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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 o22.0 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 426.0 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 r1 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.

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