Purpose

To explore current primary care practices in keratoconus management in Portugal and compare with previous reported results in two European countries (the UK and Spain), with a special focus on interdisciplinary collaboration and referral practice patterns.

Methods

An online survey adapted to European professional practice was distributed (via newsletters) by the Portuguese Optometrist Association to explore keratoconus patient management and referral practice patterns among Portuguese practitioners.

Results

Responses of 119 optometrists were compared with previous reported of 464 eye-care practitioners (126 in the UK and 338 in Spain). Most respondents (79% in Portugal, 71% in the UK and 76% in Spain; p = 0.31) had < 5 new keratoconus patients each year. No accepted referral criterion was found (p < 0.01) because small number of the respondents (14%) in Portugal referred out at initial diagnosis (50% in the UK and Spain); 32% referred out when progression was detected (17% in the UK and 30% in Spain); and a minority (10% in Portugal, 9% in the UK, and 6% in Spain) referred out when visual acuity was affected. A majority of respondents (83%) in Portugal reported no co-management with ophthalmologists (60% in the UK and 73% in Spain; p < 0.01).

Conclusion

The results of this study suggest that it is necessary to encourage interdisciplinary collaboration between practitioners to improve referral of patients with suspected keratoconus to an ophthalmology specialist to change the course of this disease, to reduce keratoconus progression and visual acuity impairment and to minimize the impact of this disease on patients’ quality of life.

中文翻译：

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初级眼保健中圆锥角膜患者的转诊模式和共同管理：对三个欧洲国家的调查

目的

探索葡萄牙当前在圆锥角膜管理中的初级保健实践，并与两个欧洲国家（英国和西班牙）先前报告的结果进行比较，特别关注跨学科合作和转诊实践模式。

方法

葡萄牙验光师协会（通过通讯）分发了一项适应欧洲专业实践的在线调查，以探索葡萄牙从业者的圆锥角膜患者管理和转诊实践模式。

结果

将 119 名验光师的反应与之前报道的 464 名眼保健从业者（英国 126 名，西班牙 338 名）进行了比较。大多数受访者（葡萄牙 79%、英国 71% 和西班牙 76%；p = 0.31）每年有 < 5 名新的圆锥角膜患者。没有发现可接受的转诊标准（p < 0.01），因为葡萄牙的少数受访者（14%）在初步诊断时转诊（英国和西班牙为 50%）；32% 在检测到进展时转诊（英国为 17%，西班牙为 30%）；少数人（葡萄牙为 10%，英国为 9%，西班牙为 6%）在视力受到影响时提及。葡萄牙的大多数受访者 (83%) 表示没有与眼科医生共同管理（英国为 60%，西班牙为 73%；p < 0.01）。

结论

这项研究的结果表明，有必要鼓励从业者之间的跨学科合作，以改善将疑似圆锥角膜患者转诊给眼科专家的情况，以改变该疾病的病程，减少圆锥角膜进展和视力损害，并尽量减少圆锥角膜的影响。这种疾病对患者的生活质量造成影响。