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.

Prevalence and clinical profile of keratoconus in patients presenting at a provincial hospital in KwaZulu, Natal, South Africa: A case study.

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu-Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five-year period (2016-2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions.

Risk Profile of Keratoconus among Secondary School Students in the West Region of Cameroon.

This study determined the risk factors of keratoconus (KC) among secondary school students in the West Region of Cameroon. A stratified, random sampling technique was used to select the 3015 secondary school students, 8 years and older, within the West Region of Cameroon. Selected school students completed the validated Keratoconus Risk Investigative Survey (KRIS) and a structured demographic questionnaire to determine the risk profile of KC. Descriptive analysis, logistic regression and p-values were used to provide an overview of the demographic findings and the risk factors of KC. Estimates were made as the proportion of affected school students and presented with a 95% confidence interval (CI). Multivariate logistic regression analysis was performed to explore the association between KC and the independent predictors that were found significant in the univariate analysis. The ages of the majority (93.2%) of students ranged from eight years to 18 years (mean = 13.18 ± years) and were mostly female (59.7%). Gender (OR 2.024, p < 0.001), eye rubbing (OR 3.615, p < 0.001), exposure to sunlight (OR 2.735, p < 0.001), blood relations with KC (OR 41.819, p < 0.001) and allergic experience (OR 1.070, p < 0.001) were considered. Eye rubbing was the most significant risk factor of keratoconus followed by refractive error, allergic experiences and sunlight exposure. These findings support the evidence that the etiology of KC is multifactorial, with eye rubbing being the most significant factor in this cohort. There is a need to address eye rubbing among students to minimize the risk of KC. Furthermore, 34.46% of students in Cameroon were at risk of developing KC. Hence the risk profile is that one engages in eye rubbing, has a family member with KC, spends more than eight hours per week in the sun and is prone to allergies. It will therefore be prudent for these risk factors for keratoconus to be included in the school health education programs.

Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective.

INTRODUCTION: Visual acuity (VA) and refractive error (RE) remain important parameters in the management of keratoconic (KC) patients. Despite rapid amelioration in capacity of diagnostic equipment, these remain inaccessible to the majority of practitioners in low-income countries. Notwithstanding limitations, practitioners are expected to utilize existing resources to satisfactorily manage their increasing numbers of keratoconic patients. PURPOSE: To determine the changes in visual acuity and refractive errors with diagnostic and management options available in low-income contexts. METHODS: A descriptive, retrospective chart analysis of medical records dating back 5 years was employed in this study. Records of patients prescribed with corneal rigid gas permeable (RGP) and scleral lenses were analyzed. Data on age, gender, stage of keratoconus, pre-, and post-visual acuities and refractive errors, mode of correction and lens parameters were evaluated. RESULTS: A total of 124 medical records were analyzed. Males comprised 58.9% and females 41.1% of the total sample, with a mean age 20.86 ± 9.50 years. The mean unaided VA in logMAR notation was 1.0±0.19, while corrected VA was 0.18±0.17. There was a significant improvement (p=0.001) in VA with corneal RGP contact lenses (mean 0.19±0.17) as compared to unaided VA (mean 1.29±0.20). Scleral lens VA also improved from a median of 1.06 to -0.01 logMAR; p=0.001. The mean RE before RGP contact lens fitting was -9.43±2.37 diopters (D) which improved to -0.41±0.78D. RE reduced significantly (p=0.001) after fitting with both corneal RGP lenses (from a mean of -9.80±4.46D to -0.45±0.80D) and scleral lenses (from a median of -8.00D to -0.02D). CONCLUSION: Significantly improved visual acuity and refractive error status were achieved with all KC patients. Despite the diagnostic equipment and contact lenses design limitations, practitioners in low-income contexts can fit the relatively more affordable corneal RGP lenses to positively impact the daily living experiences of their KC patients.