Rivkin, Angeline

Purpose: Irreversible corneal blindness disproportionately affects low- and middle-income countries where there remains a critical demand for surgeons skilled in corneal transplantation. Penetrating keratoplasty (PK) is a critical skill for ophthalmologists, especially as it remains the most widely performed type of corneal transplant in these parts of the world. Tools to teach and assess trainees in corneal transplantation are needed to help standardize training internationally. Here, we present an Ophthalmology Surgical Competency Assessment Rubric (OSCAR) aimed at assessing the competence and progress of residents in PK. Methods: A team of cornea specialists developed a rubric for PK using previously published OSCARs as a template. The draft included 11 key steps of PK and six global indices, with a grading scale based on a modified Dreyfus model. The rubric was then reviewed for face and content validity by a panel of eight international experts using an iterative feedback process. The draft underwent multiple cycles of feedback and revisions until a consensus was reached among the authors and the international expert panel. Results: The rubric contains 11 essential steps and six global indices with descriptions of expected functioning at four levels of competency (novice, beginner, advanced beginner, and competent). Conclusions: This OSCAR for PK contributes to the global standardization of ophthalmology training, helping to meet the increasing demand for corneal transplant services with high-quality care for all.

Purpose: To assess the prevalence, associated conditions, diagnostic and treatment modalities, and provider education regarding the diagnosis and management of keratoconus (KCN) in sub-Saharan Africa (SSA) based on the currently available body of literature. Methods: Peer-reviewed publications from any year and any language were included. The databases included Cochrane Database of Systematic Reviews, Embase, and Ovid. A separate search of African Journals Online was conducted using the same Medical Subject Heading (MeSH) terms as the database search. Additional publications were identified in the references during full-text extraction. The abstracts of all publications were evaluated by two reviewers. The full text was then examined by one reviewer for inclusion. A data extraction tool was used by a single reviewer to document the findings. Results: Sixty-two publications were included in data extraction. Fourteen countries in SSA were represented. Prevalence was reported in eight SSA countries and ranged from 0% to 2.8%. The highest prevalence of 1.2% was found in a cross-sectional study in Banjul, Gambia. Diagnosis in urban areas is often made using slit lamps, although some sites had access to keratometry and/or topography, whereas rural areas use penlight exams alone. Penetrating keratoplasty was reported as an available treatment in 14 manuscripts, glasses and hard contact lenses in 10, and corneal cross-linking in two. Publications discussing provider education reported a knowledge gap. Conclusions: There is a need for increased data on KCN in SSA to better inform public health policy to improve KCN patients’ access to care and quality of life.