Clinical Evaluation Criteria And Approach To Management Of Ocular Allergy By Ophthalmologists In Kenya

Abstract

Background: Despite the high prevalence (20% of the population worldwide) of ocular allergy (OA), its definition, a standard classification and staging as well as the guidelines to diagnosis and treatment are not globally accepted. Clinical evaluation criteria would allow appropriated evaluation of progression, the establishment of algorithms of treatment, as well as objective assessment for analysis of treatment efficacy. Aims: To determine the clinical evaluation of OA by ophthalmologists in Kenya and also to describe their practices regarding the clinical grading and approach to management of ocular allergy. Methods: The study was a descriptive (Knowledge, Attitude and Practice) cross-sectional study carried out in the Republic of Kenya from 1st December 2012- 31st May 2013. All qualified and practising ophthalmologists in Kenya were included in the study. Primary data was collected using self-administered questionnaires. Focus Group discussions were used as a secondary data collection tool for triangulation and to get detailed information on the attitudes and practices of the ophthalmologists regarding OA. Quantitative data analysis was undertaken using Stata version 11.0. Qualitative data was imported into NVivo 10 software for coding and data analysed through content analysis. Results: A total of 58 ophthalmologists were included in the study (69% response rate). All the participants reported diagnosing OA based on clinical findings. Majority, 82.8% (48/54 reported grading ocular allergies with 63.8% (37/58) grading OA according to the level of severity. 50% (29/58) felt that grading of OA was very important. The rational use of topical steroids was advised so as to avoid their overuse. Surgical intervention was suggested only in the management of complications of OA or conditions associated with OA. There is no national standard treatment guideline for the management of OA. Counselling was seen to form a major part of the management of a patient with OA though it is inadequate in our setting. Conclusion: Despite the high number of ophthalmologists reporting grading OA, there is no standardised grading system followed. Its establishment would allow for better documentation and assessment of treatment response during patient follow-up. Patient counselling needs to be emphasized so as to improve compliance to treatment and follow up appointments. There is a need to come up with a national guideline so as to harmonise the diagnosis, grading and treatment of ocular allergy.