Ophthalmology Department, The University of Auckland, Grafton, Auckland, New Zealand.
Eye Contact Lens. 2024 Jan 1;50(1):10-15. doi: 10.1097/ICL.0000000000001057. Epub 2023 Nov 15.
Defining the patterns of practice and referral criteria of optometrists within New Zealand to investigate the diagnosis and management of keratoconus.
Optometrists recruited through the New Zealand Association of Optometrists, Cornea and Contact Lens Society of New Zealand, and private practices were invited to complete an anonymous survey.
Responses were received from 168 optometrists (representing 20.0% of the optometrist population). Half (48%) of optometrists had ≥15 years of experience, and 22% prescribed soft contact lenses daily, whereas only 6.4% prescribed rigid gas-permeable (RGP) lenses daily. The main barriers to prescribing RGPs were experience with fitting, low market demand, and patient discomfort. When referring to an ophthalmologist, 41% reported referring on progression of corneal parameters, 27% on initial diagnosis, 21% at no set time, and 10% with a reduction in visual acuity. Most optometrists (64%) would refer for possible surgery when visual acuity dropped between 6/9 and 6/12. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal imaging unit suggested an increased likelihood of prescribing RGP lenses but did not alter referral patterns.
This survey provides an overview of current practice and highlights the importance of optometrists in the diagnosis and management of keratoconus. There was a significant discrepancy in keratoconus management, regarding optical correction modality and referral criteria for ophthalmology review. Further interdisciplinary work is required between optometry and ophthalmology to standardize referral guidelines and enhance visual outcomes.
确定新西兰视光师的实践模式和转诊标准，以调查圆锥角膜的诊断和管理。
通过新西兰视光师协会、新西兰角膜和隐形眼镜学会以及私人诊所招募视光师，邀请他们完成匿名调查。
共收到 168 名视光师（占视光师总数的 20.0%）的回复。一半（48%）的视光师有≥15 年的经验，22%每天开软性隐形眼镜处方，而只有 6.4%每天开硬性透气性隐形眼镜（RGP）处方。开 RGP 的主要障碍是配镜经验、市场需求低和患者不适。转诊给眼科医生的主要原因是角膜参数进展（41%）、初次诊断（27%）、无固定时间（21%）和视力下降（10%）。大多数视光师（64%）在视力下降到 6/9 到 6/12 之间时会建议进行可能的手术。经验丰富的视光师更有可能开 RGP 处方，并与眼科医生共同管理患者。拥有角膜成像设备表明开 RGP 处方的可能性增加，但不会改变转诊模式。
本调查概述了当前的实践情况，并强调了视光师在圆锥角膜的诊断和管理中的重要作用。在光学矫正方式和眼科会诊转诊标准方面，圆锥角膜的管理存在显著差异。需要视光师和眼科医生之间进一步开展跨学科工作，以规范转诊指南并提高视力结果。
