Best practices for trichiasis surgery
Why do we need “best
practices” for trichiasis surgery?
• Trichiasis continues to be a major cause of
blindness & disability
– Surgeries considerably fewer than needed to
eliminate backlog
– Quality of outcomes not as good as needed
• Research carried out in the past few years
provides evidence for improvements to:
– Surgery itself
– Training and supervision
– Programmatic approaches
Defining a “best practice”:
Philosophic approaches
Best practice:
• Efficient
• Effective
Philosophic
approach:
• Patient centered care
• Quality of service
important
• Evidence needed to
guide actions
• Health systems need
strengthening
Improving surgery
Problems:
• Considerable variation in
TT surgical outcome
– Poor outcome often high
– Some patients need follow
up surgery
– Evidence suggests
outcome could be improved
Improving surgery
Potential solutions:
• Post op follow up within 6 mo.
• Improve training (short incision
length associated with post
operative TT)
• Certification (need to follow
Final Assessment Manual)
• Maintain sterility
• Management of recurrence
should be tailored to clinical
features & patient needs
Can we improve the surgery training?
Problems:
• Attrition of TT surgeons often
high
• Dedicated eye workers doing
most surgery
Potential solutions:
• Selection of trainees needs
clear criteria (including
binocular vision & manual
dexterity)
• Train/use more dedicated eye
workers
• Develop training of trainers
manual
Supervision of TT surgeons
Problems:
• Minimal supervision in
place
• Outcome rarely reported
Potential solutions:
• Include supportive
supervision as part of
HSS
• Identify surgeon
supervisor as team leader
(training needed)
• Develop supervision
guidelines
Are we going to meet our TT targets?
Problems:
• At current productivity
levels 28 yrs needed to
address existing
backlog
• Campaign/outreach
often account for 6585% of total surgeries
• Static service alone
insufficient (current
approaches to train and
deploy general health
workers insufficient)
Are we going to meet our TT targets?
Potential solutions:
• Campaign/outreach
needed
• Will require additional
dedicated eye care
personnel
• Manual on how to conduct
efficient/effective outreach
needed
Summary
• All aspects of
trichiasis surgical
service delivery
needs revision
–
–
–
–
Selection of surgeons
Training of surgeons
Mobilization
Outreach
• Use evidence to
guide actions
• Reaching elimination
possible