Diagnosis and management of keratoconus: a survey of Trinidad and Tobago optometrists

PURPOSE: To evaluate the diagnostic and management practices of optometrists in Trinidad and Tobago (T&T) for keratoconus (KC), and to identify barriers affecting clinical care. METHODS: A cross-sectional survey was conducted between July and December 2023 among registered optometrists in T&T using a validated questionnaire. Data were collected on diagnostic approaches, treatment strategies, referral behaviors, and perceived challenges. Descriptive statistics and chi-square tests were used for analysis, with significance set at P <0.05. RESULTS: Of the 108 respondents, 57.4% were women and 50.0% identified as Indo-Trinidadian. While 64.8% reported diagnosing at least five KC cases annually, only 17.6% had access to corneal topography. Most practitioners (78.7%) relied on clinical examination and patient-reported symptoms for the diagnosis of KC. Rigid gas permeable (RGP) lenses were seldomly used for KC management, as 66.7% reported they did not fit RGP lenses, with cost identified as the main barrier (53.7%) to RGP use. Only 36.1% reported co-managing KC cases with ophthalmologists. Regression analysis revealed that Optometrists with ≥5 years of experience were significantly more likely to diagnose KC more frequently compared to those with less than 5 years of practice experience (OR: 4.74; 95% CI: 1.99-11.31; P = 0.001). CONCLUSIONS: Optometrists in T&T play a crucial role in KC care despite resource limitations. The development of national guidelines is urgently needed to standardize diagnosis, management, and referral pathways.