Preventing Trachoma

Dr Victor Hu explains

I was delighted to be successfully awarded the Barrie Jones Fellowship by BCPB in 2008 to conduct research into blinding trachoma. Trachoma is caused by infection with chlamydia trachomatis and is an important cause of global blindness, especially in poor, rural areas. Children are at risk of scarring of the ocular surface in later life with progression to corneal scarring and blindness. As well as vision loss, affected individuals also suffer debilitating pain from infections causing severe conjunctivitis, with eyelashes rubbing against the eye.

When I was awarded the Fellowship I was part way through Registrar training in ophthalmology in the UK. I had previously completed medical school training, general medical posts and several years of initial ophthalmic training. Gaining the Fellowship allowed me to take time out of clinical training to complete three years of dedicated research training and undertake a PhD.

This research was conducted with the International Centre for Eye Health and the London School of Hygiene & Tropical Medicine and was also supported by the Wellcome Trust. The School has a long history of research in a developing world context and is an established trachoma research centre. I was privileged to be able to work with dedicated and highly experienced colleagues and supervisors.

The research I undertook involved studying the pathogenesis of the scarring process in trachoma. While most children in trachoma endemic areas will be infected with chlamydia trachomatis, not all go on to develop blindness. We were interested in identifying what factors were involved in driving the scarring process. The research was conducted at the base of Mount Kilimanjaro in northern Tanzania, where high levels of trachoma exist. This is particularly the case amongst remote Maasai communities found in this region. Blinding trachoma results from a combination of poor water supply and facial hygiene, being surrounded by flies from cattle, and crowded living conditions.

An initial survey of 3,500 people was undertaken in an isolated village, with 2,500 individuals being examined for signs of trachoma. A cohort of 800 people with scarring from trachoma agreed to be enrolled into a study involving examinations every six months for two years. An additional 300 individuals without scarring entered a case-control study for comparison. Swabs from the eye were taken for the presence of infection, and also for gene expression to look at molecular processes in affected tissue. We were also able to procure an in vivo confocal microscope.

Since Dr Hu finished this project he has gone on to coordinate a mentoring programme to help overseas ophthalmologists develop their practices. The work he is doing now, shows how a small investment can have a cascade effect where skills and knowledge are disseminated to others.

An update about this work will be added soon