Best practices for trichiasis surgery

1. Best practices for trichiasis surgery

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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