Cataract in Kenya, just like in other country in sub-Saharan Africa remains a devastating condition. It is the leading cause of avoidable blindness worldwide, with nearly 50-90% true cataract patients remaining undiagnosed Ubah, Isawumi, & Adeoti, (2013). With these figures it is obvious that in Kenya; where there is lack of strong institutional capacity for cataract; care can be a big challenge. This study recruited forty nine optometrists working in Kenya and sought to assess knowledge, skills and practice on cataract. The results ascertained that cataract is treatable surgically and depending on the scope of practice, optometrists are well placed to diagnose and refer. However, with the current situation of optometry in Kenya, the burden of cataract will highly affect the quality of life.
With regard to knowledge of optometrists on cataract, the study findings established that 61.2% of the forty nine optometrists knew the correct definition of cataract. They possessed knowledge on the various types of cataract, symptoms of cataract and complications of cataract. This is a clear implication that optometry training in Kenya has not narrowed only on optics of the eye but pathology has been incorporated in the training. In this study, 95.9% of 49 optometrists knew of the ocular complications of cataract. There was a significant relationship between good cataract knowledge, age and duration of practice. Optometrists that had practiced for less than five years were associated with good knowledge on cataract. This high percentage of awareness about conditions associated with or complications of cataract is important as it would positively motivate optometrist in an effort to detect early and refer patients to ophthalmologists. There was a statistically significant association between age and duration of practice of optometrist with knowledge on cataract. Better knowledge among young optometrist could be explained by the fact that they recently graduated from school. There was no statistically significant association between the level of qualification with good knowledge, skills and practice on cataract. This could be explained by the fact that the only difference in training between optometrist and optometry technologist is duration of training but the syllabus is the same. This study established that despite the good level of knowledge among the optometrist, there exists a gap in skills in interpretation of type of cataract. The good knowledge of optometrists on cataract will only be significant if they put it on practice.
On assessment of skills and practice among optometrists on diagnosis, treatment of cataract, the study found that 75.5% of participant’s diagnosed cataract based on reduced visual acuity. This is comparable to what was found in a study at Light house eye hospital by Shahsuvaryan, (2016) which established that 90.6% of all cataract diagnosis was based on reduced visual acuity. Visual acuity may not be sufficient to ascertain cataract as there are several ocular related causes of reduced visual acuity. However, combining Funduscopy and reduced visual acuity will ascertain presence or absence of cataract. Hence the optometrist’s scope of practice in Kenya should be inclined towards clinical practice so as to enhance their skills. Optometrists had good understanding of other risk factors of cataract which is essential in improving vigilance of practitioners among patients at risk. This calls for a need for clear definition of the roles of optometrists in Kenya. The study established that nearly half of the optometrists referred cataract patients mainly for ophthalmologic review. The choice of hospital where patients were referred depended on availability of ophthalmologist and cataract equipment. The author compared the study findings with other results regarding the knowledge, skills and practice rate as there was limited published literature on skills on cataract among optometrists Smith, Frick, Holden, & Naidoo, (2009). However, we ascertained that this study presented issues that require a lot of attention to address the role of optometrists in cataract management in other developing countries.
In this study, 61.2% of optometrists did not screen patients age 40years and above who attended eye clinics. This was possible because optometrists find it hard to relate with optometrist and as a results they don’t see the need of referring cataract patients to the ophthalmologists, hence they major on optics. However, we also established that 52.6% of the optometrists who screened were not aware of what they were looking for. This is similar to a study by (Krishna, 2014) who found that even though 50% of optometrists screened patients above 40years, they were not aware of increased sensitivity to light as symptoms of cataract. The lack of screening awareness is probably attributed to lack of interest in pathology of the eye with a lot of interest in optics. In the Kenyan context, optometrists’ roles are confusing as they are capable of performing most procedures in relation to their scope of training. However, the Ophthalmic Division requires the optometrists to only do refraction when optometrists roles are well stipulated. So this translate that the burden of cataract may rise in Kenya as the first line eye care providers who meet majority of the patients are inclined towards optics. Hence, the Ophthalmic Division should streamline funds in management of eye care services and ensure that they restructure the roles of optometrists. The possible reason for the low skills among optometrists is attributed to lack of interest by the practitioners due to the division frustrations.
This study has some limitations: firstly, there are more than 300 optometrists in Kenya although only 149 are registered with Optometrists Association of Kenya. The sample size would have been larger if the author would have included all optometrists, however being that they are not interested in joining the association for reasons best known to them, accessing their email addresses proved futile. At the same time, Ophthalmic Division does not allow unregistered optometrists to engage in any activity. Secondly, as the respondents were only optometrists, the view of the Ophthalmic Division was not included in the study. Getting the opinion of stakeholders would have better the study. Future studies to be conducted should include the Ophthalmic Division, ophthalmologists in Kenya to confirm the study findings.