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Community Practice Patterns for Bacterial Corneal Ulcer Evaluation and Treatment

Park, Jennifer B.S.; Lee, Kim M. B.S.; Zhou, Helen B.S.; Rabin, Moriah B.A.; Jwo, Kevin M.D.; Burton, William B. Ph.D.; Gritz, David C. M.D., M.P.H.

Eye & Contact Lens: Science & Clinical Practice: January 2015 - Volume 41 - Issue 1 - p 12–18
doi: 10.1097/ICL.0000000000000059

Objective: To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists.

Methods: A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics.

Results: One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001).

Conclusions: Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.

Supplemental Digital Content is Available in the Text.

Albert Einstein College of Medicine (J.P., K.M.L., M.R., K.J., W.B.B.), Bronx, NY; State University of New York Downstate College of Medicine (H.Z.), Brooklyn, NY; Departments of Ophthalmology and Visual Sciences (K.J., D.C.G.); and Epidemiology and Population Health (D.C.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Address correspondence and reprint requests to David C. Gritz, M.D., M.P.H., Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467; e-mail:

Supported in part from a Research to Prevent Blindness Foundation unrestricted institutional grant award and Medical Student Summer Research Fellowship awards from the Albert Einstein College of Medicine.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal's Web site (

Accepted June 10, 2014

© 2015 Contact Lens Association of Ophthalmologists, Inc.