Specialist Nurse-Led Cross-Linking Service For Keratoconus, The Leeds Experience

There has been a drive to upskill allied health professionals to reduce service burden and improve patient experience. We describe the process of successfully setting up a nurse-led corneal collagen cross-linking (CXL) service in a tertiary hospital setting.

Leeds Teaching Hospitals, United Kingdom.

This is a retrospective audit of patients undergoing accelerated CXL procedure by an advanced nurse specialist between February 2018 and May 2019.  A training scheme of theoretical knowledge and supervised practice with formal assessment was developed.  Consultants vetted suitability of cross-linking cases.  Nurse-led CXL took place during sessions where an onsite consultant was present with ongoing audit results being regularly appraised.  Data was collected using electronic patient records. Statistics were performed using GraphPad and paired t-test was used to analyse changes in tomography.

186 out of 190 patients underwent CXL for keratoconus. Of the 186 patients, 179 (96.2%) did not demonstrate any evidence of progression following cross-linking. There was a mean improvement in best corrected visual acuity (BCVA) of 0.6 lines with 69 (46.3%) of these patients demonstrating an objective improvement. There was no documented change in vision in 57 (38.3%) patients.  There were no episodes of microbial keratitis or any other adverse events following nurse-led CXL. 

Results have shown successful implantation of a safe and effective nurse-led CXL service, allowing for increased departmental capacity and flexibility and reduced patient waiting times. Furthermore, senior clinicians have been freed up and surgical capacity increased to target more complex cases.