# Enhancing Keratoconus care in a public healthcare system in KwaZulu-Natal, South Africa

## TL;DR

This study explores challenges in diagnosing and managing keratoconus in South Africa's public healthcare system and suggests policy changes to improve patient care.

## Contribution

The study identifies systemic barriers to keratoconus care in KwaZulu-Natal and recommends policy revisions to address these issues.

## Key findings

- A lack of clinical equipment and infrastructure hinders keratoconus diagnosis and treatment.
- Shortage of eye care personnel and insufficient funding are major barriers to care.
- Current policies fail to meet the minimum standard of care for keratoconus patients.

## Abstract

Keratoconus (KC) is a self-limiting corneal ectasia with an unknown definitive aetiology. It presents as a corneal thinning disorder that results in myopia and irregular astigmatism and, if left untreated, leads to visual impairment.

This study aimed to understand the current enabling factors and challenges experienced in diagnosing and managing KC.

The study setting involved public health facilities in KwaZulu-Natal (KZN).

A qualitative design within an interpretive paradigm was conducted on 22 participants who were purposively selected. Interviews were conducted and data on the participant demographics and clinical and operational systems related to KC diagnoses and management were extracted.

Among participants, 55% were from the eye care field, while 23%, 14% and 9.1% were from the supply chain management, finance and operations departments, respectively. A lack of clinical equipment, inadequate clinical infrastructure, a shortage of eye care personnel and insufficient funding emerged as barriers to the provision of comprehensive eye care to patients diagnosed with KC.

The study highlighted that the minimum standard of care expected for patients diagnosed with KC is not being met. It thus recommended that a new policy be developed or existing policies for the diagnosis ad management be reviewed.

The findings of this study are expected to inform and enhance the provision of eye care services for patients diagnosed with keratoconus within the public healthcare system.