Developed by

LIONS ARAVIND INSTITUTE OF COMMUNITY OPHTHALMOLOGY

ARAVIND EYE CARE SYSTEM

equipping a secondaryeye hospital

A VISION 2020 HANDBOOK ON

A Publication of VISION 2020 The Right to Sight, INDIA

PPPPPublished bublished bublished bublished bublished byyyyyVISION 2020 The Right to SightS-390, Double Storey, Ground FloorNew Rajinder NagarNew Delhi - 110 060; IndiaPhone : 91-11-42411542 / 42411518Fax :91-11-42412107www.vision2020india.org

DDDDDeveveveveveloped beloped beloped beloped beloped byyyyyLions Aravind Institute of Community OphthalmologyAravind Eye Care System72, Kuruvikaran Salai, Gandhi NagarMadurai - 625 020; IndiaPhone: 0452 - 435 6500Fax : 91-452-253 0984www.aravind.org

PPPPPrinted atrinted atrinted atrinted atrinted atLeo prints, Madurai

JJJJJune 2008une 2008une 2008une 2008une 2008

Preface

With the rapid advancement of technology over the last decade, the field of Ophthalmology hasgrown to be significantly equipment - intensive both in the diagnostic and surgical areas.Refractive errors and cataract continue to account for significant workload in eye care. Over theyears these two conditions have become the focus of secondary level eye care settings where bulkof the curative eye care is delivered.

However, from a quality perspective it is important to go beyond cataract and refractive errors toensure comprehensive eye examinations and appropriate service delivery that includes referralcare. Thus for both diagnoses and treatment, a secondary eye hospital needs to be equipped witha comprehensive range of equipment.

The term “secondary hospital” is not very well defined, and may refer to anything from a basiccataract clinic, to a hospital offering more advanced care. Hence several factors need to be takeninto consideration when equipping a secondary eye hospital in terms of what equipment andhow many of each. The major factors are:

- range of clinical services that the hospital plans to offer- the clinical protocols to be followed and the estimated work-flow- the daily patient load the hospital expects- staffing pattern and the number of clinical staff

The hospital will need to have enough equipment and in the right balance to be able toefficiently use the time of both the ophthalmologists and the support staff.

Recognizing the role of the influencing factors described above, this manual briefly touchesupon preferred clinical protocols for various procedures and lists the equipment required toperform them. The manual includes equipment in a model secondary hospital for an assumedworkload and also gives a listing of equipment manufacturers. The purpose of this Manual onEquipping a Secondary Hospital is to throw light on the above to help hospital administratorsand funding agencies understand the rationale that should be applied while planning forequipment and other resources.

R.D. Thulasiraj

Executive Director,

LAICO - Aravind Eye Care System

Acknowledgement

We deeply appreciate the support given by VISION 2020 - The Right to Sight – India, incontributing to the cost of developing the manual and more importantly reviewing the manual.We are extremely thankful to Dr. Rajesh Noah, the Executive Director of VISION - 2020 TheRight to Sight – India for organizing and coordinating the review process. We are indebted tothe members of the review panel Dr. Lalit Verma-AIOS, Dr. Sara Varghese - CBM,Dr. Taraprasad Das-LVPEI, Dr. G.V.Rao-ORBIS, Dr. Cherian Varghese-WHO for theirpainstaking efforts to give a very detailed feedback. We acknowledge Dr. Ismael Cordero ofORBIS International for the section on procurement management. This manual was developedover a period of time, and several people contributed, while we acknowledge the inputs ofeveryone. We would particularly thank Faculty members of Aravind Eye Hospital - Dr. Prajna,Dr. R.D. Ravindran, Mr. S.P. Venkatesh, Ms. Deepa and the DTP team for their contribution.

CONTENTS

CHAPTER – I INTRODUCTION 11. Magnitude of Global blindness2. Blindness in India3. Combating blindness

CHAPTER – II SECONDARY EYE HOSPITAL 41. Introduction2. Workload estimation and infrastructure3. Human resources4. Instruments and equipment

CHAPTER – III MEDICAL RECORDS 71. Introduction2. Systems and procedures3. Instruments and equipment

CHAPTER – IV OUTPATIENT DEPARTMENT 91. General OPD services2. Refraction services

CHAPTER – V STERILISATION 141. Introduction2. Serilisation3. Advice on autoclaving

CHAPTER – VI CATARACT SERVICES 171. Pre-operative procedures2. Surgical procedures3. Post-operative procedures4. OT equipment and microsurgical instruments5. Instruments and equipment

CHAPTER – VII SUB SPECIALTY BASED OPHTHALMIC CARE 231. Introduction2. Cornea services3. Paediatric ophthalmology4. Glaucoma services5. Orbit and oculoplasty

6. Retina services7. Uveitis services8. Neuro-ophthalmic services

CHAPTER – VIII SUPPORT SERVICES 271. House keeping2. Dietary services3. Clinical laboratory4. Stores5. Medical equipment maintenance services

CHAPTER – IX OPTICAL SHOP AND PHARMACY 311. Introduction

CHAPTER – X COMMUNITY OUTREACH 321. Eye screening camp2. Primary eye care centre

CHAPTER – XI MANAGEMENT 391. Introduction2. Equipment

CHAPTER - XII PROCUREMENT MANAGEMENT 401. General financial and management considerations for owning

medical equipment2. General considerations for evaluating and procuring

ophthalmic equipment

ANNEXURE

I. INSTRUMENTS AND EQUIPMENT LIST 421. Instruments needed in OPD2. OT equipment and microsurgical instruments3. Equipment needed for sterilisation4. Basic lab equipment5. Equipment needed for a screening eye camp

II. OPHTHALMIC INSTRUMENT AND EQUIPMENT MANUFACTURERS LIST 47

III. MODEL SECONDARY SETUP 60

ABBREVIATION 65

1

CHAPTER I

INTRODUCTION

SourSourSourSourSource :ce :ce :ce :ce :

* Global initiative for elimination of avoidable blindness - Action plan 2006-2011, VISION 2020

I. Magnitude of global blindnessEvery 5 seconds a person in our world goes blind . . .

. . . and a child goes blind every minute.

been identified as immediate priorities within theframework of VISION 2020. The priorities arebased on the burden of blindness they representand the feasibility and affordability ofinterventions to prevent and treat them. The fiveconditions are:1. Cataract2. Trachoma3. Onchocerciasis4. Childhood Blindness5. Refractive Errors with specific emphasis on low

vision

Other disorders, such as glaucoma, diabeticretinopathy and corneal diseases, at present, do notmeet these criteria.

II. Blindness in IndiaIndia has the largest number of blind people in theWorld. Today’s estimated figures show the blindpopulation in India to be 12 million. Cataractaccounts for 62.6% of blindness in India, the

Worldwide it is estimated that 180 million peopleare visually disabled. Of these, 37 million peopleare blind and this number increases by 1 to 2million every year. Cataract contributes to 47% ofblindness world wide, trachoma 4%,onchocerciasis 1%, and other diseases includingglaucoma and diabetic retinopathy togethercontribute to 48%. Global blindness is expected totouch 75 million by the year 2020 unless specialefforts are made to curb this trend of increasingblindness. In order to make a concerted worldwideeffort to curb this trend throughout the world, theWorld Health Organization and a Task Force ofInternational NGOs have jointly launched acommon agenda for global action*: “VISION2020 — The Right to Sight”. VISION 2020 is aglobal initiative launched as a collaborativemovement by WHO (representing Governments)and IAPB (representing INGOs).

From among the many causes of avoidableblindness, at a global level five conditions have

2

other major causes being refractive errors (19.7%),glaucoma (5.8%) and corneal pathologies (0.9%)*.

The blind population in India is estimated torise to 15 million by the year 2020.

However, in India since trachoma is limited tocertain geographic pockets and onchocerciasis isnon-existent, glaucoma, diabetic retinopathy andcorneal diseases form priorities under India’sVISION 2020 action plan.

The goal of eliminating such avoidable blindnesswill be achieved through the following broadstrategies:1. Disease prevention and control2. Training of required personnel3. Infrastructure development and strengthening

the existing eye care infrastructure4. Development of appropriate and affordable

technology5. Advocacy and mobilization of resource

III. Combating blindnessStrengthening of infrastructure, human resourceand standards is required at all levels of eye caredelivery - primary, secondary and tertiary.Standard systems and protocols need to beinstituted. Resource mapping is needed todetermine the need for strengthening, expansionor building new facilities.

Before continuing, one should know the roleand relevance of the various levels of eye care -primary, secondary, and tertiary.

a. Primary eye care

Community eye care and universal coverage canonly be ensured through community based eyecare services. The emphasis should be onpreventive and promotive strategies, case findingand referral rather than solely depending onhospital based curative services. Primary eye care

SourSourSourSourSource :ce :ce :ce :ce :

* VISION 2020 The Right to Sight - Plan of Action NPCB, India Ophthalmology / Blindness ControlSection, Govt. of India

can create better access to eye health services. Thusto provide meaningful and needs based services,primary eye care needs to become an integralcomponent of primary health care.

The essential features of primary eye careinclude:1. Delivery of basic eye care services to all indi-

viduals who are at risk of developing blindnessor suffering from low vision, irrespective oftheir ability to pay for such services. Thisincludes preventive care, refractive services,treatment of simple eye conditions, screeningand referral for secondary care

2. Certain initiatives of social development thatpromote eye health through changes inbehaviour, environment, adequate food, safewater supply and adequate sewage disposal

3. Provision of essential drugs for eye problems4. Establishing linkages to referral systems to

support primary eye care centres

Due to the enormous expense involved in settingup a tertiary care centre and the population baserequired to support it, not many can be set up.Primary eye care can be integrated with primaryhealth centres.

b. Secondary eye care

Secondary eye care services refer to providing amix of preventive, curative and rehabilitative eye

3

care interventions with a greater focus on curativeservices as to bring about a significant reduction inblindness and ocular morbidity in the service area.Since most of the blindness can be prevented ortreated with secondary level interventions, it isimportant that this level remains most costeffective.

c. Tertiary eye care

Tertiary eye care provides the complete spectrumof sub-speciality eye care services and has theexpertise to handle complicated cases. Tertiaryhealth centres also play a vital role in training,deployment and professional updating of allcategories of eye care personnel.

4

CHAPTER – II

SECONDARY EYE CARE HOSPITAL

I. IntroductionA secondary eye care centre bridges the gapbetween the primary and tertiary eye care servicesby providing eye care services ranging fromtreatment of small ailments related to external eyeproblems to speciality cases like cataract, refractiveerrors, corneal disease, glaucoma, paediatric eyeproblems and retinal disorders etc.

These hospitals provide diagnostic and curativeeye-care services along with supervision of primaryeye-care centres and referral to tertiary eyehospitals. The scope of activities of a secondaryeye-care hospital can be categorized as:a. Providing diagnostic and curative services for

conditions such as:• Refractive errors• Cataract• Glaucoma• Trachoma• Trauma• Lacrimal surgery• Medical Strabismus

b. Diagnose and refer the following conditions toa tertiary eye hospital:• Surgical Strabismus• Disorders of the retina & vitreous• Conditions in children requiring advanced

managementc. Other organizational activities:

• Supervise and co-ordinate primary eye-carecentres

• Arrange for the referral of complicated eyeproblems

• Provide continuous medical education withprofessional development to in-house staff

II. Workload estimation and infrastructureTypically secondary eye hospital cover apopulation of 1-5 million depending on countrysetting and resource availablity. The infrastructureand equipment required for a secondary eyehospital should be decided based on the expecteddaily workload of the hospital. For the purpose ofthis manual, we have assumed the followingworkload:

WWWWWororororork Loadk Loadk Loadk Loadk Load EstimationEstimationEstimationEstimationEstimationNumber of beds 40Effective working days in a year 300Number of surgeries per year 6000Number of outpatients per year 60,000Number of surgeries per day 20Number of outpatients per day 200

For the infrastructure to be optimally utilised, theoutpatient load and surgical load must bemaintained.

III. Human resourcesThe efficiency of a hospital revolves around theophthalmologist. It is necessary to ensure that anophthalmologist is always available in the eyehospital. This would mean that, in addition to theregular ophthalmologist, there should also be juniorophthalmologist to share the workload and coverwhen the senior is unavailable. The whole clinicalworkload can be more efficiently handled with fourdoctors working full time, with two of them beingsenior and two being junior ophthalmologists.However this would work only if there is anadequate patient load to justify the employment of3 - 4 doctors and to ensure job satisfaction. Thismeans that there must be an outpatient load of at

5

least 200 patients and an average of about 20operations a day.

The main activities of the rural eye hospital wouldbe:1. Out-patient care2. In-patient care

3. Surgery4. Community outreach work - eye camps and

health education5. Some training6. Administrative work

The area required for a secondary eye hospital for the patient load indicated is as below:

DDDDDepareparepareparepartmenttmenttmenttmenttment DDDDDetailsetailsetailsetailsetails SSSSSpace Rpace Rpace Rpace Rpace Requirequirequirequirequirededededed

Outpatient Department 200 patients per day 3,750 sq. ft.(including Medical Records,Optical & Medical shop)Theatre Area 20 – 25 Surgeries per day 2,250 sq. ft.Wards 40 beds 4,000 sq. ft.Office Area 1,000 sq. ft.TTTTTotal Arotal Arotal Arotal Arotal Areaeaeaeaea 12,000 sq. ft. 12,000 sq. ft. 12,000 sq. ft. 12,000 sq. ft. 12,000 sq. ft.

For this space to be optimally utilised, the outpatient load and surgical load must be maintained.

Clinical personnel

PPPPPositionositionositionositionosition NNNNNumberumberumberumberumber FFFFFunctionunctionunctionunctionunction

Senior Ophthalmologist 1 Out patient examination, surgeries, ward rounds andadminstrative work

Junior Ophthalmologist 2 Outreach screening, assisting the senior doctor inOP&OT

Outpatient nurses 5 Preliminary vision screening 1 NurseTension, duct, assisting doctors 2 NursesRefraction 2 Nurses

Ward nurses 4 Paying ward 1 NurseFree ward 1 NurseNight duty 2 Nurses

Theatre nurses 6 Scrub nurse 2 NursesRunning nurse 2 NurseSterilization nurse 1 NurseTheatre assistant 1 Nurse

TTTTTOOOOOTTTTTALALALALAL 1818181818

An estimation of the manpower required for all the basic activities is shown in the following table alongwith a brief job description.

6

IV. Instruments and equipmentA set of basic instruments and equipment arerequired for outpatient work, the laboratory and inthe operation theatre. It is important to note that acertain minimal patient load is required for

optimum utilisation of the equipment. Theequipment purchased for the secondary eye carecentre should be of a good brand and of highquality which in turn reduces the maintenancecost and loss of revenue due to downtime.

Management personnel

PPPPPositionositionositionositionosition NNNNNumberumberumberumberumber FFFFFunctionunctionunctionunctionunction

Administrator 1 Patient flow management, coordinating the different departments,performance monitoring, HR Functions accounting and publicrelations

Eye Camp 1 Attracting sponsors, networking with the community, publicityCoordinator for camps and organising eye campsAdministrative 3 To handle registration, counselling, admissions, medical records,support staff cash and book- keepingEnquiry 1 Answering patient queries (optional)House-Keeper 1 In-charge of supervising the cleaners, interior decoration, general

maintenanceCleaners 4 Responsible for the hygiene and cleanliness of the hospitalSecurity Staff 3 Responsible for the security of the hospital, and guiding patients in

the right directionDriver 1 Responsible for the vehicle and maintenance; should also be of

assistance at the camp siteTTTTTOOOOOTTTTTALALALALAL 15 15 15 15 15

7

CHAPTER III

MEDICAL RECORDS

I. IntroductionThe basic principles involved in maintaining asmoothly functioning medical records departmentare similar in all hospitals, regardless of size. Largeteaching hospitals that support training programsfor interns, residents and nurses usually find itnecessary to elaborate on the basic records to fittheir needs.

II. Systems and procedures1. All medical records should be stored in a

physically secure place under the control andsupervision of the department in-charge

2. Entry to the medical record departmentshould be restricted to the staff working in thatdepartment

3. The medical records should not be handled bythe patient

4. No records should be removed without anauthorized requisition

5. A serial numbering system should be used asthe medical records number for outpatientpatient records. The same number should beretained and used for surgical records if thepatient is going for surgery. A separate inpa-tient number is not advised

6. Registration details should include thepatients’ full sociological details

7. The patients’ records should be completelycoded as per ICD 10 and can be continued tillthe new coding is released by WHO

8. The admission counter should function roundthe clock and is responsible for the admissionof the patient, and for the maintenance of bedoccupancy list

9. A consent form should be signed at the time ofadmission after the intervention has been

clearly explained to the patient and the familymember

Procedures

Step 1: Enquiry1. Issue the information card to the patient/

attendee and assist them in filling it2. Direct the patient to the new or review

counter3. Prepare the discharge list and cross check with

the case sheet received at the end of the day4. Analyse the follow up percentage

Step 2: New registration1. Enter the patient information2. Prepare the outpatient case sheet and ID card

(to be given to the patient)3. Collect the registration fee from the patients4. Guide them to the OPD

Step 3: Review registration1. Enter the patient information2. Collect registration fee from the patients if

required3. Retrieve the record from the racks4. Guide the patients to the OPD

8

Step 4: Coding

The outpatient and inpatient records are codedseparately according to the diagnosis, treatmentand surgical procedures accurately as per ICD-10.

Step 5: Filing

After coding the record, file the case sheet in theappropriate place according to the medical recordnumber.

III. Instruments and equipment

S. NS. NS. NS. NS. Nooooo EEEEEquipmentquipmentquipmentquipmentquipment DDDDDimensionsimensionsimensionsimensionsimensions NNNNNumberumberumberumberumber

1 Racks-(single and double cabin) four Height - 200cms Single Cabinracks in a row with eight compartments Width - 100cms

Depth - 35cms Double Cabin - 32 Pigeon hole rack Height - 26cms Five partitions in

Width - 178cms each compartmentDepth - 28ms

3 Stationary cupboard Height - 155cmsWidth - 75cms OneDepth - 40cms

4 Mobile step-ladder Height - 65cmsWidth - 35cms SixDepth - 35cms

5 Computer with printer and centralised Computers – 2processing unit with terminals Printers - 2

6. Record baskets 57 Rubber stamps With Date and As required

Department8 Mike with amplifier One (if required)9 Working tables with chairs Table - 2

Chairs – 5

9

CHAPTER - IV

OUTPATIENT DEPARTMENT

I. General OPD services

Introduction

The basic eye services covered in secondary modelare refractive error correction, treatment ofexternal eye diseases and cataract while otherservices depend on the competency and training ofthe ophthalmologist. Speciality service andexternal disease which need speciality advice willbe referred to tertiary centres.

1. Systems and procedures

A patient in the OPD should be taken through thefollowing stages:

Stage1: Preliminary vision

After the initial registration at the reception desk,irrespective of the ophthalmic pathologies, thevisual acuity of all patients should be tested withSnellen Chart, illiterate E chart or Landolt’sbroken C chart. This can be done by a trainedjunior ophthalmic assistant.

Stage 2

A routine history taking and a basic ophthalmicexamination including flash light examination, slitlamp examination and fundus examination with adirect ophthalmoscope or a 90 D lens (in caseswith clear media) should be done by a juniorophthalmologist. This stage serves as a gateway tofurther tests. Depending on the findings elicited atthis stage, further examination and investigationsmay be done.

Stage 3

All patients above the age of forty, coming forrefractive error correction, should be subjected to a

comprehensive eye examination, including IOPmeasurement and a detailed fundus examinationafter dilatation to screen for glaucoma and retinalproblems.

It is recommended that all patients over theage of forty undergo a blood test and a BP check.If the patient is found to be diabetic orhypertensive, appropriate counselling and referralshould be given.

At this stage, the patients, after havingundergone all the appropriate indicated tests, areexamined by a senior ophthalmologist fordiagnosis and to plan treatment options.

Stage 4: Dilatation for fundus examination1. All patients visiting ophthalmologist should

have a dilated fundus examination. Howeverfor some patients with conditions like acuteexternal ocular infections, narrow angle orclosed angle glaucoma, dilated fundus exami-nation may need to be deferred.

2. All patients should be dilated for fundusexamination before posting for cataract sur-gery. This will also help to decide about phacoin patients with mature cataract.

Stage 5: Final examination and counselling

By the time the patient is brought to the medicalofficer, the patient has already been seen by theparamedics and tests have been completed. Beforeprescribing treatment, advising surgery orprescribing spectacles it is important for themedical officer to quickly review the case sheet andexamine the patient to ensure that no vital detailsare missing. He / she must confirm all findings inthe case sheet fully and check for any unexplainedfindings. If required, the entire history and clinicalexamination may be repeated.

10

Counselling is possible only after the doctorreviews the case sheet. It is important to clearlyand concisely explain to the patient the nature ofhis condition, treatment options, etc., In patientswith hereditary disorders like retinitis pigmentosaand glaucoma, counselling is very important.Affected parents should be aware that theirchildren are at risk, and should be advised to havetheir family members examined at the earliestpossible.

All reference letters must be answered and acopy of the reply should be attached to the casesheet. While referring a patient to anotherhospital, the patient should be told why this isbeing done and given necessary guidance.

2. Instruments needed in outpatient department

IIIIInstrnstrnstrnstrnstrumentsumentsumentsumentsuments QQQQQuantityuantityuantityuantityuantity

Schiotz tonometer 2Flashlight (battery/electric) 6Slit lamp 2Direct ophthalmoscope 3Indirect ophthalmoscope 290 D lens 220 D lens 2Gonioprism 1Applanation tonometer head 1Kimura spatula 1No 15 surgical blade 1Binocular microscope 1Tangent screen (field test chart) 115 cm glass ruler 2Weighing machine 1Material for diplopia charting 1Torch light with red and green glass 1Slit light source 1Red, green Goggles 1

Desirable equipment for High volume centres :HFAYAG LASER

It is recommended that a functional ICU with thefollowing equipment be established in case ofstandalone eye hospital.

ICU1. ECG Machine 1 Maestros2. Oxygen Cylinder 1 Sivaji3. B.P Apparatus 14. Stethoscope 1 Microtone5. Suction Apparatus 1 Gomco6. Nebulizer 1 Aerofamily7. Pulse Oxymeter 1 Nellcor8. Torch (cell) 1 Eveready

II. Refraction services

Introduction

Refractive error is one of the most common causesof visual impairment. As treatment of refractiveerror is perhaps the simplest and most effectiveform of eye care, a high incidence of visionimpairment due to refractive errors in a populationsuggests that eye care services in that area areinadequate. In many parts of the world, refractiveerror is the second largest cause of treatableblindness, after cataract.

11

1. Systems and procedures

Mentioned below are the steps carried out in therefraction department:

a. History taking

Optometric history should include the following:1. Chief complaint (common complaints are pain

in the eye, blurred vision, headache, eyefatigue)

2. History of comfort with glasses, if used3. History of comfort with glasses, if not used4. Family history of ocular disorders (myopia,

squint & blindness)5. Occupation / nature of work – to recommend

the appropriate lens design

b. Preliminary examination by using torch light1. Ocular movements and deviation2. Cornea: clear / hazy3. Pupillary action and size - dilated / undilated4. Lens: clear / hazy (cataract)5. Any other opacities in the visual axis

c. Vision assessment1. Done for finding out the existing vision2. Assess both with and without glasses,

monoculary3. Illiterate patients and preschool children

may be tested with pictures / symbols.Vision testing to be done with fogging inpatients with latent nystagmus charts(Matching tests)

4. For patients already wearing spectacles - specifythe exact problem - Vision, nature of theframe, centering etc.,

5. Decide whether refractive correction is neededor not

d. Objective refraction (Retinoscopy)1. Best way to assess the refractive error in chil-

dren, illiterates and uncooperative patients

2. Make sure that the testing distance is properlymaintained

3. Instruct the patient to look at a distant object4. Consider the characteristics of the retinal reflex

for quick and accurate retinoscopy5. Preferable - Streak retinoscopy

e. Indications for auto-refraction1. Almost all cooperative patients especially,

patients with very high refractive power2. Illiterate patients or children under cycloplegia3. Patients who have come for the first time for

refraction4. All astigmatic patients5. Handheld autokeratometer whenever indicated

Advantages1. Quick, status of corneal curvature and degree

of astigmatism can be acurate

f. Subjective refraction1. This is done to prescribe comfortable binocu-

lar glasses. Subjective acceptance especially forcylinder may not be very accurate in childrenless than 6 years. It is better to rely on objec-tive value

2. Trial lens-frame / Phoropter are used3. Calculate the actual prescription from ob-

tained retinoscopy value4. Confirm the unaided vision first and add the

power lens accordingly5. Find out the vision improvement with sphere

first to avoid unwanted cylinder power6. Add the cylinder to correct remaining vision.

Use of jackson cross cylinder measurment ofPD

7. Accommodation BSV and steropsis should bemeasured in all cases especially inanisometropes

8. Vision testing - Binocularly with / without faceturn in case of nystagmus

12

g. Near vision assessment1. Ask the patient on his / her preferred reading /

working distance and the demands of theirprofession

2. Must be done with distance lens correction3. Allow a patient to read the chart first to decide

the required power4. If patient has a good reading speed, a weak

correction may be needed5. Determine the appropriate correction depend-

ing upon the visual needs6. Ensure binocular comfort by allowing the

patient to read the magazines/newspapers

h. Prescription writing1. Suggest suitable lens design depending upon

the patient’s occupation and working condi-tions

2. Mention the vertex distance compared withthe old glasses PD

3. Recommend only flat-top designs for constantbifocal wearers

4. Advice should be given on using plastic lensfor children for safety reasons

5. Progressive lenses to the appropriate group ofpatients

i. Advice to the patients1. Instruct the patients on using glasses for

comfortable vision2. Counsel the patient on the difficulties and

limitations of lenses like slow adaptation anddistortion

3. CL when indicated

2. Infrastructure

a. Refraction room

Ideally, a single or direct room (length: 6 meter /20 feet) is to be used. In smaller clinics (especiallyin major cities) double throw room (length: 3

meter / 10 feet) can be used with a plane mirrorand reversible chart.

b. Illumination of the consulting room

Any background illumination that falls on thescreen will reduce the contrast of the symbol 5(orcharacters). While the examination can beconducted in a dark room, it is not comfortablefor the patient and is not recommended by BritishStandards, which suggests that the minimumthe minimumthe minimumthe minimumthe minimumbackgrbackgrbackgrbackgrbackground illumination must be equal to 10%ound illumination must be equal to 10%ound illumination must be equal to 10%ound illumination must be equal to 10%ound illumination must be equal to 10%that of the charthat of the charthat of the charthat of the charthat of the chart.t.t.t.t.

3. Instruments needed for refraction

Instruments1. Torch light (battery / electric)2. Snellen test type (Snellen chart, illiterate

E-Chart, Landolt’s C Chart)3. Trial lens set4. Trial frame5. Vision testing devices for children

Retinoscope6. Plane mirror retinoscope

13

7. Streak retinoscope8. Tangent screen9. Occluder10. Jackson’s cross cylinder11. IPD ruler

Optional instruments12. Auto refractor (optional)13. Field test perimeter14. Prism bar15. Lensometer16. Accommodative Ruler17. Worth four lights - Near and Distance

14

CHAPTER V

STERILISATION

I. IntroductionSterilisation and aseptic practices in theophthalmic operation theater are aimed towardsthe prevention of postoperative infections and incataract surgery it is endophthalmitis. Thesterilization and aseptic measures that are followedhave to address the preoperative patientpreparation, washing and sterilisation ofinstruments, the operation theater environmentand finally the theater personnel. Sterilization anddisinfection are very important procedures whichminimize the risk of transferring infection.

The intention of the chapter is to provide anoverview of sterilisation in critical area and not todelve in details. We recommend the followingbooks for detailed guidelines on sterilisation.1. Sterilisation and Aseptic practices in an Oph-

thalmic Operation Theatre- By Dr. Lalitha Prajna, Dr. Annapurna

Chavali, Aravind Eye Hospital, Madurai,2. Ophthalmic Operating Theatre Practice: A

Manual for Developing Countries- By Ingrid Cox, Sue Stevens, International

Centre for Eye Health (ICEH), 20023. Operative Operation Theatre, A manual for

Eye Operation Theatre, SEWA RURAL,Jhagadia, 2008

II. SterilisationSterilization is the complete destruction of allpathogenic micro-organisms, ie: bacteria, viruses,fungi and spores. There are no half-way measures -make sure whether an item is sterile or not.

Sterilization is achieved only by• Steam under pressure• Dry heat

• Vapour• Ionising irradiation

Autoclave is the most frequently used and themost effective method for sterilisation in operationtheaters.

Disinfection

Disinfection destroys pathogenic micro-organisms,but does not destroy spores (unlike sterilisation).

Disinfection is achieved by• Boiling• Steaming• Liquid chemicals.

Care of instruments

For effective sterilization to take place theinstruments must be thoroughly cleaned beforeplacing in the autoclave. The dried viscoelastics,blood etc must be thoroughly washed off.

Cleaning

• Special attention should be given to cleansethe surgical instruments before sterilisation.

15

Surgical instruments vary in configurationfrom plain surfaces, which respond to mosttypes of cleansing, to complicated devices thatcontain box locks, blind holes and interstices

• Sharp and blunt instruments should be sepa-rated

• Instrument should be thoroughly cleansed bywashing in sterile distilled water or mineralwater

• An ultrasonic cleaner can be used for cleaningthe instruments. It thoroughly cleanses everypart of the instruments, including the depthsof the cannula, tubes and other unreachableparts, with high frequency sound waves gener-ating bubbles and vacuum zones. The tank ofthe cleaner should be filled above the level ofthe top of the instruments, suitable detergentas specified by the manufacturer is added. Thetemperature of water should be 80 to 110degrees Fahrenheit and instruments should bekept in the ultrasonic cleaner for at least 30minutes

• However, ultrasonic cleaners are not essential.One can use four bowl technique for thecleaning of the instruments as described below

• After removing the instruments from ultra-sonic cleaner, the instruments are first brushedwith a soft tooth brush

• Then washed in four basins containing min-eral water or boiled water one after the otherthe first one contains mineral water withdisinfectant. This should be done even ifultrasonic cleaner is not used

• They are then dried with clean towel; tippedwith plastic sleeve and are segregated into

separate sets. They are then packed in indi-vidual perforated stainless steel trays, which areplaced in the bins with indicator and put inthe autoclave. Three indicator tapes should beplaced, one in the bottom, one in the middleand one at the top of the bin, of course onestrip on the external surface of the bin isrequired to tell us whether the bin is sterile ornot, even without opening the lid

• Cannulated instruments are first to be flushedwith distilled water three times and then withair three times before autoclaving

• The bins/ packages must be properly labelledwith the date, ward number etc.,

III. Advice on autoclaving

Water

Distilled or rain water can be used for flashautoclave, while tap water can be used for biggerfree standing autoclaves.

Timing

Sterilisation time depends upon the steam pressurewhich is needed for the articles that are beingsterilised:

Packing and loading of bins into the autoclave

Articles can be placed in metal sterilising drumswith holes to allow for steam penetration. Thesearticles should, ideally, be used within 24 hours ofbeing sterilized.

It is important to put the lid of the autoclavecorrectly, as the steam must penetrate the drums orpackets. Do not pack items too tightly, but allow

ArArArArArticlesticlesticlesticlesticles SSSSSteam prteam prteam prteam prteam pressuressuressuressuressure lb/ine lb/ine lb/ine lb/ine lb/in22222 TTTTTempempempempemp00000 C C C C C TTTTTime /minime /minime /minime /minime /min

Drapes, linen, gowns 30 134 45

Soft goods and instruments 25 124 30

Rubber articles 10 116 40

16

space for the steam to penetrate, and the dryingcycle to be completed.

Labelling

Put autoclave tape on to all packs indicating thedate of sterilisation, who packed them, and theircontents.

Drying

When the cycle is complete, contents are to beremoved and placed on wire shelves to cool.

Storing

Once the items get cooled they can be wrapped ina polythene bag to prevent dust and externaldamage and stored in a dry place and preferablyused within two days.

Testing autoclave effectiveness• Chemical indicator – with every cycle, check

for colour change• Bowie –Dick test – once a week, see for colour

change• Biological indicator - Once a month – see for

the colour change

Check list – autoclaving problems1. Wet or damp articles maybe due to too tightly

packing2. Too little pressure, a faulty vacuum or over

packing will cause incomplete sterilization3. Autoclave register must be maintained with

the name and signature of person who startedthe autoclave, time of starting and switchingoff the autoclave and if the indicator changedcolour or not

Use of disinfection procedures

In an ophthalmic operation theater the use ofdisinfecting methods are very minimal and mustonly be used in situation where other methods arenot available or suitable.

Boiling

Boiling achieves high level disinfection and killsbacteria, viruses. Spores are killed only after 4hours of boiling. It is suitable for metal and someplastics.

Liquid chemicals (glutaraldehyde, chlorhexidine, etc.,)• Manufacturers instruction must be noted

when using chemicals• Instruments may corrode over prolonged

exposure• After soaking, Instruments must be thoroughly

rinsed in distilled water before use

Disinfection of outpatient department equipment

The common instruments that are used in theOPD consists of Tonometer, Applanation prismstips, Slit lamps, Indirect ophthalmoscopy lens. Asthese are used for multiple patients these must bedisinfected before use.

• Isopropyl alcohol 70% ( Methylated spirit)

- Gently wipe the surfaces with a clothsoaked in isopropyl alcohol and do notrinse but allow it to evaporate. This takesabout a minute.

• Sodium Hypochlorite

- This is readily available and very effectivefor bacteria, spores and viruses and can beused for OPD Instruments.

Human resources

Focus should be given on• Allocation of staff for specific functions• Clear definition of roles and responsibility of

the staff• Training and education: Delivery of service is

not sustainable without a trainingcomponent and continuing education

• Staff appraisals and assessment at differentintervals

17

CHAPTER - VI

CATARACT SERVICES

I. Pre-operative procedures

1. Admission

The patient is admitted the day before the surgery,or four hours prior to surgery on the day ofsurgery (local patients, who had pre operativeinvestigations earlier).

2. Investigations

Routine investigations1. Intraocular pressure2. Duct: If the duct is obstructed by mucus or

pus, then a preliminary DCT/DCR must bedone before cataract surgery

3. A-Scan4. Keratometry5. Blood pressure6. Blood sugar

II. Surgical proceduresManual SICS vs. Phaco

From an investment and recurring costperspectives, manual SICS is more economicalthan phacoemulsification. It is as safe and theoutcomes are nearly as effective as the latter.Manual SICS is of great relevance in large nationalor community blindness prevention programs toaddress cataract blindness and get the most out oflimited financial resources. Phacoemulsificationrequires longer training involving a steeperlearning curve. It also requires a higher surgicalload to justify the high investment costs.

The rationale behind usingphacoemulsificiation is the smaller size of theincision, which results in better immediateuncorrected visual acuity results. In order to take

advantages of the smaller incision one needs to use(the more expensive) foldable IOLs. Phaco-emulsification can therefore, be chosen when thereis significant demand from higher paying patients.However, since the investment is high, unless thehospital is able to generate a minimum volume ofpatients who can afford this procedure, it mayprove to be counter productive in terms of incomegeneration or opportunity costs.

The cost of the Phacoemulsification machine,its maintenance and replenishment of supplies, thehigh cost of foldable intraocular lens and the needfor experienced surgeons have made manual SICSthe technique of choice in many developingcountries.

1. Preparing for surgery

Before the patient is taken into the OT ensure• Topical antibiotics is instilled 3-4 times,

starting the day prior to surgery. Peribulbarblocks are effective. If necessary, facial blockscan be supplemented

• The pupil is well dilated• The eye is adequately soft with reduced intra

ocular pressure• The lid and surrounding areas have been

cleansed with iodine• The patients head is covered with a cap or

towel• The patients feet are clean• Theatre gown has been provided (optional)

Then the patient is walked or wheeled into the OT• Patients head must be positioned in line with

the top edge of the operating table (a thinpillow or circular support can be used)

18

• The patient is covered with a clean sheet /drape up to the chin

• A chest guard (metal hoop that keeps the sheetoff the patient’s face and chest) is placed toallow easy breathing (optional)

2. Cleaning and draping• Once again, clean the preoperative area from

midline ear, brow to angle of the mouth with10% povidone-iodine starting from the lidsand working to the periphery

• The eye lid margins are painted with cottonsoaked in iodoprep solution

• Instill a drop of half strength povidone-iodineinto the conjunctival sac

• Drape the patient’s head and trunk with steriletowels so that only the eye is exposed

3. The surgeon and the scrub nurse/surgical assistant must• Wear face masks and caps• Wash their hands and arms once with soap,

then scrub twice with chlorhexidine / halfstrength povidone-iodine scrub lasting fiveminutes, then rinse thoroughly with boiled orautoclaved water

• Wear sterile operating gowns, well-covered atthe back

• Wear sterile gloves and wash off the powderwith sterile water

4. Operation theatre workflow

When the surgeon is operating on one table, thescrub nurse on the other table can prepare the nextpatient. The surgeon, on finishing the surgeryshould rinse his/her hands with antisepticsolutions and can proceed to the next surgery, byswinging the arm of the microscope over to thealready prepared patient. This cuts down on thesurgeons waiting time between surgeries.

While some people feel practising twin tablesystem in operating room compromises sterility,there is no evidence to substantiate this. On theother hand the pay off is substantial in terms of

enhanced productivity and this is critical sincemost hospitals operate with scarce resources.Where institutional policies don’t allow this, thepreparation could take place outside the operatingroom on an operating table which can be wheeledinto the operating room. The principle is tominimize the waiting time between surgeries.

When the surgeon finishes a surgery, the scrubnurse on that table with the assistance of therunning nurse can take over the remainingactivities like bandaging the eye, getting thepatient off the table, sending the used instrumentsfor sterilization, etc. After finishing all thesurgeries, some of the theatre staff should preparethe theatre and instruments for the next day’ssurgery. The others can be assigned to work in theOPD and wards. The theatre should have asterilization room, patient preparation / recoveryarea, changing room, and a theatre stores attachedto it.

III. Post-operative procedure

Discharge1. The patient can be discharged around 3-4

hours after surgery2. The first post operative examination and

dressing should be done within 24 hours aftersurgery. During this time, the integrity of thewound, the corneal clarity and the presence ofinflammation are checked. In addition, thefollowing tests ought to be done- Vision with pin hole- Fundus examination

Post –operative counselling

On discharge the Patient is counselled on thefollowing:1. Compliance to prescribed medications2. Follow the suggested precautions3. Adherence to follow up scheduling4. To report to the hospital immediately in case

of severe pain, drop in vision etc.,

19

Follow up

The routine follow-up should be done as follows:

a. First follow up – After 7 - 10 days1. Vision with pinhole, slit lamp examination,

fundus examination with 90 D lens2. If visual acuity is not good, the patient should

be examined for Cystoid Macular Edema(CME) & started on NSAID drops

b. Second follow up - This follow up is highly recommended and can be scheduled as per the local protocol1. Refraction, slit lamp examination, fundus

examination2. Glass prescription if visual recovery has stabi-

lized3. If the best corrected visual acuity is not satis-

factory and does not correlate with anteriorsegment clarity look for CME and if present,start NSAID drops

4. The patient is counselled to report to thehospital immediately in case of severe pain,drop in visionAdditional follow up examination can be

scheduled in suture removalal cases.

Instruments required

For ocular examination1. Snellen Chart2. Flash light3. Slit lamp4. Direct ophthalmoscope5. Indirect ophthalmoscope

6. 90D lens, 20D lens7. Applanation tonometer8. A Scan9. Keratometer10. Facilities for performing conjuctival swab

culture (optional)

For general examination

(to rule out systemic illness and also to check forfitness in case of patients with systemic illnesses)1. Stethoscope2. Sphygmomanometer3. Glucometer4. ECG machine (optional)5. X-ray facilities (optional)6. Weighing scale

IV. OT equipment and microsurgical instruments

1. OT equipment1. Operating Microscope with the following

features:• Coaxial illumination• Good optics• Adjustable intensity of illumination• Range of magnification• Focus controls• Eye piece adjustment• Inter-pupillary distance adjustment• Adequate position adjustment• Sterile grips and knobs

20

2. Bipolar cautery3. Anterior vitrectomy machine (optional)4. Cryo machine (optional, rarely used now)5. Pulse oximeter (optional)6. Steam sterilizer, flash autoclave7. Emergency light8. Needle destroyer9. Adaptors and extension wires

2. Microsurgical instruments

The microsurgical instruments for cataract surgerydepend on the technique of the surgery and thesurgeon’s skill and preferred method in performingthe technique.

The standard list of instruments used forcataract surgery is given below:

For cataract surgery (cataract surgical set),filtering surgery, pterygium excision1. Universal eyelid speculum / Barraquer lid

speculum2. Fine toothed forceps, Hoskin’s forceps3. Heavy toothed forceps / muscle holding

forceps / superior rectus forceps4. Superior rectus needle holder (Arruga)5. Curved round bodied needle6. Mosquito clamp (anchor for bridle suture)7. Spring scissors (Westcott) - tenotomy scissors8. Bard Parker blade breaker and razor blades /

Castroviejo blade breaker9. Crescent blade, 15 Blade10. 22 Gauge disposable needle with 120º bend11. 2ml syringe for visco-elastic with a canula12. 26 Gauge needle bent / cystitome13. Corneal scissors14. Mc Phersons forceps (capsule holding)15. Vectis / lens loop / irrigating vectis16. Lens spoon / squint hook (nucleus delivery)17. Simcoe irrigation aspiration cannula & handle18. 5cc syringe for manual aspiration19. Lens holding forceps20. Sinskey hook

21. Needle holder22. Non-toothed forceps (for tying)23. Vannas scissors24. Straight scissors (optional)25. Iris repositor, iris scissors, iris forceps (op-

tional), Elshnig cyclo dialysis spatula26. Kelly’s punch, 26 guage needle (additional if

trabeculectomy is to be performed with IOLsurgery - combined procedure)

27. Artery clamp / Kalt needle holder28. Phaco machine (phaco emulsifier)

Other supplies required1. Silk (8-0), nylon (10-0), nylon (9-0), sutures -

5-0 silk/cotton bridle suture2. Instrument trays (stainless steel tray with

perforated bottom)3. Trays for holding Cidex ®, OPA solutions and

distilled water (stainless steel trays with nonperforated bottom)

Other materials required1. Surgical gloves size 6 to 82. Cotton gauze, cotton pad3. Sterile wipers made from a cotton roll4. Eye shield5. Intraocular lens6. Adhesive tape7. Alcohol (hand wash between cases)8. Dish for povidone-iodine ½ strength (for

sterilization between cases)9. Cotton tipped buds / triangular cellular

sponges10. Mannitol 20%11. Ringer lactate / balanced salt solution / visco-

elastics12. 1/1000 adrenalin13. IV set, IV stand14. Emergency drug tray15. Linen16. Caps and masks17. Sterile gowns

21

18. Theatre dress for patients (optional)19. Sheets to drape over patients20. Eye towel21. Plastic drapes22. Chest guard for asthmatics

Furniture required1. 2 or 3 tables, dimension 6.6. 72" x 21" x 30",

with head rest at surgeon’s end2. Surgeon’s stool - adjustable elevation and

cushion (with or without) back support3. Footstool - to help patient mount the table4. Instrument trolleys (stainless steel top is

preferable) of adequate area5. IV drip stand, with variable height adjustment

Instruments required for post operative care in the wards1. Snellen chart2. Torch light3. Slit lamp4. Direct ophthalmoscope5. 90 D lens6. BP Apparatus7. Stethoscope8. Steel bins9. Toothed forceps

Other supplies like sterile cotton pads, cotton towels,wipers, gauze, and medicine tray are also needed inthe wards.

V. Instruments and equipment (capacity–2 theatres)

1. Surgical equipment

NNNNNameameameameame QQQQQuantityuantityuantityuantityuantity

Operating microscope 2

Bipolar coagulator 2

Vitrectomy machine 1

2. OT - General accessories

NNNNNameameameameame SSSSSizizizizizeeeee QQQQQuantityuantityuantityuantityuantity

Operation table 72" x 22"x 32" 4Instrument trolley 26"x18"x32" 4Revolving stool 3Foot stool 24"x12"x12" 4IV stand 3Head rest 4Chest rod 4Patient stand 2Pinky ball 2Stretcher 1Wheel chair 1

3. OT linen

SSSSSl.Nl.Nl.Nl.Nl.Nooooo..... NNNNNameameameameame SSSSSizizizizizeeeee ColourColourColourColourColour QQQQQuantityuantityuantityuantityuantity

1.* Eye towels 46"x34" (centre eye Green 40hole Size = 2.5") Light blue 40

2.* Coat Green 15Light blue 15

3.* Table towels 41" x 34" Green 25Light blue 25

4.* Gown Green 10Light blue 10

5. Pant & shirt Blue 256. Cap & mask Light blue 257. Stretcher cloth 80" x 25" White 68. Bed sheet 85" x 56" White 69. Hand towel 21" x 14" Blue 20

Note: * Green / Light blue - For use on alternative days.

22

4. Surgical instruments

NNNNNameameameameame QQQQQuantityuantityuantityuantityuantity

Universal eye speculum 8Wire speculum 8Superior rectus needle holder 8Superior rectus forceps 8Toothed forceps 8Plain forceps 4Artery forceps 8Scleral forceps 8B.P. Handle 8Tenotomy scissors 8Capsule forceps 8Mini blade holder sharpedge co.1615o Holder sharpedge company 8Irrigating vertis 8Simcoe cannula 8Lens holding forceps 8Sinsky hook 8Lens expresser 8

Vectis 8Corneal scissors 8Corneal needle holder 8Tying forceps 8Corneal forceps 8Cyclo dialysis spatula 4Caliper 4Conjunctival needle holder 2Iris forceps 4Vannas scissors 4Rhexis forceps 4Kuglen hook 2Kelley’s punch 1Blade breaker 8Scissors 4Chopper 2Big artery clamp 6

5. OT vessels

NNNNNameameameameame QQQQQuantityuantityuantityuantityuantity

Basin 4Saline cup with cover 14Water jug 2Wiper jars 6Cryo bin 1

NNNNNameameameameame QQQQQuantityuantityuantityuantityuantity

Surgical tray 4Perforated tray 8Citelli forceps 1Urine can 1

NNNNNameameameameame QQQQQuantityuantityuantityuantityuantity

23

CHAPTER - VII

SUB SPECIALITY BASED OPHTHALMIC CARE

I. IntroductionIt is assumed that 15-20% of the patientsattending the OPD at a secondary eye care centrewill require subspeciality care. The secondary carecentres should be equipped with basicsubspeciality instruments and diagnosticequipment, with the ultimate goal of broadeningthese service areas as the organisations mature. Forinstance, laser units used for treating diabeticretinopathy were available only in tertiary carecentres until a decade ago. Today, these facilitiesare a part of the services offered by secondary carecentres. Suggested below are some subspeciality-oriented facilities which can be made available at asecondary eye care centre. Availability of thesefacilities will enable comprehensive, high quality,secondary eye care.

II. Corneal services

Corneal infections are commonly encountered inday-to-day practice. In a significant number ofcases, it may often be impossible to arrive at anetiological diagnosis with the clinical presentationof the infection. In developing countries likeIndia, fungi and bacteria cause corneal ulcers inalmost equal proportions and hence empiricaltherapy may not be a very safe and effective idea. Abasic ocular microbiological set up is an importantprerequisite for corneal ulcer management in asecondary care centre.

1. Basic secondary eye care setting

The centre should have basic diagnosticequipment like a slit lamp, materials likefluorescein strips, rose bengal stains for stainingprocedures and Shirmers strips for assessment of

tear film. These help in arriving at a correctdiagnosis of the corneal lesion and renderingappropriate treatment.

The centre should be able to treat suppurativekeratitis, corneal abrasions, corneal foreign bodies,pterygiums, corneal tears with or without irisprolapse, simple dry eye and other similarproblems. Ophthalmologists should be trained toperform surgical procedures like pterygiumexcision, excision for suspected conjuctival, corneallesions , and suturing of corneal tears.

Biopsy of excised specimen (e.g.,: forconjuctival epithelioma) can be done at the centreif histopathology examination (HPE) facilities areavailable or can be given to a pathology lab forHPE and further management can be done basedon the result.

a. Instruments needed for treatment of corneal ulcer1. Slit lamp2. Kimura spatula3. No. 15 surgical blade4. Table binocular microscope

b. Other supplies required for treatment1. Flourescein strips2. Schirmers strips3. 10% KOH, materials to perform gram stain4. Cover slips, glass slides5. Spirit lamp

III. Paediatric ophthalmology

1. Basic secondary eye care settings

In addition to the routine ophthalmic equipmentlike slit lamps and ophthalmoscopes, the followingare required for providing paediatric services:

24

1. Sets of prism bars2. Streak retinoscopes3. Hess screen4. Pulse air tonometer5. Keratometer6. Complete set of special vision assessment

charts for children7. All other minor accessory instruments neces-

sary for strabismus evaluation which includeWorth’s Four Dot Test, RAF Ruler, MaddoxRod, Maddox Wing, Bagolini Glasses, Colourvision charts, test book for stereopisis (TNObook), Sheriden Gardiner Chart, CambridgeCrowding Cards (matching test), Keeler acuitycards (forced choice preferential lookingcharts), Cardiff acuity cards (vanishing opto-type) apart from routine Snellen charts

8. Separate computer system

2. Surgical services

The operation theatre should be equipped forgeneral anaesthesia and paediatric surgeriescovering cataract, glaucoma, strabismus, traumas,lacrimal problems, lid and orbital problems. Thereshould be separate pre-op and post-op rooms forchildren undergoing surgery.

IV. Glaucoma services

1. Basic secondary eye care setting

Essential aspects of clinical evaluation of glaucomainclude: slit lamp bio-microscopy of anteriorsegment, intraocular pressure measurement, opticdisc evaluation using direct ophthalmoscope,indirect ophthalmoscope or a slit lamp bio-microscope using a posterior pole lens (90D or78D). All these should be carried out in thesecondary ophthalmic centre.

Documentation of the optic nerve headchanges in each visit can be done either by a handdrawn fundus diagram or a fundus picture(optional - can be done at the advanced centre).

The patient should be categorized according to thetype of glaucoma - primary open angle (POAG),primary closed angle (PCAG), or secondaryglaucoma. Target IOP should be determined foreach case and medical management should beaimed at achieving the target IOP.

The centre should be able to administer,monitor and assess outcomes of medical treatmentfor all categories of glaucoma. The centre shouldbe able to give emergency treatment for PACGand secondary glaucoma when indicated. Surgerieslike trabeculectomy, trabeculectomy with PCIOLimplantation, and glaucoma triple procedure canbe carried out in appropriate and indicated cases.

Instruments needed for treatment:1. Slitlamp bio-microscope2. Gonio prisms3. Schiotz tonometer4. Applanation tonometer5. 90D lens6. Computerized visual field analyzer

2. Advanced secondary eye care setting

As the centre’s patient load increases, availability oflaser delivery system can facilitate doing YAG PI inindicated cases at the secondary ophthalmic carelevel.....

Instrument required1. Nd-YAG Laser unit attached with laser slit

lamp adapter – for purpose of performingYAG PI and YAG capsulotomy.

3. Referral services

Juvenile glaucoma patients and patients withbuphthalmos can be referred to higher centres forappropriate treatment. Other cases not respondingto conventional medication and surgery shouldalso be referred to a higher centre for alternativeprocedures.

POAG patients can be referred to a highercentre for advanced tests like automated field

25

analysis, optic nerve head and retinalmeasurements for more definitive diagnosis.Further follow up treatments as suggested, canthen be continued at the secondary centre itself.

V. Orbit and oculoplastyThe centre should be able to render medicaltreatment for inflammatory and infectiveconditions with the administration of analgesics,anti inflammatory drugs and antibiotics. Theadministration of medication can be topical, orsystemic (oral, IV, IM routes) depending on theseverity of the case.

In indicated cases, surgical procedures likedacrocystectomy (DCT), dacrocystorhinostomy(DCR), simple tarsorraphy, chalazion incision andcurettage, lid abcess incision and drainage,enucleation, eviceration, entropion and ectropioncan be done at the hospital itself. The surgical setsfor the above procedures should be available. Casesrequiring correction for entropion, ectropion,ptosis and those requiring artificial eye fitting,ultra sound B scan (USG B Scan), cases of orbitalfracture, and tumors can be referred to highercenters.

VI. Retinal servicesA routine indirect ophthalmoscopy and a 90Dfundus examination are mandatory tests to beperformed at the centre itself. Documentation offindings by appropriate colour coding helps toestimate the progress of the disease in follow upvisits. Over a period of time, fundus cameras canbe added to the facilities available.

1. Basic secondary eye care setting

Medical retinal pathologies like diabeticretinopathy, vascular occlusions, central serousretinopathy etc. can be well documented andmanaged at the centre itself.

Instruments needed for treatment1. Direct ophthalmoscope2. Indirect ophthalmoscope with scleral depressor

3. Slit Lamp bio-microscope4. 90 D Lens5. 20 D lens

2. Advanced secondary eye care setting

Fundus fluorescein angiography and lasers used forretinal photocoagulation, are important requisitesfor advanced secondary level service delivery.Availability of lasers and their delivery system forpan retinal photocoagulation and focalphotocoagulation will prevent unnecessaryreferrals to higher centres.

Additional Instruments needed in an advanced level set up:1. Fundus camera2. Laser unit for retinal photocoagulation with

slit lamp laser adapter and/or indirectophthalmoscope adapted for laser delivery(laser indirect ophthalmoscope)

3. Referral services

All cases needing surgical management like aretinal detachment can be promptly referred to atertiary care centre. For cases which are referred forinitial advanced treatment, follow up can be doneat the secondary centre, and upon requirement ofany further advanced treatment or progression ofdisease, can be again referred to the tertiary centre.If this is done, the patient will benefit from nothaving to spend money on long distance travel,and the centre will also gain clinical experience.

VII. Uveitis servicesAll basic diagnostic procedures, like performing aslit lamp examination, an examination with 90Dlens, and an indirect ophthalmoscope examinationcan done and details should be documented in thecase record of the patient.

Basic lab tests for determining blood totalcount (TC), differential count (DC) anderythrocyte sedimentation rate (ESR), skin test likemantoux, other specific tests like VDRL shouldideally be available in the centre or in a lab whichcan be easily accessed.

26

These tests will help to arrive at an etiology forthe manifestation and aid in rendering appropriatemanagement for that patient. The treatment canbe modified or upgraded, depending on theresponse observed in each follow up visit.

Instruments needed for work-up:• Slit Lamp biomicroscope• 90 D lens• Indirect ophthalmoscope• 20 D lens• Basic lab instruments• Cell counter• Table microscope• Glucometer

Referral services

Cases which need USG B SCAN, sophisticatedtests for diagnosis, and immunosuppressivemedication can be referred to higher centre.

VIII. Neuro-ophthalmic servicesSingle nerve palsies caused by underlying medicalconditions like diabetes mellitus, or hypertension

can be treated symptomatically, if radiological andimaging support facilities are available. If not, thenthese patients can be referred to places, where suchfacilities can be accessed. Base line detailsregarding diplopia can be recorded using Hesschart and diplopia charting.

During the follow up visit, this will aid inlooking for improvement of the pathologyfollowing treatment.

Instruments requiredTangent screen Automated field analyzer is

optional

Hess chart screen B.P Apparatus

Stethoscope Glucometer

Supplies required Torch with light source as aslit

Red green goggles Colour vision charts

Referral services

Cases which require CT scan and advancedneurological evaluation and young patients withneuro-ophthalmologic manifestation can bereferred to higher centres.

27

CHAPTER – VIII

SUPPORT SERVICES

I. Housekeeping services

Introduction

Housekeeping is one of the basic functionsessential for the operation of a health careinstitution. It is housekeeping’s responsibility tomaintain an environment that is• Safe and provides maximum bacteriological

control throughout the hospital• Pleasant with furnishings whose design and

colour are pleasing to the patients andconducive to their recovery

• Functional, with everything necessary for thepatient’s recovery properly maintained andconveniently arranged.

Responsibilities of the housekeeping department

a. Environmental sanitation areas1. Public areas such as lobbies and reception

areas, canteens2. Circulating spaces such as halls, elevators,

stairways3. Patient accommodation4. Operating theatre(s), outpatient treatment

rooms, laboratory5. Toilets6. Service and supply rooms

b. Environmental sanitation procedures1. Window washing2. Wall washing3. Floor care (including rug and carpet cleaning,

where necessary)4. Furniture dusting, washing and polishing,

upholstery cleaning5. Light fixture cleaning

6. Rubbish removal7. Disinfections8. Ensuring clean linen

c. Noise control1. Reduction of noise made by large equipment2. Soundproofing of housekeeping and mainte-

nance equipment

d. Interior decoration1. Furniture repair and refinishing2. Replacement of furniture and furbishing3. Drapery making and/or repair4. Ensuring attractive surroundings (paintings,

flowers, etc)

Cleaning

The cleaning of windows, doors, walls, etc., helpsin arresting deterioration and preservingappearances.

Preservation: With the help of protective coatingsof paints, varnishes, waxing of floors, etc., thebuilding and its furnishings can be preserved.

Replacement and repair

This involves timely repairs or replacement ofsanitation equipment, water supply, electricalfittings, etc.

Hospital waste management• Hospital waste contains biological materials,

which possess potentially harmful microorgan-isms; special care should be taken while man-aging it

• Waste management should conform to legalrequirements, Government norms and beacceptable to the general public

28

• Care should be given in segregation, transport,temporary storage and final disposal of hospi-tal waste

• Segregation should take place at the source ofgeneration of waste. It is very important thatdifferent colour code is followed and main-tained throughout the hospital

• Non infectious items can be collected in blackbags

• Infectious items – sharps, plastic items, humananatomical waste can be collected in blue, redand yellow bags respectively

• Non infective wastes are disposed in a landfill• Infected solid wastes and human anatomical

wastes (contents of yellow bags) areincinerated

II. Dietary services

Introduction

Dietary services are important in a hospital thatprovides inpatient care. Nutritious and appetizingmeals help ensure patient satisfaction and aid thehealing process. Service is usually provided in-house, but may be contracted to a responsiblecaterer. Meal service will be determined by localcustoms, hospital routines and procedures, andpatient preferences. Nonpaying patients canreceive free or low cost meals. Paying patients mayexpect meals to be included in their surgery andaccommodation fee.

Attributes of effective dietary services1. Meals should be available within hospital

premises. Many patients will expect roomservice

2. Food must be of high quality. Patients withspecial diets, such as diabetics, must be servedappropriate meals

3. The capacity of dietary services should matchthe expected volume of patients. In a growingeye care program, this might mean expanding

or renovating the kitchen space, purchasingmore cooking equipment, and hiring more staff

4. Staff must be well trained and knowledgeableabout nutrition and special diets. They shouldunderstand the connection between dietaryservices, patient satisfaction, large volume andlow cost

5. Patient attendees can bring revenue to thehospital, where appropriate, through theirbusiness to the canteen or coffee shop

III. Clinical laboratory

Basic lab equipment1. Table microscope - 12. Cell counter - 13. Glucometer - 14. Chemical balance - 15. Calorimeter - 16. Other minor equipment (Test tubes, stand,

etc.,)

IV. Stores (Materials management)

Introduction

Materials management means keeping track of allthe hospital’s supplies. It is the analysis, planning,implementation and control of carefully developedsystems and programmes designed to achievemaximum cost efficiencies in the variable costareas of supplies, equipment, services andpersonnel, consistent with organisationalobjectives. Materials management includes allaspects of purchase or procurement, inventorymanagement, and issue and usage. It mightinclude vendor negotiations, routine purchasingafter sources have been established, demandforecasting, budgeting for supplies, maintenance/disposal / recycling of supplies, receipt inspectionand payment, stocking and storage, inventorycontrol and loss prevention to minimize loss dueto spoilage or pilferage.

29

Importance of stores

Efficient storekeeping helps to keep productivityhigh. Materials management is one of the keyfactors for improving performance of anydepartment. Higher inventories mean higher(avoidable) costs, and they block scarce funds thatmight be required by the organization foroperations or essential development.

Role of stores

The tasks of the storekeeper range from the safecustody and preservation of the material stocked,to the receipts and accounting, and to the issuingof supplies. The storekeeper’s tasks are:1. To maintain the continuity of supply by

ensuring that all the materials are available atthe needed time at an optimum cost

2. To facilitate the hospital operation by provid-ing high quality goods

3. To reduce the operating cost4. To decide whether to make something or

buy it5. To exercise control over the usage of goods

Principles of storekeeping

Supplies can be categorized under three headings:vital, essential and desirable. These three categorieswill determine how much of each item should bein stock at any given time. There are sevenprinciples of material management that must bekept in mind to ensure good results.

The storekeeper in charge must follow theseprinciples (the 7 R’s).1. Right time2. Right quantity3. Right price4. Right source5. Right delivery6. Right methods7. Right people

Models and systems of storekeeping

Stores departments can be centralized ordecentralized. A centralized materialmanagement network focuses on the suppliesneeded for each activity or function of the entirehospital. A decentralized material managementmodel is one where each area or departmentperforms the various material managementfunctions itself.

V. Medical equipment maintenance services

Introduction

The appropriate and safe operation of medicalequipment is important to the proper functioningof any health care facility. A Medical EquipmentMaintenance Department (also called medicalinstrument maintenance department, biomedicalengineering department or clinical engineeringdepartment, etc.) is responsible for testing,repairing, and maintaining the hospital’sdiagnostic and therapeutic equipment.

In smaller hospitals, the role of medicalequipment maintenance may be incorporated intothe facilities maintenance department. Smallhospitals that are part of a larger hospital systemmay also receive their medical equipmentmaintenance services from the medical equipmentmaintenance department of the central tertiaryhospital of the system.

Role of medical equipment maintenance department

The major functions of this service are:• Perform incoming inspection, installation,

preventive and corrective maintenance, andspecial request service on clinical equipmentowned, and/or used within the health systemin compliance with regulatory agencies

• Minimize downtime of medical equipment byproviding efficient follow-up on equipmentproblems

30

• Assist the materials management departmentand other departments with pre-purchaseevaluations of new technology and equipment

• Assist clinical departments with service con-tract analysis, negotiations and management

• Provide coordination of clinical equipmentinstallations including, planning, scheduling,and overseeing

• Training of clinical staff on operation and careof equipment

• Maintain equipment service records in an assetmanagement filing system or database

• Assure patient and employee safety related tomedical devices and systemsIn smaller hospitals, some of the suggested

roles presented may be taken on by theMaterials Management Department or otherdepartments.

Required facilities and equipment

Some important physical assets needed for thisdepartment:1. A work space that can accommodate the

equipment technicians and the materials thatfollow

2. Repair tools3. Test equipment4. Workbenches, stools, shelves and other furni-

ture5. Work lights6. Essential spare parts7. Library of operation and service manuals8. Electrical outlets9. Running water10. This department should have access to a

computer in the hospital for electronic storingof equipment inventory and repair records

31

CHAPTER - IX

OPTICAL AND PHARMACY SERVICES

IntroductionThe optical shop and pharmacy are among themost important supporting departments in an eyehospital. Both can contribute to a high quality,and sustainable eye care program. To control thequality of spectacles and medications, both shopsshould be inside the hospital premises. Havingthem in-house also helps to keep the hospitalrunning by generating additional revenues.

a. Attributes of an effective optical shop1. Access to postal or courier services are neces-

sary since prompt delivery is vital2. If lens grinding occurs on site, the manufactur-

ing area should be located near the opticalshop for quick service

3. The optical shop should be treated like a retailbusiness, with regular business hours, amplespace for customer comfort, as well as friendly,helpful and knowledgeable staff

4. Quality must be monitored and maintained toensure that patients receive the correct powerin their glasses

5. A wide choice of glasses and frames should beavailable for purchase

6. All available frames should be hypoallergenic

b. Attributes of an effective pharmacy1. The pharmacy should be open during ex-

tended business hours and available for emer-gency purchases as well

2. Stock should exceed expected demand so thatshortages never occur. An experienced phar-macy supervisor should monitor purchasingand inventory to minimize loss due to spoil-age. Bulk purchasing will help keep costs low

3. Quality must be maintained very carefully toavoid errors and to ensure patientsatisfaction

4. All staff must be well trained, knowledgeableand courteous

5. The pharmacy should be situated for easyaccess to patients or their attendees

Efficient service will help ensure the hospital’sproductivity and reputation.

32

CHAPTER - X

COMMUNITY OUTREACH

I. Eye screening camp

Introduction

In developing countries eye care still remains to bea low priority considering other health care needsin the allocation of resources, besides the exisitingresources are not utilized to optimal level. Hospitalservices are not accessed by potential beneficiariesand the reasons being socio-economic problems,illiteracy and ignorance. The problems are similarin most of these countries. As an alternativestrategy to increase access, the hospital shouldproactively go into the community and screenpatient by organising outreach camps and healthvolunteers in villages should be trained to screenpeople for operatable cataract and motivate themto accept surgery.

In order to develop and maintain a highquality, large volume, sustainable eye care setup, itis essential to have this proactive approach ofattracting patients instead of waiting for them toarrive on their own. It is necessary to generatedemand for the services of your institution throughcommunity outreach activities.

The objectives of screening eye camps should be:

1. To identify people with cataract and offersurgery to restore their sight

2. To create awareness among the blind andmotivate them to utilise the existing facilities

3. To detect other eye problems and advise /provide appropriate treatment (comprehensiveeye care)

4. To prescribe and provide glasses for refractiveerrors (at affordable rates)

5. To detect and treat (referring for surgery whenrequired) cases with diseases such as pterygium,chronic dacryocystitis and other infections

6. To identify and treat / refer school children inthe villages with refractive errors, squint,amblyopia, nutritional deficiencies

7. To provide health education on proper eye carein the community

8. To develop and maintain a relationship be-tween the institution and the community

9. To market eye care facilities and servicesoffered

10. To provide a training ground for medical staffin order to develop their capacity

The various eye camps are:

1. Screening (diagnostic) camp2. Outreach (mobile) surgery camp3. School eye health screening programs4. Community-based referral systems

33

1. Systems and Procedures for Conducting Community Outreach

a. Pre-camp activities

AAAAActivitiesctivitiesctivitiesctivitiesctivities TTTTTime frameime frameime frameime frameime frame

Develop an annual plan and weekly/monthly schedule. At the beginning of the year

Contact the sponsors and help them understand the At least one month before the campneed for camps.

Judge the sponsor’s financial capacity and manpower At the time of approachavailability.

Make sure the sponsors understand their commitment. At the time of approach

Explain the camp procedure to the sponsor. At the time of approach

Suggest a suitable date that does not coincide with One month priorlocal festivals, harvest, etc.,

Select and confirm the camp site. One month prior

Assist the sponsor in planning the work and the After finalizing the date and placepublicity strategies.

Update the sponsor on hospital based activities Periodicallyrelated to camps.

Give the sponsor a standard format for notice bills One month beforeand posters for publicity work.

Ensure the execution of publicity work (proper Two weeks before the campplanning and delegation).

Conduct periodical meetings (monthly / weekly) at Once in a monththe base hospital to assess the number of doctors,paramedical staff, drivers and vehicles needed.

Plan the accommodation and food for the expected During the camp meetinginpatients on the camp day.

Prepare the operation and discharge schedule. During the camp meeting

Finalize the camp posting and inform the people A week before the campconcerned.

Make sure the stores has been informed on all the A week before the campmaterials required (medicines, printed forms, etc.,).

Plan transportation for the patients from the campsite A week before the campto the hospital and back.

34

b. Camp day activities

AAAAActivitiesctivitiesctivitiesctivitiesctivities TTTTTime frameime frameime frameime frameime frame

Make sure the OP & IP registers, other documents, One day before the campmedicines, equipment etc. are ready.

Arrange furniture and facilities in the camp site for One day before the campvarious stages in the screening of patients.

Give the volunteers instructions on registering the One day before the camppatients and regulating the flow of patients.

Counsel the patients advised for surgery. On the camp day

Check the patient’s BP and do urine tests at the On the camp daycamp site.

Enter the inpatients details in the relevant forms. On the camp day

Arrange food for medical team as well as the patients One day before the campselected for surgery.

Arrange transport to take the patients to the hospital. On the camp day

c. Post-camp activities

AAAAActivitiesctivitiesctivitiesctivitiesctivities TTTTTime Fime Fime Fime Fime FrameramerameramerameAdmit the patients brought from the camp. On the camp dayInform the doctors and paramedical staff to take A week before the camp (a temporarycare of preoperative procedures. schedule)Make food arrangements for the patients. On the camp daySupervision of the medication provided to the Dailypatient after surgery.Inform the sponsor of the results of the camp and Next day of campthank him for his cooperation.Maintain a good rapport with the sponsor. Periodical visit, mailing and meetingDiscuss the success and failure; review the plan Every weekand performance.Draw camp reports and statistics (update). For each camp after dischargeSend the reports to the local agencies, government For each camp whenever it is neededsectors, supporting agencies.Get interdepartmental feedback to maintain the Periodical meetinglevel of satisfaction and growth.Plan future outreach programs End / beginning of the year

35

Flow of patients in a camp

The flow of patients in a camp should be managedso as to facilitate a comprehensive eye examinationof all patients in a short time. This requires goodcoordination and cooperation among the staffmembers in the camp.

Station 1 - Patient registration1. Volunteers record the patient’s name, age and

address in the case sheet2. These volunteers must have legible handwrit-

ing (usually teachers)3. Patients are given identity cards, which should

be retained for future follow-up

Flow Chart of examination protocol at campsite

Registration

Vision testing

Preliminary examination by doctor, using torch, direct ophthalmoscope, drops

• Common medical problem

• Very early cataract

• Surgical cases

• Immature cataract

• Fundus pathology

Advise treatment Dilate

Surgical cases withmajor medical

problems

Optical Refer to physician

Direct admission

Refraction

Final exam by doctor

Tension, Duct, BP, US

Glasses prescribed Select cases forsurgery

Counselling

Admission

36

Stage 2 - Preliminary vision testing1. Vision testing is conducted by ophthalmic

assistants, aided by volunteers2. Vision charts, such as the Snellen chart in the

local language and illiterate E type charts, areused with adequate illumination

Stage 3 - Preliminary diagnostic examination1. Junior ophthalmologists conduct the prelimi-

nary examination2. They use flashlights (torches) and ophthalmo-

scopes to examine the external eye andfundus

3. They need a dimly lit room with desk, chairs,and two functioning electrical outlets

4. If there is no electricity, doctors use battery-operated instruments

Stage 4 - Intraocular pressure and tear duct function

1. This test is conducted by trained ophthalmicassistants, with the help of community volun-teers

Station 5 – Refraction1. Patients with complaints of defective vision

due to refractive errors, myopia, presbyopia,outdated glasses, or aphakia are examined

2. Well-trained ophthalmic technicians refractwhile volunteers help control the patient flow

3. Mostly refraction is accomplished without

dilation, but young children and some adultsreceive cycloplegia. There are adjoining wait-ing rooms for dilatation

Stage 6 - Final examination

Senior doctors evaluate the test findings andconduct the final examination, review the patient’srecord, make the final diagnoses and prescribetreatment. In a small camp, one doctor will doboth the preliminary exam and the final exam.Senior doctors can prescribe glasses or medicine,or advise the patient to undergo surgery.

Stage 7 - Optical shop1. This is managed by an optician who attends

the screening camp2. If the patient is advised glasses he or she can

purchase readymade spectacles, if available

Stage 8 - Patient counselling and IP admission1. Those patients scheduled for surgery are

registered, counselled, and transported to thebase hospital at the close of the eye camp

2. These patients receive surgery, post-operativecare, meals, and round-trip transportation

2. Man power requirement for outreach activities

The manpower requirement in a camp depends onthe size of the camp. Ideal man power utilizationcan be as in the table below:

NNNNNumber of expected patientsumber of expected patientsumber of expected patientsumber of expected patientsumber of expected patients <200<200<200<200<200 200-400200-400200-400200-400200-400 400-600400-600400-600400-600400-600 >600>600>600>600>600EEEEExpected cataract operationsxpected cataract operationsxpected cataract operationsxpected cataract operationsxpected cataract operations 10-4010-4010-4010-4010-40 40-8040-8040-8040-8040-80 80-12080-12080-12080-12080-120 >120>120>120>120>120Ophthalmologists 1 2 3 5-7Ophthalmic assistants: (3) (6) (9) (11-12)

- Preliminary vision 1 2 3 3-4- IOP & duct 1 2 3 4- Refraction 1 2 3 4

Optician 1 1 1 1Camp organizer 1 1 1 2Patient counsellor 1 1 1 1

37

II. Primary eye care centreScreening eye camps, conducted with minimuminfrastructure requirements, rely heavily uponreaching out efficiently to more people in ruralareas and also encouraging active involvement ofthe community.

In spite of the enormous amount of work donethrough outreach camps, studies show only 7% ofpeople who need eye care access these services.

Outreach camp is the short term strategy usedin order to clear the backlog, to create awareness inthe community and to create demand for thehospital. But in the long run a more sustainablesolution is to establish permanent eye care facilitiesin the community in the form of vision centreswhich will provide primary eye care services andalso act as a referring point channelling thepatients to the secondary hospital for surgeries.

3. Equipment needed for a screening eye camp

NNNNNumber of expected patientsumber of expected patientsumber of expected patientsumber of expected patientsumber of expected patients <200<200<200<200<200 200-400200-400200-400200-400200-400 400-600400-600400-600400-600400-600 >600>600>600>600>600EEEEExpected cataract operationsxpected cataract operationsxpected cataract operationsxpected cataract operationsxpected cataract operations 10-4010-4010-4010-4010-40 40-8040-8040-8040-8040-80 80-12080-12080-12080-12080-120 >120>120>120>120>120Snellen chart 4 6 7 8Tonometer 1 2 2 2Ophthalmoscope 1 1 2 3Flashlight (battery/electric) 2 2 4 4Medicine tray 1 2 2 3Basin 1 2 2 2Cubicle set and cloth 1 2 3 4Trial lens set 1 2 3 4Retinoscopy mirror 1 2 3 4Wire set with bulb & bulb holder 3 4 5 6Extension switch board 1 1 1 2Bulb 3 4 5 6Jar / bin 1 1 1 1Needle2 4 6 10Syringe 1 2 3 5Kidney tray 1 1 1 1

For running a vision centre, in other wordsprimary eye care centre, with 2 mid levelophthalmic personnel, the following instrumentsand equipment are adequate.

Equipment needed for primary eye care centreSlit lamp 1Streak retinoscope 1Direct ophthalmoscope 1

38

Trial sets 1IPD scale 1JCC 1Mirror (refraction) 1Snellen chart (drum) 1Near vision chart 190 D lens 1Applanation 1Basic sterilizer 1LoLoLoLoLow w w w w VVVVVisionisionisionisionision Hand held magnifier 1OOOOOptical dispensingptical dispensingptical dispensingptical dispensingptical dispensing Grinding, edging kit and machine 1

39

CHAPTER – XI

MANAGEMENT

IntroductionThe administrator and his or her team must beresponsible for all the non-medical activities. Thiswill broadly comprise of getting adequate patientload through innovative social marketingapproaches and ensuring that the clinical servicesare provided in a cost effective manner throughoptimum utilization of resources. The team willalso need to manage functions such as medicalrecords (a necessity in face of the growingmalpractice suits), inventory, housekeeping,security and support services. Adequate area foradministration and support services must be

provided. In addition to routine administration ofaccounts, inventory, etc., the community outreachwork will form a significant part of theadministration.

1. Equipment

S.NS.NS.NS.NS.Nooooo PPPPParararararticularsticularsticularsticularsticulars QQQQQuantityuantityuantityuantityuantity

1 Computers 12 Printers 13 UPS 14 Server 15 LCD Projector 16 Furniture To requirements

40

CHAPTER - XII

PROCUREMENT MANAGEMENT

General financial and management considerations forowning medical equipmentMedical equipment costs money to operate and tomaintain during its life cycle. On average, theoriginal purchase cost only constitutes about 20%of the entire life cycle costs of the equipment.Installation of certain equipment such as largesterilizers will involve initial additional costs fordedicated water and electrical supplies. Expensiveconsumables, which generally are not re-usable, arerequired for devices such as phaco and vitrectomymachines.

All medical devices, regardless of theircomplexity and ruggedness, require periodicmaintenance and corrective maintenance at somepoint. Even a simple device such as anophthalmoscope requires ongoing costs forreplacement of bulbs and batteries, includingrechargeable ones.

As a rule, equipment owners should budgetanywhere from 3% to 7% of the purchase cost peryear for each device to cover consumables, parts,maintenance, and user training. The life cycle of amedical device can range between 5 and 15 years,depending on the design and ruggedness of thedevice and the environment in which it is used. Aplan must be in place to replace equipment.

All eye care departments and institutionsshould have a medical equipment managementprogram to assure the maximum and most costeffective utilization of its technology. Thisequipment management program may, dependingon the available resources and capacity of theinstitution, be handled by an in-house biomedicalengineering department, by an outside serviceorganization, or by an equipment maintenanceservice shared by several linked institutions. Thisprogram should include equipment inventory,

preventive maintenance, corrective maintenance,emergency repair services, vendor and contractmanagement, technology planning (includingselection, procurement and retirement ofequipment), training for equipment users andpatient safety, among other functions.

General considerations for evaluating and procuringophthalmic equipmentEquipment planning should be fully integratedinto any plans for new construction or renovationsto assure that the equipment will fit in the newspace and that matters such as work flow, safety,and appropriate electrical, plumbing, cooling, andother utilities are available.

The suggestions below might prove beneficial whenevaluating new equipment for purchase• Consult other users of the same equipment

and, if possible, of the very same brand andmodel. Ask the salesperson for the names ofthe hospitals and the physicians in thosehospitals who are using his company’s prod-ucts. If there are no local users of thismanufacturer’s equipment, you may wish toconsider other manufacturers with morecustomers in your area. (The company ismore likely to be able to provide better serviceif it has several customers in the same area)

• Communicate with colleagues in major teach-ing centers that are likely to have the specificdevices being considered

• Consult the major ophthalmology publicationsfor articles containing objective evaluations ofthe particular equipment of interest

• Ask vendors to loan the hospital a unit to betested by the hospital’s staff

41

• Seek help from non-governmental organiza-tions (NGOs) that might be in a position toobtain objective information from otherpractitioners abroad

• If possible, defer the purchase until a visit to amajor equipment exhibition at a professionalmeeting or conference where other users canbe consulted and comparison of the productsof many different manufacturers can take placeall in one setting

In addition to quality and performance of the devices, someadditional important criteria that should beconsidered when evaluating equipment for purchase are:• Total purchase price?• Estimated ownership costs per year (supplies,

spare parts, accessories)?• Terms of payment?• Installation costs?• Delivery costs?• Delivery time?• Installation services provided?• User and maintenance training provided?• Operation manuals in local language included?• Warranty period?• Service costs per hour after warranty period?• Post-warranty service contract available? If so,

what is the cost per year?• Factory trained service engineers available

locally?• Availability of spare parts and consumables

locally• Estimated time for service eng. to arrive on site

for service?It is advisable to get quotations or proposals

from at least 3 different vendors, if possible. Oncea vendor is selected, the hospital will need toprepare a purchase order (P.O.), which is adocument clearly stating everything a hospitalwishes to purchase from a particular vendor and itrepresents an agreement between the hospital andthe vendor, on the terms of that purchase.

On some occasions, the vendor may present astandard purchase agreement for use as an examplefor the hospital’s P.O. This document should beread carefully, & unless it includes all the provi-sions that are considered necessary, the vendorshould revise it or the hospital should write its ownP.O. This ensures that it includes all the provisionsyou wish and that can be jointly agreed upon.

The first and most important requirement isthat the P.O. contains detailed pricing information.If the device being bought contains assemblies,hand pieces, foot switches or other accessories thatare not included in the basic machine price, eachitem should be listed separately. Some other itemsthat may be necessary to itemize in a P.O.:• Warranty terms• Payment arrangements• Delivery terms• Installation terms• Manuals to be included• Additional accessories• Additional software• Maintenance or service contracts beyond the

warranty period• Any wiring, plumbing or construction work

that the seller or his contractor must performin order to prepare the installation site

• Any other parts, assemblies or attachments forwhich you have negotiated

• Additional arrangements for training or in-service either on or off siteThe important point to remember is that

everything that is expected to be received should beshown on the P.O. to eliminate surprises ormisunderstandings.

Offers of equipment donations byhumanitarian agencies and NGOs should becritically evaluated with the same rigor, if not more,that is performed for purchases. This will eliminatethe common problems associated withinappropriate donations such as obsolescence, lackof local service support, lack of manuals, lack ofspare parts, etc.

42

ANNEXURE

I. INSTRUMENTS AND EQUIPMENT LIST

IntroductionAdequate and appropriate instruments available atan eye care centre help eye care personnel to arriveat a correct diagnosis, to render proper treatment,and thus provide comprehensive high quality eyecare to its patients.

All supplies, instruments and equipmentshould be used efficiently and effectively. It is veryimportant that all the instruments are kept in

good working condition at all times and “downtime” during which any instrument is not workingis kept to a minimum.

The following is a comprehensive list ofinstruments required in a secondary care hospital.The total number calculated is based on the manpower in the hospital and the distribution of manpower everyday within the hospital.

Basic Secondary Eye Care Setting:

I. Instruments needed in OPD

a. Diagnostic equipments

1. Schiotz tonometer 22. Flashlight (battery/electric) 63. Slit lamp 24. Direct ophthalmoscope 35. Indirect ophthalmoscope 26. 90 D lens 27. 20 D lens 28. Gonioprism 19. Applanation tonometer 110. Kimura spatula 111. No 15 Surgical Blade 112. Binocular microscope 113. Bjerum’s screen

(field test chart) 114. Goldman perimeter 1 (optional)

(field test perimeter)15. 15 cm glass ruler 216. Hess chart screen 117. Weighing machine 118. Material for diplopia charting 119. Torch light with red and green 120. Slit light source,21. Red green goggles 1

b. Supplies needed for refraction

1. Snellen test type(Trial drum or separate charts) 4

2. Near vision testing (Jaegerchart or Snellen near visiontest type) 4

3. Retinoscopea. Plane mirror retinoscope 1b. Streak retinoscope 1

4. Trial frames (light, readilyadaptable, allowing adjustmentfor each eye separately) 2

5. Trial case 26. Prism bar 17. Refractometer 18. A-scan 19. Keratometer 110. Occluder 1

Additional instruments to provide advanced secondary eye care

1. Fundus camera 12. Laser unit (YAG LASER) with

slit lamp adapter 13. Laser unit for retinal

photocoagulation 14. Exopthalmometer (optional) 1

43

II. OT equipment and microsurgical instruments

a. Instruments needed in block room

b. Equipment required for OT

1. Two Microscope, with the followingfeatures- Coaxial illumination- Good optics- Adjustable intensity of illumination- Range of magnification- Focus controls; Eye piece adjustment- Interpupillary distance adjustment- Adequate position adjustment- Sterile grips and knobs

2. Bipolar cautery machine - 23. Automated vitrectomy machine

if possible - 14. Cryo machine (optional, rarely used now)5. Steriliser (flash autoclave) - 16. Boyle’s apparatus7. Suction machine

Microsurgical instruments

(For cataract surgery, filtering surgery, pterygiumexcision). The microsurgical instruments forcataract surgery depend on the technique of thesurgery and the surgeon’s skill and preferredmethod in performing the technique. Thestandard list of instruments used for cataractsurgery is listed below.

a. Cataract surgical set1. Universal eyelid speculum / Barraquer lid

speculum2. Fine toothed forceps, Hoskin’s forceps3. Heavy toothed forceps / muscle holding

forceps / superior rectus forceps4. Superior rectus needle holder (Arruga)5. Curved round bodied needle6. Mosquito clamp (anchor for bridle suture)7. Spring scissors (Westcott)-tenotomy scissors8. Bard Parker blade breaker and razor blades /

Castroviejo blade breaker9. Crescent blade, 15 Blade10. 22 gauge disposable needle with 120º bend11. 2ml syringe for viscoelastic with a canula

12. 26 gauge needle bent/cystitome13. Corneal scissors14. Mc Phersons forceps (capsule holding)15. Vectis/lens loop/irrigating Vectis16. Lens spoon/squint hook (nucleus delivery)17. Simcoe irrigation aspiration cannula and

handle, and 5cc syringe for manual aspiration18. Lens holding forceps19. Sinskey hook20. Needle holder21. Nontoothed forceps (tying)22. Vannas scissors23. Straight scissors (optional)24. Iris repositor, iris scissors, iris forceps

(optional), Elshnig cyclo dialysis spatula25. Kelly’s punch, 26 Guage needle26. Artery clamp/Kalt needle holder27. Capsulorhexis forceps28. Anterior capsulotomy scissors29. Posterior capsule polisher cannula30. Hydro cannula 25G31. Towel clip

1. Balancing weight, pinky balls,kulvari stands 2

2. Oxygen cylinder and nasalcannula 1

3. Endo tracheal intubation tubes 14. Ambu bag 15. Laryngoscope 16. BP apparatus 17. Stethoscope 1

Other supplies:1. Soap – liquid soap or bar soap2. Surgical scrub3. Emergency kit

44

Other important supplies:1. Instrument trays (stainless steel tray with

perforated bottom)2. Trays for holding cidex® OPA solutions and

distilled water (stainless steel trays with nonperforated bottom)

3. Silk (8-0), nylon (10-0), nylon (9-0) sutures,5-0 silk/cotton bridle suture

b. For chalazion incision and curettage1. Bard parker handle, 15 blade2. Chalazion forceps/clamp (Lambert)3. Chalazion curette (Meyerhoffer)4. Toothed forceps

c. For dacryocystorhinostomy and dacryocystectomy1. Bard parker handle, 11 blade2. Curved small size artery clamp3. Toothed forceps4. Lang’s lacrimal sac dissector/bone dissector5. Cat paw retractor6. Tenotomy / lacrimal sac cutting scissor7. Castroviejo punctum dilator8. Bowman naso lacrimal duct probe9. Needle holder10. Thudicum’s nasal speculum11. Tilley’s nasal forceps12. Meuller lacrimal sac retractor13. Bone punch small and large (Citelli’s or

Ronguer forceps)14. Suture materials:

- 4-0 silk suture- 6-0 vicryl sutures

Optional1. Probe set2. Sac cannula

3. Pawar implant introducer4. St. Tying forceps

d. For enucleation and evisceration1. Universal eye speculum /PA speculum2. Tenotomy scissors3. Toothed forceps4. BP handle, 11 blade5. Evisceration spoon (Mule)6. Enucleation spoon (Well’s)7. Muscle hook8. Enucleation scissors9. Needle holder10. St. Tying forceps

III. Equipment needed for sterilisation1. Single drum electrical autoclave for

sterilisation 12. Stainless steel drum with electric

coil with tight lid with tap 13. Ultra sonic cleaner 14. Flash autoclave-high speed steriliser 15. Surgical drum (capacity to hold 6 sets) 26. Separate drums for autoclaving

linen from OT 1

IV. Basic lab equipment1. Table microscope2. Cell counter3. Glucometer

V. Equipment needed for a screening eye campEquipment needed for a screening camp dependon the volume of patients to be seen in thecamp.

An ideal list of supplies for a screening eye campcan be as in the following table:

45

Optical dispensing equipment

I. Manual Edging Sets1. Manual Edging Machine ( Avanti Motor)2. Frame Warmer3. Screw Driver

- Br.2mm- Br.1.50mm- Br.1.mm

4. Marking Pencil5. Adjustment Pliers6. Nose pad Pliers7. Nose Pliers8. Chipping Pliers9. Diamond Cutter10. Axis Marking Chart11. All Screw Box Unit

12. Machine Hose13. All Nose pads

II. Rimless & Supra Frames Grooving Machine1. Auto Grooving Machine ( Supra Frames)2. Drilling Machine ( Three Piece Frames )3. Nut Driver

III. Cleaning1. Acetone2. IPA3. Tissue Paper4. Selvet Cloth

IV. Power Checking1. Lensometer ( Automatic Power checking

Machine)2. Trial Set ( manual Power checking )

Camp sizCamp sizCamp sizCamp sizCamp sizeeeee

PPPPParararararticularsticularsticularsticularsticulars SSSSSmallmallmallmallmall MMMMMediumediumediumediumedium LargeLargeLargeLargeLarge VVVVVererererery Largey Largey Largey Largey Large

Number of expected patients <200 200-400 400-600 >600Expected cataract operations 10-40 40-80 80-120 >120Snellenchart 4 6 7 8Tonometer 1 2 2 2Ophthalmoscope 1 1 2 3Flashlight (battery/electric) 2 2 4 4Medicine tray 1 2 2 3Basin 1 2 2 2Cubicle set and cloth 1 2 3 4Trial lens set 1 2 3 4Retinoscopy mirror 1 2 3 4Wire set with bulb & bulb holder 3 4 5 6Extension switch board 1 1 1 2Bulb 3 4 5 6Jar / bin 1 1 1 1Needle 2 4 6 10Syringe 1 2 3 5Kidney tray 1 1 1 1

46

LensometerAuto EdgerManual Edger

V. Automated Fitting Sets1. Kappa Edger2. Kappa tracer3. Lens Tracer

4. Adhesive Pads5. Pluger6. Bar Coding Sheet

47

II. O

PHTH

ALM

IC IN

STRU

MEN

TS A

ND EQ

UIPM

ENT M

ANUF

ACTU

RERS

LIST

- GL

OBAL

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

120

10 P

erfe

ct V

isio

nA

m T

aube

nfel

d 21

/1w

ww

.201

0pv.

com

Lase

r: R

efra

ctiv

e C

orne

aH

eide

lber

g (G

erm

any)

D-6

9123

Surg

ery,

VIS

X, L

ASI

K, P

RK

2A

ccut

ome

Inco

rpor

ated

42 L

loyd

Ave

nue

ww

w.a

ccut

ome.

com

Oph

thal

mic

Kni

ves,

Bla

des,

Surg

ical

Ins

trum

ent T

ools

Mal

vern

, PA

(U

SA)

1935

5

3A

cum

en S

urgi

cal P

vt L

tdPO

145

9, C

apit

al R

oad

ww

w.a

cum

ensu

rgic

al.c

omK

nive

s, B

lade

s, S

urgi

cal

Jinn

ah, S

ialk

ot (

Paki

stan

)In

stru

men

t to

ols,

Oph

thal

mic

Med

ical

Ins

trum

ents

4A

D I

nstr

umen

ts -

Res

earc

h19

49 L

andi

ngs

Dri

vew

ww

.adi

nstr

umen

ts.c

omEy

e M

ovem

ent T

rack

ing

Mou

ntai

n V

iew

, CA

(U

SA)

9404

3Sy

stem

s, A

nim

al F

unct

ion

Mon

itor

s

5A

dvan

ced

Med

ical

Opt

ics

3400

Cen

tral

Exp

ress

way

ww

w.v

isx.

com

Lase

r: R

efra

ctiv

e C

orne

a(A

MO

)Sa

nta

Cla

ra, C

A (

USA

) 95

051

Surg

ery,

VIS

X, L

ASI

K, P

RK

6A

lcon

Lab

orat

orie

s In

c62

01 S

Fre

eway

ww

w.a

lcon

labs

.com

Oph

thal

mic

Kni

ves,

Bla

des,

Fort

Wor

th, T

X (

USA

) 76

134

Surg

ical

Ins

trum

ent

tool

s

7A

llerg

an, I

ncP.

O. B

ox 1

9534

http

://w

ww

.alle

rgan

.com

/sit

e/

8A

mer

ican

Sur

gica

l Ins

trum

ents

26 P

laza

Dri

vew

ww

.asi

co.c

omO

phth

alm

ic K

nive

s, B

lade

s,C

orpo

rati

on (

ASI

CO

)W

estm

ont,

IL

(USA

) 60

559

Surg

ical

Ins

trum

ent

tool

s

9A

ncho

r Pr

oduc

ts C

o52

Off

icia

l Rd

ww

w.a

ncho

rsur

gica

l.com

Kni

ves,

Bla

des,

Sur

gica

lA

ddis

on, I

L (U

SA)

6010

1To

ols,

Oph

thal

mic

Ins

trum

ent

10A

ppas

amy

Ass

ocia

tes

-N

o 20

SB

I O

ffic

ers

Col

ony

ww

w.a

ppas

amy.

com

Oph

thal

mic

Kni

ves,

Bla

des,

Oph

thal

mic

Ins

trum

ents

Firs

t St

reet

, C

henn

ai,

Surg

ical

Ins

trum

ent

tool

sTa

mil

Nad

u (I

ndia

) 60

0 10

6

11A

pplie

d Sc

ienc

e La

bora

tori

es17

5 M

iddl

esex

Tur

npik

ew

ww

.a-s

-l.c

omEy

e M

ovem

ent T

rack

ing

(ASL

) -

Eye

Trac

king

Bed

ford

, MA

(U

SA)

0173

0Sy

stem

s

12A

RC

Las

erV

on-B

rent

ano-

Str

31C

ww

w.a

rcla

ser.d

eLa

ser:

Ret

inal

, Pho

toco

agul

ator

,E

cken

tal F

orth

(G

erm

any)

D-9

0542

Trab

ecul

opla

sty

13A

urol

abL

AIC

O B

uild

ing

ww

w.a

urol

ab.c

omIn

trao

cula

r le

nses

, Sut

ure

72, K

.K.S

alai

, Gan

dhi N

agar

Nee

dles

pha

rmac

euti

cal d

rugs

,

48

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

Mad

urai

- 6

25 0

20, T

amil

Nad

uM

icro

surg

ical

Oph

thal

mic

blad

es, B

ipol

ar C

oagu

lato

r

14A

vote

c In

c60

3 N

Buc

k he

ndry

way

ww

w.a

vote

c.or

gEy

e M

ovem

ent T

rack

ing

Stua

rt, F

L (U

SA)

3495

7Sy

stem

s

15B

ausc

h &

Lom

bO

ne B

ausc

h &

Lom

b Pl

ace

ww

w.b

ausc

h.co

mLa

ser:

Ref

ract

ive

Cor

nea

Roc

hest

er, N

Y (

USA

) 14

604

Surg

ery,

VIS

X, L

ASI

K, P

RK

16B

ioC

ontr

ol S

yste

ms

PO 1

9569

, Sta

nfor

d,w

ww

.bio

cont

rol.c

omEy

e M

ovem

ent T

rack

ing

CA

(U

SA)

9430

9Sy

stem

s

17B

oss

Inst

rum

ents

- S

urgi

cal

1838

Elm

Hill

Pik

e #1

19w

ww

.bos

sins

t.co

mO

phth

alm

ic K

nive

s, B

lade

s,In

stru

men

tsN

ashv

ille,

TN

(U

SA)

3721

0Su

rgic

al I

nstr

umen

t to

ols

18C

anon

Inc

- H

eadq

uart

ers

30-2

Shi

mom

aruk

o, 3

-cho

me

ww

w.c

anon

.com

Oht

a-ku

, Tok

yo (

Japa

n) 1

46-8

501

19C

arl Z

eiss

5160

Hac

iend

a D

rw

ww

.med

itec

.zei

ss.c

omC

amer

a, R

etin

al I

mag

ing

Dub

lin, C

A (

USA

) 94

568

Syst

em c

orne

al t

opog

raph

y,K

erat

omet

er, o

phth

alm

omet

ers.

Lase

r: r

efra

ctiv

e co

rnea

sur

gery

,V

ISX

, LA

SIK

, PR

K. L

aser

:R

etin

al, P

hoto

coag

ulat

or,

Trab

ecul

opla

sty

Ligh

t B

ulbs

,La

mps

: Sur

gica

l exa

mM

icro

scop

es: S

urgi

cal,

Med

ical

,sl

it la

mps

, ref

ract

or in

stru

men

tsTo

nom

eter

s, G

lauc

oma

Test

Inst

rum

ents

20D

uckw

orth

Ken

t Su

rgic

alTe

renc

e H

ouse

, 7 M

arqu

isw

ww

.duc

kwor

th-a

nd-k

ent.c

omO

phth

alm

ic K

nive

s, B

lade

s,In

stru

men

tsB

usin

ess

Cen

ter,

Roy

ston

Rd

Surg

ical

Ins

trum

ent

tool

sB

aldo

ck, H

erts

(U

K)

SG7

6XL

21E

agle

Lab

orat

orie

s10

201

Trad

emar

k St

reet

, Sui

te A

ww

w.e

agle

labs

.com

Oph

thal

mic

Kni

ves,

Bla

des,

Ran

cho

Cuc

amon

ga,

Surg

ical

Ins

trum

ent

tool

sC

A (

USA

) 91

730

22E

LEN

Las

erV

ia B

alda

nzes

e 17

ww

w.e

leng

roup

.com

Lase

r: C

apsu

loto

my,

Sel

ecti

veC

alen

zano

, Flo

renc

e (I

taly

) 50

041

Trab

ecul

otom

y (S

LT)

49

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

23E

mer

ald

Surg

ical

Com

pany

Fact

ory

Ror

as R

oad

ww

w.e

mer

alds

urgi

cal.c

omO

phth

alm

ic K

nive

s, B

lade

s,Si

alko

t (P

akis

tan)

Surg

ical

Ins

trum

ent

tool

s

24.

Esc

alon

Med

ical

Cor

p -

2440

Sou

th 1

79th

Str

eet

ww

w.e

scal

onm

ed.c

omC

amer

a, R

etin

al I

mag

ing

Hea

dqua

rter

sN

ew B

erlin

, WI

(USA

) 53

146

Syst

em K

nive

s, B

lade

s, S

urgi

cal

Inst

rum

ent

tool

s, O

phth

alm

ic,

Oph

thal

mos

cope

, Ret

inal

Imag

ing,

Ult

raso

und:

Dia

gnos

tic,

Oph

thal

mic

,Pa

chym

eter

vas

cula

r D

oppl

er,

Blo

od F

low

Mon

itor

s

25Ey

equi

p -

Cor

neal

Top

ogra

phy

5150

Pal

m V

alle

y R

d #3

05w

ww

.eye

quip

.com

Cor

neal

Top

ogra

phy,

Pont

e V

edra

Bea

ch, F

L (U

SA)

3208

2K

erat

omet

er, o

phth

alm

omet

ers

26Fr

itz

Ruc

k O

phta

lmol

ogis

che

Julic

her

Stra

be 1

15w

ww

.frit

zruc

k-gm

bh.d

eO

phth

alm

ic K

nive

s, B

lade

s,Sy

stem

e G

mbH

,Esc

hwei

ler-

Dur

wib

Surg

ical

Ins

trum

ent

tool

s(G

erm

any)

522

49

27H

aag

Stre

itVe

rkau

f, K

unde

ndie

nst S

chw

eiz

ww

w.ha

ag-s

trei

t.com

Cor

neal

Top

ogra

phy,

Gar

tens

tads

tras

se 1

0K

erat

omet

er, O

phth

alm

omet

ers,

Kon

iz (S

witz

erla

nd) C

H-3

098

Furn

iture

: Hos

pita

l Bed

s, Ex

amTa

bles

, Lig

ht B

ulbs

, Lam

ps:

surg

ical

exa

m, o

ptic

al le

ns, S

litLa

mps

, ref

ract

or I

nstr

umen

ts,

Tono

met

ers,

Gla

ucom

a te

st,

Inst

rum

ents

, Visi

on T

est

Inst

rum

ent,

Acu

ity E

ye C

hart

s

28H

eide

lber

g E

ngin

eerin

g -

Stra

sse

30w

ww.

heid

elber

geng

inee

ring.

com

Cor

neal

Top

ogra

phy,

Ker

atom

eter

,H

eadq

uart

ers

Hau

ptm

ann

opht

halm

omet

ers,

opht

halm

osco

pe,

Ger

hart

, Dos

senh

eim

Ret

inal

Im

agin

g U

ltras

ound

:(G

erm

any)

692

21di

agno

stic,

oph

thal

mic

, pac

hym

eter

29H

eine

Kie

ntal

stra

sse

7w

ww

.hei

ne.c

omH

eadl

amps

, Hea

dlig

hts:

Her

rsch

ing

(Ger

man

y) D

-822

11Fi

bero

ptic

lary

ngos

cope

,br

onch

osco

pe,

rhin

osco

pe,

light

bul

bs, l

amps

: sur

gica

l exa

m,

loup

e m

agni

fiers

, oph

thal

mos

cope

,re

tinal

imag

ing,

oto

scop

es, s

cale

s:

50

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

med

ical

, dig

ital

sig

moi

dosc

ope,

anos

cope

, upp

er G

I, e

ndos

copy

,sl

it la

mps

, ref

ract

or in

stru

men

ts,

Sphy

gmom

anom

eter

s (N

IBP)

30H

owar

d In

stru

men

ts I

nc47

49 A

pple

tree

Lan

ew

ww

.how

ardi

nstr

umen

ts.c

omO

phth

alm

ic K

nive

s, b

lade

s,Tu

scal

oosa

, AL

(USA

) 35

405

surg

ical

inst

rum

ent

tool

s

31H

S In

tern

atio

nal

5040

Com

mer

cial

Cir

cle

Uni

t A

ww

w.h

sisu

rgic

al.c

omO

phth

alm

ic K

nive

s, B

lade

s,C

onco

rd, C

A (

USA

) 94

520

Surg

ical

inst

rum

ent

tool

s

32H

uco

Vis

ion

PO B

ox 1

47w

ww

.huc

ovis

ion.

com

Oph

thal

mic

Kni

ves,

Bla

des,

St B

lais

e (S

wit

zerl

and)

CH

-207

2Su

rgic

al in

stru

men

t to

ols

33In

sigh

t In

stru

men

ts I

nc -

2602

SE

Will

ough

by B

lvd

ww

w.in

sigh

tins

trum

ents

.com

End

osco

py E

quip

men

t,R

etin

al E

ndos

cope

Stua

rt, F

L (U

SA)

3499

4en

dosc

opes

hea

dlam

ps,

head

light

s: F

iber

opti

cO

phth

alm

osco

pe, R

etin

alIm

agin

g

34Ir

idex

Cor

p12

12 T

erra

Bel

la A

venu

ew

ww

.irid

ex.c

omLa

ser:

Ret

inal

, Pho

toco

agul

ator

,M

ount

ain

Vie

w, C

A (

USA

) 94

043

35Is

con

Surg

ical

s Lt

d -

Syri

nges

,22

-4 H

eavy

Ind

ustr

ial A

rea

ww

w.is

cons

urgi

cals

.com

Oph

thal

mic

Kni

ves,

Bla

des,

Nee

dles

, Bla

des

Jodh

pur,

Raj

asth

an (

342

001)

Surg

ical

inst

rum

ent

tool

s

36K

ashm

ir S

urgi

cal W

orks

1888

-B10

Bal

dev

Nag

erw

ww

.kas

hmir

surg

ical

s.ne

tC

orne

al t

opog

raph

y,A

mba

la, H

arya

na (

Indi

a) 1

34 0

07ke

rato

met

er, o

phth

alm

omet

ers

fiber

opt

ic: I

llum

inat

or li

ghts

lary

ngos

cope

, br

onch

osco

pe,

rhin

osco

pe, l

oupe

mag

nifie

rs,

slit

lam

ps, r

efra

ctor

inst

rum

ents

spec

ula,

vag

inal

spe

culu

m

37K

aten

a Pr

oduc

ts I

nc -

Sur

gica

l4

Stew

art

Cou

rtw

ww

.kat

ena.

com

Oph

thal

mic

Kni

ves,

Bla

des,

Eye

Inst

rum

ents

Dan

ville

, NJ

(USA

) 07

834

surg

ical

inst

rum

ent

tool

s

38K

onan

Med

ical

Cor

pora

tion

10-2

9, M

iyan

ishi

cho

ww

w.k

onan

.com

Cor

neal

top

ogra

phy,

Nis

hino

miy

a, H

yogo

kera

tom

eter

, oph

thal

mom

eter

s,(J

apan

) 66

2-09

76M

icro

scop

es: s

urgi

cal,

med

ical

51

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

39K

owa

Com

pany

Ltd

6-29

Nis

hiki

3 C

hom

ew

ww

.kow

a.co

.jpA

ctiv

ated

Car

bon,

Cam

era,

Nak

a K

u, N

agoy

are

tina

l im

agin

g sy

stem

, cor

neal

(Jap

an)

460

0003

topo

grap

hy, k

erat

omet

er,

opht

halm

omet

ers

coug

h, c

old

med

icin

e, N

on-p

resc

riptio

n O

TC

opti

cal l

ens,

pai

n re

lieve

rs, N

on-

pres

crip

tion

OT

C, a

nalg

esic

sph

arm

aceu

tical

s: de

rmat

olog

y,A

cne,

pso

rias

is, e

czem

a,ph

arm

aceu

tica

ls: o

phth

alm

ic e

yem

edic

atio

n, p

harm

aceu

tica

ls:

pate

nted

dru

gs, s

lit la

mps

,re

frac

tor

inst

rum

ents

, ton

omet

ers,

glau

com

a te

st in

stru

men

ts,

Vit

amin

B-1

, B-2

, B-6

, B-1

2,R

ibof

lavi

n

40La

Pre

cisi

on M

osan

e (L

PM)

Rue

Bel

lair

e 18

Bw

ww

.pre

cisi

on-m

osan

e.be

Oph

thal

mic

Kni

ves,

Bla

des,

Rot

heux

Rim

iere

s (B

elgi

um)

B-4

120

Surg

ical

inst

rum

ent

tool

s

41La

serS

ight

Tec

hnol

ogie

s In

c68

48 S

tapo

int

Ct

ww

w.la

se.c

omLa

ser:

Ref

ract

ive

Cor

nea

Win

terP

ark,

FL

(USA

) 32

792

Surg

ery,

VIS

X, L

ASI

K, P

RK

42LK

C T

echn

olog

ies

Inc

-2

Prof

essi

onal

Dr

#222

ww

w.lk

c.co

mEy

e m

ovem

ent

trac

king

Gai

ther

sbur

g, M

D (

USA

) 20

879

syst

ems

visu

al e

lect

roph

ysio

logy

43Lu

men

isA

tidi

m S

cien

ce I

ndus

tria

l Par

kw

ww

.lum

enis

.com

Lase

r: C

apsu

loto

my,

Sel

ecti

veN

eve

Shar

ett,

PO

131

35Tr

abec

ulot

omy

(SLT

)Te

l Avi

v (I

srae

l) 6

1131

44M

arco

Oph

thal

mic

Inc

1182

5 C

entr

al P

arkw

ayw

ww

.mar

coop

h.co

mC

orne

al to

pogr

aphy

,ke

rato

met

er,

Jack

sonv

ille,

FL

(USA

) 32

224

opht

halm

omet

ers,

slit

lam

ps,

refr

acto

r ins

trum

ents

, ton

omet

ers,

glau

com

a te

st in

stru

men

ts

45M

assi

e La

bora

tori

es I

nc (

MLI

)57

75 W

est

Las

Posi

tas

Blv

dw

ww

.mas

sie-

labs

.com

Oph

thal

mos

cope

, Ret

inal

Plea

sant

on, C

A (

USA

) 94

588

Imag

ing

52

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

46

Mas

tel P

reci

sion

Inc

2843

Sam

co R

oad

ww

w.m

aste

l.com

Oph

thal

mic

Kni

ves,

bla

des,

Rap

id C

ity,

SD

(U

SA)

5770

2su

rgic

al in

stru

men

t to

ols

47M

D B

iote

ch I

nc51

1 B

urro

ughs

St

ww

w.m

dbio

tech

inc.

com

Bio

met

ric

Rea

der,

Scan

ner:

Iri

s,M

orga

ntow

n, W

V (

USA

) 26

505

Fing

erpr

int,

Fac

ial C

orne

alTo

pogr

aphy

, Ker

atom

eter

,O

phth

alm

omet

ers

48M

edi A

lexa

Eng

inee

ring

Co

Waz

irab

ad R

oad

ww

w.m

edia

lexa

.com

Oph

thal

mic

Kni

ves,

bla

des,

Moh

alla

h M

uslim

Tow

n,su

rgic

al in

stru

men

t to

ols

Ugo

kie

Sial

kot

(Pak

ista

n)

49M

edic

al I

nstr

umen

t14

477

Cat

alin

a St

reet

ww

w.m

idla

bs.c

omO

phth

alm

ic K

nive

s, b

lade

s,D

evel

opm

ent

Labs

Inc

San

Lean

dro,

CA

(U

SA)

9457

7su

rgic

al in

stru

men

t t

ools

50M

edLo

gics

2606

1 M

erit

Cir

cle

#102

ww

w.m

logi

cs.c

omO

phth

alm

icK

nive

s, b

lade

s,La

guna

Hill

s, C

A (

USA

) 92

653

surg

ical

inst

rum

ent

tool

s

51M

edtr

onic

6743

Sou

thpo

int

Dri

ve N

orth

ww

w.s

olan

.com

Oph

thal

mic

Kni

ves,

bla

des,

Jack

sonv

ille,

FL

(USA

) 32

216

surg

ical

inst

rum

ent

tool

s

52M

oria

- L

ASI

K S

urge

ry15

rue

Geo

rges

Bes

sew

ww

.mor

ia-s

urgi

cal.c

omO

phth

alm

ic K

nive

s, b

lade

s,A

nton

y (F

ranc

e) 9

2160

surg

ical

inst

rum

ent

tool

s

53N

idek

- H

eadq

uart

ers

34-1

4 M

aeha

ma

ww

w.n

idek

.co.

jpO

phth

alm

ic e

quip

men

tH

iroi

shi-

cho

Gam

agor

i, A

ichi

(Jap

an)

443-

038

54N

orw

ood

Abb

ey L

td47

0 C

ollin

s St

, Lev

el 7

ww

w.n

orw

ooda

bbey

.com

.au

Lase

r: R

efra

ctiv

e C

orne

a Su

rger

y,M

elbo

urne

, Vic

tori

a (A

ustr

alia

) 30

00V

ISX

, LA

SIK

, PR

K

55O

asis

Med

ical

Inc

510-

528

S V

erm

ont

Ave

ww

w.o

asis

med

ical

.com

Oph

thal

mic

Kni

ves,

bla

des,

Gle

ndor

a, C

A (

USA

) 91

740

surg

ical

inst

rum

ent

tool

s

56O

culu

s O

ptha

lmic

Dia

gnos

tics

1890

2 N

E 1

50th

St

ww

w.o

culu

s.de

Cam

era,

ret

inal

imag

ing

syst

emW

oodi

nvill

e, W

A (

USA

) 98

072

corn

eal t

opog

raph

y, k

erat

omet

er,

opht

halm

omet

ers

Furn

itur

e:H

ospi

tal b

eds,

exa

m t

able

s, M

icro

-sco

pes:

sur

gica

l, m

edic

al, v

isio

nte

st in

stru

men

t, a

cuit

y ey

e ch

arts

.

53

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

57O

phth

alm

ic T

echn

olog

ies

Inc

37 K

odia

k A

venu

ew

ww

.oti-

cana

da.c

omC

orne

al to

pogr

aphy

, ker

atom

eter

,U

nit

16 D

owns

view

,op

htha

lmom

eter

s en

dosc

opy

Ont

ario

(C

anad

a) M

3J3E

5E

quip

men

t, e

ndos

cope

s,U

ltra

soun

d: d

iagn

osti

cop

htha

lmic

, Pac

hym

eter

58O

ptik

on 2

000

Inte

rnat

iona

l SpA

Via

del

Cas

ale

di S

ette

bagn

i 13

ww

w.o

ptik

on.c

omC

orne

al to

pogr

aphy

, ker

atom

eter

,R

oma

I-00

138

opht

halm

omet

ers,

phac

oem

ulsif

icat

ion,

cor

neal

mic

roke

rato

me,

ton

omet

ers,

Gla

ucom

a Te

st I

nstr

umen

tsU

ltra

soun

d: D

iagn

osti

cO

phth

alm

ic, P

achy

met

er.

Vit

rect

omy

Syst

ems,

Pro

bes

59Pa

radi

gm M

edic

al In

dust

ries I

nc23

55 S

outh

107

0 W

est

ww

w.p

arad

igm

-med

ical

.com

Oph

thal

mos

cope

, ret

inal

imag

ing

Salt

Lak

e C

ity,

UT

(U

SA)

8411

9to

nom

eter

s, g

lauc

oma

test

inst

rum

ents

, ultr

asou

nd:

diag

nost

ic o

phth

alm

ic, p

achy

met

er

60Pa

ram

ount

Sur

gim

ed L

tdPl

ot n

o 1

LSC

Okh

la M

ain

Roa

dw

ww

.par

amou

ntbl

ades

.com

Oph

thal

mic

Kni

ves,

bla

des,

Okh

la I

ndus

tria

l Are

a Ph

ase

EE

surg

ical

Ins

trum

ent

tool

sN

ew D

elhi

(In

dia)

110

020

61R

efra

ctec

Inc

- C

ondu

ctiv

e5

Jenn

er #

150

ww

w.r

efra

ctec

.com

Ker

atop

last

y: C

ondu

ctiv

e,K

erat

opla

sty

Irvi

ne, C

A (

USA

) 92

618

The

rmal

62R

hein

Med

ical

5460

Bea

umon

t C

ente

rw

ww

.rhe

inm

edic

al.c

omO

phth

alm

icK

nive

s, b

lade

s,B

lvd

Suit

e 50

0su

rgic

al in

stru

men

t to

ols

Tam

pa, F

L (U

SA)

3363

4

63R

ibbe

l Int

erna

tion

al L

td5A

-4 1

st F

loor

Ans

ari R

dw

ww

.rib

bel.c

omO

phth

alm

icK

nive

s, b

lade

s,D

arya

Gan

j, N

ew D

elhi

110

002

surg

ical

inst

rum

ent

tool

sIn

dia

64R

oboz

Sur

gica

l Ins

trum

ent

PO 1

0710

ww

w.r

oboz

.com

Oph

thal

mic

Kni

ves,

Bla

des,

Co

Inc.

Gai

ther

sbur

g, M

D (

USA

) 20

898

surg

ical

inst

rum

ent

tool

s

54

NNNN Noooo o

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

65Sc

hwin

d Ey

e Te

ch S

olut

ions

Mai

npar

kstr

asse

6-1

0w

ww

.eye

-tec

h-so

luti

ons.

deLa

ser:

Ref

ract

ive

Cor

nea

Kle

inos

thei

m b

ei A

scha

f-Su

rger

y, V

ISX

, LA

SIK

, PR

Kfe

nbur

g (G

erm

any)

D-6

3801

66St

ar O

phth

alm

ic In

stru

men

ts In

c71

01 A

dam

s St

Sui

te 2

ww

w.s

taro

p.co

mO

phth

alm

ic: U

sed

Equ

ipm

ent,

Will

owbr

ook,

IL

(USA

) 60

521

Rep

air

67Su

rgic

al S

peci

altie

s C

orpo

ratio

n10

0 D

enni

s D

rive

ww

w.s

urgs

pec.

com

Oph

thal

mic

Kni

ves,

bla

des,

Rea

ding

, PA

(U

SA)

1960

6su

rgic

al in

stru

men

t to

ols

68Su

rgin

Inc

1476

2 B

entl

ey C

ircl

ew

ww

.sur

gin.

com

Oph

thal

mic

Kni

ves,

bla

des,

Tust

in, C

A (

USA

) 92

780

surg

ical

inst

rum

ent

tool

s

69To

mey

Cor

pora

tion

2-11

-33

Nor

itak

eshi

nmac

hiw

ww

.tom

ey.c

o.jp

Cor

neal

top

ogra

phy,

Nis

hi-k

u, N

agoy

a (J

apan

) 45

1-00

51ke

rato

met

er, o

phth

alm

omet

ers,

slit

lam

ps, r

efra

ctor

inst

rum

ents

Ult

raso

und:

dia

gnos

tic

opht

halm

ic, p

achy

met

er

70To

pcon

75-1

Has

unum

a-ch

ow

ww

.top

con.

co.jp

Cam

era,

Ret

inal

Im

agin

gIt

abas

hi-k

u, T

okyo

Syst

em c

orne

al t

opog

raph

y,(J

apan

) 17

4-85

80ke

rato

met

er, o

phth

alm

omet

ers,

GPS

sys

tem

s: n

avig

atio

n,m

icro

met

ers,

lase

r di

men

sion

,m

icro

scop

es: s

urgi

cal,

med

ical

slit

lam

ps, r

efra

ctor

inst

rum

ents

, ton

omet

ers,

glau

com

a te

st in

stru

men

ts,

visi

on t

est

inst

rum

ent,

acu

ity

eye

char

ts

71V

alle

y Fo

rge

Scie

ntifi

c C

orp

3845

Cor

pora

te C

entr

e D

rw

ww

.syn

erge

tics

usa.

com

Oph

thal

mic

Kni

ves,

bla

des,

(VFS

C)

St C

harl

es, M

O (

USA

) 63

304

surg

ical

inst

rum

ent

tool

s

72W

aveF

ront

Sci

ence

s In

c14

810

Cen

tral

Ave

Sou

thea

stw

ww

.wav

efro

ntsc

ienc

es.c

omC

orne

al t

opog

raph

y,A

lbuq

uerq

ue, N

M (

USA

) 87

123

kera

tom

eter

, oph

thal

mom

eter

s,se

mic

ondu

ctor

, waf

erin

spec

tion

, m

etro

logy

55

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

App

asam

y as

soci

ates

20, s

bi o

ffic

er's

col

ony,

fir

st s

tree

t,H

ttp:

//w

ww

.app

asam

y.co

mO

ptha

lmic

& o

ptic

alp.

h. R

oad,

aru

mba

kkam

,eq

uipm

ents

Che

nnai

600

106,

Tam

ilnad

u, I

ndia

Asc

on m

edic

al10

/17,

5th

str

eet,

Dr.

Thi

rum

urth

iht

tp:/

/ww

w.a

scon

indi

a.or

gO

phth

alm

ic e

quip

men

tsin

stru

men

ts p

vt. L

td.

naga

r, N

unga

mba

kkam

,C

henn

ai 6

0003

4, T

amiln

adu,

Ind

ia

Aur

olab

Laic

o bu

ildin

g 72

, K.K

.Sal

ai,

http

://w

ww

.aur

olab

.com

Intr

aocu

lar

lens

es, s

utur

e ne

edle

s,G

andh

i nag

ar, M

adur

ai -

625

020

phar

mac

euti

cal d

rugs

,Ta

mil

Nad

u, I

ndia

mic

rosu

rgic

al o

phth

alm

ic b

lade

s,bi

pola

r co

agul

ator

Bio

med

ix o

ptot

echn

ik &

P.O

.Box

No.

275

1, I

I flo

or,

Htt

p://

ww

w.b

iom

edix

devi

ces.

com

Med

ical

oph

thal

mic

equ

ipm

ents

devi

ces

Pvt.

Ltd

.B

asav

a N

ivas

, No.

29,

K. H

. Roa

d,vi

z., a

-sca

n bi

omet

er, p

haco

bang

alor

e 56

0027

, Kar

nata

ka, I

ndia

emul

sific

atio

n sy

stem

Bio

tech

vis

ion

care

Plot

555

, 556

, 557

, nea

r Su

bham

tex-

o-pa

ck K

hatr

aj –

Vad

sar

Roa

d,K

athr

aj, K

alol

tal

uka,

Gan

dhin

agar

380

006,

Guj

arat

, Ind

iaH

ttp:

//w

ww

.bio

tech

visi

onca

re.c

omIn

tra

ocul

ar le

nses

, vis

coel

asti

cs,

sodi

um h

ylou

rana

te a

nd o

ther

opht

halm

ic s

olut

ions

Cen

tral

opt

ical

wor

ks12

5- L

awra

nce

Roa

d, O

pp.

Htt

p://

ww

w.la

bora

toyi

tem

s.co

mO

ptic

al M

icro

scop

es, m

odel

s,H

otel

Bat

ra P

alac

e, A

mba

la 1

3300

1,ch

arts

, so

rgic

al-m

icro

scop

esH

arya

na, I

ndia

Cho

na S

urgi

cal C

o.15

5-15

6, a

ggar

wal

cha

mbe

r II

I, V

ikas

Oph

thal

mic

inst

rum

ent

and

Mar

g, S

haka

rpur

, Del

hi 1

1009

2,eq

uipm

ents

Indi

a

Dha

rshi

ni E

nter

pris

esN

o.4,

Tan

kbun

d R

oad,

Nun

gam

bakk

am,

Oph

thal

mic

inst

rum

ents

Che

nnai

600

034,

Tam

ilnad

u, I

ndia

Dsa

exp

orts

7/1,

Ush

a G

anj,

NR

. Shu

bham

Htt

p://

ww

w.d

saex

port

s.co

mO

phth

alm

ic in

stru

men

tsG

as C

o., I

ndor

e 45

2001

,M

adhy

a pr

ades

h, I

ndia

OPHT

HALM

IC IN

STRU

MEN

TS A

ND EQ

UIPM

ENTS

MAN

UFAC

TURE

RS -I

NDIA

56

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

Idea

l opt

ics

ltd.

3rd

flr.,

Nar

otta

m C

ompl

ex,

Man

ufac

ture

rs &

exp

orte

rs o

fB

huya

ngde

v cr

oss

Rd.

, Sol

a R

oad,

P.M

.M.A

. (on

e pi

ece

& t

hree

Ahm

edab

ad 3

8006

1, G

ujar

at, I

ndia

piec

e) in

trao

cula

r le

nses

&m

icro

surg

ical

kni

ves.

Inte

rnat

iona

l Med

ical

17, I

ndus

tria

l Est

ate,

Mar

uti

Htt

p://

ww

w.im

dind

ia.c

omIn

trac

ular

lens

, opt

halm

icD

evic

es P

vt. L

td.

Com

plex

, Sec

tor-

18, P

alam

,so

luti

ons

Gur

gaon

-122

015,

Har

yana

, Ind

ia

Inte

rnat

iona

l Med

ical

17, I

ndus

tria

l Est

ate,

Mar

uti C

ompl

ex,

Htt

p://

ww

w.im

dind

ia.c

omM

anuf

actu

rers

& e

xpor

ter.

ofD

evic

es p

vt. L

td.

Sec

tor-

18, P

alam

, Gur

gaon

122

015,

intr

a oc

ular

lens

es, o

phth

alm

icH

arya

na, I

ndia

solu

tion

& e

quip

men

t.

Isco

n Su

rgic

als

Ltd.

22/4

, Hea

vy I

ndl.

Are

a,H

ttp:

//w

ww

.pri

con.

org

Dis

posa

ble

syri

ngs,

nee

dle,

I.V

.Jo

dhpu

r 34

2003

, Raj

asth

an, I

ndia

Sets

, opt

harm

ic c

annu

lae,

inst

rum

ents

Kam

al K

ardi

o K

are

1st

floor

, D.R

.Tow

ers

(dot

tyH

ttp:

//w

ww

.mah

ajan

opht

halm

ic.c

omO

phth

alm

ic s

urgi

cal i

nstr

umen

tsar

t bu

ildin

g) 1

26, D

ispe

nsar

y ro

ad,

& e

quip

men

tB

anga

lore

560

001,

Kar

nata

ka, I

ndia

Kho

sla

Surg

ical

s"D

war

kash

ish"

A-1

58, S

hark

arPu

r,H

ttp:

//w

ww

.gee

tasu

rgic

als.

com

Opt

halm

ic in

stru

men

ts &

Vik

as M

arg,

Del

hi 1

1009

2, I

ndia

equi

pmen

ts, t

itan

ium

inst

rum

ents

Mad

hu I

nstr

umen

ts5/

12 A

B, I

ndus

tria

l ara

, Kir

ti N

agar

,H

ttp:

//w

ww

.mad

huin

stru

met

nts.

com

Oph

talm

ic in

stru

men

ts, s

urgi

cal

Del

hi 1

1001

5, I

ndia

equi

pmen

t

Med

icar

e In

stru

men

tsN

o. 6

, 5th

Cro

ss, M

alle

shw

aram

,O

ptha

lmol

gy in

stru

men

ts a

nd a

fB

anga

lore

560

003,

Kar

nata

ka, I

ndia

inst

rum

ents

and

equ

ipm

ent

Med

icur

e In

stru

men

ts30

6, A

garw

al C

ham

ber-

IV,

Man

ufac

ture

rs &

exp

orte

r. O

f27

, Vee

r Sa

vark

ar b

lock

, Sha

karp

ur,

mic

rosc

ope

(eye

& e

nt)

Vik

as M

arg,

Del

hi 1

1009

2, I

ndia

colo

posc

ope,

slit

lam

p,sy

nopt

opho

re, k

erat

omet

er,

lens

omet

er, t

rial

set

, cau

try

&su

rgic

al in

stru

men

ts

Mic

rotr

ack

surg

ical

sA

/38,

Ada

rsh-

2, I

ndl.

Est

.,M

anuf

actu

rers

. Of a

ll ty

pe o

fB

/H A

ashi

sh m

angl

am c

inem

a,op

thal

mic

sur

gica

l bla

des

&

57

Odh

av, A

hmed

abad

382

415,

inst

rum

ents

, cre

scen

t bl

ades

,G

ujar

at, I

ndia

lanc

etip

bla

de, m

vr b

lade

s.

Nor

ville

Aut

oflo

w I

ndia

D-8

/4, t

.t.c

. Ind

ustr

ial A

rea,

Oph

thal

mic

lens

es m

achi

nery

Pvt.

Ltd

.M

.I.D

.C. T

urbh

e, N

avi

Mum

bai 4

0070

5, M

ahar

asht

ra, I

ndia

Om

ni L

ens

Pvt.

Ltd

.5,

sam

rudd

hi, O

pp. S

akar

-III

,H

ttp:

//w

ww

.om

nile

ns.b

izIS

O 9

001C

o. M

anuf

actu

rers

&N

avra

ngpu

ra, A

hmed

abad

380

014,

expo

rter

s of

(ce

cer

tifie

d) p

mm

aG

ujar

at, I

ndia

IOL

and

aqua

fold

(ac

rylic

)fo

ldab

le le

nses

, oph

thal

mic

equi

pmen

t.

Oph

tech

nics

Unl

imit

ed22

09, P

hase

-IV,

DLF

cit

y,M

anuf

actu

rers

& e

xpor

ters

of

Gur

gaon

122

002,

Har

yana

, Ind

iaop

htha

lmic

pro

duct

s PM

MA

intr

aocu

lar

lens

, fol

dabl

ein

trao

cula

r le

ns, s

urgi

cal

spon

ges(

pva

& c

ellu

lose

), s

urgi

cal

blad

es, t

itan

ium

& s

tain

less

ste

elsu

rgic

al in

stru

men

ts, e

ndoc

apsu

lar

tens

ion

ring

s, h

pmc

visc

oela

stic

,ca

rbac

hol m

ioti

c, t

rypa

n bl

ue,

fluor

esce

in s

odiu

m s

trip

, sch

irm

erte

ar t

est

stri

p

Opt

ilab

P.O

. Box

No.

77,

old

Kha

nder

iaH

ttp:

//w

ww

.eop

tila

b.co

mO

ptic

al in

stru

men

tsH

ospi

tal B

ldg.

, Sta

tion

Roa

d,A

nand

388

001,

Guj

arat

, Ind

ia

Ova

tion

inte

rnat

iona

lB

-24,

Kis

hori

Apa

rtm

ent,

Htt

p://

ww

w.o

vati

onin

t.co

mM

anuf

actu

rer

& e

xpor

ters

of

Prab

hum

arg,

Tila

k N

agar

,in

trao

cula

r le

nses

(pm

ma

&Ja

ipur

302

004,

Raj

asth

an, I

ndia

fold

able

), v

itre

oret

inal

impl

ants

,m

icro

surg

ery

inst

rum

ents

, lat

est

hard

edg

e te

chno

logy

sci

ssor

s,kn

ives

, can

nula

s, p

haco

& la

sik

ass.

, slit

lam

p, m

icro

scop

es,

vitr

ecto

my,

try

pan

blue

, hpm

c,ca

rbac

hol.

Plan

tech

Med

ical

58, T

irup

ati i

ndl.

Est

ate,

Htt

p://

ww

w.p

lant

echi

ndia

.com

Man

ufac

ture

r &

exp

orte

r of

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

58

Syst

ems

Priv

ate

Nr.

Jay

Bha

rat

Ran

gsha

la C

omp.

,op

htha

lmic

equ

ipm

ent

and

Lim

ited

B/H

. Am

ber

Cin

ema,

Sar

aspu

r,in

stru

men

ts, r

efra

ctio

n un

it m

odel

Ahm

edab

ad 3

8002

4, G

ujar

at, I

ndia

- po

-eu

/ cs

-200

0/ c

s- 2

000(

sl)

msl

it-l

amp-

mod

el-s

l-10

0,op

erat

ion

tabl

e -

optb

-500

, vis

ion

test

ing

drum

m d

octo

r op

erat

ive

stoo

l,su

rgeo

n ch

air

for

O.T

. M p

haco

stan

d, p

horo

ptor

arm

Rel

ite

opti

cal i

ndus

trie

s4-

1-35

4/H

, opp

. Red

dy h

oste

l nea

rA

ll ki

nds

of o

phth

alm

icho

tel J

aya,

Abi

ds, I

nter

nati

onal

,le

nses

Hyd

erab

ad 5

0000

1, A

ndhr

a Pr

ades

h,In

dia

Rol

ex S

urgi

care

Inc

.90

7/7,

Gid

c Es

tate

, Nr G

ocoo

l, Ic

ecre

am,

Htt

p://

ww

w.r

olex

surg

ical

.com

Man

ufac

ture

rs. &

exp

orte

r of

Sect

or-2

8, G

andh

inag

ar 3

8202

8,op

htha

lmic

cha

ir u

nit

&G

ujar

at, I

ndia

equi

pmen

t / h

ospi

tal e

quip

men

t

Ron

ak O

vers

eas C

ompa

nyN

ear

Gen

diga

te, S

ant

Kab

ir r

oad,

Htt

p://

ww

w.r

onak

over

seas

.com

Oph

thal

mic

lens

esP.

O. B

ox 3

3, V

adod

ara

3900

01,

Guj

arat

, Ind

ia

Sega

l Ins

trum

ents

368,

Kal

bade

vi R

oad,

Htt

p://

ww

w.s

egal

opti

cs.c

omSu

rgic

al in

stru

men

ts &

Exp

orts

Mum

bai 4

0000

2, M

ahar

asht

ra, I

ndia

opht

halm

ic e

quip

men

t, m

eeti

ngth

e de

man

d fo

r pr

ecis

ion,

the

wor

ldov

erSh

ivam

oph

thal

35, C

hinu

bhai

tow

er, A

shra

m r

oad,

Oph

thal

mic

mic

ro in

stru

men

tsA

hmed

abad

380

009,

Guj

arat

, Ind

ia

Smr O

phth

alm

ic P

vt. L

td.

4,V

ijay

Indl

.Est

.Lin

k R

oad,

Htt

p://

ww

w.s

mri

ndia

.com

Man

ufac

ture

rs &

exp

orte

rs o

f :M

alad

(W

), M

umba

i 400

064,

arti

ficia

l eye

s, o

ptic

al im

plan

ts,

Mah

aras

htra

, Ind

iam

icro

-sur

gica

l bla

des

& k

nive

s(r

ound

& fl

at s

tock

) op

tiku

t -

blad

ez -

dia

mat

rix

(all

size

s), i

ols-

usio

l, or

ion

iol,

sidr

a io

l, au

rola

bio

l, pm

ma

& fo

ldab

le io

ls m

pst

tray

s, o

cula

r in

st. H

ydro

xypa

tite

impl

ant,

ent

ire

rang

e of

opth

alm

ic in

stru

men

ts

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

59

Sona

Int

erna

tion

al82

, Raj

ende

r N

agar

, nea

r So

naH

ttp:

//w

ww

.son

aint

erna

tion

al.in

Aut

ocla

ves,

por

tabl

e, s

teri

lizer

s,Pr

essu

re C

ooke

rs, O

pp. D

ass

fact

ory,

med

ical

sur

gica

l ins

trum

ents

P.O

.Moh

an n

agar

, Gha

ziab

ad 2

0100

7,eq

uipm

ents

, hos

pita

l sup

plie

s U

ttar

pra

desh

, Ind

iala

bora

tory

sci

enti

fic, p

ress

ure

cook

ers,

alu

min

ium

alu

min

um,

ster

lizer

s, s

tain

less

ste

el, d

ress

ing

drum

s, g

oods

coo

kwar

es

Suna

yana

Sur

gica

ls46

5, S

omw

ar P

eth,

nea

r D

haru

wal

aH

ttp:

//w

ww

.sun

ayan

asur

gica

ls.c

omO

ptha

lmic

(ey

e) in

stru

men

t an

dpo

ol, P

une

4110

11, M

ahar

asht

ra, I

ndia

equi

pmen

t

Sura

j Hi-

tech

Pvt

. Ltd

.C

pr-4

, Wat

u Ta

nk R

oad,

MM

DA

Opt

halm

olog

y eq

uipm

ent

colo

ny, A

rum

bakk

am, C

henn

ai 6

0010

6,Ta

miln

adu,

Ind

ia

Susr

uta

Inst

rum

ents

8-10

, ist

floo

r, sh

ah c

ham

bers

,H

ttp:

//w

ww

.sus

ruta

-ins

trum

ents

.com

Man

ufac

ture

rs &

exp

orte

rs o

f : m

Pvt.

Ltd

.C

TM

Cha

rras

ta, A

hmed

abad

380

026,

opht

halm

ic m

icro

sur

gica

l kni

ves

Guj

arat

, Ind

ia(c

e 04

34)

M r

eusa

ble

opht

halm

icca

nnul

as M

.S.S

.&T

I in

stru

men

tsM

mic

ro s

urgi

cal E

NT

Topm

ost

inst

. Cor

p.42

84, C

ross

roa

d N

o.2,

Am

bala

Can

tt,

Man

ufac

ture

rs &

exp

orte

rs o

fO

f in

dia

Har

yana

, Ind

iasu

rgic

al o

pera

ting

mic

rosc

opes

,sl

it la

mps

, ker

atom

eter

,co

lpos

cope

, len

som

eter

s, c

ryo,

bipo

lar,

phac

o &

IO

L

Vaa

nsar

i Mar

keti

ng3-

B, L

aksh

mi s

tree

t, T

hiru

man

gala

mH

ttp:

//w

ww

.vaa

nsar

i.com

All

lase

rs, o

ptha

lmic

, EN

T, O

.T.

Serv

ices

Roa

d, C

henn

ai 6

0004

9, T

amiln

adu,

Equ

ipm

ent,

dri

lls, C

CD

cam

eras

,In

dia

endo

scop

es, l

ight

sou

rce

&ot

osco

pe, e

tc.

Vis

ine

Inst

rum

ents

145-

A, D

yal B

agh,

Bay

al r

oad,

Htt

p://

ww

w.v

isin

eins

trum

ents

.com

Opt

halm

ic, E

NT,

opt

ical

, sur

gica

lA

mba

la C

antt

133

001,

inst

rum

ents

& e

quip

men

tH

arya

na, I

ndia

Wes

tern

Sur

gica

lN

o. 2

04, 2

nd fl

oor,

Pras

ad C

ham

bers

,H

ttp://

ww

w.g

atew

ayto

indi

a.co

m/w

este

rnSu

rgic

al in

stru

men

ts a

nd e

quip

-C

orpo

rati

onN

ear

Rox

y C

inem

a, O

pera

hou

se,

men

t, o

ptha

lmic

inst

rum

ents

Mum

bai 4

0000

4, M

ahar

asht

ra, I

ndia

MMMM Man

ufac

tur

anuf

actu

ran

ufac

tur

anuf

actu

ran

ufac

tur e

rererer erAAAA A

ddr

ddr

ddr

ddr

ddr e

ssess

ess

ess

ess

WWWW Web

site

ebsi

teeb

site

ebsi

teeb

site

PPPP Prrrr r o

duct

sod

ucts

oduc

tsod

ucts

oduc

ts

60

IntroductionThis annexure is attached to this report with aview to give a snapshot of a secondary eyehospital’s functioning. Aravind Eye Hospital,Theni is the first satellite hospital of Aravindstarted in 1985, situated 80 Kms to the north ofMadurai, Tamil Nadu.

Location and service areaTheni Aravind Eye Hospital is located in Theni -Allinagaram Municipality in the Theni Taluk ofTheni District. Theni Taluk is a small town with apopulation of 111,542. Aravind Eye Hospital,Theni serves Andipatty, Uthamapalayam,Periyakulam and Bodinayakannur Taluks of TheniDistrict, falling within the radius of 50km andcovering a population of 1.1 million. Besides thisprimary service area the hospital also covers theneighbouring areas in Kottayam and Idukkidistricts of Kerala state with a population of 3.1

ANNEXURE

III. MODEL SECONDARY SETUP

million (3,082,867) and thus serving a totalpopulation of 4.2 million.

Builtup area

Paying section

Ground Floor - 9,840 Sq. Feet

First Floor - 9,840 Sq. Feet

Second Floor - 9,840 Sq. Feet

Third Floor - 780 Sq. Feet

Total Area - 30,300 Sq. Feet

Free Section

Ground Floor - 1,800 Sq. Feet (OP area: 1180 Sq.Feet; Nursing Hostel:620 Sq.Feet)

First Floor - 1,800 Sq. Feet

Second Floor - 1,800 Sq. Feet

Total Area - 5,400 Sq. Feet

TTTTTotal Arotal Arotal Arotal Arotal Area (paying + frea (paying + frea (paying + frea (paying + frea (paying + free side) – 35,700 See side) – 35,700 See side) – 35,700 See side) – 35,700 See side) – 35,700 Sq.Fq.Fq.Fq.Fq.Feeteeteeteeteet

List of instrument and equipments

NNNNName of Eame of Eame of Eame of Eame of Equipmentquipmentquipmentquipmentquipment NNNNNumberumberumberumberumber MMMMManufacturanufacturanufacturanufacturanufacturer / Ser / Ser / Ser / Ser / Supplierupplierupplierupplierupplier

Outpatient department

1. Direct Ophthalmoscope 5 Keeler2. Indirect Ophthalmoscope 3 Keeler3. Tonometer 2 Riester4. Torch (Electric) 15 Eveready5. Retinoscope streak - Electric 6 Heine beta6. Trial frame 6 Baliwalla7. Trial set 5 Baliwalla8. Slit Lamp 7 Topcon9. Keratometer 1 Ascon10. Hess Chart Board 111. A scan 1 Sonomed

61

NNNNName of Eame of Eame of Eame of Eame of Equipmentquipmentquipmentquipmentquipment NNNNNumberumberumberumberumber MMMMManufacturanufacturanufacturanufacturanufacturer / Ser / Ser / Ser / Ser / Supplierupplierupplierupplierupplier

12. BP apparatus 2 Indian electronics Allied Products13. Stethoscope 2 Microtone Instruments limited14. Torch (cell) 8 Eveready15. Gonio lens (3 Mirror – 1: 1 Mirror -2) 3 Volk16. 20D lens 3 Volk17. 90D Lens 1 Volk18. 78D Lens 1 Volk19. Applanation Tonometer 3 Haag-Streit20. Yag Laser, 532, Green 1 Iris Medical21. Humphery Field Analyser 1 Zeiss22. Fundus Camera 1 Topcon-Tokyo optical company Ltd,

(OTRC – 50Ex RC)23. YAG laser 1064 1 Zeiss24. Autorefractometer 1 Topcon25. Lensometer 1 Ascon26. Non Contact Tonometer 1 Topcon27. Wide Field laser lens 1 Ocular Instruments

Lab

1. Microscope 1 Nikon2. Colorimeter 1 Photochem-53. Centrifuge 14. Blood cells counter 15. Syringe cutter 1 Insta Need6. Gluco meter 1 Advantage

Ward

1. BP apparatus 1 Allied products

2. Stethoscope 1 Microtone

3. Tonometer 1 Schiotz

4. Torch (cell) 1 Eveready

5. Slit Lamp 1 Topcon

Operation theatre

1. Operating microscope 4 Takagi, Zeiss2. Operating light 2 Segal optics3. Cryo unit 1 Ascon4. Tonometer 1 Riester5. BP apparatus 2 Allied products6. Stethoscope 2 Microtone7. Bipolar Coagulator 6 TL instruments

/ Aurolab -38. Phaco machine 2 AMO Sovereign

/ AMO OPSYS9. Vitrectomy machine 1 Allergan10.OT Care 1 OT safe11.Instaclave 1 Gold’s worth

12. Autoclave 3 Hoslab13. Oxygen Cylinder 1 Sivaji14. Cooker Autoclave 1 Hoslab15. Suction Apparatus 116. Ultra sonic Cleaner 117. Sealing Machine 1 Sevana18. Needle Cutter 1 Saratech electrical

Syringe & needledestroys

19. Compressor 1 Elgi20. Torch Cell 2 Eveready21. Television 1 Samsung22. Camera 1 Zeiss

62

Camp

1. Direct Ophthalmoscope 1 Keeler2. Retinoscope Streak Cell 2 Heine3. Torch (Electric) 8 Eveready4. Tonometer 4 Schiotz5. BP Apparatus 26. Stethoscope 2 Microtone7. Torch (cell) 6 Eveready8. Trail Set & Trail Frame 3 Balliwalla

ICU

1. ECG Machine 1 Maestros2. Oxygen Cylinder 1 Sivaji3. B.P Apparatus 14. Stethoscope 1 Microtone5. Suction Apparatus 1 Gomco6. Nebulizer 1 Aerofamily7. Pulse Oxymeter 1 Nellcor8. Torch (cell) 1 Eveready

Human resource

Clinical Team - 53Chief Medical Officer - 1Medical Officer - 1PG / Fellow - 7PPPPParamedical Saramedical Saramedical Saramedical Saramedical Staffstaffstaffstaffstaffs ----- 2525252525Nursing Coordinator - 1Refractionist - 7OP Nurse - 5Counselor - 2OT Nurse - 6Ward Nurse - 2Lab Technician - 1Instrument Technician - 1TTTTTraineesraineesraineesraineesrainees ----- 1919191919Refractionist - 5OP Nurse - 4Counselor - 1OT Nurse - 7Ward Nurse - 2AAAAAdministrativdministrativdministrativdministrativdministrative e e e e TTTTTeameameameameam ----- 3131313131

Manager - 1Assistant Manager - 1Accountant - 1Electronic Data Processing(EDP) - 1Camp Organizer - 1School Screening Organizer - 1Telemedicine / Stores - 1MRD / Reception - 2House Keeping - 2Sanitary Workers - 8Security - 5Driver - 1Gardner - 2Electrician (Part-time) - 1Trainees - 03MRD / Reception - 3Total Trainees - 22Full Time Staffs - 62Vision Centre Staff - 13

Bed strength

The hospital was started with 100 beds, of which40 was paying and 60 was for camp (free) patients.The bed strength in the paying section has notbeen increased till now. The total number of bedsat present in all sections of the hospital is 163.

SSSSSectionectionectionectionection NNNNNooooo. of B. of B. of B. of B. of Bedsedsedsedseds

Paying Section - 40Direct Walk-in (Free) - 23Camp Section (Free) - 100Total Beds - 163

63

Performance

The performance of the hospital in terms of both outpatient and inpatient services for the past 5 yearsare depicted below.

Outpatient statistics

Year

Patients (New + Review) 2002 2003 2004 2005 2006

Paying 40,149 45,043 49,010 54,427 59,086

Direct walk-in (Free) 19,886 18,894 23,209 23,424 21,385

Camp (Free) 21,799 26,167 19,532 25,703 25,193

Total 81,834 90,104 91,751 103,554 105,664

Inpatient statistics

Year

Patients 2002 2003 2004 2005 2006

Cataract Others Cataract Others Cataract Others Cataract Others Cataract Others

Paying 1,367 496 1,531 693 1,730 592 1,851 1,110 2,000 1,367

Direct (Free) 855 121 1,070 269 1,256 338 1,512 503 1,887 372

Camp (Free) 4,216 81 4,286 86 5,080 117 5,151 160 4,442 167

Total 6,438 698 6,887 1,047 8,066 1,047 8,514 1,773 8,329 1,906

GGGGGrand rand rand rand rand TTTTTotalotalotalotalotal 7,136 7,136 7,136 7,136 7,136 7,934 7,934 7,934 7,934 7,934 9,113 9,113 9,113 9,113 9,113 10,28710,28710,28710,28710,287 10,23510,23510,23510,23510,235

Vision centers statisticsThe performance of all the Vision Centers till now is illustrated in the table given below:

All vision centers performance (till December 2006)

Out Patients

  TTTTTotal Motal Motal Motal Motal Monthsonthsonthsonthsonths OPOPOPOPOP AAAAAvg OP /vg OP /vg OP /vg OP /vg OP / AAAAAvg OP /vg OP /vg OP /vg OP /vg OP /of Sof Sof Sof Sof Sererererervicevicevicevicevice so farso farso farso farso far monthmonthmonthmonthmonth D D D D Dayayayayay

Ambai 33 5814 176 7

Andipatti 25 9117 365 15

Bodi 16 5426 339 14

Chinnamanur 10 2810 281 11

Periyakulam 8 2274 284 11

TTTTTotalotalotalotalotal 9292929292 2544125441254412544125441 14451445144514451445 5858585858

64

Spectacles

  PPPPPrrrrrescribedescribedescribedescribedescribed OOOOOrrrrrderderderderderededededed AAAAAvg Gvg Gvg Gvg Gvg Glasseslasseslasseslasseslasses GGGGGlass Alass Alass Alass Alass Acceptancecceptancecceptancecceptancecceptanceso farso farso farso farso far so farso farso farso farso far / M / M / M / M / Monthonthonthonthonth RateRateRateRateRate

Ambai 916 754 23 82 %

Andipatti 1129 956 38 85 %

Bodi 945 777 49 82 %

Chinnamanur 370 330 33 89 %

Periyakulam 439 402 50 92 %

TTTTTotalotalotalotalotal 37993799379937993799 32193219321932193219 193193193193193 86 %86 %86 %86 %86 %

In Patients

  RRRRReferreferreferreferreferrededededed SSSSSur Dur Dur Dur Dur Doneoneoneoneone AAAAAvg Rvg Rvg Rvg Rvg Ref /ef /ef /ef /ef / AAAAAvg Svg Svg Svg Svg Sur /ur /ur /ur /ur /SSSSSo faro faro faro faro far SSSSSo faro faro faro faro far monthmonthmonthmonthmonth monthmonthmonthmonthmonth

Ambai 365 262 11 8

Andipatti 353 247 14 10

Bodi 306 188 19 12

Chinnamanur 112 72 11 7

Periyakulam 103 75 13 9

TTTTTotalotalotalotalotal 12391239123912391239 844844844844844 6868686868 4646464646

65

ABBREVIATION

WHO World Health OrganizationIAPB International Agency for the Prevention of BlindnessINGO International Non-Governmental OrganizationCME Continuing Medical EducationOP OutpatientsIP InpatientsOPD Outpatient DepartmentICD International Classification of Diseases