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
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