Referral pathways and management of contact lens-related microbial keratitis in Australia and New Zealand
Keay, Lisa, Edwards, Katie P., & Stapleton, Fiona (2008) Referral pathways and management of contact lens-related microbial keratitis in Australia and New Zealand. Clinical & Experimental Ophthalmology, 36(3), pp. 209-216.
We examine the referral pathways and treatment for contact lens-related microbial keratitis in Australia and New Zealand. METHODS: Cases were reported in May 2003-September 2004; data on presentation, referral and treatment collected from practitioners and via patient interview. Severity was graded, 1-week cure rate estimated, delays in treatment and medications documented. Hospital and private clinic managements were compared. RESULTS: A total of 297 eligible cases were reported; detailed information on treatment and referral pathways was available on a subset of these cases. Presentation was to optometrists (81/200, 41%), general practitioners (GPs) (69/200, 34%) or emergency departments (46/200, 23%). Optometrists referred to private ophthalmologists (47/79, 60%) more often than hospitals (27/79, 34%). GPs initiated treatment (39/68, 57%) but also referred to hospitals (22/68, 32%) and to private ophthalmologists (7/68, 10%). Of all cases, 67% (195/297) were managed in hospitals (29% admitted, 87/297). Hospitalized cases were predominantly managed with fortified aminoglycoside/cephalosporin (66/81, 82%) and others fluoroquinolones (168/195, 86%). Steroids were used in 36% (98/276) commencing on day 5 (median, interquartile range = 3-7). One-week cure rate was 60% (49/82) in private clinics, 72% (62/86) for hospital outpatient cases and 37% (25/67, P < 0.001) for inpatient cases, which were more severe diseases (47%, 52% and 0% mild, respectively). Delays (>/=12 h) receiving therapy were experienced by 33% (55/168) because of initial inappropriate treatment (48/55), time delays (7/55) but not remoteness (P = 0.6). CONCLUSIONS: The majority of treatment is via hospital clinics, but milder disease is managed in private clinics. The referral process via optometrists, GPs and emergency departments is generally efficient; however, one-third of cases experienced some delays before receiving appropriate therapy highlighting the need for timely diagnosis.
Impact and interest:
Citation counts are sourced monthly from and citation databases.
These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.
Citations counts from theindexing service can be viewed at the linked Google Scholar™ search.
|Item Type:||Journal Article|
|Additional Information:||Accession Number: 18412588 Language: English. Date Created: 20080416. Date Completed: 20080515. Update Code: 20081217. Publication Type: Journal Article. Journal ID: 100896531. Publication Model: Print. Cited Medium: Internet. NLM ISO Abbr: Clin. Experiment. Ophthalmol.. Comment in: Clin Experiment Ophthalmol. 2008 Apr;36(3):204-5. (PMID: 18412586).|
|Keywords:||referral and consultation, contact lenses adverse effects, keratitis microbiology & therapy, adolescent, adult, ambulatory care, Australia, emergency medical services, family practice, health services accessibility, hospitalization, humans, middle aged, New Zealand, optometry, pilot projects, time factors|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300)|
|Divisions:||Current > Institutes > Institute of Health and Biomedical Innovation|
|Copyright Owner:||Copyright 2008 Blackwell|
|Deposited On:||21 May 2009 01:02|
|Last Modified:||10 Aug 2011 17:36|
Repository Staff Only: item control page