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. 2023 Sep;71(9):3229-3234.
doi: 10.4103/IJO.IJO_595_23.

Prevailing practice patterns in keratoconus among Indian ophthalmologists

Rashmi Deshmukh  1 , Alok Kumar Shrivastava  2 , Pravin Krishna Vaddavalli  3
Affiliations

Prevailing practice patterns in keratoconus among Indian ophthalmologists

Rashmi Deshmukh et al. Indian J Ophthalmol. 2023 Sep.

Abstract

Objective: The past few years have seen a rapid advancement in the management of keratoconus (KC). However, there is no prescribed standard of care for the management of KC. This study evaluated the prevailing practice patterns among Indian ophthalmologists in the diagnosis and treatment of KC via an online survey.

Methods: This was a survey-based cross-sectional study in which a questionnaire (Supplement 1) was created. Questions pertaining to the practicing experience, setting of practice, and training background were asked in addition to the investigations done and decision making in KC management. Responses were collected via Survey Monkey (Survey Monkey, Palo Alto, California, USA) and statistical analysis performed using R software (4.1.3).

Results: The survey was answered by 273 ophthalmologists. Pentacam was the most used topographer (195 users), followed by Orbscan (41 users), Sirius (34 users), and Galilei (3 users). The lowest limit of pachymetry for performing collagen crosslinking (CXL) was 400μ for most practitioners. More than half the respondents (50.55%) did not perform photorefractive keratectomy (PRK) or intracorneal ring segment (ICRS) implantation in a suitable patient. Accelerated 10-minute protocol (9 mW/cm2 for 10 minutes) was the most commonly (54.21%) used for CXL, followed by Dresden protocol (3 mW/cm2 for 30 minutes) (36.63%). When a patient was unsuitable for CXL, 55.31% surgeons advise contact lens (CL) trial, 35.16% surgeons advise keratoplasty, 26.74% surgeons perform stromal augmentation, and 7.69% surgeons advise spectacle correction. Corneal scar was the most common indication (49.45%) for performing keratoplasty.

Conclusion: Topography remains the most used diagnostic modality for initial diagnosis. Optical coherence tomography and epithelial mapping are increasingly being used for early diagnosis of KC. Not all ophthalmologists were comfortable performing ICRS or PRK. When patients are unsuitable for CXL, CL trial remains the most frequently advised option followed by keratoplasty.

Keywords: Keratoconus; practice patterns; survey.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Graphs showing trends of (a) Practicing experience of ophthalmologists in the survey, (b) Practice setting of the ophthalmologists in the survey, (c) Training background of ophthalmologists in the survey
See this image and copyright information in PMC

References

    1. Gokul A, Patel DV, McGhee CNJ. Dr John Nottingham's 1854 landmark treatise on conical cornea considered in the context of the current knowledge of keratoconus. Cornea. 2016;35:673–8. - PubMed
    1. Deshmukh RS, Vaddavalli PK. Changing paradigm in the diagnosis and management of keratoconus. In: Das S, editor. Keratoconus: Diagnosis and Treatment. Singapore: Springer Nature; 2022. pp. 291–9.
    1. Seitz B, Behrens A, Langenbucher A. Corneal topography. Curr Opin Ophthalmol. 1997;8:8–24. - PubMed
    1. Shetty R, Agrawal A, Deshmukh R, Kaweri L, Rao HL, Nagaraja H, et al. Effect of post crosslinking haze on the repeatability of Scheimpflug-based and slit-scanning imaging devices. Indian J Ophthalmol. 2017;65:305–10. - PMC - PubMed
    1. Koh S, Inoue R, Ambrósio R, Maeda N, Miki A, Nishida K. Correlation between corneal biomechanical indices and the severity of keratoconus. Cornea. 2020;39:215–21. - PubMed

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