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 % 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