Fiona Stapleton PhD

Publications (2)3.95 Total impact

• Article: Referral pathways and management of contact lens‐related microbial keratitis in Australia and New Zealand

  Lisa Keay PhD, Katie Edwards BAppSci, Fiona Stapleton PhD
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  ABSTRACT: Background:  We examine the referral pathways and treatment for contact lens-related microbial keratitis in Australia and New Zealand.Methods:  Cases were reported in May 2003–September 2004; data on presentation, referral and treatment collected from practitioners and via patient interview. Severity was graded, 1-week cure rate estimated, delays in treatment and medications documented. Hospital and private clinic managements were compared.Results:  A total of 297 eligible cases were reported; detailed information on treatment and referral pathways was available on a subset of these cases. Presentation was to optometrists (81/200, 41%), general practitioners (GPs) (69/200, 34%) or emergency departments (46/200, 23%). Optometrists referred to private ophthalmologists (47/79, 60%) more often than hospitals (27/79, 34%). GPs initiated treatment (39/68, 57%) but also referred to hospitals (22/68, 32%) and to private ophthalmologists (7/68, 10%). Of all cases, 67% (195/297) were managed in hospitals (29% admitted, 87/297). Hospitalized cases were predominantly managed with fortified aminoglycoside/cephalosporin (66/81, 82%) and others fluoroquinolones (168/195, 86%). Steroids were used in 36% (98/276) commencing on day 5 (median, interquartile range = 3–7). One-week cure rate was 60% (49/82) in private clinics, 72% (62/86) for hospital outpatient cases and 37% (25/67, P < 0.001) for inpatient cases, which were more severe diseases (47%, 52% and 0% mild, respectively). Delays (≥12 h) receiving therapy were experienced by 33% (55/168) because of initial inappropriate treatment (48/55), time delays (7/55) but not remoteness (P = 0.6).Conclusions:  The majority of treatment is via hospital clinics, but milder disease is managed in private clinics. The referral process via optometrists, GPs and emergency departments is generally efficient; however, one-third of cases experienced some delays before receiving appropriate therapy highlighting the need for timely diagnosis.
  Clinical and Experimental Ophthalmology 03/2008; 36(3):209 - 216. · 1.98 Impact Factor
• Article: Evaluation of surveillance methods for an epidemiological study of contact lens related microbial keratitis

  Lisa Keay BOptom, Katie Edwards BAppSci(Optom, Garry Brian FRANZCO, Thomas Naduvilath PhD, Fiona Stapleton PhD
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  ABSTRACT: Purpose: To evaluate surveillance methods in a pilot epidemiological study of contact lens related microbial keratitis (MK) cases identified by ophthalmic practitioners in Australia and New Zealand between May and August 2003 inclusive.Methods: Twelve ophthalmologists and 55 optometrists from rural and metropolitan locations were sent a study information pack with postal reporting forms. After 2 months, practitioners were emailed a link to a website for Internet reporting. After 4 months, practitioners were prompted by email and then by telephone if a response was not received. Passive response rates were the rate of returns after posting information and emailing the website link. Active response rates included personalized email and telephone follow-up.Results: Ten cases of MK were identified by optometrists and five by ophthalmologists. The passive response rates were 79% and 58% for the first and second reporting periods, respectively. There was a lower response rate in the second reporting period compared to the first (P = 0.02). With active surveillance the response rate increased to 97% and 96%. A large proportion of optometrists (62%) and ophthalmologists (55%) used the website for at least one reporting period. Internet reporting was used by all New Zealand practitioners (5/5).Conclusions: A surveillance study to estimate the incidence of contact lens related MK in Australia and New Zealand is feasible and acceptable. Internet-based reporting offers a reliable, rapid and cost-effective means of running a large scale, international surveillance study. Active surveillance methods are necessary to enhance reporting rates.
  Clinical and Experimental Ophthalmology 07/2004; 32(4):349 - 353. · 1.98 Impact Factor