Clinical evaluation criteria of ocular allergy by ophthalmologists in Kenya and suggested grading systems
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Background: Despite the high prevalence (20% of the population worldwide) of ocular allergy (OA), its deﬁnition, a standard classiﬁcation and grading 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. Objectives: To determine the clinical evaluation of OA by ophthalmologists in Kenya, describe their practices regarding its clinical grading and propose a standardised grading system. Methods: The study was a descriptive (Knowledge, Attitude and Practice) cross-sectional study carried out in the Republic of Kenya from 1st December 2012 to 31st May 2013. All qualiﬁed and practising ophthalmologists in Kenya were eligible to participate in the study. Primary data was collected using self-administered questionnaires as an online survey. Focus Group Discussions and a group key informant interview 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. 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%, reported grading ocular allergy with 63.3% grading it according to the level of severity. Majority of the ophthalmologists (88.3%) felt that grading of OA is important as it impacts on the clinical decision-making. Two systems were suggested for the grading of OA with grading system 1 incorporating both the assessment of symptoms and signs with the frequency/severity of each being graded on a likert scale. The score of the more severe eye would indicate the level of severity. Grading system 2 took into consideration the signs that are picked by the clinician and the most severe sign present in the more severe eye determines the grade. Most ophthalmologists preferred the second system because of its simplicity. There was a general agreement on grading OA patients according to the levels of severity regardless of the classiﬁcation. Conclusion: Despite the high number of ophthalmologists reporting grading OA, there is no standardised grading system followed. The adoption of grading system 2 would allow for a common agreement for the assessment of ocular allergy, and as a result help in the establishment of set guidelines in Kenya on the management of OA.