Early treatment of corneal abrasions and ulcers–estimating clinical and economic outcomes

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Early treatment of corneal abrasions and ulcers–estimating clinical and economic outcomes


JournalThe Lancet Regional Health – Southeast Asia
Article typeJournal research article – Clinical research
Publication date – Jul – 2022
Authors – Varsha M. Rathi, Praveen Thokala, Sheila MacNeil, Rohit C. Khanna, Peter N. Monk, Prashant Garg
KeywordsCorneal abrasion, Corneal ulcer, Early treatment, health economics, health policy
Open access – Yes
SpecialityOphthalmology
World region Southern Asia
Country: India
Language – English
Submitted to the One Surgery Index on July 28, 2022 at 12:38 am
Abstract:

Background
In low-and-middle income countries, corneal abrasions and ulcers are common and not always well managed. Previous studies showed better clinical outcomes with early presentation and treatment of minor abrasions, however, there have been no formal studies estimating the financial impact of early treatment of abrasions and ulcers compared to delayed treatment.

Methods
We used the LV Prasad Eye Institute’s (LVPEI’s) electronic health record system (eyeSmart) to estimate the impact of early presentation on clinical outcomes associated with abrasions and ulcers. 861 patients with corneal abrasion and 1821 patients with corneal ulcers were studied retrospectively, and 134 patients with corneal abrasion prospectively. A health economic model was constructed based on LVPEI cost data for a range of patient scenarios (from early presentation with abrasion to late presentation with ulcer).

Findings
Our findings suggest that delayed presentation of corneal abrasion results in poor clinical and economic outcomes due to increased risk of ulceration requiring more extensive surgical management, increasing associated costs to patients and the healthcare system. However, excellent results at low cost can be achieved by treatment of patients with early presentation of abrasions at village level health care centres.

Interpretation
Treatment of early minor corneal abrasions, particularly using local delivery of treatment, is effective clinically and economically. Future investment in making patients aware of the need to react promptly to corneal abrasions by accessing local healthcare resources (coupled with a campaign to prevent ulcerations occurring) will continue to improve clinical outcomes for patients at low cost and avoid complex and more expensive treatment to preserve sight.

Funding
This research was funded by the Medical Research Council, grant MR/S004688/1.

OSI Number – 21671

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