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

Abstract

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.

Keywords:

• keratoconus
• optometrist
• barriers
• Africa
• Kenya
• optometry education

Abbreviations

CPD, Continuous professional development; CXL, Corneal cross-linking; KHPOA, Kenya Health Professionals Oversight Authority; KMTC, Kenya Medical Training College; KC, Keratoconus; MMUST, Masinde Muliro University of Science and Technology; NEHSP, National Eye Health Strategic Plan; OAK, Optometry Association of Kenya; RGP, Rigid contact lens; OSU, Ophthalmic Services Unit; Ministry of Health Kenya.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article.

Ethical Approval and Informed Consent

Ethical approval was obtained from Amref Health Africa, Kenya (ESRC P1918/2021) and the Biomedical Research Ethics Committee at the University of KwaZulu-Natal (BREC/00001226/2020) and was carried out in compliance with the tenets of the Declaration of Helsinki. In the preamble of the online questionnaire where the study purpose was explained, it was stated that “Your return of this anonymous survey implies your consent to participate in this research”. The consenting procedure was approved by Amref Health Africa, Kenya and the Biomedical Research Ethics Committee at the University of KwaZulu-Natal.

Acknowledgments

The authors would like to thank all the optometrists who participated in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.