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• EffectivePhilosophic 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 surgeryPotential 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 reportedPotential 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 65-85% 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