title: Community practice patterns for bacterial corneal ulcer evaluation and treatment.
abstract: OBJECTIVE
  To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists.
  
  
  METHODS
  A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics.
  
  
  RESULTS
  One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001).
  
  
  CONCLUSIONS
  Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.
authors.affiliation: Albert Einstein College of Medicine (J.P., K.M.L., M.R., K.J., W.B.B.), Bronx, NY; State University of New York Downstate College of Medicine (H.Z.), Brooklyn, NY; Departments of Ophthalmology and Visual Sciences (K.J., D.C.G.); and Epidemiology and Population Health (D.C.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Park
authors.forename: Kim M
authors.initials: KM
authors.lastname: Lee
authors.forename: Helen
authors.initials: H
authors.lastname: Zhou
authors.forename: Moriah
authors.initials: M
authors.lastname: Rabin
authors.forename: Kevin
authors.initials: K
authors.lastname: Jwo
authors.forename: William B
authors.initials: WB
authors.lastname: Burton
authors.forename: David C
authors.initials: DC
authors.lastname: Gritz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001431:Bacteriological Techniques; D003153:Community Health Services; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions