Evidence-based treatment of herpes simplex virus keratitis

Background: Herpes simplex virus (HSV) keratitis is a common cause of ocular and visual morbidity. Since the release of the first antiviral agent in 1962, treatment options have expanded considerably. A recent systematic review delineated the best available evidence for appropriate treatment. However, provider adherence to best practices may be affected by time and the type of training they have received.

Objective: The goal of this study was to determine if therapy for HSV eye disease differs by provider types.

Methods: A survey was administered to 361 ophthalmologists (MD/DO) and 253 optometrists (OD). Respondents were asked to complete their demographic and practice profile, as well as rank six treatments (from most to least appropriate) for three variants of HSV (Variant 1=dendritic HSV epithelial keratitis, Variant 2=HSV stromal keratitis, and Variant 3=recurrent HSV stromal keratitis). Logistic regression analyses were conducted to estimate the likelihood of achieving adherence as a function of training, controlling for demographic and practice characteristics.

Results: Seventy-six-percent of respondents were male, 32.6% were age 40 or younger, and 82% were in private practice. Treatment of HSV keratitis differed by training. Ophthalmologists were 2.20 (95% CI: 1.36, 3.56), 2.59 (95% CI: 1.70, 3.96), and 1.91 (95% CI: 1.22, 2.98) times as likely to prescribe appropriate treatment compared to their counterparts in optometry, for Variants 1, 2, and 3, respectively.

Conclusion: Our findings show that training is a predictor for appropriate HSV treatment. Treatment guidelines for HSV keratitis may be indicated to better communicate best practices to all eye care providers.