Contact lens fitting in North-West Province, South Africa : practitioner clinical competencies and contact lens related practices

Abstract

Background: Contact lens remain one of the critical options for vision correction. In a rapidly evolving global landscape of ocular healthcare, the application of new information in contact lens clinical practice appears paramount to sustaining proficiency and patient satisfaction by optometrists. Superior clinical proficiency and availability of relevant equipment enhance success in contact lens fitting and contact lens wear. Purpose: The study aimed to determine practitioner clinical competencies and contact lens-related practices of optometrists, to inform the need to address challenges encountered for optimal fitting of patients essential for improved eye health planning and curriculum advancement for contact lenses. Methods: A descriptive cross-sectional quantitative design was used in the study which entailed a questionnaire to establish the clinical competencies of practitioners and contact lens-related practices in the North-West Province. The analyses included descriptive analysis of data, using statistical package for Social Science (SPSS) version 28.0 software, in consultation with the statistician. For the association of variables, categorical variables were compared for association and a chi-square test was performed with the significance level set at p=0.05 or less. Results: A total of 121 questionnaires were completed by optometrists working in the North-West Province. The majority of the participants were Black African (96%) and 53.8% with 6 years or more of working experience. There was a significant difference (p=0.011) in the number of years spent in practice and fitting of contact lenses. One hundred and one (83.5%) participants indicated that they fitted contact lens in the practices, with the majority fitting soft lens (73.9%) and few scleral lens (6.7%). There was no significant difference in whether participants fitted contact lens by gender (p=0.333), and by race (p=0.310). Many indicated having a keratometer (86.8%), followed by a slit lamp biomicroscope with very few corneal topographers (5%). There was a significant difference (p=0.039) in contact lens fitting between participants having slit lamp biomicroscopy and those without contact lens fitting. A mean score of 4.74±0.56 was calculated for the self-reported competencies of contact lens fitting suggesting an excellent rating. Eighty-nine (72.2%) indicated that they referred vi keratoconus patients followed by myopia (70.7%). Participants reported keratoconus as the most common corneal ectasia (84%) followed by pellucid marginal degeneration (32%) among patients presenting in different settings. Lens use and personal hygiene (46.3%) followed by the importance of aftercare (12.4%) were highlighted as the most important factors that formed part of contact lens patient education. Conclusion: To guarantee the effective utilisation of contact lens wear and fitting, optometrists require sufficient clinical knowledge and skills in screening and examination of different ocular conditions. There is a need for the rein-enforcement of relevant continued clinical training and working resources for contact lens-related practices to improve service provision