Trachomatous trichiasis (TT, inturning of the eyelashes to touch the eye following longterm infection with Chlamydia trachomatis) affects over seven million people world-wide. Corrective eyelid surgery is the recommended treatment for TT. A study published in PLOS Neglected Tropical Diseases 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. WHO 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).
Picture by Esmael Habtamu
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".