TT surgery improves both vision and health

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Corrective eyelid surgery is the recommended treatment for trachomatous trichiasis (TT, in-turning of the eyelashes to touch the eye following long-term infection with Chlamydia trachomatis) that affects over 7m people world-wide. Now a study reports that surgery substantially increases the quality of life (QoL) for affected people, even when their vision is not improved.

TT can cause vision loss over time and is the major cause of infectious blindness in the world. Besides compromising eye health, TT also causes social withdrawal and exclusion, as well as inability to work and earn an income. The World Health Organisation has developed and validated several tools for measuring health-related quality-of-life. These include a questionnaire designed to measure vision-related quality of life (VRQoL), and one which measures general health-related quality of life (HRQoL).

Using the two questionnaires, Esmael Habtamu from the London School of Hygiene and Tropical Medicine in London, UK, and colleagues had previously reported that TT has a profound impact on vision- and health-related QoL, even for patients with good vision. In this study, the researchers measured vision- and health-related quality of life of 1000 TT patients in Ethiopia (the country with the highest disease burden) before and 12 months after TT surgery and calculated the changes.

To control for effects not related to the surgery, they compared these QoL scores with the baseline and 1 year follow-up scores of 200 ‘matched’ individuals (that is, people of the same sex, similar age, and living in the same village) who had never had trichiasis or eye surgery.

TT surgery, the researchers found, significantly improved both vision- and health-related QoL of people with TT, even in patients who had no improvement in vision (although larger gains in VRQoL were seen in those with improved vision). In contrast, they saw no substantial improvement in the QoL of the trichiasis-free participants (who were sharing the same environment over the study period). Improvements highlighted by patients who had the surgery included less pain and irritation as well as increased capacity to work.

Their results, the researchers say, “provide clear evidence that the benefit of trichiasis surgery goes beyond preventing the risk of blindness and improves the overall wellbeing and health perception of affected individuals, indicating the need to provide prompt surgical intervention for affected individuals”.

Background: Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia.
Methodology/Principal Findings: We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1–42.0 points (p<0.0001) and 4.7–17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months.
Conclusions/Significance: Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve overall wellbeing and health perception of affected individuals.

PLOS journals material
PLOS Neglected Tropical Diseases abstract

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