Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia.

Esmael Habtamu,Kelly Callahan,Mulat Zerihun,Saul N Rajak,Zebideru Zewudie,Sarah Polack,Helen A Weiss,Matthew J Burton,David C W Mabey,Robin L Bailey,Paul M Emerson,Zerihun Tadesse,Hannah Kuper,Sintayehu Aweke,Tariku Wondie,Aderajew Mohammed,Joseph M Vinetz

doi:10.1371/journal.pntd.0004627

Abstract

BackgroundTrachomatous 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 FindingsWe 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/SignificanceTrichiasis 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.

Highlights

Trachoma, an eye disease caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide [1]
We previously reported that Trachomatous Trichiasis (TT) has a profound impact on vision and heath related quality of life (QoL), even when vision is not impaired
We found strong evidence that surgery substantially improves both vision and heath related QoL of TT case, even when there is no improvement in vision; while there was no evidence of improvement in the QoL of the trichiasis free participants

Summary

Introduction

An eye disease caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide [1]. Trachomatous trichiasis is a painful condition, which can have a major impact on the individual’s general health and wellbeing, even prior to the development of visual impairment [4]. It may have major socioeconomic consequences for affected families and communities [4,5,6]. We have previously reported that trichiasis adversely impacts vision and health related quality of life (QoL), even before visual impairment develops [7]. Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia

Methods

Results

Discussion

Conclusion