Knowledge, attitude and practice of eye care professionals in Kenya on atropine prescription for myopia progression in children aged 4–12 years
Abstract
BACKGROUND: Myopia has predominantly been shown to negatively impact ocular health and quality of life. However, with a variation in the scope of practice for eye care professionals destined to address myopia, this study intended to assess the knowledge, attitude, and practice of different eye care professionals in Kenya regarding atropine prescription for the management of myopia progression in pediatric patients aged 4–12 years.
MATERIAL AND METHODS: A cross-sectional mixed-method study was conducted among ophthalmologists, optometrists, and ophthalmic clinical officers practicing in Kenya’s private and public health sectors. Initially, purposive sampling and then snowball sampling were used to recruit the participants. Data was collected via an online survey which consisted of closed-ended questions aiming to explore the eye care professional’s knowledge, attitude, and practice regarding prescribing different concentrations (0.01%, 0.025%, and 0.05%) of atropine for pediatric myopes. In addition, a semi-structured interview was conducted telephonically from April to June 2023.
RESULTS: All participants (100%) were aware of 1% atropine and utilized it often for pediatric refractions. A composite awareness score revealed ophthalmologists specializing in pediatrics at the top in terms of having good knowledge of atropine prescription for children with myopia progression, followed by general ophthalmologists, optometrists, and ophthalmic clinical officers. The attitude of all pediatric ophthalmologists towards the prescription of atropine for pediatrics with progressing myopia was better when compared to optometrists, ophthalmic clinical officers, and general ophthalmologists. All pediatric ophthalmologists prescribed atropine for children with myopia progression, while other cadres, such as optometrists and general ophthalmologists, utilized atropine primarily for pediatric refraction.
CONCLUSION: Atropine is predominantly used by eye care professionals in Kenya for pediatric refraction, with minimal usage as a management option for myopia progression. Continuous medical education is thus desirable among eye care professionals on the use of atropine to monitor and manage myopia progression in children. Furthermore, developing a pediatric refraction guideline integrating a clinical-based utilization of low concentrations of atropine is desirable.
Keywords: atropineknowledgeattitudepracticeeye care professionalspediatricsmyopiamyopia progressionchildren
References
- Rodge HY, Lokhande S. Refractive Error in Children. Int J Cur Res Rev. 2021; 12(23): 185.
- Wei S, Li SM, An W, et al. Safety and Efficacy of Low-Dose Atropine Eyedrops for the Treatment of Myopia Progression in Chinese Children: A Randomized Clinical Trial. JAMA Ophthalmol. 2020; 138(11): 1178–1184.
- Galvis V, Tello A, Parra MM, et al. Topical Atropine in the Control of Myopia. Med Hypothesis Discov Innov Ophthalmol. 2016; 5(3): 78–88.
- Azuara-Blanco A, Logan N, Strang N, et al. Low-dose (0.01%) atropine eye-drops to reduce progression of myopia in children: a multicentre placebo-controlled randomised trial in the UK (CHAMP-UK)-study protocol. Br J Ophthalmol. 2020; 104(7): 950–955.
- Pérez-Flores I, Macías-Murelaga B, Barrio-Barrio J, et al. Multicenter Group of Atropine Treatment for Myopia Control (GTAM). A multicenter Spanish study of atropine 0.01% in childhood myopia progression. Sci Rep. 2021; 11(1): 21748.
- Muma S, Obonyo S. The prevalence and causes of visual impairment among children in Kenya - the Kenya eye study. BMC Ophthalmol. 2020; 20(1): 399.
- Kenya Ministry of Health. Scope of practice for ophthalmic workers. 2022.
- Kalua K, Gichangi M, Barassa E, et al. Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania. Hum Resour Health. 2014; 12 Suppl 1(Suppl 1): S2.
- Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016; 123(5): 1036–1042.
- Khanal S, Phillips JR. Which low-dose atropine for myopia control? Clin Exp Optom. 2020; 103(2): 230–232.
- Li F, Yam J. Low-Concentration Atropine Eye Drops for Myopia Progression. Asia-Pacific J Ophthalmol. 2019; 8(5): 360–365.
- Pan C, Ramamurthy D, Saw SM. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2012; 32: 3–16.
- Fricke TR, Jong M, Naidoo KS, et al. Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling. Br J Ophthalmol. 2018; 102(7): 855–862.
- Muma S, Aduda D, Onyango P. Uptake of conventional interventions, level of awareness and perception on computer vision syndrome: a cross-sectional study among University students, Kenya. Ophthalmol J. 2021; 6(0): 1–9.
- Wu PC, Chuang MN, Choi J, et al. Update in myopia and treatment strategy of atropine use in myopia control. Eye (Lond). 2019; 33(1): 3–13.
- Tan D, Tay SA, Loh K, et al. Topical Atropine in the Control of Myopia. Asia-Pacific J Ophthalmol. 2016; 5(6): 424–428.
- Larkin GL, Tahir A, Epley KD, et al. Atropine 0.01% Eye Drops for Myopia Control in American Children: A Multiethnic Sample Across Three US Sites. Ophthalmol Ther. 2019; 8(4): 589–598.
- Utz VM. Appendix 1 : Prescribing Practices for Refractive Errors in Pediatric Patients. In: Traboulsi E, Utz VM. ed. Practical Management of Pediatric Ocular Disorders and Strabismus A Case-based Approach. Springer 2016.
- Mirzajani A, Amini Vishteh R, Khalilian M. Introducing a new method of retinoscopy for refraction of infants and young children: The "Mirza" tele lens retinoscopy. J Optom. 2021; 14(3): 254–262.
- Gifford KL, Richdale K, Kang P, et al. IMI — Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019; 60(3): M184–M203.
- Muma S, Naidoo KS, Hansraj R. Estimation of the Prevalence of Refractive Error in Kenya: A Systematic Review and Meta-Analysis. Optom Vis Perform. 2023; 11(3).
- Muma S, Obonyo S. The prevalence and causes of visual impairment among children in Kenya - the Kenya eye study. BMC Ophthalmol. 2020; 20(1): 399.
- Kandel H, Khadka J, Shrestha MK, et al. Impact of refractive error on quality of life: a qualitative study. Clin Exp Ophthalmol. 2017; 45(7): 677–688.
- WorldBank. Mobile Usage at the Base of the Pyramid in Kenya. 2012.
- Saxena R, Sharma P. National consensus statement regarding pediatric eye examination, refraction, and amblyopia management. Indian J Ophthalmol. 2020; 68(2): 325.