Development of a Web-Based Algorithm for Understanding the Intraocular Lens-Based Surgery in Stable and Progressing Keratoconus for Non-Specialist Ophthalmologists

• Published in: Current eye research Vol. 49; no. 2; pp. 140 - 149
• Main Authors: Nanavaty, Mayank A., Ashena, Zahra, Bekono-Nessah, Ingrid, Harding, Jennie
• Format: Journal Article
• Language: English
• Published: England 01.02.2024
• Subjects: Algorithms; Corneal Topography; Humans; Internet; Keratoconus - diagnosis; Keratoconus - surgery; Lenses, Intraocular; Ophthalmologists; Refraction, Ocular; Visual Acuity; implantable contact lens; Toric intraocular lens; keratoconus
• ISSN: 0271-3683; 1460-2202; 1460-2202
• DOI: 10.1080/02713683.2023.2270727

To propose an algorithm to facilitate lens-based surgery in keratoconus. A literature review was performed to prepare a software algorithm based on cone location, stability, best spectacle-corrected distance visual acuity (BSCVA) level and whether there is a clear or cataractous lens. The software usability was assessed through a 10-question questionnaire and two hypothetical keratoconus case histories (moderately simple and moderately complex) given to 15 trainees. The usability questionnaires were graded on a Likert scale (1 = strongly disagree to 5 = strongly agree) and two case histories (1 = very difficult to 7 = very easy). The algorithm can be found at https://www.sussexeyelaserclinic.co.uk/keratoconus/. Thirteen trainees completed the questionnaire. 91.9% would frequently use it; for 100%, it was easy to use independently without technical support; for 63.7%, it was strongly integrated; for 100%, it was consistent; 100% thought that most people would learn to use it quickly, 91.9% found the system not cumbersome to use, felt very confident to use it and need not learn a lot to use it. The first case was found easy by 63.7% and the second by 45%. We present an algorithm as a guide for lens-based surgery in stable and progressing keratoconus, which is classified based on cone location. This algorithm will help trainee and "non-specialist" ophthalmic surgeons understand the pre-operative planning for the surgery and referral to the "specialist" corneal surgeon, considering factors such as progression, BSCVA, keratometry, topography and apex location of the cone in keratoconus patients.