Evaluation of an allied health professionals-led keratoconus service in a tertiary UK centre.

Abstract

Background: Keratoconus is an ectatic corneal disorder, which requires regular monitoring for early detection of progression and prompt treatment with collagen cross-linking (CXL) to stabilise the condition. This conflicts with the demand on corneal specialists to review acute referrals into the corneal service, delaying diagnosis and treatment. In this study, we examined the outcomes of an Allied Health Professional (AHP)-led keratoconus service for routine workup, monitoring, performing CXL and follow-up thereafter.

Methods: Refraction, topography and CXL operative details were taken from electronic patient records. Statistical analysis was performed in R^® (R Foundation for Statistical Computing, Vienna, Austria). 82 eyes had CXL performed by a nurse practitioner (NP) and 42 eyes by ophthalmologists. Pre- and post-operative evaluation were done by optometrists.

Results: In total, 271 eyes of 177 patients were included. 92 patients (128 eyes) were consented and underwent CXL. 85 patients (143 eyes) where CXL was not indicated, were monitored routinely. All patients had baseline refraction and topography. Patients were reviewed at 12 and 24 months. All had topography at every visit. 71/72 eyes (98.61%) had refraction at 12 months and 57/58 eyes (91.28%) had refraction at 24 months. Patients who were operated on by NP found improvements in visual acuity at 12 months and 24 months (p < 0.05, Mann-Whitney U Test).

Conclusion: The AHP-led keratoconus service delivered satisfactory outcomes and can be an efficient means of dealing with these patients, complementing specialist corneal services in the NHS.