title: Referral pathways and management of contact lens-related microbial keratitis in Australia and New Zealand.
abstract: BACKGROUND
  We examine the referral pathways and treatment for contact lens-related microbial keratitis in Australia and New Zealand.
  
  
  METHODS
  Cases were reported in May 2003-September 2004; data on presentation, referral and treatment collected from practitioners and via patient interview. Severity was graded, 1-week cure rate estimated, delays in treatment and medications documented. Hospital and private clinic managements were compared.
  
  
  RESULTS
  A total of 297 eligible cases were reported; detailed information on treatment and referral pathways was available on a subset of these cases. Presentation was to optometrists (81/200, 41%), general practitioners (GPs) (69/200, 34%) or emergency departments (46/200, 23%). Optometrists referred to private ophthalmologists (47/79, 60%) more often than hospitals (27/79, 34%). GPs initiated treatment (39/68, 57%) but also referred to hospitals (22/68, 32%) and to private ophthalmologists (7/68, 10%). Of all cases, 67% (195/297) were managed in hospitals (29% admitted, 87/297). Hospitalized cases were predominantly managed with fortified aminoglycoside/cephalosporin (66/81, 82%) and others fluoroquinolones (168/195, 86%). Steroids were used in 36% (98/276) commencing on day 5 (median, interquartile range = 3-7). One-week cure rate was 60% (49/82) in private clinics, 72% (62/86) for hospital outpatient cases and 37% (25/67, P < 0.001) for inpatient cases, which were more severe diseases (47%, 52% and 0% mild, respectively). Delays (>/=12 h) receiving therapy were experienced by 33% (55/168) because of initial inappropriate treatment (48/55), time delays (7/55) but not remoteness (P = 0.6).
  
  
  CONCLUSIONS
  The majority of treatment is via hospital clinics, but milder disease is managed in private clinics. The referral process via optometrists, GPs and emergency departments is generally efficient; however, one-third of cases experienced some delays before receiving appropriate therapy highlighting the need for timely diagnosis.
authors.affiliation: Intitute for Eye Research and Vision CRC; School of Optometry and Vision Science, University of NSW, Australia. lkeay1@jhmi.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
authors.forename: Katie
authors.initials: K
authors.lastname: Edwards
authors.forename: Fiona
authors.initials: F
authors.lastname: Stapleton
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001315:Australia; D003261:Contact Lenses / Q000009:adverse effects*; D004632:Emergency Medical Services; D005194:Family Practice; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy*; D008875:Middle Aged; D009520:New Zealand; D009907:Optometry; D010865:Pilot Projects; D012017:Referral and Consultation; D013997:Time Factors