Developing a clinical guideline for private eye care practice for the management of keratoconus with scleral contact lenses
Järvinen, Mikko (2025)
2025
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https://urn.fi/URN:NBN:fi:amk-202504166806
https://urn.fi/URN:NBN:fi:amk-202504166806
Tiivistelmä
Purpose: This thesis project was aimed at constructing a clinical guideline for private eye care practice for both assessing and managing keratoconus patients with scleral lenses.
Methods: This research project was a rapid literature review analysis-based research endeavour: following the literature review, a clinical guideline founded on the selected literature specifically focused on private eye care practice was developed. More specifically, the first phase involved a literature search focused on pre-existing and valid clinical guidelines concentrating on both keratoconus assessment and management, as well as scleral lens fitting guides, with company or product-related studies being excluded. Subsequently, only two publications met the specified inclusion criteria, which were selected for the study. Two independent raters with experience in fitting scleral lenses rated the publications using the AGREE (Appraisal of Guidelines for Research and Evaluation) II tool (Brouwers et al., 2010).
Results: The selected clinical guidelines for fitting scleral lenses by van der Worp (2015) and Barnett & Fadel (2018) were found to differ in terms of focus: while the former guide provided a theoretical account of the development work supplemented by direct input from actual clinicians, the latter guideline presented a “hands-on” practical approach replete with numerous colour photographs, information about staff training and checklists, with sparse information about the specifics of the development work. The data from these two guidelines were synthesised in order to construct a clinical guideline for private eyecare practitioners to both assess and manage keratoconus patients with scleral lenses. Using the guideline, practitioners can identify the clinical signs of keratoconus as well as are provided with tools to assess the severity of the disease. Thus, the guideline provided herein offers both knowledge and step-by-step treatment protocol for managing keratoconus with scleral lenses.
Conclusions: Keratoconus evaluation and management require cooperation with eye care professionals and the patient. The existing evidence-based clinical guidelines help eye care professionals to employ a successful strategy for fitting scleral contact lenses in patients with keratoconus.
Keywords: Clinical guideline, keratoconus, keratoconus assessment, keratoconus management, AGREE II, scleral lenses, rapid review
Methods: This research project was a rapid literature review analysis-based research endeavour: following the literature review, a clinical guideline founded on the selected literature specifically focused on private eye care practice was developed. More specifically, the first phase involved a literature search focused on pre-existing and valid clinical guidelines concentrating on both keratoconus assessment and management, as well as scleral lens fitting guides, with company or product-related studies being excluded. Subsequently, only two publications met the specified inclusion criteria, which were selected for the study. Two independent raters with experience in fitting scleral lenses rated the publications using the AGREE (Appraisal of Guidelines for Research and Evaluation) II tool (Brouwers et al., 2010).
Results: The selected clinical guidelines for fitting scleral lenses by van der Worp (2015) and Barnett & Fadel (2018) were found to differ in terms of focus: while the former guide provided a theoretical account of the development work supplemented by direct input from actual clinicians, the latter guideline presented a “hands-on” practical approach replete with numerous colour photographs, information about staff training and checklists, with sparse information about the specifics of the development work. The data from these two guidelines were synthesised in order to construct a clinical guideline for private eyecare practitioners to both assess and manage keratoconus patients with scleral lenses. Using the guideline, practitioners can identify the clinical signs of keratoconus as well as are provided with tools to assess the severity of the disease. Thus, the guideline provided herein offers both knowledge and step-by-step treatment protocol for managing keratoconus with scleral lenses.
Conclusions: Keratoconus evaluation and management require cooperation with eye care professionals and the patient. The existing evidence-based clinical guidelines help eye care professionals to employ a successful strategy for fitting scleral contact lenses in patients with keratoconus.
Keywords: Clinical guideline, keratoconus, keratoconus assessment, keratoconus management, AGREE II, scleral lenses, rapid review