Therapeutic treatment of keratoconus: a survey of local optometric practice criteria

Job satisfaction of Spanish and Portuguese optometrists

PURPOSE

Given the increase in demand for optometry services by society and the importance of the Optometry profession in Portugal and Spain, the objective of this study was to determine job satisfaction and important factors related to this satisfaction in a sample of Portuguese and Spanish optometrists.

METHODS

A prospective, cross-sectional, and observational study was carried out from June to December 2021. An adaptation of the 15-item job satisfaction in eye-care personnel (JSEP) questionnaire validated by Paudel et al. was administered to Portuguese and Spanish optometrists. The questionnaire was shared through different social media (Facebook, LinkedIn, WhatsApp, etc.) in a Google form during the months of June to December 2021 in Portugal and Spain.

RESULTS

A total of 530 surveys were collected in Portugal (42.3%; n = 224) and Spain (57.7%; n = 306). The factors that most influence overall job satisfaction are salary, career development opportunities, recognition/prestige in society, good work-life balance (all p<0.001), workplace equipment and facilities, and encouragement reward positive feedback (both p = 0.002). When comparing the determinants of job satisfaction of optometrists, it was found that Portuguese professionals were generally more satisfied than Spanish ones (p<0.001). However, Spanish optometrists reported feeling more supported by their colleagues (p<0.001).

CONCLUSION

This study has shown that the level of job satisfaction was higher in Portugal than in Spain. The most important factors influencing job satisfaction were salary, job stability, and support from colleagues.

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

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.

Patterns in refractive error and treatment delay in keratoconus-An Australian study

Keratoconus is the most common primary corneal ectasia and is associated with significant morbidity. In its early stages, keratoconus is often asymptomatic, making the identification of subclinical disease challenging. Refractive error is a parameter that is documented at most routine optometry visits, yet interestingly, changes in refraction of keratoconic patients over time have not yet been studied and compared with the general population. Early diagnosis of keratoconus facilitates timely referral for treatments such as corneal collagen cross-linking, which has been shown to slow disease progression. In this context, documenting delays between initial presentation to the optometrist and referral for collagen-cross-linking as well as comparing the trends in visual acuity and refractive error between keratoconic and non-keratoconic patients over time are particularly relevant.

Keratoconus Management in the Community: A Survey of Optometrists

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.

Diagnosis and management of keratoconus by eye care practitioners in Kenya

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.

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

BACKGROUND

Keratoconus (KC) has been regarded as a rare condition, although recent studies, including those in South Africa, suggest it is common and is increasing in prevalence. Furthermore, South African-based studies have shown that KC is normally detected at advanced or severe stages. Knowledge and skills for examination, diagnosis and management of KC by optometrists are important for the early detection and management of the disease.

AIM

This study aimed to evaluate self-reported knowledge and skills for examination, diagnosis and management of KC patients among public sector optometrists.

SETTING

Seven public hospitals of the Capricorn district of the Limpopo province, South Africa.

METHODS

A quantitative cross-sectional descriptive study design was used. A self-administered online questionnaire was used to collect data on demographic characteristics of participants and their knowledge, skills and practice for the diagnosis and management of KC.

RESULTS

Twenty-four optometrists (n = 24) with a mean age of 39 ± 5.67 years, 18 (75%) of whom were female, participated in the study. Nineteen (79%) reported that their hospitals did not have the appropriate equipment to examine, diagnose and manage KC patients. Lack of equipment, poor knowledge, skills and competencies, hospital's level of services, policy and lack of interest were cited as barriers to contact lens fittings in KC patients. Using a dichotomised summation of self-reported knowledge and skills of KC, 13 (54.2%) of the optometrists were knowledgeable and skilled on risk factors of KC and examining, diagnosing and managing KC patients.

CONCLUSION

A significant proportion of optometrists did not have the appropriate knowledge and skills to examine, diagnose and manage KC patients. Lack of equipment and poor knowledge and skills were the main barriers to contact lens fittings in managing KC.Contribution: This article highlights the need for the district to upskill the optometrists through a structured programme with a theory and practical component and also provide the necessary equipment to enhance patient care.

Diagnosis and Management of Keratoconus-A Narrative Review of Clinicians' Perspectives

This review discusses the current practices, attitudes, and trends in diagnosing and managing keratoconus (KC) in adults and children by optometrists and ophthalmologists in order to highlight the differences on a global scale. Two independent reviewers searched the electronic databases and grey literature for all potential articles published from 1 January 2000 to 1 June 2022 on management of KC. Keywords used in searches included "keratoconus", "diagnosis", "management", "treatment", "attitude", "practices", "opinion", "optometrist", "ophthalmologist", "consensus", and "protocol". A total of 19 articles was included in this review-12 from the database search and seven from the grey literature. Although a common stepwise approach of non-surgical management was noted, there were differences in the rates of prescribing rigid gas permeable lenses. Furthermore, while clinicians agreed on the need for early diagnosis, the timeline and type of referral varied significantly. A similar discordance was found in the milestones for surgical intervention and preferred surgical techniques. Practice patterns in keratoconus diagnosis and management vary throughout the world. Multiple recommendations and suggestions to minimise the differences have been provided in the literature, with the main themes being improvement in education, interdisciplinary patient care, and further research to reach consensus.

Optometric practices and attitudes in keratoconus patient management in Latin America

CLINICAL RELEVANCE

To explore optometric practices and attitudes in the management of keratoconus patients in LatinAmerica and how they are influenced by eye-care technology will help to minimise disease progression and their impact on patients' quality of life in Latin America.

BACKGROUND

Keratoconus is a progressive, bilateral and asymmetric corneal disorder that requires a multidisciplinary approach, the use of different eye assessment technology, and different management approaches; mainly contact lenses and surgery.

METHODS

Self-reported answers to an online survey (adapted to primary eye care) distributed via a newsletter emailed by various professional organisations across 15 Latin American countries were assessed and compared with those previously reported in three European countries.

RESULTS

Answers from 977 eye care practitioners (60%) with >10 years of experience (396 in Latin America and 581 in Europe) were assessed. A total of 65.9% of Latin American responders prescribed rigid corneal lenses (RCL), although more than half of the respondents (54.0%) would fit more RCL if they underwent further training in RCL fitting. A majority of Latin American practitioners (74.0%) considered that RCL fitting is more difficult in keratoconus, requiring more diagnostic lenses (4.6 ± 2.7; median 4; range 1-10) than are necessary for healthy eyes. Low availability of corneal topography was reported in Latin America (23%), although practitioners with topographers are more likely to prescribe RCL (92.3%) and detect more new patients with keratoconus per year (83.5%). A minority of respondents referred keratoconus patients to another optometrist (25.8%) or (40.4%) participated in comanagement with ophthalmologists.

CONCLUSION

This study provides initial evidence regarding keratoconus management in Latin America and suggests that actions are necessary to improve RCL training, facilitate eye-care technology accessibility and encourage comanagement between eye care practitioners to minimise disease progression and their impact on patients' quality of life in Latin America.

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

PURPOSE

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.

Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework

PURPOSE

Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery.

RECENT FINDINGS

PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling.

SUMMARY

The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.

Patient-related barriers to Rigid Gas Permeable (RGP) lens wear among keratoconus patients in Jordan

PURPOSE

To assess potential patient-related barriers to rigid gas permeable (RGP) lens wear for vision rehabilitation in a sample of keratoconus (KC) patients in Jordan.

METHODS

Barriers for RGP contact lens wear among KC patients were discussed and specified by a focus group which consisted of five optometrists who are involved in contact lens practice. The focus group addressed potential barriers for RGP lens wear from the patient's perspective. The identified barriers were then used to design the final questionnaire used in the study. The questionnaire consisted of 8 questions which ask the participant to rate, within a 5-points scale (1: strongly disagree to 5: strongly agree), how each suggested item is considered a barrier for RGP lens wear.

RESULTS

204 KC patients (86 females, 118 males) were involved in a semi-structured interview to answer the questionnaire. The average age of participants was 30.85 (±8.74) years old and ranged from 18 to 62 years. The average age of diagnosis of KC (±standard deviation) is 21.96 (±7.22) years old with a range of 12-52 years. All participants reported that they had never tried RGP lenses for their vision rehabilitation; however, other management options were reported such as glasses, keratoplasty, collagen cross linking and Intacs. The mean score of total barriers to RGP wear was high at 3.8 (±0.4) (out of 5). The major identified barriers were: lack of awareness of the benefits of RGP lenses, fear of possible lens complications, lack of medical insurance and high cost of the lens.

CONCLUSIONS

The study reveals that several barriers were identified as prevalent. Consequently, there is an imperative need to adopt better planning strategies for management protocol of KC in order to assure best eye care service for KC patients in Jordan.

Current optometric practices and attitudes in keratoconus patient management

PURPOSE

To compare the current optometric practices and attitudes in the management of keratoconus patients in the UK and Spain.

METHODS

An online survey (adapted to optometric practices) was distributed via a newsletter emailed by various professional organizations in the UK and Spain.

RESULTS

Four hundred and sixty-four practitioners (126 in the UK; 338 in Spain) who prescribed gas permeable GP contact lenses (CLs) more than once per month (54.8% of UK practitioners and 28.1% of practitioners in Spain; p<0.01) responded to the questionnaire. A combination of multiple factors is considered necessary in the keratoconus detection (79.4% in the UK, 75% in Spain; p=0.68), and the use of classification criteria is considered relevant (67.5% in the UK, 70.7% in Spain; p=0.49). There is a high consensus on the consideration that GP CL fitting is more difficult in keratoconus (79.4% in the UK, 80.5% in Spain; p=0.79) requiring more diagnostic lenses (3.2±1.4 and 3.4±1.2 in the UK and Spain, respectively; p=0.72) than are necessary for healthy eyes. Using corneal topography is uncommon from both countries (38.1% in the UK, 59.8% in Spain; p<0.01), with a similar ophthalmologist referral pattern (at initial diagnosis, 50% in both the UK and Spain; p=1.00). Few cases of co-management with ophthalmologists were noted (no co-management reported by 60.3% in the UK and 72.8% in Spain, p=0.01).

CONCLUSION

This study provides initial observations and evidence regarding keratoconus management by optometrists in the UK and Spain and shows similarity in the professional practices and attitudes of practitioners in these two countries.

Nonsurgical Procedures for Keratoconus Management

Objectives

To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications.

Methods

A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed.

Results

The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity.

Conclusions

In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.