Keratoconus management at public sector facilities in KwaZulu-Natal, South Africa: Practitioner perspectives

Abstract

Background: Keratoconus (KC) is a non-inflammatory, self-limiting corneal ectasia that causes reduced visual acuity and if left undiagnosed and/or untreated may lead to visual impairment. Optometrists remain the first point of contact for affected patients, making appropriate timeous care essential.Aim: To investigate keratoconus management in the public sector in KwaZulu-Natal, South Africa.Setting: Public sector eye care facilities in KwaZulu-Natal, South Africa.Methods: In a quantitative, cross-sectional study, a questionnaire was distributed to optometrists employed by the Department of Health in KwaZulu-Natal (DoH-KZN). Data on practitioner demographic profile and clinical competence, facility attendance statistics, resources available and KC clinical protocols were collected.Results: The response rate was 36 (71%). The optometrists’ mean age was 30.19 ± 4.53 years, and 80% of them had work experience of less than 10 years. The majority of the health facilities (63.9%) reported a monthly attendance of 51–300 patients, and, of these, 72% of the respondents reported seeing only between 1 and 10 keratoconic patients. A lack of equipment and/or fitting of contact lenses being disallowed by the DoH-KZN were cited by the majority (61%) as the reason for routinely referring KC patients to optometrists in private practice.Conclusion: This study highlights a deficiency in the minimum standard of optometric care for KC in the public sector in KZN, primarily because of a lack of equipment and resources. It is recommended that the management of KC at all levels of the public health system be reviewed to improve the quality of service for keratoconic patients.

Self-reported knowledge and skills related to diagnosis and management of keratoconus among public sector optometrists in the Limpopo province, South Africa

“…Similar to the findings of Gcabashe et al 27 in their public sector study in the KwaZulu-Natal province, there were predominantly more female (75%) than male (25%) optometrists. The difference in the proportion of women to men in both these studies may be attributed to the predominance of women in the registration statistics of the HPCSA and student intake in South African universities offering optometry programmes.…”

“…26 They are usually more experienced and skilled and have better consistency and direction, hence providing stability in an organisation, and they further have a better compliance and adherence to organisational boundaries. 26 Similar to the findings of Gcabashe et al 27 in their public sector study in the KwaZulu-Natal province, there were predominantly more female (75%) than male (25%) optometrists. The difference in the proportion of women to men in both these studies may be attributed to the predominance of women in the registration statistics of the HPCSA and student intake in South African universities offering optometry programmes.…”

“…The difference in the proportion of women to men in both these studies may be attributed to the predominance of women in the registration statistics of the HPCSA and student intake in South African universities offering optometry programmes. 27 This phenomenon has also been observed as a growing global trend, as shown in the United States of America where almost 70% of students in most classes are women. 28 , 29 , 30 The predominance of women in public sector employment may be because of the job security, better work–life balance within the public sector and reluctance to take risks in the current over-burdened global economy.…”

Diagnosis and Management of Keratoconus by Eye Care Practitioners in Kenya

“…This will inform national guidelines to promote early diagnosis and management; aimed at preventing progression and ultimately avoiding the need for corneal transplants. Similar studies have been conducted in Australia [13], the UK and Spain [14], Portugal [15] Latin America [16] and South Africa [17]. This is the rst study of eye care practices related to keratoconus patient management in Kenya.…”

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review

“…This condition leads to corneal protrusion, severe myopia, and irregular astigmatism. [ 1 ] While early stages are typically managed with corrective lenses, advanced cases often necessitate corneal transplantation, making KC a leading indication for such procedures in 10%–20% of cases. [ 2 ] Conventionally, penetrating keratoplasty (PK) served as the gold standard for addressing various corneal pathologies, including KC, demonstrating commendable graft survival rates.…”