measurements.

11. Explain the following and its effects upon biometry measurements: Myopia, Keratoconus, Lasik surgery, hypermetropia, presbyopia and emmetropia.

12. Demonstrate knowledge of causes of cataract such as ageing, diabetes, trauma, genetic and myopic shift.

13. Position patient, showing awareness of patient safety and comfort and adjust equipment accordingly.

14. Undertake biometry measurements including K readings, axial lengths and anterior chamber readings on the IOL master.

15. Explain how to ascertain the quality of measurements.

16. Explain how many k readings and axial lengths are needed to take for satisfactory biometry measurements.

17. Explain what to do if accurate k readings and axial lengths are not possible and the implications this would



have on a patients outcome.

18. Explain the impact the following may have on Biometry measurements:

Shallow AC.

Lens thickness.

Position of patient.

Poor fixation.

Corneal problems.

Previous surgery.

Silicone oil/gas.

Use of contact lenses

Previous Refractive Surgery

19. If appropriate explain lens type and its aeffect upon biometry measurements such as: Anterior chamber lens, alcon and Baush&Lombe Acrylic lenses, iris claw lens.

20. Demonstrate knowledge of where to find information on what size lens and what type of lenses are held in stock. Identify situations when it would be necessary to notify someone to obtain a special lens ordered. Explain what

21. At the request of the surgeon, demonstrate knowledge of how to change the lens calculation to Hoffer Q, SRKT, or Haigis L (Myopia vs Hypermetropia) on Medisoft.

22. Print out lens calculation and measurements. At PCH staff will need to print name, designation and sign signature on both (Please make sure your name is legible). At HH this is not required as print out has the Practitioners details on.

23. Document any significant readings or problems on the biometry and inform the doctor.

24. Transfer data to medisoft.

25. Demonstrate ability to manage any issues that arise.

26. Demonstrate appropriate care and storage of equipment.

27. Recognise equipment faults and report them in line with local policy.

28. Demonstrate good communication, rapport and ability to answer patient’s queries.

29. Demonstrate adherence to infection control, COSHH and other local risk management guidelines for the entire procedure.

30. Prepare equipment for the next patient.



31. Describe personal accountability around scope for practice and demonstrates and understanding of department guidelines (re cataract).



Appendix 2 Undertaking Biometry measurements with an A scan:

Supervised Practice The Registered Practitioner must perform a minimum of 10 supervised A-scan measurements as per competency requirements below. When the Registered Practitioner and assessor agree the Registered Practitioner is confident and competent then the competency assessment must be completed prior to unsupervised practice.



1.

2.

3.

4.

5.

6.

7.

8.

9.

10.



Undertaking Biometry measurements on the A scan by a Registered Practitioner: Competency Assessment

The Registered Practitioner will be able

to: Pass Fail

1. Perform hand washing prior to commencing procedure and demonstrate knowledge of disinfection of A-scan probe.

2. Demonstrate how to turn on the machine, calibrate the machine and change paper roll in the printer and where they are kept.


4. Explain the procedure to patient in an understandable manner.

5. Put oxybruprocaine/ proxymetacaine eye drops in both the eye(s) to be assessed and document in patient’s notes under PGD and on medisoft.

6. Set up A-scan settings and demonstrate knowledge of why settings sometimes need to be changed.

7. Undertake measurements.

Gently hold open patient’s upper and lower eyelid

Place probe on cornea & take axial length readings, ensuring as little pressure as possible is exerted on the eye

Correctly choose appropriate readings and remove inaccurate ones (if not automatically done by the machine)

Repeat measurements if further readings needed. Repeat this on other eye if needed.

8. Explain how to ascertain the quality of measurements.

9. Explain what to do if measurements were not possible.

10. Print measurements.



11. Enter correct data into Medisoft and calculate lens.



14. Attach A-scan readings to biometry print out and highlight that the readings are from the A-scan.

15. At PCH transfer data to medisoft and highlight boxes to say axaial length readings were from Tomey. At HH this will not be needed as data transfers automatically into medisofthighlight to say the measurements were from Nidek.


17. Demonstrate cleaning of the probes, adherence to infection control, COSHH and other local risk management guidelines.

18. Demonstrate how to troubleshoot any concerns and log any malfunctions with machinery.


20. Describe personal accountability and scope for practice.



Appendix 3 Undertaking Biometry measurements with a Hand Held Keratometer:

Supervised Practice

The Registered Practitioner must perform a minimum of 10 supervised Hand Held Keratometer measurements as per competency requirements below. When the Registered Practitioner and assessor agree the Registered Practitioner is confident and competent then the competency assessment must be completed prior to unsupervised practice.



1.

2.

3.

4.

5.

6.

7.

8.

9.

10.



Undertaking Biometry measurements with a Hand Held Keratometer: Competency assessment

The Registered Practitioner will be able to: Pass Fail

1. Perform hand washing prior to commencing procedure.

2. Demonstrate how to change paper roll in hand held Keratometer and how to make sure it is on charge.


4. Explain the procedure to patient.

5. Undertake measurements.

6. Print measurements on Hand Held Keratometer printer.

7. Enter data into Medisoft and calculate lens.




11. Demonstrate adherence to infection control, COSHH and other local risk management guidelines.


13. Describe personal accountability and scope for practice.



Appendix 4 Assessment: Undertaking Biometry measurements on athe IOL Master,

A- Scan and hand held Keratometer

Statement of competence

This statement should be signed only when the practitioner and the assessor are confident that the former has attained the learning outcomes.

1. Registered Practitioner has successfully completed the competency document Yes/No

2. Registered Practitioner has successfully practised

the appropriate procedures under supervision Yes/No

Registered Practitioner Assessor Signature: …………………………….… Signature: …………………………. Please print name:……………………. Please print name:..……………… Date: ……………………………………. Date: ……………………………….

One copy of this statement should be kept in personal file and another copy given to the Registered Practitioner



Quality Assurance Checklist - Version Number: 2 Appendix: 5

Y/N/n/a COMMENTS (where necessary)

1 Title of document Undertaking and Performing Biometry Registered Practitioners Competency Assessment (C0986)

2 Type of document (e.g. guidance, code of practice)

Assessment

Is it clear whether the document type is (e.g. guideline, procedure)?

Yes

3 Introduction

Are reasons for the development of the document clearly stated?

Yes

4 Content

Is there a standard front cover? Yes

Are the key points identified? Yes

Is the document in the correct format? Yes

Is the purpose of the document clear? Yes

5 Approval Route

Does the document identify which committee/group will approve it?

Yes

6 Review Date

Is the review date identified? Yes

If answers to any of the above questions is ‘no’, then this document is not ready for ratification, it needs further review.

Compliance Team:

1. Date of Compliance Team approval 25/09/2017

2. Comments to author for any amendments

3. Name of compliance lead Jim Walker, Quality Governance & Policies Assistant

Approval Committee: Ophthalmology CMT

If the committee/group is happy to approve this document would the chair please sign below and send the document and the minutes from the approval committee to the author. To aid distribution all documentation should be sent electronically wherever possible.

Name

Date

Signature

DO WE HAVE CMTS ANY MORE??

Ratifying Committee: NMAG

If the committee/group is happy to ratify this document would the chair please sign below and send the document and the minutes from the ratifying committee to the author. To aid distribution all documentation should be sent electronically wherever possible.

Name

Date

Signature

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