207810 Evidence-based treatment of herpes simplex virus keratitis

Tuesday, November 10, 2009

Stephen Neely , Department of Biostatistics, University of Oklahoma, Oklahoma City, OK
Ann F. Chou, PhD, MPH , College of Public Health & College of Medicine, University of Oklahoma, Oklahoma City, OK
Rob C. Wild, MS, MPH, CPH , College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Scott Guess, MD , Department of Ophthalmology, University of Oklahoma, Oklahoma City, OK
James Chodosh, MD, MPH , Harvard Medical School - Howe Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA
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.

Learning Objectives:
Evaluate treatment adherence of eye disease as predicted by medical training

Keywords: Treatment Adherence, Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting biostatistical modeling for this analysis. I have had six years of statistical experience in the research setting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.