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M. A. Wolle, S. D. Cassard, E. W. Gower, B. E. Munoz, W. Alemayehu, S. K. West; Impact of Trichiasis Surgery on Physical Functioning in Ethiopian Patients: STAR Trial. Invest. Ophthalmol. Vis. Sci. 2010;51(13):944.
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Trachoma, an ocular infection caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Approximately 150 million children have active trachoma, and about 1.3 million people, mainly adults, are blinded from the late sequelae, trichiasis. Trichiasis surgery is done to prevent further visual loss. Previous research has shown that surgery improves photophobia, and ocular pain, and even restores some visual acuity, but it is unclear if the surgery actually improves the lives of the trichiasis patients. Here, we evaluate the physical functioning of Ethiopian trichiasis surgery patients pre and 6 months post surgery.
This study was nested within the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) clinical trial; participants recruited during the third recruitment period were included in this sub-study. Demographic information, full ocular examinations, and physical functioning assessments were collected before and 6 months after surgery. Trichiasis surgery was performed in at least 1 eye. Visual acuity was measured using standard illiterate E versions of the Early Treatment Diabetic Retinopathy Study charts. Physical functioning was assessed using an instrument previously validated in a study of trichiasis patients in a rural setting in Tanzania;Ethiopia specific questions were added, based on field-testing.
Four hundred twenty participants were evaluated at baseline. Of the 420 participants, 411 had complete 6-month follow-up data, of whom 74% were women. 50% showed signs of severe trichiasis and 80% had bilateral trichiasis at baseline. Overall, 70% of individuals reported at least some difficulty with at least one activity of daily living at baseline. However, women were more likely to report some difficulty with at least one activity (74% vs. 58%; p = 0.002). At follow up, the percentage of individuals reporting difficulty with one or more activities of daily living decreased significantly; only 38% of individuals reported difficulty with at least one activity at follow up.
Surgery to correct trichiasis appears to improve patients’ physical functioning. More effort in promoting trichiasis surgery is essential; not only to prevent corneal blindness but also to enable improved functioning in daily life.
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