Development of a Web-Based Algorithm for Understanding the Intraocular Lens-Based Surgery in Stable and Progressing Keratoconus for Non-Specialist Ophthalmologists

To propose an algorithm to facilitate lens-based surgery in keratoconus. A literature review was performed to prepare a software algorithm based on cone location, stability, best spectacle-corrected distance visual acuity (BSCVA) level and whether there is a clear or cataractous lens. The software usability was assessed through a 10-question questionnaire and two hypothetical keratoconus case histories (moderately simple and moderately complex) given to 15 trainees. The usability questionnaires were graded on a Likert scale (1 = strongly disagree to 5 = strongly agree) and two case histories (1 = very difficult to 7 = very easy). The algorithm can be found at https://www.sussexeyelaserclinic.co.uk/keratoconus/. Thirteen trainees completed the questionnaire. 91.9% would frequently use it; for 100%, it was easy to use independently without technical support; for 63.7%, it was strongly integrated; for 100%, it was consistent; 100% thought that most people would learn to use it quickly, 91.9% found the system not cumbersome to use, felt very confident to use it and need not learn a lot to use it. The first case was found easy by 63.7% and the second by 45%. We present an algorithm as a guide for lens-based surgery in stable and progressing keratoconus, which is classified based on cone location. This algorithm will help trainee and “non-specialist” ophthalmic surgeons understand the pre-operative planning for the surgery and referral to the “specialist” corneal surgeon, considering factors such as progression, BSCVA, keratometry, topography and apex location of the cone in keratoconus patients.

本研究旨在提出一种辅助圆锥角膜透镜类手术的算法。本研究通过文献调研，结合圆锥顶点位置、病变稳定性、最佳框架矫正远视力（best spectacle-corrected distance visual acuity, BSCVA）水平以及晶状体是否透明或伴发白内障等维度，开发了一款配套软件算法。本研究向15名眼科受训医师发放包含10个问题的易用性问卷，并提供两份模拟圆锥角膜病例（分别为中度简易型与中度复杂型），以此评估该软件的易用性。其中易用性问卷采用李克特5级评分量表（1分=完全不同意，5分=完全同意），病例操作难度评估采用7级评分量表（1分=极为困难，7分=极为简单）。该算法的公开获取地址为：https://www.sussexeyelaserclinic.co.uk/keratoconus/。本次调研共有13名受训医师完成问卷。调研结果显示：91.9%的受访者表示会频繁使用该工具；100%的受访者认为无需技术支持即可独立便捷地操作该系统；63.7%的受访者认为系统整合性极强；100%的受访者认为系统操作逻辑统一；100%的受访者认为多数用户可快速掌握其使用方法；91.9%的受访者认为系统操作并不繁琐，使用时信心充足且无需投入大量学习成本。针对两份模拟病例，63.7%的受访者认为第一例操作难度偏低，45%的受访者认为第二例操作难度偏低。本研究提出的算法可作为稳定型及进展型圆锥角膜患者透镜类手术的辅助指导工具，其分类依据为圆锥顶点位置。该算法可帮助眼科受训医师及非专科眼科医师明确圆锥角膜患者的术前规划流程，并指导其转诊至专科角膜病医师，参考维度包括病变进展情况、BSCVA、角膜曲率、角膜地形图以及圆锥顶点位置等。