PURPOSE:To describe the characteristics of keratoconus (KC) patients seen in a contact lens clinic of a children's hospital in Kenya.RESULTS:A total of 254 patients’ records were analyzed. Mean age at presentation to the clinic was 20.97 ± 11.13 year (range, 6–84 years) with 75% between the ages of 6 and 25 years. There was a preponderance of males (59.8%). Most patients were referred by an ophthalmologist. All patients were Africans. The most common complaints were blurred vision (50%), poor visual acuity with spectacles (33.5%), contact lens intolerance (11.8%), and other (unspecified). Most cases were severe (71%) followed by moderate (22.9%) and mild (6.2%). Mean BCVA was 0.24 ± 0.23 (6/11). An optical correction was provided in 98% of cases; 34.6% with spectacles, 31.1% with gas permeable lenses and the remaining with both. Referral for keratoplasty was warranted in 16.5%.CONCLUSION:This is the first study of KC conducted in Kenya. KC presented at a very early age and tended to be severe. Ophthalmologists were the main source of referral. The main presenting symptom was reduced vision. Optical correction was the most common management and the percentage of patients referred for surgery concurred with other studies.

Background To explore current eye care practice in keratoconus diagnosis and management in Kenya. Methods An online questionnaire was distributed to ophthalmic clinical officers (OCO) and optometrists. Results A total of 203 responses were received from 52 OCOs and 151 optometrists with a response rate of 24.4% and 53.5% respectively. The majority reported having access to retinoscopes (88.5%; p = 0.48) and slit lamps (76.7; p = 0.14). Few practitioners had access to a corneal topographer (13.5%; p = 0.08) and rigid contact lens (CL) fitting sets (OCOs 5.8%, optometrists 33.8%; p < 0.01). One-third did not feel that retinoscopy (38.7%; p = 0.21), slit lamp findings (30.3%; p = 0.10) and corneal topography (36.6%; p = 0.39) are important investigations in keratoconus diagnosis. Corneal topography was not recommended in two-thirds of patients (59.0%; p = 0.33) with vernal keratoconjunctivitis (VKC). The majority counselled against eye rubbing in mild (73.6%; p = 0.90) VKC, 52.9% in moderate (p = 0.40) and 43.6% in severe (p = 0.24) cases. The majority prescribed spectacles in mild (90.2%; p = 0.95), 29% (p = 0.97) in moderate and 1.9% (p = 0.05) in severe cases. When the binocular best corrected visual acuity (BCVA) with spectacles was ≤ 6/18, 76.9% of OCOs and 58.9% of optometrists referred for CLs (p = 0.02). When binocular BCVA with CLs dropped to ≤ 6/18, 83.7% (p = 0.18) referred to the ophthalmologist for surgical intervention. Few OCOs fitted rigid CLs (15.4% OCOs, 51.0% optometrists; p = 0.01), majority referred to optometrists (82.7% OCOs, 43.7% optometrists; p < 0.01). Progression was monitored in 70.1% (p = 0.11) of mild, 50.9% (p = 0.54) moderate and 25.3% (p = 0.31) advanced cases. Few OCOs (15.4%) performed corneal cross-linking (CXL). A few respondents (5.4%; p = 0.13) did not know when to refer keratoconus patients for CXL. Co-management with ophthalmologists was reported by 58.0% (p = 0.06) of respondents. Conclusion The results of this study highlight the need to map services for keratoconus patients, review current curricula and continuous education priorities for mid-level ophthalmic workers, develop guidelines for the diagnosis and management of keratoconus and improve interdisciplinary collaboration.

Background: To explore current eye care practice in keratoconus diagnosis and management in Kenya. Methods: An online questionnaire was distributed to ophthalmic clinical officers (OCO) and optometrists. Results: A total of 203 responses were received from 52 OCOs and 151 optometrists with a response rate of 24.4% and 53.5% respectively. The majority reported having access to retinoscopes (88.5%; p=0.48) and slit lamps (76.7; p=0.14). Few practitioners did not have access to a corneal topographer (13.5%; p=0.08) and rigid contact lens (CL) fitting sets (OCOs 5.8%, optometrists 33.8%; p<0.01). One-third did not feel that retinoscopy (38.7%; p=0.21), slit lamp findings (30.3%; p=0.10) and corneal topography (36.6%; p= 0.39) are important investigations in keratoconus diagnosis. Corneal topography was not recommended in two-thirds of patients (59.0%; p=0.33) with vernal keratoconjunctivitis (VKC). The majority counselled against eye rubbing in mild (73.6%; p=0.90) VKC, 52.9% in moderate (p=0.40) and 43.6% in severe (p=0.24) cases. The majority prescribed spectacles in mild (90.2%; p=0.95), 29% (p=0.97) in moderate and 1.9% (p=0.05) in severe cases. When the binocular best corrected visual acuity (BCVA) with spectacles was ≤ 6/18, 76.9% of OCOs and 58.9% of optometrists referred for CLs (p=0.02). When binocular BCVA with CLs dropped to ≤6/18, 83.7% (p=0.18) referred to the ophthalmologist for surgical intervention. Few OCOs fitted rigid CLs (15.4% OCOs, 51.0% optometrists; p=0.01), majority referred to optometrists (82.7% OCOs, 43.7% optometrists; p<0.01). Progression was monitored in 70.1% (p=0.11) of mild, 50.9% (p=0.54) moderate and 25.3% (p=0.31) advanced cases. Few OCOs (15.4%) performed corneal cross-linking (CXL). Keratoconus patients were referred to an ophthalmologist when BCVA dropped (50.4%; p=0.35) and on signs of progression (59.8%; p=0.37). About one-quarter (26.1%; p=0.10) referred for CXL regardless of age and progression, two-thirds (68.5%; p=0.46) when keratoconus was progressing and a few (5.4%; p=0.13) did not know when to refer. Co-management with ophthalmologists was reported by 58.0% (p=0.06) of respondents. Conclusion: The results of this study highlight the need to map services for keratoconus patients, review current curricula and continuous education priorities for mid-level ophthalmic workers, develop guidelines for the diagnosis and management of keratoconus and improve interdisciplinary collaboration.