Shannath L. Merbs, MD, PhD: Improving Outcomes Through Research

For Shannath L. Merbs, MD, PhD, international ophthalmology is defined by what continues after the visiting surgeon returns home, including whether a procedure can be taught clearly, adopted confidently, and sustained locally.

Her work includes National Eye Institute-funded clinical trials aimed at improving surgical outcomes for trichiasis caused by trachoma, the most common infectious cause of blindness worldwide. During her recent time in Tanzania, she began a new clinical study focused on treating individuals with recurrent disease who have already undergone prior surgery. These cases involve severe disease with altered anatomy and scarring. Dr. Merbs refined a surgical technique tailored to this complexity and is evaluating its long-term outcomes

In many regions where trachoma remains endemic, the surgical workforce reflects local realities. “In many parts of Africa, because there are so few physicians, the individuals trained to perform trichiasis surgery are surgical technicians rather than doctors,” she explains. That context shapes the study, since any surgical modification must be reproducible within the existing system and transmitted clearly to the clinicians who will continue caring for patients year after year.
Within our ophthalmology department, surgical training emphasizes judgment, repetition, and improved surgical skills. The international setting makes surgical training much more challenging and requires teaching that adapts to context and extends beyond the individual case.

In Tanzania, conducting the trial requires substantial logistical coordination. Screening teams travel to rural villages to identify eligible patients, and equipment and sterile supplies are transported daily to temporary surgical sites that lack permanent infrastructure. Procedures are performed under local anesthesia, and instruction often moves through multiple layers of translation before reaching both trainees and patients. “The inability to communicate directly is one of the more frustrating aspects of the work,” she says. “Patients are awake. They are hearing everything. And you want to be able to reassure them.” Her comment captures the human dimension of the work, where surgical precision meets linguistic and cultural complexity.

Her involvement in trachoma research began with questions about recurrence patterns and evolved into sustained investigation focused on improving surgical effectiveness. This research aligns with the World Health Organization SAFE strategy, which combines surgery, antibiotics, face washing, and environmental improvements to reduce disease burden. While antibiotic programs have lowered transmission in many regions, millions of patients continue to live with established scarring, and surgical intervention remains essential to preventing blindness.

Working in settings with limited infrastructure has altered her perspective on practice at home. “Operating in those environments reinforces how well resourced we are and how easy it is to take those resources for granted,” she reflects. Shortly after returning from Tanzania, emergency maintenance at UVA required relocating her cases to an alternate clinical space, an adjustment that required coordination and flexibility while maintaining the same standard of care. The experience revealed how much institutional structure quietly supports daily surgical work in Charlottesville.

International clinical research of this scale proceeds within the structure of the department, where clinic schedules shift, colleagues absorb additional responsibilities, and operating room time is rearranged to accommodate global work. Dr. Merbs is grateful for the support of her colleagues and support staff that enable her to pursue her passion. The perspective gained abroad continues to shape her approach to surgery and teaching within the department.

For Dr. Merbs, success lies in whether refinements endure, whether they can be transmitted clearly, and whether patients benefit long after the research team has returned home. In that sense, the work is defined by solutions that last and can be taught.