Assessment of Kenyan ophthalmic clinical officer’s knowledge, skills and practice on glaucoma

Abstract

Background: Glaucoma is a major contributor to blindness in the world. It is chronic optic neuropathy characterized by typical optic disc, retinal nerve fiber layer (RNFL) defects, and progressive visual field loss. The most important risk factor is raised intraocular pressure (IOPs). Though studies have focused on the causes and treatment of glaucoma, there is no data on Ophthalmic Clinical Officer’s (OCO’s) knowledge, skill and practice on glaucoma in Kenya. The OCOs are the primary health care providers for glaucoma patients, they are well placed to assess, provide treatment and refer glaucoma patients to the specialist ophthalmologists. Results: A total of 49 OCOs were interviewed over a period of two months, the male to female ratio was 1.7:1, mean age of 41.8(68%) years, age ranged from 29-56 years with mean duration of practice of one year and maximum of 32 years. One hundred percent OCOs had good knowledge and understanding of importance of intraocular pressure measurement in making glaucoma diagnosis. However, our results found that (83.6%) of OCOs used direct ophthalmoscope for assessment of optic disc glaucomatous changes in patients. On skills, OCOs were classified as having poor skills as shown in Humphrey’s visual field interpretation with thirty nine (79.6%) being unable to interpret. 61.2% of OCOs did not screen patients aged 40 years and above who attended eye clinics for glaucoma. The most common challenges reported for not screening was long queues. The study further established that the OCOs had various reasons to refer patients to another hospital including 52.6% for availability of ophthalmologists and 39.5% of OCOs for availability of equipment. Conclusion This study we established that despite the good level of knowledge among the ophthalmic clinical officers on glaucoma, there exists gaps in skills in interpretation of glaucoma Humphrey visual fields. Majority of OCOs do not screen patients Aged 40 years and above for glaucoma.