Abstract
Background: Despite the high prevalence (20% of the population worldwide) of ocular allergy (OA), its
definition, a standard classification and grading as well as the guidelines to diagnosis and treatment are
not globally accepted. Clinical evaluation criteria would allow appropriated evaluation of progression,
the establishment of algorithms of treatment, as well as objective assessment for analysis of treatment
efficacy.
Objectives: To determine the clinical evaluation of OA by ophthalmologists in Kenya, describe their
practices regarding its clinical grading and propose a standardised grading system.
Methods: The study was a descriptive (Knowledge, Attitude and Practice) cross-sectional study carried
out in the Republic of Kenya from 1st December 2012 to 31st May 2013. All qualified and practising
ophthalmologists in Kenya were eligible to participate in the study. Primary data was collected using
self-administered questionnaires as an online survey. Focus Group Discussions and a group key
informant interview were used as a secondary data collection tool for triangulation and to get detailed
information on the attitudes and practices of the ophthalmologists regarding OA.
Results: A total of 58 ophthalmologists were included in the study (69% response rate). All the
participants reported diagnosing OA based on clinical findings. Majority, 82.8%, reported grading
ocular allergy with 63.3% grading it according to the level of severity. Majority of the ophthalmologists
(88.3%) felt that grading of OA is important as it impacts on the clinical decision-making. Two systems
were suggested for the grading of OA with grading system 1 incorporating both the assessment of
symptoms and signs with the frequency/severity of each being graded on a likert scale. The score of
the more severe eye would indicate the level of severity. Grading system 2 took into consideration
the signs that are picked by the clinician and the most severe sign present in the more severe eye
determines the grade. Most ophthalmologists preferred the second system because of its simplicity.
There was a general agreement on grading OA patients according to the levels of severity regardless of
the classification.
Conclusion: Despite the high number of ophthalmologists reporting grading OA, there is no standardised
grading system followed. The adoption of grading system 2 would allow for a common agreement for
the assessment of ocular allergy, and as a result help in the establishment of set guidelines in Kenya on
the management of OA.
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