Knowledge, Perceptions, and Referral Practice of Complications of High Myopia Among Optometrists in Kenya

Abstract

Background: Approximately two billion people (28.3%) globally suffer from myopia. Among them are 277 million people (4.0%) who have high myopia. Projections indicate that by 2050, myopia will afflict 50% of the world's population, with 10% of them having high myopia. High myopia causes ocular complications, including optic disc abnormalities, choroidal neovascularization, retinal detachment, cataract, glaucoma, and peripheral retinal issues. The majority of these complications are vision threatening and frequently result in permanent loss of vision. In Kenya, patients with retinal detachment present late to Ophthalmologists. Patients with myopia are often first attended by optometrists for dispensing spectacles or contact lenses and therefore, it is important to assess their knowledge, perception, and practice. Methods: This was a descriptive cross-sectional study with a mixed-method approach. The Optometrists Association of Kenya register formed the sampling frame of the study. All optometrists in the register were consecutively included. An online survey was used to gauge knowledge, perception, and referral practice. This was a census survey. Results: A total of 99 completed surveys were gathered from various regions of the country, reflecting a 22.8% response rate. The majority of respondents had knowledge of the association between high myopia and retinal detachment (81.8%), cataracts (61.6%), and glaucoma (62.6%). However, knowledge regarding retinal breaks, foveoschisis, and choroidal neovascularization was low. They routinely performed subjective refraction (58.6%) and non-cycloplegic refraction (55.6%) as the initial clinical procedures but only 18.2% performed dilated retinal fundus exam. There is a positive perception of the complications of high myopia with optometrists agreeing that high myopia can lead to permanent loss of vision. The findings indicate that 93% of the optometrists’ prescribed spectacles for correction for patients with high myopia. Optometrists recognised the significance of referring patients to ophthalmologists and most (67%) referred to general ophthalmologists. Conclusion: Optometrists had a good level of knowledge and had positive perception regarding complications associated with high myopia. They faced various barriers that hindered them from providing optimal clinical care. Optometrists routinely performed non-cycloplegic retinoscopy and subjective refraction at the initial consultation, preferred prescribing spectacles as the initial intervention for correcting high myopia and referred patients with high myopia to general ophthalmologist.