Evaluation of Allied Health Professional-Led Keratoconus Management Service in the United Kingdom: The Birmingham and Midland Eye Centre Study

Abstract

Purpose : Keratoconus is the most common corneal ectatic disorder globally. Ophthalmic units across the UK are seeing a significant increase in hospital referrals of keratoconus patients in view of the improved community awareness and screening. To cope with the increased workload, several innovative pathways, including the setup of services led by allied health professionals (AHPs) have been established. This study aimed to evaluate the feasibility, clinical effectiveness, and safety of AHP-led keratoconus management service in Birmingham and Midland Eye Centre (BMEC), a large UK tertiary ophthalmic referral centre.

Methods : This study was designed as a prospective clinical audit, including patients from the two nurse- and two optometrist-led keratoconus clinics between June- October 2023. Relevant data, including demographic factors, corneal tomographic findings, and diagnosis (either normal/regular astigmatism, keratoconus, or keratoconus suspect) was collected from our local electronic health record (Medisoft). The AHPs were requested to make and document their decision independently. The decision was recorded as one of the following: (1) observe, (2) list for CXL, (3) discuss with senior cornea specialist, or (4) uncertain. The appropriateness, accuracy and concordance of decision making between AHPs and consultant ophthalmologists were analysed.

Results : A total of 181 patients were included in this study; the mean age was 31 years (SD 10.8) and 43.1% female. In terms of diagnosis, 146 (80.7%) patients were diagnosed with bilateral keratoconus, 23 (12.7%) unilateral keratoconus, 3 (1.7%) suspect keratoconus, 2 (1.1%) with post-laser ectasia, 3 (1.7%) pellucid marginal degeneration, and 6 (3.3%) normal eyes. Of these, 118 (65.2%) were follow up patients. The AHPs' decisions included 148 observations, 11 listed for CXL, 11 discharges, and 11 uncertainty. Of the 170 cases with decision made, an agreement with consultant’s decision was achieved in 165 (97%) cases. Of the 11 (6.1%) cases with uncertainty, the consultant recommended 2 cases for discharge, 4 for CXL, and 5 for observation.

Conclusions : This study observed a high concordance between AHPs and consultant ophthalmologists in managing patients with keratoconus, highlighting the effectiveness, safety and feasibility of AHP-led keratoconus services (with support from consultant ophthalmologists).

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.