Referral pattern and co-management of keratoconus patients in primary eye care: A survey of three European countries

Abstract

To explore current primary care practices in keratoconus management in Portugal and compare with previous reported results in two European countries (the UK and Spain), with a special focus on interdisciplinary collaboration and referral practice patterns. Methods: An online survey adapted to European professional practice was distributed (via newsletters) by the Portuguese Optometrist Association to explore keratoconus patient management and referral practice patterns among Portuguese practitioners. Results: Responses of 119 optometrists were compared with previous reported of 464 eye-care practitioners (126 in the UK and 338 in Spain). Most respondents (79% in Portugal, 71% in the UK and 76% in Spain; p = 0.31) had < 5 new keratoconus patients each year. No accepted referral criterion was found (p < 0.01) because small number of the respondents (14%) in Portugal referred out at initial diagnosis (50% in the UK and Spain); 32% referred out when progression was detected (17% in the UK and 30% in Spain); and a minority (10% in Portugal, 9% in the UK, and 6% in Spain) referred out when visual acuity was affected. A majority of respondents (83%) in Portugal reported no co-management with ophthalmologists (60% in the UK and 73% in Spain; p < 0.01). Conclusion:The results of this study suggest that it is necessary to encourage interdisciplinary collaboration between practitioners to improve referral of patients with suspected keratoconus to an ophthalmology specialist to change the course of this disease, to reduce keratoconus progression and visual acuity impairment and to minimize the impact of this disease on patients' quality of life.

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.…”

“…Referrals took place between the respondents and ophthalmologists for surgical intervention and the majority of OCOs referred their keratoconus patients to optometrists for CL tting. The rate of co-management between MLOWs and ophthalmologists after surgical interventions in keratoconus patients in Kenya (58.0%) is similar to that in Australia (58.8%) and much higher than in Latin America (40.4%), the UK (39.7%), Spain (27.2%) and Portugal (17.1%) [13][14][15][16]. After surgical interventions such as CXL, ICRS or corneal transplants, vision rehabilitation with spectacles or CLs is still required [3] and hence it is important for ophthalmologists to co-manage keratoconus patients with MLOWs to improve visual outcomes.…”

“…After surgical interventions such as CXL, ICRS or corneal transplants, vision rehabilitation with spectacles or CLs is still required [3] and hence it is important for ophthalmologists to co-manage keratoconus patients with MLOWs to improve visual outcomes. The need for improving interdisciplinary collaboration and the development of clinical guidelines in keratoconus diagnosis and management has been highlighted across the globe in four similar studies [13][14][15][16].…”

The Lifetime Expenditure in People with Keratoconus in Saudi Arabia

“…The condition is difficult to detect at early stages and it's usually possible to achieve good visual acuity with standard glasses, resulting in the unchecked progression of the disease. Studies into the sequence of events leading up to the keratoconus diagnosis show lack of awareness among patients and the criticality of referrals from primary points of contact to optometrists, ophthalmologists, and other specialists [29,30].…”

“…Collaboration is, however, little known and efforts are usually geared towards most prevalent eye diseases, age-related disorders, and primary care referral patterns [29]. Advanced stage keratoconus is difficult to correct and it's a common indicator of corneal surgery [9,10].…”