Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya

Abstract

Background Early diagnosis and management of keratoconus (KC) are important for limiting visual complications of the disease. This study aimed to explore the perspectives of optometrists on the barriers to effective diagnosis and management of KC in Kenya. Methods An online questionnaire was distributed to optometrists in Kenya to collect data on barriers to the diagnosis and management of KC. Results The majority (60.9%) of optometrists were confident in retinoscopy and subjective refraction. Fewer were confident in the use of keratometers (46.4%) and corneal topographers (24.9%) and in the fitting of rigid gas permeable (RGP) contact lenses (25.0%). The most commonly reported barriers to improving their knowledge and skills were, limited continuous professional development opportunities (87.4%), high costs of conferences (86.1%) and the lack of diagnostic tools (79.5%). Impediments cited to diagnosing and managing KC effectively were a lack of national guidelines (64.9%), patient education material (71.5%), equipment (58.9%) and RGP supply (68.2%) and cost (67.5%). Most commonly reported barriers related to patients were compliance (91.4%), affordability (90.7%), RGP discomfort (89.4%), willingness to pay (88.1%) and the lack of patient education about KC (87.4%). Conclusion This study showed that the lack of national guidelines, essential equipment and adequate practitioner knowledge and skills were barriers to KC diagnosis and management. Regulation of optometric education and clinical practice, development of national guidelines for diagnosis and management of KC, up-skilling of practitioners and cost-effective solutions for equipment procurement and maintenance may improve both access to, and quality of, care to patients with KC.

Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya [Letter]

“…In conclusion, once again, we thank Rashid et al 1 for their attention towards improving health outcomes as their study presents essential findings that contribute to our understanding of the barriers to Keratoconus diagnosis and management in Kenya; the suggestions offered here aim to build upon this foundation. By expanding the scope of research, employing a mix of qualitative and quantitative methods, and adopting a longitudinal perspective, we can foster a more holistic and dynamic understanding of the challenges faced and practical actions that can be introduced.…”

“…We are writing to express our appreciation to Rashid et al 1 for their insightful study on “Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya”. As medical students in the UK with keen interests in global health and improving patient outcomes, we find the research to be a significant contribution to our understanding of the optometric landscape in Kenya, particularly concerning Keratoconus - a progressive eye condition characterised by the thinning and bulging of the cornea into a cone-like shape, impacting visual acuity and vision-related quality of life.…”

“…The study has identified challenges such as the need for more access to advanced diagnostic equipment, limited continuous professional development opportunities, and the absence of standardised national guidelines. 1 By highlighting these issues, the research showcases the specific needs of optometrists and also the broader implications for patient care, including prevention, early detection and management.…”

“…However, upon reflection of the study’s methodology, 1 we propose areas for improvement that could further display the rationale and enrich our understanding and approach to overcoming these barriers. Firstly, implementing focus groups to gather quantitative data would provide a deeper, qualitative understanding of the problems identified in the survey.…”

Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya [Response to Letter]

“…We reviewed the Letter to the Editor by Mahdi Sadeghi and Sabrina Shahid which refers to our published article “Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya” 1 and their interest is noted. However, at the time of designing the study, the methodology was intentionally selected and considered rigorous enough to meet its specific objectives by accessing as many respondents as possible.…”