{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:14:36Z","timestamp":1785417276478,"version":"3.56.0"},"reference-count":46,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations which are proceeded by corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical.\n\nAim: To explore the experiences of KC patients attending public eye care facilities in Capricorn District of Limpopo province.\n\nSetting: Capricorn District, Limpopo province, South Africa.\n\nMethods: Descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews.\n\nResults: Patients reported to have developed gradual vision loss which worsened when they grew older. There was lack of knowledge of KC amongst patients and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances.\n\nConclusion: Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Programmes to promote practitioner and patient education are required to improve the perceived service level provided to KC patients.\n\nContribution: The findings of this study will assist to improve the experiences of KC patients on perceived service quality received from public facilities.<\/jats:p>","DOI":"10.4102\/phcfm.v16i1.3974","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T18:46:26Z","timestamp":1708454786000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Experiences of keratoconus patients attending public eye care facilities in South Africa"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2086-8002","authenticated-orcid":false,"given":"Pheagane M.W.","family":"Nkoana","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8199-0891","authenticated-orcid":false,"given":"Percy K.","family":"Mashige","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-974X","authenticated-orcid":false,"given":"Vanessa R.","family":"Moodley","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"key":"ref0","unstructured":"World Health Organization. Blindness and vision impairment [homepage on the Internet]. World Health Organization; 2021 [cited 2022 May 28]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/blindness-and-visual-impairment"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Romero-Jim\u00e9nez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: A review. Contact Lens Anterior Eye. 2010;33(4):157\u2013166. https:\/\/doi.org\/10.1016\/j.clae.2010.04.006","DOI":"10.1016\/j.clae.2010.04.006"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Shetty R, Khamar P, Kundu G, Ghosh A, Sethu S. Inflammation in keratoconus. Elsevier, 2023; p. 159\u2013168.","DOI":"10.1016\/B978-0-323-75978-6.00011-X"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Kymes SM, Walline JJ, Zadnik K, Gordon MO. Quality of life in keratoconus. Am J Ophthalmol. 2004;138(4):527\u2013535. https:\/\/doi.org\/10.1016\/j.ajo.2004.04.031","DOI":"10.1016\/j.ajo.2004.04.031"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Contact Lens Anterior Eye. 2022;45(3):101559. https:\/\/doi.org\/10.1016\/j.clae.2021.101559","DOI":"10.1016\/j.clae.2021.101559"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Hashemi H, Heydarian S, Hooshmand E, et al. The prevalence and risk factors for keratoconus: A systematic review and meta-analysis. Cornea. 2020;39(2):263\u2013270. https:\/\/doi.org\/10.1097\/ICO.0000000000002150","DOI":"10.1097\/ICO.0000000000002150"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Akowuah PK, Kobia-Acquah E, Donkor R, Adjei-Anang J, Ankamah-Lomotey S. Keratoconus in Africa: A systematic review and meta-analysis. Ophthalmic Physiol Opt. 2021;41(4):736\u2013747. https:\/\/doi.org\/10.1111\/opo.12825","DOI":"10.1111\/opo.12825"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Omer K. Epidemiology of keratoconus worldwide. Open Ophthalmol J. 2018;12(1):289\u2013299. https:\/\/doi.org\/10.2174\/1874364101812010289","DOI":"10.2174\/1874364101812010289"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Mohammadpour M, Heidari Z, Hashemi H. Updates on managements for keratoconus. J Curr Ophthalmol. 2018;30(2):110\u2013124. https:\/\/doi.org\/10.1016\/j.joco.2017.11.002","DOI":"10.1016\/j.joco.2017.11.002"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Barnett M, Mannis MJ. Contact lenses in the management of keratoconus. Cornea. 2011;30(12):1510\u20131516. https:\/\/doi.org\/10.1097\/ICO.0b013e318211401f","DOI":"10.1097\/ICO.0b013e318211401f"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Lamoureux EL, Pallant JF, Pesudovs K, Rees G, Hassell JB, Keeffe JE. The effectiveness of low-vision rehabilitation on participation in daily living and quality of life. Invest Ophthalmol Vis Sci. 2007;48(4):1476\u20131482. https:\/\/doi.org\/10.1167\/iovs.06-0610","DOI":"10.1167\/iovs.06-0610"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Aydin KS, Altun A, Gencaga T, Akkaya S, Sengor T. Vision related quality of life in patients with keratoconus. J Ophthalmol. 2014;2014:694542. https:\/\/doi.org\/10.1155\/2014\/694542","DOI":"10.1155\/2014\/694542"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO. Changes in the quality-of-life of people with keratoconus. Am J Ophthalmol. 2008;145(4):611\u2013617. https:\/\/doi.org\/10.1016\/j.ajo.2007.11.017","DOI":"10.1016\/j.ajo.2007.11.017"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Rensburg R. Healthcare in South Africa: How inequity is contributing to inefficiency. The Conversation; 2021 [cited 2022 May 28]. Available from: https:\/\/www.wits.ac.za\/news\/latest-news\/opinion\/2021\/2021-07\/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency.html","DOI":"10.64628\/AAJ.hkvftjycr"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Lilian RR, Railton J, Schaftenaar E, et al. Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package. PLoS One. 2018;13(5):e0197432. https:\/\/doi.org\/10.1371\/journal.pone.0197432","DOI":"10.1371\/journal.pone.0197432"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Nkoana PM, Moodley VR, Mashige KP. Self-reported knowledge and skills related to diagnosis and management of keratoconus among public sector optometrists in the Limpopo province, South Africa. Afr J Prim Health Care Fam Med. 2022;14(1):1\u20139. https:\/\/doi.org\/10.4102\/phcfm.v14i1.3668","DOI":"10.4102\/phcfm.v14i1.3668"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Van Staden D, Buthelezi LM. Integrating eye health into policy: Evidence for health systems strengthening in KwaZulu-Natal. Afr Vis Eye Health. 2020;79(1):a549. https:\/\/doi.org\/10.4102\/aveh.v79i1.549","DOI":"10.4102\/aveh.v79i1.549"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Pinto RD, Abe RY, Gomes FC, et al. Quality of life in keratoconus: Evaluation with Keratoconus Outcomes Research Questionnaire (KORQ). Sci Rep. 2021;11(1):1\u20139. https:\/\/doi.org\/10.1038\/s41598-021-92346-1","DOI":"10.1038\/s41598-021-92346-1"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Rebenitsch RL, Kymes SM, Walline JJ, Gordon MO. The lifetime economic burden of keratoconus: A decision analysis using a markov model. Am J Ophthalmol. 2011;151(5):768\u2013773. https:\/\/doi.org\/10.1016\/j.ajo.2010.10.034","DOI":"10.1016\/j.ajo.2010.10.034"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Crewe JM, Morlet N, Morgan WH, et al. Quality of life of the most severely vision-impaired. Clin Exp Ophthalmol. 2011;39(4):336\u2013343. https:\/\/doi.org\/10.1111\/j.1442-9071.2010.02466.x","DOI":"10.1111\/j.1442-9071.2010.02466.x"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Kawahara T. Intelligent transcription system based on spontaneous speech processing. In: Proceedings \u2013 Second international conference on Informatics Research for Development of Knowledge Society Infrastructure, ICKS 2007. Kyoto: IEEE, 2007; p. 19\u201326.","DOI":"10.1109\/ICKS.2007.13"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Nikander P. Working with transcripts and translated data. Qual Res Psychol. 2008;5(3):225\u2013231. https:\/\/doi.org\/10.1080\/14780880802314346","DOI":"10.1080\/14780880802314346"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC Psychiatry. 2019;19(1):426. https:\/\/doi.org\/10.1186\/s12888-019-2387-x","DOI":"10.1186\/s12888-019-2387-x"},{"key":"ref23","unstructured":"Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland J High Educ. 2017;9(3):3351\u201333514."},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Mutlu S, \u00c7etinkaya A, Y\u0131lmaz E. Emergency service perceptions and experiences of patients: \u2018Not A Great Place, But Not Disturbing\u2019. J Patient Exp. 2021;8:23743735211034298. https:\/\/doi.org\/10.1177\/23743735211034298","DOI":"10.1177\/23743735211034298"},{"key":"ref25","unstructured":"Creswell J, Poth C. Qualitative inquiry and research design. 4th ed. Thousand Oaks, CA: Sage; 2018."},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Choi JA, Kim MS. Progression of keratoconus by longitudinal assessment with corneal topography. Invest Ophthalmol Vis Sci. 2012;53(2):927\u2013935. https:\/\/doi.org\/10.1167\/iovs.11-8118","DOI":"10.1167\/iovs.11-8118"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Chia E-M, Mitchell P, Ojaimi E, Rochtchina E, Wang JJ. Assessment of vision-related quality of life in an older population subsample: The Blue Mountains Eye Study. Opthalmic Epidemiol. 2009;13(6):371\u2013377. https:\/\/doi.org\/10.1080\/09286580600864794","DOI":"10.1080\/09286580600864794"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Orta A\u00d6F, \u00d6zt\u00fcrker ZK, Erkul S, Bayraktar \u015e, Yilmaz OF. The correlation between glaucomatous visual field loss and vision-related quality of life. J Glaucoma. 2015;24(5):e121\u2013e127. https:\/\/doi.org\/10.1097\/IJG.0000000000000225","DOI":"10.1097\/IJG.0000000000000225"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Cheng HC, Guo CY, Chen MJ, Ko YC, Huang N, Liu CJ. Patient-reported vision-related quality of life differences between superior and inferior hemifield visual field defects in primary open-angle glaucoma. JAMA Ophthalmol. 2015;133(3):269\u2013275. https:\/\/doi.org\/10.1001\/jamaophthalmol.2014.4908","DOI":"10.1001\/jamaophthalmol.2014.4908"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Vazirani J, Basu S. Keratoconus: Current perspectives. Clin Ophthalmol. 2013;7:2019\u20132030. https:\/\/doi.org\/10.2147\/OPTH.S50119","DOI":"10.2147\/OPTH.S50119"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Moshirfar M, Heiland MB, Rosen DB, Ronquillo YC, Hoopes PC. Keratoconus screening in elementary school children. Ophthalmol Ther. 2019;8(3):367. https:\/\/doi.org\/10.1007\/s40123-019-0199-1","DOI":"10.1007\/s40123-019-0199-1"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Maake ME, Moodley VR. An evaluation of the public sector optometric service provided within the health districts in KwaZulu-Natal, South Africa. Afr Vis Eye Health. 2018;77(1):a407. https:\/\/doi.org\/10.4102\/aveh.v77i1.407","DOI":"10.4102\/aveh.v77i1.407"},{"key":"ref33","unstructured":"Hirsch L. Visual impairments factsheet [homepage on the Internet]. KidsHealth; 2021 [cited 2022 Jun 17]. Available from: https:\/\/kidshealth.org\/en\/parents\/vision-factsheet.html"},{"key":"ref34","unstructured":"Willings C. Common visual impairments \u2013 Teaching students with visual impairments [homepage on the Internet]. Teaching visually impared. 2022 [cited 2022 Jun 17]. Available from: https:\/\/www.teachingvisuallyimpaired.com\/common-visual-impairments.html"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Moschos MM, Nitoda E, Georgoudis P, Balidis M, Karageorgiadis E, Kozeis N. Suppl-1, M8: Contact lenses for keratoconus-current practice. Open Ophthalmol J. 2017;11:241. https:\/\/doi.org\/10.2174\/1874364101711010241","DOI":"10.2174\/1874364101711010241"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"McMonnies CW. Inflammation and keratoconus. Optom Vis Sci. 2015;92(2):e35\u2013e41. https:\/\/doi.org\/10.1097\/OPX.0000000000000455","DOI":"10.1097\/OPX.0000000000000455"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Baenninger PB, Bachmann LM, Iselin KC, et al. Mismatch of corneal specialists\u2019 expectations and keratoconus knowledge in general ophthalmologists \u2013 A prospective observational study in Switzerland. BMC Med Educ. 2021;21(1):297. https:\/\/doi.org\/10.1186\/s12909-021-02738-0","DOI":"10.1186\/s12909-021-02738-0"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Nkoana PMW, Moodley VR, Mashige KP. Keratoconic patient profile and management at public sector facilities in South Africa. Afr Vis Eye Health. 2023;82(1):a780. https:\/\/doi.org\/10.4102\/aveh.v82i1.780","DOI":"10.4102\/aveh.v82i1.780"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Mofokeng MS, Reid M, Pienaar M, Nel M. Health literacy of Sesotho-speaking patients diagnosed with chronic conditions in South Africa. Afr J Prim Health Care Fam Med. 2022;14(1):1\u20136.","DOI":"10.4102\/phcfm.v14i1.3627"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Pinquart M, Pfeiffer JP. Associations of extroversion and parental overprotection with forming relationships with peers among adolescents with and without visual impairments. J Vis Impair Blind. 2019;105(2):96\u2013107. https:\/\/doi.org\/101177\/0145482X1110500207.","DOI":"10.1177\/0145482X1110500207"},{"key":"ref41","unstructured":"Childline SA. Bullying \u2013 Childline South Africa [homepage on the Internet]. Chilldline SA. [cited 2022 Jun 17]. Available from: https:\/\/www.childlinesa.org.za\/children\/for-children\/issues-affecting-you\/bullying\/"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Rose CA, Monda-Amaya LE, Espelage DL. Bullying perpetration and victimization in special education: A review of the literature. Remedial Spec Educ. 2011;32(2):114\u2013130. https:\/\/doi.org\/10.1177\/0741932510361247","DOI":"10.1177\/0741932510361247"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Rose CA, Monda-Amaya LE. Bullying and victimization among students with disabilities: Effective strategies for classroom teachers. Interv Sch Clin. 2012;48(2):99\u2013107. https:\/\/doi.org\/10.1177\/1053451211430119","DOI":"10.1177\/1053451211430119"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Iskandarsyah A, De Klerk C, Suardi DR, Soemitro MP, Sadarjoen SS, Passchier J. Psychosocial and cultural reasons for delay in seeking help and nonadherence to treatment in Indonesian women with breast cancer: A qualitative study. Health Psychol. 2014;33(3):214. https:\/\/doi.org\/10.1037\/a0031060","DOI":"10.1037\/a0031060"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Stevelink SAM, Malcolm EM, Fear NT. Visual impairment, coping strategies and impact on daily life: A qualitative study among working-age UK ex-service personnel Health behavior, health promotion and society. BMC Public Health. 2015;15(1):1118. https:\/\/doi.org\/10.1186\/s12889-015-2455-1","DOI":"10.1186\/s12889-015-2455-1"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"link":[{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/3974\/6843","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/3974\/6844","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/3974\/6845","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/3974\/6846","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/3974\/6846","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T09:05:57Z","timestamp":1776071157000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/3974"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12,21]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v16i1.3974","relation":{},"ISSN":["2071-2928","2071-2936"],"issn-type":[{"value":"2071-2928","type":"print"},{"value":"2071-2936","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]},"article-number":"a3974"}}