Background: Defining the threshold for therapeutic and surgical intervention in patients with keratoconus presents a considerable challenge given the lack of clear, evidence-based data. Little is known about the patterns of practice and referral criteria of optometrists within Australia. Methods: All members of the NSW branch of Optometrist Association Australia were invited to complete an online survey in January 2013. This survey was designed to elicit practice information regarding the evaluation and therapeutic treatment of patients with keratoconus in the optometric setting. Results: Responses were received from 71 optometrists, of whom 65.2 per cent had 15 years or greater experience as an optometrist. Many (35.4 per cent) responded that they prescribed soft contact lenses daily. This percentage dropped to 9.2 per cent for rigid gaspermeable lenses (RGP), although 47.7 per cent said they would prescribe RGP lenses at least once per month. The main barriers to prescribing were experience with fitting RGP lenses, time and low market demand. In terms of patient referral to an ophthalmologist, the results were variable, with 34.4 per cent stating that they would refer on progression of corneal signs, 23.4 per cent suggesting no set time and 7.8 per cent would refer on initial diagnosis. Many optometrists (62.9 per cent) would refer a patient for possible surgery, when visual acuity dropped to between 6/9 and 6/12. The size or location of the practice was not associated with the number of newly diagnosed cases of keratoconus. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal topographic unit suggested an increased likelihood of prescribing RGP lenses but did not appear to alter referral patterns.
Conclusion:Optometrists have an integral role in the diagnosis and management of patients with keratoconus. Our survey provides a basic snapshot of current, local practice. Additionally, ophthalmology should continue to work with optometry to develop guidelines for referral and co-management to optimise future outcomes for our patients.
Previous analyses of the optical effects of bending hydrophilic lenses, i.e. lens flexure, have been based on theoretical models rather than empirical data. This study, based on the analysis of results for 84 thin (0.18 mm) spherical, minus powered lenses and 4 plus powered lenses, suggests that the value of the models suggested so far is limited. Simply stated, this analysis indicates that with the type of lenses used in this study, minus powered lenses gain very little power on bending and plus lenses 'lose' power. This finding is contrary to predictions of what should occur based on either equal change or equal percentage change (proportional) hypotheses. Such simplistic models are misleading if applied .
This paper is based on clinkai data derived from 35 patients having worn a variety of contact lenses on a continuous wear basis for periods up to two years. Aspects discussed include oedema-induced changes in the ocular parameters, miscellaneous disturbances to corneal integrity end adverse eye reactlonr.Although there has been considerable variation in the corneel swelling response (depending on contact lens gas tranmlssbn, patient age and state of the comes), most patients have shown adaptation within the first one to two weeks. Epithelial microvesicular changes have been observed h a significant number of patients. The adverse eye reactions encountered included corneal ulceration, pannus and acute 'red-eye' reaction.
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