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

Abstract

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.

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

“…Other African countries such as South Africa and Ghana have reported similar results regarding poor access to corneal topographers. 15 , 16 , 28 There is therefore a need for African universities to initiate innovations to design cost-effective corneal topographers to improve the diagnosis and management of KC.…”

“…Half the number of optometrists had access to and were confident in performing keratometry, this being similar to reports from South Africa and Ghana. 15 , 16 , 28 Despite keratometry measurements being limited to the central 3 to 4mm of the cornea and the cone in KC decentering as it progresses, 29 keratometers are cost-effective with good repeatability up to K-readings of 55D. 30 In the absence of corneal topographers practitioners should, at the least, use the keratometer, combined with other clinical signs such as a split/scissor retinoscopy reflex and/or astigmatism of >2.00DC and/or slit lamp signs of KC to screen and monitor for progression.…”

“…A quarter of the respondents were confident in RGP fitting compared to 54.2% to 83.3% of those practicing in South Africa. 15 , 16 The lack of experience in RGP fitting is not unique to Africa and has been reported in Australia, Spain and the UK. 11 , 12 There are no RGP manufacturing companies in sub-Saharan Africa, except in South Africa.…”

Keratoconus Management in the Community: A Survey of Optometrists

“…Few studies have previously examined keratoconus management and referral patterns for community optometrists. 8,[10][11][12] A previous study of 71 optometrists, completed in New South Wales, Australia, identified barriers to prescribing RGP lenses and criteria for referring patients for ophthalmological assessment and further management. 8 This study sought to assess the diagnostic, referral, and therapeutic management of optometrists in New Zealand and investigate possible mechanisms to support primary care to achieve the best outcomes for patients with keratoconus.…”

“…Few studies have previously examined keratoconus management and referral patterns for community optometrists. 8,10–12 A previous study of 71 optometrists, completed in New South Wales, Australia, identified barriers to prescribing RGP lenses and criteria for referring patients for ophthalmological assessment and further management. 8…”