Keratoconus Management in the Community: A Survey of Optometrists

Abstract

Objectives: Defining the patterns of practice and referral criteria of optometrists within New Zealand to investigate the diagnosis and management of keratoconus. Methods: Optometrists recruited through the New Zealand Association of Optometrists, Cornea and Contact Lens Society of New Zealand, and private practices were invited to complete an anonymous survey. Results: Responses were received from 168 optometrists (representing 20.0% of the optometrist population). Half (48%) of optometrists had ≥15 years of experience, and 22% prescribed soft contact lenses daily, whereas only 6.4% prescribed rigid gas-permeable (RGP) lenses daily. The main barriers to prescribing RGPs were experience with fitting, low market demand, and patient discomfort. When referring to an ophthalmologist, 41% reported referring on progression of corneal parameters, 27% on initial diagnosis, 21% at no set time, and 10% with a reduction in visual acuity. Most optometrists (64%) would refer for possible surgery when visual acuity dropped between 6/9 and 6/12. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal imaging unit suggested an increased likelihood of prescribing RGP lenses but did not alter referral patterns. Conclusion: This survey provides an overview of current practice and highlights the importance of optometrists in the diagnosis and management of keratoconus. There was a significant discrepancy in keratoconus management, regarding optical correction modality and referral criteria for ophthalmology review. Further interdisciplinary work is required between optometry and ophthalmology to standardize referral guidelines and enhance visual outcomes.

Evaluation of ophthalmic healthcare professional-led keratoconus management service in the United Kingdom: the Birmingham and Midland Eye Centre (BMEC) study

“…Timely diagnosis and early intervention such as corneal cross-linking (CXL) is essential to stabilise progressive keratoconus, preserve vision and reduce the need for corneal transplantation [2]. In view of improved community screening [3], ophthalmic units across the UK are seeing a significant increase in community-to-hospital referrals for keratoconus management. To cope with the increased workload, several innovative pathways/services have been established, including the setup of virtual keratoconus clinics and CXL services led by nurses and optometrists [collectively known as allied health professionals (AHPs)] [4,5].…”