Prescribing trends in infectious keratitis: a survey of New Zealand ophthalmologists

Purpose: To obtain an overview of the treatment of infectious diseases of the cornea by New Zealand ophthalmologists and to analyse the data in the context of evidence-based treatment recommendations. Methods: A questionnaire was sent to all New Zealand ophthalmologists. It comprised 23 multiple-choice questions pertaining to the characteristics of the respondents, the nature of their practice and their prescribing preferences in infectious conjunctivitis and keratitis. Results: Of the 93 ophthalmologists surveyed, 80.6% returned the questionnaire. Of those in clinical practice, 91.4% regularly treated patients with corneal disease. A subspecialty interest in cornea was stated by 12.5% of these. This paper reports observations for adenoviral conjunctivitis and adenoviral, Herpes simplex, varicella zoster, bacterial, acanthamoebal and fungal keratitis. In some conditions prescribing practice varied dramatically, such as in adenoviral conjunctivitis where 50% of respondents prescribed a corticosteroid and 51.6% an antibiotic, whereas 37.5% prescribed only lubrication or no topical treatment. In other conditions there was a high degree of agreement between ophthalmologists; indeed, all ophthalmologists treated Herpes simplex dendritic keratitis with topical acyclovir. No statistically significant differences in prescribing habits were identified between subspecialist and non-subspecialist groups, although some important clinical differences emerged. There were occasional marked differences in response when the age group of respondents was considered, particularly in relation to the management of adenoviral infections and bacterial keratitis. Conclusions: The findings of this survey suggest that the majority of New Zealand ophthalmologists generally follow international guidelines for the management of infectious keratitis. The identified variations in management provide a foundation for informed clinical debate and the development of treatment guidelines, in line with evidence-based recommendations.