Vanessa Raquel Moodley

This study assessed eye care practitioners’ competencies, clinical practices, and barriers related to KC diagnosis and management in Malawi. A national cross-sectional study was conducted among eye care practitioners in Malawi. Data were collected using a structured questionnaire assessing demographics, self-reported competency in KC diagnosis and management, clinical practices, service availability, and barriers to care. Data analysis was conducted using Stata version 15 and R version 4.5.1. A total of 110 practitioners participated (response rate: 58.5%). The mean age was 35.4 ± 7.4 years, and optometrists constituted 60.9% of respondents. Diagnostic competency scores were consistently higher than management competency scores across knowledge, skills, and experience domains. Higher educational attainment was independently associated with diagnostic competency, with undergraduate (aOR = 3.3; 95% CI: 1.13–9.63) and postgraduate practitioners (aOR = 6.6; 95% CI: 1.91–22.62) demonstrating greater odds of competency than diploma holders. Equipment shortages were significantly associated with facility type (p = 0.035), while other barriers showed no significant variation across regions or levels of care. Eye care practitioners in Malawi reported moderate competency in KC diagnosis and management, with stronger confidence in diagnosis than management. Strengthening practitioner training, improving access to diagnostic technologies, and enhancing affordability of contact lens services may improve KC care delivery and visual outcomes.

This study assessed the facility-based proportion, demographic profile, clinical characteristics, and factors associated with KC among patients attending tertiary referral refraction clinics in Malawi. A retrospective cross-sectional review of clinical records was conducted at Malawi's four national referral eye hospitals. Records of patients aged 10-45 years who attended refraction services between January 2014 and December 2018 were reviewed. KC cases were ascertained using predefined clinical criteria. Analyses were performed using R version 4.5.1 (R Foundation for Statistical Computing). Of the 1,400 targeted records, 1,180 (84.3%) were successfully retrieved. The facility-based proportion of KC was 5.7% (67/1180; 95% CI: 4.4-7.2%). KC was most common among individuals aged 18-35 years (p = 0.001) and varied significantly by facility and region (p < 0.005). Blurred vision was the predominant presenting complaint (88.1%), while diagnosis relied primarily on retinoscopy, slit-lamp examination, and keratometry. Significant inter-eye differences were observed for best-corrected visual acuity and astigmatic axis (p < 0.005), but not for keratometric measurements. Median visual acuity improved from 0.2 to 0.6 following refractive correction. In multivariable analyses, cylindrical refractive error remained independently associated (AUC ≈ 0.88) with KC, whereas age and gender were not. Sensitivity analyses produced findings consistent with the primary results. Keratoconus represents a substantial clinical burden within Malawi's tertiary eye-care system and is associated with considerable visual impairment. Strengthening early detection, access to corneal imaging, specialised rehabilitation services, and clinical information systems may improve diagnosis, management, and visual outcomes.

Background: Using a cross-sectional design, this study assessed and compared myopia knowledge among parents and teachers of schoolchildren aged 6–15 years in Beirut, Lebanon. Methods: Two cross-sectional surveys were conducted between October 2022 and February 2024 among parents (n = 1256) and teachers (n = 366) of children aged 6–15 years. Using validated online Google Form questionnaires, data were collected on demographics, awareness, risk factors, and myopia knowledge, and analyzed with Statistical Package for the Social Sciences version 28 (SPSS v28) through descriptive statistics and logistic regression. Results: Findings showed that 78.3% of parents and 79.5% of teachers had poor knowledge of myopia. Among teachers, better knowledge was linked to being male, having a family history of myopia, positive attitudes toward eyeglasses use, and attending regular or occasional eye care visits (all statistically significant). Among parents, higher knowledge was associated with having previously heard of myopia, higher income and education levels, and a family history of myopia, while parents of private-school children were less knowledgeable. Odds ratios below 1 indicate lower odds of good myopia knowledge relative to the reference category. Conclusions: Both groups showed inadequate knowledge, underscoring the urgent need for targeted educational interventions to improve myopia awareness and prevention.

Background: Dry eye disease (DED) is a common, yet largely underdiagnosed, disorder of the eye encountered in healthcare facilities. It disrupts the tear film, causing ocular discomfort symptoms such as itching, tearing and irritation. Aim: This study aimed to determine the clinical profile of DED patients at a tertiary eye hospital to inform a public sector intervention strategy. Setting: The study was conducted at McCord Provincial Eye Hospital (MPEH). Methods: A quantitative, descriptive study design was undertaken and included 602 patients. The standardised patient evaluation of eye dryness (SPEED) questionnaire was administered, after which the tear break-up time (TBUT), Schirmer 2, blink rate, tear meniscus height (TMH) and meibography clinical tests were done. Data were managed using Statistical Package for Social Sciences (SPSS) version 28.0. Results: The prevalence of DED was 83.2%, with the majority being in the age group 41 years – 55 years (mean = 48.54 ± 18.76) and female (84.1%). The disease increased significantly with age (p = 0.02) and the prevalence of aqueous deficient, evaporative and mixed DED was 3.2%, 62.7% and 34.1%, respectively. Irrespective of the associated risk factors, the majority had either moderate (45.3%) or severe (30.9%) DED, with those with a history of glaucoma, hypertension and post-cataract surgery mostly having severe DED (p < 0.001). Conclusion: Noting the chronic discomfort and other complications of DED, the high prevalence found among public sector hospital patients warrants a strategic intervention. Interventions could include a DED management protocol with clinical guidelines for interventions from primary to tertiary levels of care. Further, as most older patients presented with systemic diseases such as diabetes and hypertension, DED clinical guidelines should be extended to multidisciplinary teams managing systemic diseases. Contribution: In addition to contributing to the scholarship of DED, the study provides empirical data to assist the provincial hospital and its eleven catchment district facilities in developing a comprehensive DED management strategy. Although conducted in the eThekwini District, the guideline has generic features which may be applied to health districts throughout the province of KwaZulu-Natal.

Background: Dry eye disease (DED) is a common condition affecting millions worldwide, causing vision problems, discomfort and decreased quality of life. Many factors cause this local ocular surface disease and involve multiple mechanisms. Effective management and care of DED is crucial to reduce associated risks. Aim: This study aimed to evaluate practitioners’ DED knowledge, clinical protocols and barriers experienced in the management of DED. Setting: This study targeted three levels of spheres – primary, secondary and tertiary – in Durban, KwaZulu-Natal (KZN), South Africa. Methods: An exploratory, descriptive qualitative design was used for this study. Participants were clinical eye care providers from the McCord Provincial Eye Hospital and its referral catchment facilities in South Africa. Three focus group interviews were conducted with 16 participants, lasting 60 min 80 min. Results: Thematic analysis identified five major themes: eye care services, dry eye knowledge, diagnosis, management, and barriers and challenges. A key finding reported was that facilities lacked appropriate equipment to examine, diagnose and manage DED. Further, limited DED medicine availability, understaffing and inadequate practitioner knowledge of DED management were challenges cited in DED diagnosis and management. Conclusion: Understanding the complexity of factors involved in diagnosing and managing DED will guide future facility planning, practitioner education and eye health policy development. It is recommended that facility leadership engage with respective health professions to identify and mitigate barriers to DED diagnosis and management. Contribution: This article highlights challenges to DED management at the represented KZN health facilities and the need to upskill health practitioners and provide the necessary equipment to improve service delivery.

Knowledge of reliable cut-off values for screening tests can facilitate early disease identification and referral. This study compared the validity of clinical tests used to screen for keratoconus in high school students. In this population-based, prospective, cross-sectional study, multistage cluster sampling was used to select participants who underwent visual acuity assessment, auto-refraction, retinoscopy and corneal topography. Students were classified into three groups: non-keratoconus, keratoconus suspect and keratoconus. A total 3051 students, mean age of 17.4 ± 1.6 years ranged from 13 to 25 years participated in this study. Of the 51 (1.7%) students diagnosed with keratoconus, one-third (31.4%) had a binocular visual acuity of ≤0.2 logMAR. The median visual acuity was worse, the spherical equivalent refractive error was more myopic and the astigmatism was higher in the keratoconus group compared to the non-keratoconus group (all p values < 0.05). However, there was a considerable overlap when comparing these parameters between the three groups, making it difficult to establish a reliable cut-off. Asymmetry was a feature of a large proportion of the students with keratoconus. When using scissor reflex on retinoscopy, maximum anterior corneal curvature or astigmatism individually as referral criteria, retinoscopy yielded the highest Youden Index (0.44). However, combining the use of all three parameters where either of them is positive: a scissors reflex or maximum anterior corneal curvature > 46.5 D or astigmatism >2.50 D was the most effective (Youden index 0.46). Monocular visual acuity, retinoscopy, keratometry and refraction should be included in keratoconus screening protocols with the inclusion of corneal topography to increase effectiveness. A combined referral criterion of a scissors reflex on retinoscopy or maximum anterior corneal curvature > 46.5 D or astigmatism > 2.50 D is recommended.

Aim To determine the prevalence of keratoconus and its associated risk factors within the adult population of Trinidad and Tobago. Method A population-based cross-sectional study was conducted among adults in Trinidad and Tobago, utilizing the Keratoconus Risk Assessment Questionnaire (KRIS) for data collection. Data were exported to the Statistical Package for Social Sciences (SPSS) version 27 for analysis. Descriptive statistics were employed to summarize the variables, while logistic regression was used to identify associated risk factors, with a significance level set at p < 0.05. Results A total of 413 participants were included in the study, yielding a response rate of 97.4% (413/424). The prevalence of keratoconus (KC) was 1.5% (95% CI: 0.33 – 2.67%). The condition was more prevalent among females (98.5%), individuals aged 19–30 years (66.7%), and participants of mixed race (50%). Allergic or atopic diseases were identified as the most common established risk factor for KC, affecting 50.1% of all participants. Among those diagnosed with KC, eye rubbing emerged as the most common established risk factor. Family history of KC (95% CI: 1.841–48.352, p < 0.007) and the use of rigid contact lenses (95% CI: 8.696–286.051, p < 0.001) were statistically significant predictors of KC. Specifically, participants with a family history of KC were 49.8 times more likely to develop the condition (OR = 49.875), while those using rigid contact lenses were 9.4 times more likely (OR = 9.436). Conclusion The prevalence of KC in Trinidad and Tobago was found to be significant. Among the identified risk factors, atopy was the most common. Additionally, a positive family history and the use of rigid contact lenses were significant predictors of KC. Early screening for keratoconus in this country is strongly recommended to facilitate prompt detection and appropriate management of the condition.

Purpose: To determine the prevalence and demographic profile of keratoconus (KC) among high school students in Nairobi County, Kenya. Methods: In this population-based, prospective, cross-sectional study, multistage cluster sampling was used to select the participants. All students underwent visual acuity measurement, auto-refraction, retinoscopy and corneal topography. Students with a scissors reflex on retinoscopy or corneal topography patterns suspicious of KC were referred for corneal tomography. Results: A total of 3051 students from 29 schools, with a mean age of 17.4 ± 1.6 years (range: 13–25 years) were screened. The prevalence of KC was 1.7% ( n = 51) (95% CI, 1.2–2.2) and of KC suspects was 3.8% ( n = 117) (95% CI, 3.2–4.6). There were no significant associations between the prevalence of KC and gender, age or ethnicity (all p > 0.05). In the KC group, 88.2% ( n = 45) were unaware of their condition, 52.9% ( n = 27) were treated for allergic conjunctivitis, 45.1% ( n = 23) required spectacles, 11.8% ( n = 6) were recommended contact lenses in at least one eye and 49.0% ( n = 25) were recommended corneal cross-linking. Conclusions: Among adolescents, the results of this study indicate a higher prevalence of KC compared to that reported in South Korea, Norway, Brazil and Caucasians in New Zealand, but less than that reported in some countries in the Middle East. Given the high prevalence revealed in this study, a national school screening program and clinical guidelines for screening, diagnosis and management of KC is recommended.

Background: Keratoconus (KC), a progressive, corneal, ectatic disease varies in prevalence globally. Differences and similarities in KC prevalence have been observed, and despite clinicians anecdotally reporting many KC cases, no empirical evidence of KC prevalence in Tanzania exists. Aim: This study aimed to determine the KC prevalence and demographic and clinical profiles of patients attending a tertiary hospital. Setting: The study was conducted at the Kilimanjaro Christian Medical Centre in Tanzania. Methods: The study applied a quantitative, retrospective study design whereby identified data were extracted from clinical records of patients aged 12 years – 45 years, presenting with corneal abnormalities, between the years 2016 and 2020. Statistical Package for Social Sciences was used for data analysis. Results: Of the 140 523 presenting patients, 1089 (0.77%) had corneal abnormalities, among whom KC prevalence was 10.0%. Patients were more likely to be men (odds ratio [OR]:1.5; P = 0.033) referred from lower-level clinics (OR:2.4; P ≤ 0.001) and residing in the Arusha region (OR:1.8; P = 0.012). Clinically, KC patients were more likely than non-KC to have vernal keratoconjunctivitis (VKC) (OR:3.8; P ≤ 0.001) and ocular allergies (OR:1.6; P = 0.028); be astigmatic (OR:6.5; P = 0.001) and myopic (OR:2.5; P = 0.001). Conclusion: The prevalence of KC among patients with corneal abnormalities is high, with significant predominance in patients with myopia, astigmatism and VKC. Data quality revealed a need for KC clinical guidelines, improved record keeping. Contribution: First study providing empirical KC data to guide improved patient care planning in Kilimanjaro.