It has been recognised for quite some time now that considerable differences occur in the treatments offered by doctors to apparently similar patients, both across countries and within countries.1-5 Reasons for studying these variations are based upon the wish to improve practice, to help to develop innovative aspects of care and also, very importantly, to monitor patient uptake and access to care. Variations in clinical practice occur despite the fact that healthcare professionals in their chosen clinical specialty basically share the same body of knowledge as a basis for their activities. Cataract surgery is apparently no exception, as shown in the paper by Norregaard et al, in this issue of theBJO (p1107), who have studied and described international variations in the indications for surgery.

Within the ophthalmic healthcare service there is an approach which we might adopt in contributing to the study of variations in ophthalmic care. We could:

(1)

Lay more emphasis on the collection and use of basic clinical indicators such as visual acuity at the time of patient presentation, operation, …