Clinical Ophthalmology (Dec 2023)
Impact of First Healthcare Provider on Acanthamoeba Keratitis Course: How to Overcome Poor Prognosis in Acanthamoeba Keratitis Treatment? A Single Tertiary Center, Observational Study
Abstract
Joanna Przybek-Skrzypecka,1,2 Andrew Walkden,3,4 Arun Brahma,3 Jaya Chidambaram,5 Fiona M Carley3,6 1Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland; 2SPKSO Ophthalmic University Hospital, Warsaw, Poland; 3Cornea Department, Manchester Royal Eye Hospital, Manchester University NHS Foundation, Manchester, UK; 4School of Biological Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; 5Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; 6School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKCorrespondence: Joanna Przybek-Skrzypecka, Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, Warsaw, 00-576, Poland, Tel +48 22 511 62 37, Email [email protected]; [email protected]: To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first healthcare provider (HCP) seen.Methods: Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and Acanthamoeba subspecies.Results: Forty-one patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4– 14 days), while mean time to the correct diagnosis of AK was 15 days (IQR 7– 29 days). Patients saw an optician, optometrist or ophthalmologists significantly earlier than GPs (median 4 days, vs 15 or 5 days, respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the ophthalmologists’ group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36).Conclusion: AK patients often seek ocular help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP seen, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.Keywords: keratitis, Acanthamoeba, corneal ulcer, diagnosis, healthcare providers
