Keratoconus in Africa

NKCF hears from patients who sometimes have trouble finding contact lens solution: imagine that inconvenience on a permanent basis.  Living with keratoconus in places like Africa presents daily challenges.

A 32-year-old from South Africa recently wrote to NKCF that he was diagnosed with KC ten years ago and underwent crosslinking.  He was subsequently fitted with GP lenses which “worked really great”.  The problem, he wrote, is the inability to get cleaning supplies for his lenses.  And so, he no longer wears them.

Two recent scientific papers highlight the keratoconus experience in Africa:

Faculty at the University of KwaZulu-Natal (UKZN) surveyed optometrists working for Dept. of Health eye clinics in this province on the east coast of South Africa.  KwaZulu-Natal has a population of more than 11 million; most of the residents are low income and get their eyecare at government-run clinics.  Thirty-six optometrists completed the survey (out of 51 eligible ODs).  Most were recent graduates of the UKZN School of Health Science.  During their optometry education, they were trained in fitting contact lenses.

The survey results were distressing.  The government-run clinics had a minimum of equipment available.  Only one clinic reported having a corneal topography machine, and none of the clinics had contact lens solution or contact lens trial fitting sets.

Patients diagnosed with keratoconus were referred to UKZN in Durban or were referred to private optometrists.  Contact lenses prescribed by a private eye doctor are an out-of-pocket expense, which poses a significant economic burden for patients.  The authors determined most keratoconus patients never received adequate follow-up care because of cost, transportation issues, or a lack of understanding about their disease.  They concluded that if government-run eye clinics were better equipped, optometrists would be able to apply the full scope of their trA second article attempted to determine the prevalence of keratoconus on the continent of Africa.  The lead authors were Dr. Prince Kwaku Akowuah OD, who trained as an optometrist in Ghana and is now conducting graduate studies at the University of Houston and Dr. Emmanuel Kobia-Acquah, OD who also trained in Ghana and is now conducting graduate research in Dublin, Ireland. aining and patient care would be improved.

The authors analyzed a dozen recent peer-reviewed articles found the rates of KC in Africa varied from 0.4% to 30.9%.  The authors estimated the continent-wide prevalence to be over 7% (among the highest rates of KC in the world).  Dr. Akowuah wrote to NKCF, “One of the highlights of our paper was the apparent lack of population-based studies in Africa, necessitating the need for more epidemiological studies to accurately quantify  prevalence and risk factors of KC in Africa.”  He also wrote, “the lack of treatment options such as gas permeable contact lenses and crosslinking is alarming.”  Drs. Akowuah and Kobia-Acquah advocate for measures that improve availability and accessibility to GP lenses.

While the mission of NKCF is to provide information to those living in the US, we share our resources with international  organizations when possible.  In 2021, NKCF participated in a zoom meeting with representatives from Lions SightFirst Eye Hospital in Nairobi, Kenya who established a volunteer network to educate the public about keratoconus.

References:  Gcabashe N, Moodley V, Hansraj R, Keratoconus management at public sector facilities in KwaZulu-Natal, South Africa: Practitioner perspectives, Afr Vision Eye Health, 81:a698, doi.org/10.4102/, 2022.

Akowuah PK, Kobia-Acquah E, Donkor R, et al, Keratoconus in Africa: A systematic review and meta-analysis, Ophthalmic & Physiological Optics, 41:736-747, 2021