Comparison of the Diagnosis and Management of Demodex Blepharitis Between Eye Care Practitioners in India and Australasia – A Survey-Based Comparison

Nikhil Sharma,1 Eilidh Martin,1 Edward Ian Pearce,1 Suzanne Hagan,1 Christine Purslow,2 Jennifer P Craig3 1Glasgow Caledonian University, Glasgow, Scotland, UK; 2Christine Purslow – School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, UK; 3Jennifer P Craig – Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New ZealandCorrespondence: Nikhil Sharma, Email [email protected]: The primary aim of this study was to compare how eyecare professionals in disparate regions of the world diagnose and manage Demodex blepharitis. A secondary aim was to explore interprofessional differences in diagnostic and management practices.Methods: Ophthalmologists and optometrists from India and Australia/New Zealand, were invited to complete an online survey on Demodex blepharitis. Clinical practice patterns relating to patients with Demodex blepharitis, with details of how they investigate and manage Demodex blepharitis in clinical practice, were collected along with clinician demographics and general perceptions on eyelid health. Mann–Whitney U, and Fisher’s exact tests were used for statistical analysis.Results: A total of 261 eyecare professionals completed the survey, comprising 207 from India (84% optometrists) and 54 from Australia and New Zealand (91% optometrists). Almost 70% of practitioners across the 3 countries recognized Demodex blepharitis as a cause of ocular discomfort, yet only 45% reported attempting to identify Demodex in their patients. There were significant differences noted in clinical practice between those in Australasia and India. Perceived prevalence of Demodex blepharitis also differed (60% in Australasia vs 27% in India; p< 0.01), as well as, the choice of slit lamp magnification used to detect the mites (25x in Australasia vs 16x in India; p = 0.02), preferred treatment option to manage Demodex blepharitis (tea tree oil in Australasia vs Standard lid hygiene in India; p = 0.01), treatment duration (from 3– 4 weeks to over 12 weeks in Australasia vs 3– 4 weeks in India; p = 0.02) and treatment application frequency (once daily in Australasia vs twice daily in India; p = 0.01).Conclusions: This study highlights differences in clinical evaluation and treatment practices between eyecare professionals in India and Australasia. Overall, practitioners in Australia and New Zealand were more evidence-based in their investigation and management. However, in both regions, interprofessional differences in perceived optimal treatment duration and frequency were reported.Keywords: Demodex blepharitis, practitioners’ perspective, ocular surface, dry eye