The year was 1996, and Netherlands medical student Danny Haddad had just seen his first example of a woman blinded by trachoma. He photographed what looked to be an older woman but in actuality she was only in her 50s. Both eyes were scarred with the telltale evidence of trachoma—advanced to its worst conclusion, total blindness. It made an indelible impression on him, and his life was forever changed.
From that point forward, his efforts have changed the lives of many in endemic countries suffering from the ravages of trachoma. The burden of the disease, only recently coming under control, impacts entire families, local communities and trachoma patients' self worth and longevity.
The leading infectious cause of blindness in the world: trachoma
Progress is being made through the efforts of the WHO’s Alliance for the Global Elimination of Trachoma by 2020 (GET2020) and the members of the International Coalition for Trachoma Control, a membership of NGOs, professional associations, eye care and research institutions, like Emory Eye Center, and corporations. Increased awareness, identifying resources and implementing hygiene measures are strategies to facilitate disease control.
Trachoma typically is present in developing countries: it is widespread in the Middle East, North and Sub-Saharan Africa, parts of India, Southern Asia and China. There are pockets in Latin America, Australia (in remote areas) and the Pacific Islands.
Estimates are that 7.3 million people worldwide have trichiasis and need surgery. Some 2.2 million in endemic areas are visually impaired.
Trachoma more widespread among women than men. As they care for their children, the infection is passed back and forth, and they have less access to health care and are more reluctant to use it. With re-infections, blindness becomes more likely. Internal eyelid scarring and entropion lead to trichiasis and ultimately corneal scarring and blindness.
The disease can be successfully treated with both drugs and surgery. Today, prevention is key. WHO has instituted the SAFE program that field workers are using to educate many. Its components are simple:
• Surgery to correct trichiasis
• Antibiotic treatment with an annual single dose of azithromycin
• Facial cleanliness
• Environmental changes (clean water, fly control, health education)
Mass antibiotic treatment is available to areas where active trachoma affects more than 10 percent of young children. Surgical treatment for those with end-stage trachoma is being done by nurses in many cases. A fairly simple eyelid surgery allows for the eyelid to go back to its original state instead of turning inward.
There are opportunities for training for high-quality surgery using mannequins followed by more training and assessment. Haddad notes that some of the patients receiving surgery for trichiasis are often in need of surgery again, due to poor surgical skills, so that the focus now is on the quality of surgery.