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Blinding-Disease Surgery Is Done Safely in Villages, by Nonphysicians

Specially trained nurses and health assistants are as effective as ophthalmologists in performing vision-preserving surgery for a blinding disease called trachoma trichiasis, a new review has found.//

The review also found that village-based surgery was as safe and effective as surgery performed in hospitals, while reducing travel time and expense for patients.

Trachoma, an eye disease caused by bacterial infection, is the leading cause of preventable blindness worldwide. The World Health Organization estimates that 8 million people are visually impaired or blind due to trachoma. Another 84 million are at risk of losing their eyesight due to active infection with Chlamydia trachomatis, the culprit bacteria.

“There are multiple personal and societal barriers to surgery for trachoma trichiasis,” said lead author David Yorston, of the Tennent Institute of Ophthalmology in Glasgow, Scotland. “By delivering surgery in the community we can reduce the distance barrier, but it is more difficult to eliminate the others.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Although no region of the world has been untouched by trachoma, today the disease is largely confined to developing countries where poverty, crowding and a lack of clean water and hygiene fuel the transmission of infection from person to person.

A single bout of infection is not enough to cause blindness. However, with repeated infections, the inside of the upper eyelid becomes riddled with scar tissue. As the scar tissue contracts, the eyelashes turn inward and brush against the cornea. This is trichiasis.

Left untreated, the constant
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