Practice patterns and opinions in the treatment of allergic eye disease: A survey among Indian ophthalmologists

Abstract

Purpose: Management of allergic eye disease is seldom straightforward and often challenging. We conducted an online survey to elicit opinions on the preferred practice pattern in the treatment of allergic eye disease. Methods: An online survey questionnaire was sent to all practicing ophthalmologists using social media platforms. The respondents were asked about their clinical experience and preferred treatment in various scenarios such as mild-moderate vernal keratoconjunctivitis (VKC), chronic VKC, refractory VKC, steroid responders, giant papillae, and shield ulcer. Respondents were asked about the newer molecule (alcaftadine) and reservations regarding systemic immuno-suppressants and ordering allergy tests in their practice. Results: Ninety - one participants responded to the survey. About 57.1% of ophthalmologists reported coming across more than 10 cases per week in their practice. The most common age group was 5–10 years (61.1%), but adult onset VKC was also reported at 41.6% (1–2 per month), 37.1% (3–5 per month), and 13.5% (more than 10 per month). The disease is perennially present (36.7%), and a mixed form has been reported by 47.8% of ophthalmologists. Dual-acting agents were preferred by 40% in mild-moderate clinical variants. Topical steroids in slow tapering dosage were preferred by 86.7% in their prescription. Tacrolimus 0.03% was preferred by 65.9% and given for at least 3 months of continuous usage by 47.6% of ophthalmologists. High-dose topical steroids were preferred for giant papillae (67.8%) and Shields ulcers (68.3%) in our survey. Supratarsal steroid injection was preferred by 50% in treating refractory VKC in our survey. Conclusion: Allergic eye disease is a common yet annoying disease. The signs and symptoms can vary from subtle, innocuous forms to devastating variants affecting vision and day-to-day work. This survey aims to elicit responses from clinicians spreading across different geographical areas and compares responses based on experience in practice.

Vernal Keratoconjunctivitis: A Systematic Review

“…55% of treated patients required the additional use of a 3-day course of topical dexamethasone with 1.13 ± 0.81 mean courses/month High Senthil et al [ 153 ] 2022 India 82 15.8 To report outcomes and assess the risk factors for failure of trabeculectomy, trabeculectomy with mitomycin‑C, and combined trabeculectomy with cataract extraction in VKC eyes with steroid-induced glaucoma The surgical success for all three types of surgery is similar at 5 years. Chronic VKC and long‑term steroid use are associated with surgical failure High Arora et al [ 154 ] 2023 India 3 17.0 To evaluate the effectiveness of repeat deep anterior lamellar keratoplasty (DALK) in patients of previous failed DALK Best-corrected visual acuity improved from 20/120 to 20/30 at the end of 1‑year post repeat DALK in all except one patient Medium Priyadarshini and Das [ 155 ] 2023 India N/A N/A To elicit opinions on the preferred practice pattern in the treatment of allergic eye disease Dual-acting agents are preferred by 40% in mild-moderate clinical variants. Topical steroids in slow tapering dosage are preferred by 86.7% of ophthalmologists Medium Rashid et al [ 156 ] 2023 South Africa N/A N/A To explore keratoconus diagnosis and management in Kenya Few practitioners had access to a corneal topographer (13.5%; p = 0.08).…”