Retinal Detachment Data Set - The Royal College of Ophthalmologists

Table of ContentsIntroduction 4Application 4Scope 5Principles 5Data types 5Components of Data Set 6Demographics 7Initial assessment 8Fellow eye 10Operation 11Common elements 11Anterior segment 13Pneumatic retinopexy 13Removal of silicone oil 14Vitrectomy 14Buckle 15Buckling elements (LIST) 16Retinopexy 16Tamponade 17Complications 17Follow-up 18Final follow up visit 18Comments 19Notes 20References 21© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158ScopeThis data set applies only to patients with rhegmatogenous retinal detachment (RRD), which isdefined as retinal detachment associated with retinal breaks, including retinal dialyses. Thefollowing sub-categories are excluded;• Traumatic retinal detachment from penetrating injury or severe contusion (RRD associated withretinal dialyses with or without a history of trauma are included)• RRD associated with vasoproliferative disorders such as proliferative diabetic retinopathy,sickle cell retinopathy or retinopathy of prematurity• RRD associated with Inflammatory eye disease including (e.g. CMV, ARN, Pars planitis,endophthalmitis)PrinciplesThe data set is designed to comply with the following principles1. The data set should be a subset of information routinely collectedThe intention is not to burden already busy clinicians with additional work, so the data setshould be constructed of items that are, or should be, recorded as part of the routine clinicalmanagement of the patient.2. Items not required for likely analysis should be excludedThe collection of data requires time and effort, and therefore the total number of items should bekept to a minimum. The range of analyses likely to be conducted on the data is largelypredictable, and items not required for these analyses should be excluded.3. Items in common with other College data sets should be congruentA number of data items (for example visual acuity, IOP) will be common to other ophthalmicdata sets. It makes sense to ensure that only one definition for each item is used throughout alldata sets, particularly within a subspecialty.4. The data set should be capable of implementation in an electronic patient recordIt is likely that the maximum benefit of the data set will only be achieved when information isbeing routinely collected using electronic patient record systems. It is therefore essential that itis capable of being implemented electronically.Data typesEach item of the data set has a data type, from the list below. These correspond to data typesavailable in most relational database management systems (RDMS), which generally form thecore of real EPR systems.© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk5

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158TypeDescriptionNULLA special entity representing an uncertain or unassigned valueINTEGERAn integer value, normally unsigned (i.e. zero or positive valuesonly)FLOATA floating point value, positive or negativeBOOLA value representing true or falseSTRINGA value containing text (alphanumeric data) of unspecified lengthENUMA value which represents one of a limited range of valuesDATEA value representing a dateDATETIMEA value representing a date and timeThe term ‘LIST’ is not a data type, but will be used in this document to represent a ‘one-to-manyrelationship’. This is a standard way in a RDMS of representing data items which can vary innumber (for example a patient could have one, two or any number of symptoms)Components of Data SetThe data set is divided into five sections, described as follows;• Demographics - demographic data about the patient• Initial assessment - characteristics of the eye and the retinal detachment• Fellow eye - characteristics of the fellow eye• Operation - details of the operation (as a LIST, since more than one may be required)• Final assessment - outcome and follow up detailsItems marked with an asterisk (*) have additional explanations in the Notes section of thisdocument.© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk6

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158DemographicsThe elements in this section are likely to be common to all ophthalmic data sets.Item Description Values/formatPatient IDAn identifier which will uniquely identify thepatient. In England and Wales this could bethe NHS number. This would be removed inanonymised data setsINTEGERAgeThe age of the patient in years at the time ofpresentation. Age provides sufficientinformation for scientific analysis, without alsobeing patient identifiable data (PID), unlikedate of birthINTEGERSex The patient’s gender ENUM (Male, Female)PostcodeThe postcode district (outward code). This isthe first part of a postcode, and generallycorresponds to a post town. It gives usefulinformation for demographic analysis, withoutbeing PIDSTRINGConsultantIdentifier for consultant in charge of patient(to allow individual audits)INTEGEREthnic categoryThe ethnicity of the patient using theclassification used for the 2001 census 3ENUM (British, Irish, Any otherWhite background, White andBlack Caribbean, White andBlack African, White andAsian, Any other mixedbackground, Indian, Pakistani,Bangladeshi, Any other Asianbackground, Caribbean,African, Any other Blackbackground, Chinese, Anyother ethnic group, Not stated)© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk7

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatRoute of referral Route by which patient arrived in theophthalmic department, based on who madethe initial diagnosis (e.g. if an Optometristsends a patient via the GP with a suspecteddiagnosis of RRD, this item would have avalue of ‘Optometrist’)ENUM (Optometrist, GP,Ophthalmologist from otherTrust, Ophthalmologist fromsame Trust, General A&E,Ophthalmic A&E, Newdiagnosis in clinic, Other)Initial assessmentSome of the elements in this section will be common to other ophthalmic data sets. Note that manyof the items that might be expected in this section are found in the operation section. This is toavoid duplication of data entry, and reflects the fact that initial examination findings are oftenrefined at the time of surgery.Item Description Values/formatAssessment Date Date of this assessment DATESymptoms List of presenting symptoms LIST (Floaters, Flashes, Fieldloss, Central vision loss)Date of onset ofsymptomsDate when patient first noticed anysymptoms, or NULL if no symptomsDATE* or NULLDate of onset ofcentral vision lossDate when patient fist noticed centralvision loss, or NULL if no central visionlossDATE* or NULLSystemic conditionRelevant systemic condition associatedwith retinal detachmentENUM (None, Marfan’s, ROP,Stickler)Eye Eye ENUM (Right, Left)Refraction Refractive error as spherical equivalent FLOAT© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk8

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatPrior refractionEstimated refractive error prior to any formof refractive surgery (LASIK, cataractsurgery etc)ENUM (Myopia, Emmetropia,Hypermetropia)Assessment Acuity Best recorded acuityVisual acuity*Anterior segmentabnormalityRelevant abnormalities of the anteriorsegmentLIST(Corneal opacity,Posterior synechiae,Coloboma, Odontokeratoprosthesis)LensStatus of lens of eye. (Phakic - cataract isdefined as a lens opacity sufficient towarrant lens surgery at the sameoperation)ENUM (Phakic, Phakiccataract, Aphakic, AphakicSoemmerring ring, PC IOL, ACIOL, Phakic IOL, Anglesupported IOL, Iris clip IOL)Date of cataractsurgeryIf pseudophakic or aphakic, date ofcataract surgeryDATE* or NULLIOP Intraocular pressure in mmHg INTEGERDate of previousRRD surgeryDate of previous RRD surgeryDATE* or NULLVitreousAttached or detached on clinicalexamination. (definition of PVD is at thediscretion of examining ophthalmologist)ENUM (Uncertain, PVD, NoPVD, Vitrectomised eye)VitreoushaemorrhageAmount of blood in the vitreous* ENUM (0 - 4)PredisposinglesionsClock hours of lattice, or lattice-like lesions ENUM (0 - 12)ProphylaxisEvidence of previous prophylacticretinopexyBOOL© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk9

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatPathologicalmyopiaPosterior segment features of pathologicalmyopia including staphyloma, and RPEatrophyBOOLFellow eyeItem Description Values/formatRefraction Refractive error as spherical equivalent FLOATPrior refractionEstimated refractive error prior to any formof refractive surgery (LASIK, cataractsurgery etc)ENUM (Myopia, emmetropia,hypermetropia)Acuity Best recorded acuity Visual acuity*VitreousAttached or detached on clinicalexamination. (definition of PVD is at thediscretion of examining ophthalmologistENUM (Uncertain, PVD, noPVD, Vitrectomised eye)VitreoushaemorrhageAmount of blood in the vitreous* ENUM (0 - 4)PredisposinglesionsClock hours of lattice, or lattice-like lesions ENUM (0 - 12)Retinal breaks Number of retinal breaks INTEGERProphylaxisEvidence of previous prophylacticretinopexyBOOLRetinal detachment Presence of retinal detachmentBOOL© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk10

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158OperationThe operation is made up of a core of common elements, including the examination findings at thetime of surgery, plus optional additions. These additions are designed to be compatible with futuredata sets for other vitreoretinal conditions (for example macular hole, epiretinal membrane). Thisinformation is collected for every retinal procedure carried out between the initial assessment andfinal follow up.Common elementsItem Description Values/formatAdmission type Type of admission ENUM (Outpatient, Day case,Inpatient)Date and timeDate and time of surgery (time is includedto allow analysis of out of hours surgery)DATETIMESurgeonIdentifier for primary surgeon (to allowindividual audits)INTEGERSurgeon grade Grade of primary surgeon ENUM (Consultant, Fellow,Specialist registrar, Associatespecialist, Clinical assistant,Trust Doctor)Assistant Grade of assistant if any ENUM (None, Consultant,Fellow, Specialist registrar,Associate specialist, Clinicalassistant, Trust Doctor, Nurse)Anaesthetic Type of anaesthetic ENUM (Topical, Peribulbar,Subtenon, General)Antisepsis Preparation of eye prior to surgery ENUM (Chlorhexidine,Povidone iodine, Other)Cause of failure If a redo, what was the cause of failure? ENUM (Not applicable,Untreated break, Treatedbreak open, PVR, Unknown)© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk11

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatFoveal attachmentStatus of fovea, on, off, or subretinal fluidbisecting the foveaENUM (On, Off, Bisected)ComorbidityConcurrent pathology with the potential tocompromise central visionENUM (AMD, RVO, DMO,Macular hole, Amblyopia,Optic neuropathy, Other)Extent (STquadrant)Extent of detachment in clock hours at ora ENUM (0 - 3)Extent (SNquadrant)Extent of detachment in clock hours at ora ENUM (0 - 3)Extent (INquadrant)Extent of detachment in clock hours at ora ENUM (0 - 3)Extent (ITquadrant)Extent of detachment in clock hours at ora ENUM (0 - 3)Chronic Signs of chronicity (cysts, thin retina, etc) BOOLPVR type Grade of PVR according to the 1991classification*ENUM (None, A, B, C)PVR CP Extent of PVR CP in clock hours ENUM (0 - 12)PVR CA Extent of PVR CA in clock hours ENUM (0 - 12)Subretinal bands Presence or absence of subretinal bands BOOLChoroidalsPresence or absence of choroidal effusion BOOLBreaks in detachedretinaNumber of breaks found in detachedretinaINTEGER© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk12

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatBreaks in attachedretinaNumber of breaks found in attached retina INTEGERType of largestbreakType of largest breakENUM (Not found, ‘U’ tear,Round hole, Dialysis, GRT,Macular hole, Outer leaf break,Peripapillary break)Size of largestbreakSize of largest retinal break in clock hours ENUM (0.5, 1 - 12)Position of lowestbreakPosition of most inferior break in detachedretina in clock hoursENUM (1 - 12)PositioninginstructionsPosturing instructions. Log roll is definedas a sequence of posturing positionsintended to displace sub retinal fluid awayfrom the maculaENUM (None, Prone, Supine,One cheek, Alternate cheeks,Log roll, Other)Anterior segmentItem Description Values/formatLens surgery Phakoemulsifcation or lensectomy ENUM (None,Phakoemulsification,Lensectomy)IOL Insertion of IOL ENUM (None, AC IOL, Irisclip IOL, PC IOL rigid, PC IOLfoldable)Keratoprosthesis Use of a temporary keratoprosthesis BOOL© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk13

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Pneumatic retinopexyItem Description Values/formatSite of injection Entry point of injection as a clock hour ENUM (1-12)Volume Volume of gas injected in millilitres FLOATOrder Order of procedures ENUM (Retinopexy first, Gasfirst)StagesWhether one stage or two stageprocedure (If 2 stage, date applies tostage 1)ENUM (1,2)Removal of silicone oilItem Description Values/formatRouteRoute of oil removal. Limbus implies anaphakic eye, capsule means removal via aposterior capsulotomy as part of combinedPhako/ROSOENUM (None, Limbus,Capsule, Sclerotomy)360 retinopexy Supplementary retinopexy in order tocreate a 360 barrier walling off the anteriorretinaBOOLVitrectomyItem Description Values/formatViewing systemType of viewing system used for themajority of the operation. Contact lens isdefined as a Goldman type (flat faced)contact lens which does not give a wideangle viewENUM (Wide angle viewingsystem, Contact lens, Indirectophthalmoscope)Conjunctiva Treatment of conjunctiva ENUM (Peritomy, Localincisions, TSV)© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk14

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatGauge Gauge of vitrectomy system ENUM (None, 20g, 23g, 25g)Cut rate Maximum cutter speed INTEGERVitreous base Treatment of vitreous base ENUM (Standard, Indentedtrim)Drainage Type of drainage of subretinal fluid ENUM (None, Through break,Drainage retinotomy,Externally)PFCL Use of perfluorocarbon liquids BOOLSclerostomiessuturedNumber of sclerostomies suturedINTEGERInduction of PVD The creation of a PVD during surgery BOOLPeel Peeling of epiretinal membranes BOOLRelaxingretinectomyExtent in degrees (0 indicates noretinotomy)INTEGERTriamcinoloneUse of triamcinolone to enhancevisualisation during vitrectomyBOOLICG Use of ICG BOOLMembrane blue Use of membrane blue BOOLVision blue Use of vision blue BOOL© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk15

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158BuckleItem Description Values/formatPeritomyExtent of conjunctival peritomy in clockhoursENUM (1-12)Muscles slung Number of extraocular muscles slung ENUM (1 -4)DrainageType of subretinal drainage. SND is asuture needle drainENUM (None, SND, Laser,Cutdown)Paracentesis Whether a paracentesis was carried out BOOLBuckling elements (LIST)Item Description Values/formatType of element Buckling element ENUM (Other, 3mm sponge,4mm sponge, 5mm sponge,7mm sponge, 276, 277, 279,280, 40 band, 240 band)Configuration Configuration of buckle ENUM (Encircling, Radial,Circumferential)Extent In clock hours (for circumferential only) ENUM (1 - 12)SuturesNumber of sutures used to secure theelementINTEGER© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk16

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158RetinopexyItem Description Values/formatCryotherapy Cryotherapy used for retinopexy BOOLEndolaser Endolaser used for retinopexy BOOLIndirect laser Indirect laser used for retinopexy BOOLTrans scleral diode Trans scleral diode used for retinopexyBOOL360 Retinopexy applied 360 degrees BOOLTamponadeItem Description Values/formatType Type of tamponade agent ENUM (None, Air, SF6, C2F6,C3F8, 1000cS oil, 2000cS oil,5000cS oil, Densiron, OxaneHD, PFCL)Percent If gas, the concentration used in percent INTEGERComplicationsItem Description Values/formatChoroidalhaemorrhageBOOLLens touchBOOLEntry site break/sIatrogenic break at vitreous base or orawithin one clock hour either side of asclerostomyBOOL© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk17

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatOther iatrogenicbreaksNon-entry site iatrogenic retinal break fromthe vitreous cutter, peeling or other causeBOOLDeep sutureBOOLDrain haemorrhageBOOLIncarcerationBOOLFollow-upFinal follow up visitItem Description Values/formatDate Date of visit DATEType Discharge or ongoing follow up ENUM (Discharge, Ongoing)ManagementcompleteNo additional retinal management planned(This would be true for patients with oiland no plans to remove it)BOOLReadmission Readmission within 28 days BOOLNumber ofoperationsTotal number of operations for retinaldetachment prior to this point, includingremoval of silicone oilINTEGERAttached Fully attached retina* BOOLOil Silicone oil tamponade present BOOLAcuity Visual acuity Visual acuity*© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk18

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158Item Description Values/formatLensStatus of lens of eye. (Phakic - cataract isdefined as a lens opacity sufficient towarrant lens surgery, or to obscure view offundus)ENUM (Phakic, Phakiccataract, Aphakic, Aphakic -Soemmerring ring, PC IOL, ACIOL, Phakic IOL, Anglesupported IOL, Iris clip IOL)IOP problemWhether RRD management has inducedan ongoing pressure problem (pressurerequiring either monitoring or treatment inan eye that had neither pre-operatively)BOOLFoveal attachmentStatus of fovea, on, off, or subretinal fluidbisecting the foveal. Fovea on is a clinicaldefinition includes cases with subfovealblebs on OCTENUM (On, Off, Bisected)Macular ERMEpiretinal membrane at the maculadefined as acquired macular distortion andor sight limiting oedema in presence of anERMBOOLMacular hole Macular hole BOOLMacular foldA retinal fold at or near the macularesulting in significant visual symptomssuch as distortion or torsional diplopia.BOOLHypotony Defined as IOP less than 5mmHg BOOLCommentsItem Description Values/formatCommentsAny additional comments on any aspect ofthe case not otherwise appearing in thedata set.STRING© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk19

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158NotesThis section gives additional detail for some of the terms used in the data set.TermExplanationRetinal re-attachmentRetinal reattachment is defined as attachment of the retinawith no tamponade present, and no subretinal fluid whichcould spread. This would include those eyes with smalltraction detachments posterior to a circumferential orencircling buckle. It would also include eyes with anteriorfluid walled off by 360 degree retinopexy.DateThe DATE type is used for the majority of items whichrefer to points in time. For some items (such as duration ofvisual symptoms, most patients will express this in termsof days or weeks, rather than a particular date. However,this can be converted into a date for storage, andrecreated in any time units (days, weeks, or months) bydate subtraction.Primary surgeonThe surgeon carrying out the most significant componentsof the operation. In most cases this will be the surgeonthat carries out the majority of the operation. However, inthe case of a scleral buckling procedure, where surgeon Aslings the muscles, sutures the buckle, and completes theoperation, and surgeon B carries out the shorter but moresignificant steps of external search and cryotherapy, theprimary surgeon would be Surgeon B.PVRPVR is classified according to the modified Retina Societyclassification of 1991. 4Visual acuityVisual acuity is an important measure of visual function,but is measured, and expressed in a wide variety of ways(Snellen, ETDRS, LogMar etc). Since this measure iscommon to all ophthalmic data sets, the datatype andmethod of storage should be standardised. This is thesubject of a separate initiative by the Informatics and AuditCommittee.© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk20

The Royal College of Ophthalmologists Retinal Detachment Data Set 2011/PROF/158TermExplanationVitreous haemorrhageVitreous haemorrhage is assessed using a simple fourpoint density grading scheme 5 as follows;Grade 0: No blood present in the vitreous, the entire retinais visible.Grade 1: Some hemorrhage present, which obscuresbetween a total of 1 to 5 clock hours of retina.Grade 2: Hemorrhage obscures between a total of 5 to 10clock hours of central and/or peripheral retina, or a largehemorrhage is located posterior to the equator, withvarying clock hours of anterior retina visible.Grade 3: A red reflex is present, with no retinal detail seenposterior to the equator.Grade 4: Dense VH with no red reflex presentReferences1. Cataract National Data set V1.2 – Royal College of Ophthalmologists.2. VR database from “Vitreoretinal Surgery” Thomas Williamson, Springer 2008.3. NHS Data dictionary4. Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RG. An updated classificationof retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol 1991;112:159-165.5. Lieberman RM, Gow JA, Grillone LR. Development and Implementation of a Vitreous HemorrhageGrading Scale. Retinal Physician May, 2006.© The Royal College of Ophthalmologists 2011 All rights reservedFor permission to reproduce any of the content contained herein please contact beth.barnes@rcophth.ac.uk21