Impact of first health care provider on Acanthamoeba keratitis course. How to overcome poor prognosis in AK treatment? Single tertiary center, observational study

Abstract

Abstract Background To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first health care 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 41 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 significantly earlier than GPs or ophthalmologists (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). Conclusions AK patients often seek help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP, 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.