Diagnosis and management of keratoconus by eye care practitioners in Kenya

Abstract

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.

Vernal Keratoconjunctivitis: A Systematic Review

“…Chronic VKC and long‑term steroid use are associated with surgical failure High Arora et al [ 154 ] 2023 India 3 17.0 To evaluate the effectiveness of repeat deep anterior lamellar keratoplasty (DALK) in patients of previous failed DALK Best-corrected visual acuity improved from 20/120 to 20/30 at the end of 1‑year post repeat DALK in all except one patient Medium Priyadarshini and Das [ 155 ] 2023 India N/A N/A To elicit opinions on the preferred practice pattern in the treatment of allergic eye disease Dual-acting agents are preferred by 40% in mild-moderate clinical variants. Topical steroids in slow tapering dosage are preferred by 86.7% of ophthalmologists Medium Rashid et al [ 156 ] 2023 South Africa N/A N/A To explore keratoconus diagnosis and management in Kenya Few practitioners had access to a corneal topographer (13.5%; p = 0.08). Corneal topography was not recommended in two-thirds of patients (59.0%; p = 0.33) with VKC High Saha et al [ 157 ] 2023 India 36 7.7 To compare the efficacy and safety of tacrolimus 0.03% and 0.1% eye ointment in the treatment of recalcitrant VKC Both strengths of tacrolimus (0.03% and 0.1%) are effective in recalcitrant VKC.…”

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

“…The responses from both cadres to questions 1–21 relating to access to equipment, knowledge, practice and referral patterns have been published in a separate paper. 22 This paper presents the responses of the optometrists only to questions 24–29 relating to their confidence, perceived barriers and interest in further training in the screening, diagnosis and management of KC ( Figure S1 ). The 151 optometrists who responded were weighted to reflect the total number of 282 registered optometrists.…”

Prevalence and clinical characteristics of vernal keratoconjunctivitis in sub-Saharan Africa

“…Very few studies use corneal topography in the diagnosis of keratoconjunctivitis in SSA. In Kenya, it was not recommended to 59% of patients, although they had been diagnosed with VKC by eyecare professionals [53 ▪ ].…”