Equip Second Manual

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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


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PPPPPublished bublished bublished bublished bublished by y y y y VISION 2020 The Right to Sight S-390, Double Storey, Ground Floor New Rajinder Nagar New Delhi - 110 060; IndiaPhone : 91-11-42411542 / 42411518 Fax :91-11-42412107 www.vision2020india.org

DDDDDev ev ev ev ev eloped beloped beloped beloped beloped by y y y y

Lions Aravind Institute of Community Ophthalmology Aravind Eye Care System72, Kuruvikaran Salai, Gandhi Nagar

Madurai - 625 020; IndiaPhone: 0452 - 435 6500 Fax : 91-452-253 0984 www.aravind.org

PPPPPrinted atrinted atrinted atrinted atrinted atLeo prints, Madurai

J J J J June 2008une 2008une 2008une 2008une 2008


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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 bulk of 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 assumed

workload 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


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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 of ORBIS International for the section on procurement management. This manual was developedover a period of time, and several people contributed, while we acknowledge the inputs of everyone. 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.


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CONTENTS

CHAPTER I INTRODUCTION 1

1. 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 14

1. 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 ophthalmology 4. Glaucoma services5. Orbit and oculoplasty


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

CHAPTER VIII SUPPORT SERVICES 271. House keeping2. Dietary services3. Clinical laboratory 4. 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 equipment

5. Equipment needed for a screening eye camp

II. OPHTHALMIC INSTRUMENT AND EQUIPMENT MANUFACTURERS LIST 47

III. MODEL SECONDARY SETUP 60

ABBREVIATION 65


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CHAPTER I

INTRODUCTION

Sour Sour Sour Sour Sour ce :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 of interventions 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 the

World. Todays 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% of blindness world wide, trachoma 4%,onchocerciasis 1%, and other diseases includingglaucoma and diabetic retinopathy togethercontribute to 48%. Global blindness is expected to

touch 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, the

World Health Organization and a Task Force of International 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


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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 IndiasVISION 2020 action plan.The goal of eliminating such avoidable blindness

will 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

technology 5. 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 careCommunity eye care and universal coverage canonly be ensured through community based eye

care services. The emphasis should be onpreventive and promotive strategies, case findingand referral rather than solely depending onhospital based curative services. Primary eye care

Sour Sour Sour Sour Sour ce :ce :ce :ce :ce :* VISION 2020 The Right to Sight - Plan of Action NPCB, India Ophthalmology / Blindness Control

Section, 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 of their 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 in

behaviour, environment, adequate food, safe water supply and adequate sewage disposal3. 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 primary health centres.

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


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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 or

treated 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. Tertiary

health centres also play a vital role in training,deployment and professional updating of allcategories of eye care personnel.


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CHAPTER II

SECONDARY EYE CARE HOSPITAL

I. Introduction A 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 primary eye-care centres and referral to tertiary eyehospitals. The scope of activities of a secondary eye-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 country setting 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 of this manual, we have assumed the following

workload:

W W W W W ororororork 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, the

outpatient 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 cover

when the senior is unavailable. The whole clinical workload 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 of 3 - 4 doctors and to ensure job satisfaction. Thismeans that there must be an outpatient load of at


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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 - 155cms Width - 75cms OneDepth - 40cms

4 Mobile step-ladder Height - 65cms Width - 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


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Counselling is possible only after the doctorreviews the case sheet. It is important to clearly and concisely explain to the patient the nature of his condition, treatment options, etc., In patients

with 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 Q Q Q Q Q uantity uantity uantity uantity uantity Schiotz tonometer 2Flashlight (battery/electric) 6Slit lamp 2Direct ophthalmoscope 3Indirect ophthalmoscope 290 D lens 220 D lens 2Gonioprism 1

Applanation tonometer head 1Kimura spatula 1No 15 surgical blade 1Binocular microscope 1Tangent screen (field test chart) 115 cm glass ruler 2

Weighing machine 1Material for diplopia charting 1Torch light with red and green glass 1Slit light source 1

Red, green Goggles 1Desirable equipment for High volume centres :HFA

YAG LASER It is recommended that a functional ICU with thefollowing equipment be established in case of standalone eye hospital.

ICU1. ECG Machine 1 Maestros2. Oxygen Cylinder 1 Sivaji3. B.P Apparatus 1

4. Stethoscope 1 Microtone5. Suction Apparatus 1 Gomco6. Nebulizer 1 Aerofamily 7. Pulse Oxymeter 1 Nellcor8. Torch (cell) 1 Eveready

II. Refraction services

IntroductionRefractive 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.


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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 by

washing in sterile distilled water or mineral water

An ultrasonic cleaner can be used for cleaningthe instruments. It thoroughly cleanses every part 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 of the cleaner should be filled above the level of the 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 brushed

with 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 if ultrasonic cleaner is not used

They are then dried with clean towel; tipped

with 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 flushed with distilled water three times and then withair three times before autoclaving

The bins/ packages must be properly labelled with 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 pressure which is needed for the articles that are being

sterilised:Packing and loading of bins into the autoclave

Articles can be placed in metal sterilising drums with holes to allow for steam penetration. Thesearticles should, ideally, be used within 24 hours of being 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

Ar Ar Ar Ar Articlesticlesticlesticlesticles SSSSSteam prteam prteam prteam prteam pressuressuressuressuressure lb/ine lb/ine lb/ine lb/ine lb/in22222 TTTTTempempempempemp00000 CCCCC TTTTTime /minime /minime /minime /minime /min

Drapes, linen, gowns 30 134 45Soft goods and instruments 25 124 30Rubber articles 10 116 40


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

LabellingPut 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.

StoringOnce the items get cooled they can be wrapped ina polythene bag to prevent dust and externaldamage and stored in a dry place and preferably used 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 proceduresIn an ophthalmic operation theater the use of disinfecting methods are very minimal and mustonly be used in situation where other methods arenot available or suitable.

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

plastics.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 effective

for 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


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

A chest guard (metal hoop that keeps the sheetoff the patients 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 patients 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 / half strength 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 powder with 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 surgery should rinse his/her hands with antisepticsolutions and can proceed to the next surgery, by

swinging 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 dont 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 days

surgery. The others can be assigned to work in theOPD and wards. The theatre should have asterilization room, patient preparation / recovery area, changing room, and a theatre stores attachedto it.

III. Post-operative procedure

Discharge1. The patient can be discharged around 3-4

hours after surgery

2. The first post operative examination anddressing should be done within 24 hours aftersurgery. During this time, the integrity of the

wound, the corneal clarity and the presence of inflammation 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.,


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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 andcan be scheduled as per the local protocol

1. Refraction, slit lamp examination, fundusexamination

2. Glass prescription if visual recovery has stabi-lized

3. 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 vision

Additional follow up examination can bescheduled in suture removalal cases.

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

6. 90D lens, 20D lens7. Applanation tonometer8. A Scan

9. Keratometer10. Facilities for performing conjuctival swabculture (optional)

For general examination

(to rule out systemic illness and also to check forfitness in case of patients with systemic illnesses)1. Stethoscope2. Sphygmomanometer3. Glucometer

4. 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


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4. Surgical instruments

NNNNNameameameameame Q Q Q Q Q uantity uantity uantity uantity uantity Universal eye speculum 8

Wire speculum 8Superior rectus needle holder 8Superior rectus forceps 8Toothed forceps 8Plain forceps 4

Artery forceps 8Scleral forceps 8B.P. Handle 8Tenotomy scissors 8Capsule forceps 8Mini blade holder sharpedge co.16

15o

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 2

Kelleys punch 1Blade breaker 8Scissors 4Chopper 2Big artery clamp 6

5. OT vessels

NNNNNameameameameame Q Q Q Q Q uantity uantity uantity uantity uantity Basin 4Saline cup with cover 14

Water jug 2 Wiper jars 6Cryo bin 1

NNNNNameameameameame Q Q Q Q Q uantity uantity uantity uantity uantity

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

NNNNNameameameameame Q Q Q Q Q uantity uantity uantity uantity uantity


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

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

Non infectious items can be collected in black bags

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 responsible

caterer. Meal service will be determined by localcustoms, hospital routines and procedures, andpatient preferences. Nonpaying patients canreceive free or low cost meals. Paying patients may expect 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 dietary services, 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 - 1

2. 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 hospitals 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, inventory management, 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, inventory control and loss prevention to minimize loss dueto spoilage or pilferage.


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Importance of stores

Efficient storekeeping helps to keep productivity high. Materials management is one of the key factors for improving performance of any

department. 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 storekeepers 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 categories

will 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 Rs).1. Right time2. Right quantity

3. Right price4. Right source5. Right delivery 6. Right methods7. Right people

Models and systems of storekeeping

Stores departments can be centralized ordecentralized. A centralized materialmanagement network focuses on the supplies

needed 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 functioning

of 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 hospitalsdiagnostic and therapeutic equipment.

In smaller hospitals, the role of medicalequipment maintenance may be incorporated intothe facilities maintenance department. Small

hospitals that are part of a larger hospital systemmay also receive their medical equipmentmaintenance services from the medical equipmentmaintenance department of the central tertiary hospital 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 by providing efficient follow-up on equipmentproblems


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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 systems

In smaller hospitals, some of the suggestedroles 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 outlets

9. Running water10. This department should have access to acomputer in the hospital for electronic storingof equipment inventory and repair records


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Trial sets 1IPD scale 1

JCC 1Mirror (refraction) 1

Snellen chart (drum) 1Near vision chart 190 D lens 1

Applanation 1Basic sterilizer 1LoLoLoLoLo w w w w w V V V V V isionisionisionisionisionHand held magnifier 1OOOOO ptical dispensingptical dispensingptical dispensingptical dispensingptical dispensing Grinding, edging kit and machine1


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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 hospital

wishes 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 hospitals 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 for

which 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 by humanitarian 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, lack of local service support, lack of manuals, lack of spare parts, etc.


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ANNEXURE

I. INSTRUMENTS AND EQUIPMENT LIST

Introduction Adequate 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 very important 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 of instruments 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 2

7. 20 D lens 28. Gonioprism 19. Applanation tonometer 110. Kimura spatula 111. No 15 Surgical Blade 112. Binocular microscope 113. Bjerums 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, readily adaptable, 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


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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. Langs lacrimal sac dissector/bone dissector5. Cat paw retractor6. Tenotomy / lacrimal sac cutting scissor7. Castroviejo punctum dilator8. Bowman naso lacrimal duct probe9. Needle holder10. Thudicums nasal speculum11. Tilleys nasal forceps12. Meuller lacrimal sac retractor13. Bone punch small and large (Citellis 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 (Wells)7. Muscle hook 8. 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:


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Optical dispensing equipmentI. Manual Edging Sets

1. 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 Pliers

8. 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. IPA 3. Tissue Paper4. Selvet Cloth

IV. Power Checking1. Lensometer ( Automatic Power checking

Machine)2. Trial Set ( manual Power checking )

Camp sizCamp sizCamp sizCamp sizCamp sizeeeeePPPPParararararticularsticularsticularsticularsticulars SSSSSmallmallmallmallmall MMMMMediumediumediumediumedium LargeLargeLargeLargeLarge V V V V V ererererery Largey Largey Largey Largey Large

Number of expected patients 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 4

Wire set with bulb & bulb holder 3 4 5 6

Extension switch board 1 1 1 2Bulb 3 4 5 6 Jar / bin 1 1 1 1Needle 2 4 6 10Syringe 1 2 3 5Kidney tray 1 1 1 1


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Lensometer Auto Edger Manual Edger

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

4. Adhesive Pads5. Pluger6. Bar Coding Sheet


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I I . O P H T H A L M I C I N S T R U M E N T S A N D E Q U I P M E N T M A N U F A C T U R E R S L I S T

- G L O B A L

N N N N N o o o o o M M M M M a n u f a c t u r

a n u f a c t u r

a n u f a c t u r

a n u f a c t u r

a n u f a c t u r e r e r e r e r e r

A A A A A d d r d d r

d d r d d r d d r e s s e s s e s s e s s e s s

W W W W W e b s i t e

e b s i t e

e b s i t e

e b s i t e

e b s i t e

P P P P P r r r r r o d u c t s

o d u c t s

o d u c t s

o d u c t s

o d u c t s

1 2 0 1 0 P e r f e c t V i s i o n

A m T a u b e n f e l d 2 1 / 1

w w w . 2 0 1 0 p v . c o m

L a s e r : R e f r a c t i v e C o r n e a

H e i d e l b e r g ( G e r m a n y ) D - 6

9 1 2 3

S u r g e r y , V I S X , L A S I K , P

R K

2 A c c u t o m e I n c o r p o r a t e d

4 2 L l o y d A v e n u e

w w w . a c c u t o m e . c o m

O p h t h a l m i c K n i v e s , B

l a d e s ,

S u r g i c a l I n s t r u m e n t T o o l s

M a l v e r n , P A ( U S A ) 1 9 3 5 5

3 A c u m e n S u r g i c a l P v t L t d

P O 1 4 5 9 , C a p i t a l R o a d

w w w . a c u m e n s u r g i c a l . c o m

K n i v e s , B l a d e s , S u r g i c a l

J i n n a h , S i a l k o t ( P a k i s t a n )

I n s t r u m e n t t o o l s , O p h t h a l m i c

M e d i c a l I n s t r u m e n t s

4 A D I n s t r u m e n t s - R e s e a r c h

1 9 4 9 L a n d i n g s D r i v e

w w w . a d

i n s t r u m e n t s . c o m

E y e M o v e m e n t T r a c k i n g

M o u n t a i n V i e w , C A ( U S A ) 9 4 0 4 3

S y s t e m s , A n i m a l F u n c t i o n

M o n i t o r s

5 A d v a n c e d M e d i c a l O p t i c s

3 4 0 0 C e n t r a l E x p r e s s w a y

w w w . v i s x . c o m


( A M O )

S a n t a C l a r a , C

A ( U S A ) 9 5 0 5 1


R K

6 A l c o n L a b o r a t o r i e s I n c

6 2 0 1 S F r e e w a y

w w w . a l c o n l a b s . c o m


l a d e s ,

F o r t W o r t h , T

X ( U S A ) 7 6 1 3 4

S u r g i c a l I n s t r u m e n t t o o l s

7 A l l e r g a n , I n c

P . O . B o x 1 9 5 3 4

h t t p : / / w w w . a l l e r g a n . c o m / s i t e /

8 A m e r i c a n S u r g i c a l I n s t r u m e n t s 2 6 P l a z a D r i v e

w w w . a s i c o . c o m


l a d e s ,

C o r p o r a t i o n ( A S I C O )

W e s t m o n t , I L ( U S A ) 6 0 5 5 9


9 A n c h o r P r o d u c t s C o

5 2 O f f i c i a l R d

w w w . a n c h o r s u r g i c a l . c o m

K n i v e s , B l a d e s , S u r g i c a l

A d d i s o n , I L ( U S A ) 6 0 1 0 1

T o o l s , O p h t h a l m i c I n s t r u m e n t

1 0 A p p a s a m y A s s o c i a t e s -

N o 2 0 S B I O f f i c e r s C o l o n y

w w w . a p p a s a m y . c o m


l a d e s ,

O p h t h a l m i c I n s t r u m e n t s

F i r s t S t r e e t ,

C h e n n a i ,


T a m i l N a d u ( I n d i a ) 6 0 0 1 0 6

1 1 A p p l i e d S c i e n c e L a b o r a t o r i e s

1 7 5 M i d d l e s e x T u r n p i k e

w w w . a - s - l . c o m


( A S L ) - E y e T r a c k i n g

B e d f o r d , M A ( U S A ) 0 1 7 3 0

S y s t e m s

1 2 A R C L a s e r

V o n - B r e n t a n o - S t r 3 1 C

w w w . a r c l a s e r . d e

L a s e r : R e t i n a l , P h o t o c o a g u l a t o r ,

E c k e n t a l F o r t h ( G e r m a n y ) D - 9

0 5 4 2

T r a b e c u l o p l a s t y

1 3 A u r o l a b

L A I C O B u i l d i n g

w w w . a u r o l a b . c o m

I n t r a o c u l a r l e n s e s , S u t u r e

7 2 , K . K . S a l a i , G a n d h i N a g a r

N e e d l e s p h a r m a c e u t i c a l d r u g s ,


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

M a d u r a i - 6

2 5 0 2 0 , T a m i l N a d u

M i c r o s u r g i c a l O p h t h a l m i c

b l a d e s , B

i p o l a r C o a g u l a t o r

1 4 A v o t e c I n c

6 0 3 N B u c k h e n d r y w a y

w w w . a v o t e c . o r g


S t u a r t , F L ( U S A ) 3 4 9 5 7

S y s t e m s

1 5 B a u s c h & L o m b

O n e B a u s c h & L o m b P l a c e

w w w . b a u s c h . c o m


R o c h e s t e r , N Y ( U S A ) 1 4 6 0 4


R K

1 6 B i o C o n t r o l S y s t e m s

P O 1 9 5 6 9 , S t a n f o r d ,

w w w . b i o c o n t r o l . c o m


C A ( U S A ) 9 4 3 0 9

S y s t e m s

1 7 B o s s I n s t r u m e n t s - S u r g i c a l

1 8 3 8 E l m H i l l P i k e # 1 1 9

w w w . b o s s i n s t . c o m


l a d e s ,

I n s t r u m e n t s

N a s h v i l l e , T N ( U S A ) 3 7 2 1 0


1 8 C a n o n I n c - H e a d q u a r t e r s

3 0 - 2

S h i m o m a r u k o , 3 - c

h o m e

w w w . c a n o n . c o m

O h t a - k u , T o k y o ( J a p a n ) 1 4 6 - 8

5 0 1

1 9 C a r l Z e i s s

5 1 6 0 H a c i e n d a D r

w w w . m e d i t e c . z e i s s . c o m

C a m e r a , R e t i n a l I m a g i n g

D u b l i n , C

A ( U S A ) 9 4 5 6 8

S y s t e m c o r n e a l t o p o g r a p h y ,

K e r a t o m e t e r , o p h t h a l m o m e t e r s .

L a s e r : r e f r a c t i v e c o r n e a s u r g e r y ,

V I S X , L A S I K , P R

K . L a s e r :

R e t i n a l , P h o t o c o a g u l a t o r ,

T r a b e c u l o p l a s t y L i g h t B u l b s ,

L a m p s : S u r g i c a l e x a m

M i c r o s c o p e s : S u r g i c a l , M e d i c a l ,

s l i t l a m p s , r e f r a c t o r i n s t r u m e n t s

T o n o m e t e r s , G l a u c o m a T e s t


2 0 D u c k w o r t h K e n t S u r g i c a l

T e r e n c e H o u s e , 7

M a r q u i s

w w w . d u c k w o r t h - a n d - k e n t . c o m


l a d e s ,


B u s i n e s s C e n t e r , R o y s t o n R d


B a l d o c k , H e r t s ( U K ) S G 7 6 X L

2 1 E a g l e L a b o r a t o r i e s

1 0 2 0 1 T r a d e m a r k S t r e e t , S u i t e A

w w w . e a g l e l a b s . c o m


l a d e s ,

R a n c h o C u c a m o n g a ,


C A ( U S A ) 9 1 7 3 0

2 2 E L E N L a s e r

V i a B a l d a n z e s e 1 7

w w w . e l e n g r o u p . c o m

L a s e r : C a p s u l o t o m y , S e l e c t i v e

C a l e n z a n o , F

l o r e n c e ( I t a l y ) 5 0 0 4 1

T r a b e c u l o t o m y ( S L T )


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

2 3 E m e r a l d S u r g i c a l C o m p a n y

F a c t o r y R o r a s R o a d

w w w . e m e r a l d s u r g i c a l . c o m


l a d e s ,

S i a l k o t ( P a k i s t a n )


2 4 .

E s c a l o n M e d i c a l C o r p -

2 4 4 0 S o u t h 1 7 9 t h S t r e e t

w w w . e s c a l o n m e d . c o m

C a m e r a , R e t i n a l I m a g i n g

H e a d q u a r t e r s

N e w B e r l i n , W I ( U S A ) 5 3 1 4 6

S y s t e m K n i v e s , B l a d e s , S u r g i c a l

I n s t r u m e n t t o o l s , O p h t h a l m i c ,

O p h t h a l m o s c o p e , R e t i n a l

I m a g i n g , U l t r a s o u n d :

D i a g n o s t i c , O p h t h a l m i c ,

P a c h y m e t e r v a s c u l a r D o p p l e r ,

B l o o d F l o w M o n i t o r s

2 5 E y e q u i p - C o r n e a l T o p o g r a p h y

5 1 5 0 P a l m V a l l e y R d # 3 0 5

w w w . e y e q u i p . c o m

C o r n e a l T o p o g r a p h y ,

P o n t e V e d r a B e a c h , F L ( U S A ) 3 2 0 8 2

K e r a t o m e t e r , o p h t h a l m o m e t e r s

2 6 F r i t z R u c k O p h t a l m o l o g i s c h e

J u l i c h e r S t r a b e 1 1 5

w w w . f r i t z r u c k - g m b h . d e


l a d e s ,

S y s t e m e G m b H , E s c

h w e i l e r - D u r w i b


( G e r m a n y ) 5 2 2 4 9

2 7 H a a g S t r e i t

V e r k a u f , K u n d e n d i e n s t S c h w e i z

w w w . h a a g - s t r e i t . c o m

C o r n e a l T o p o g r a p h y ,

G a r t e n s t a d s t r a s s e 1 0

K e r a t o m e t e r , O p h t h a l m o m e t e r s ,

K o n i z ( S w i t z e r l a n d ) C H - 3

0 9 8

F u r n i t u r e : H o s p i t a l B e d s , E x a m

T a b l e s , L

i g h t B u l b s , L a m p s :

s u r g i c a l e x a m , o p t i c a l l e n s , S l i t

L a m p s , r e f r a c t o r I n s t r u m e n t s ,

T o n o m e t e r s , G l a u c o m a t e s t ,

I n s t r u m e n t s , V i s i o n T e s t

I n s t r u m e n t , A c u i t y E y e C h a r t s

2 8 H e i d e l b e r g E n g i n e e r i n g -

S t r a s s e 3 0

w w w . h e i d e l b e r g e n g i n e e r i n g . c o m

C o r n e a l T o p o g r a p h y , K e r a t o m e t e r ,

H e a d q u a r t e r s

H a u p t m a n n

o p h t h a l m o m e t e r s , o p h t h a l m o s c o p e ,

G e r h a r t , D o s s e n h e i m

R e t i n a l I m a g i n g U l t r a s o u n d :

( G e r m a n y ) 6 9 2 2 1

d i a g n o s t i c , o p h t h a l m

i c , p a c h y m e t e r

2 9 H e i n e

K i e n t a l s t r a s s e 7

w w w . h e i n e . c o m

H e a d l a m p s , H e a d l i g h t s :

H e r r s c h i n g ( G e r m a n y ) D - 8

2 2 1 1

F i b e r o p t i c l a r y n g o s c o p e ,

b r o n c h o s c o p e , r h i n o s c o p e ,

l i g h t b u l b s , l a m p s : s u r g i c a l e x a m ,

l o u p e m a g n i f i e r s , o p h t h a l m o s c o p e ,

r e t i n a l i m a g i n g , o t o s c o p e s , s c a l e s :


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

m e d i c a l , d i g i t a l s i g m o i d o s c o p e ,

a n o s c o p e , u p p e r G I , e n d o s c o p y ,

s l i t l a m p s , r e f r a c t o r i n s t r u m e n t s ,

S p h y g m o m a n o m e t e r s ( N I B P )

3 0 H o w a r d I n s t r u m e n t s I n c

4 7 4 9 A p p l e t r e e L a n e

w w w . h o w a r d i n s t r u m e n t s . c o m

O p h t h a l m i c K n i v e s , b

l a d e s ,

T u s c a l o o s a , A L ( U S A ) 3 5 4 0 5

s u r g i c a l i n s t r u m e n t t o o l s

3 1 H S I n t e r n a t i o n a l

5 0 4 0 C o m m e r c i a l C i r c l e U n i t A

w w w . h s i s u r g i c a l . c o m


l a d e s ,

C o n c o r d , C

A ( U S A ) 9 4 5 2 0

S u r g i c a l i n s t r u m e n t t o o l s

3 2 H u c o V i s i o n

P O B o x 1 4 7

w w w . h u c o v i s i o n . c o m


l a d e s ,

S t B l a i s e ( S w i t z e r l a n d ) C H - 2

0 7 2


3 3 I n s i g h t I n s t r u m e n t s I n c -

2 6 0 2 S E W i l l o u g h b y B l v d

w w w . i n s i g h t i n s t r u m e n t s . c o m

E n d o s c o p y E q u i p m e n t ,

R e t i n a l E n d o s c o p e

S t u a r t , F L ( U S A ) 3 4 9 9 4

e n d o s c o p e s h e a d l a m p s ,

h e a d l i g h t s : F i b e r o p t i c


I m a g i n g

3 4 I r i d e x C o r p

1 2 1 2 T e r r a B e l l a A v e n u e

w w w . i r i d e x . c o m

L a s e r : R e t i n a l , P h o t o c o a g u l a t o r ,

M o u n t a i n V i e w , C A ( U S A ) 9 4 0 4 3

3 5 I s c o n S u r g i c a l s L t d - S y r i n g e s ,

2 2 - 4

H e a v y I n d u s t r i a l A r e a

w w w . i s c o n s u r g i c a l s . c o m


l a d e s ,

N e e d l e s , B

l a d e s

J o d h p u r , R a j a s t h a n ( 3 4 2 0 0 1 )


3 6 K a s h m i r S u r g i c a l W

o r k s

1 8 8 8 - B

1 0 B a l d e v N a g e r

w w w . k a s h m i r s u r g i c a l s . n e t

C o r n e a l t o p o g r a p h y ,

A m b a l a , H a r y a n a ( I n d i a ) 1 3 4 0 0 7

k e r a t o m e t e r , o p h t h a l m o m e t e r s

f i b e r o p t i c : I l l u m i n a t o r l i g h t s

l a r y n g o s c o p e , b r o n c h o s c o p e ,

r h i n o s c o p e , l o u p e m a g n i f i e r s ,

s l i t l a m p s , r e f r a c t o r i n s t r u m e n t s

s p e c u l a , v a g i n a l s p e c u l u m

3 7 K a t e n a P r o d u c t s I n c - S u r g i c a l

4 S t e w a r t C o u r t

w w w . k a t e n a . c o m


l a d e s ,

E y e I n s t r u m e n t s

D a n v i l l e , N

J ( U S A ) 0 7 8 3 4


3 8 K o n a n M e d i c a l C o r p o r a t i o n

1 0 - 2

9 , M i y a n i s h i c h o

w w w . k o n a n . c o m

C o r n e a l t o p o g r a p h y ,

N i s h i n o m i y a , H y o g o

k e r a t o m e t e r , o p h t h a l m o m e t e r s ,

( J a p a n ) 6 6 2 - 0

9 7 6

M i c r o s c o p e s : s u r g i c a l , m e d i c a l


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

3 9 K o w a C o m p a n y L t d

6 - 2 9 N i s h i k i 3 C h o m e

w w w . k o w a . c o . j p

A c t i v a t e d C a r b o n , C a m e r a ,

N a k a K u , N a g o y a

r e t i n a l i m a g i n g s y s t e m , c o r n e a l

( J a p a n ) 4 6 0 0 0 0 3

t o p o g r a p h y , k e r a t o m e t e r ,

o p h t h a l m o m e t e r s c o u g h , c o l d

m e d i c i n e , N o n - p r e s c r i p t i o n O T C

o p t i c a l l e n s , p a i n r e l i e v e r s , N o n -

p r e s c r i p t i o n O T C , a n a l g e s i c s

p h a r m a c e u t i c a l s : d e r m a t o l o g y ,

A c n e , p s o r i a s i s , e c z e m a ,

p h a r m a c e u t i c a l s : o p h t h a l m i c e y e

m e d i c a t i o n , p h a r m

a c e u t i c a l s :

p a t e n t e d d r u g s , s l i t l a m p s ,

r e f r a c t o r i n s t r u m e n t s , t o n o m e t e r s ,

g l a u c o m a t e s t i n s t r u m e n t s ,

V i t a m i n B - 1 , B - 2 , B - 6 , B - 1

2 ,

R i b o f l a v i n

4 0 L a P r e c i s i o n M o s a n e ( L P M )

R u e B e l l a i r e 1 8 B

w w w . p r e c i s i o n - m o s a n e . b e


l a d e s ,

R o t h e u x R i m i e r e s ( B e l g i u m ) B - 4

1 2 0


4 1 L a s e r S i g h t T e c h n o l o g i e s I n c

6 8 4 8 S t a p o i n t C t

w w w . l a s e . c o m


W i n t e r P a r k , F L ( U S A ) 3 2 7 9 2


R K

4 2 L K C T e c h n o l o g i e s I n c -

2 P r o f e s s i o n a l D r # 2 2 2

w w w . l k c . c o m

E y e m o v e m e n t t r a c k i n g

G a i t h e r s b u r g , M D ( U S A ) 2 0 8 7 9

s y s t e m s v i s u a l e l e c t r o p h y s i o l o g y

4 3 L u m e n i s

A t i d i m S c i e n c e I n d u s t r i a l P a r k

w w w . l u m e n i s . c o m

L a s e r : C a p s u l o t o m y , S e l e c t i v e

N e v e S h a r e t t , P O 1 3 1 3 5

T r a b e c u l o t o m y ( S L T )

T e l A v i v ( I s r a e l ) 6 1 1 3 1

4 4 M a r c o O p h t h a l m i c I n c

1 1 8 2 5 C e n t r a l P a r k w a y

w w w . m a r c o o p h . c o m

C o r n e a l t o p o g r a p h y , k e r a t o m e t e r ,

J a c k s o n v i l l e , F L ( U S A ) 3 2 2 2 4

o p h t h a l m o m e t e r s , s

l i t l a m p s ,

r e f r a c t o r i n s t r u m e n t s , t o n o m e t e r s ,

g l a u c o m a t e s t i n s t r u m e n t s

4 5 M a s s i e L a b o r a t o r i e s I n c ( M L I )

5 7 7 5 W e s t L a s P o s i t a s B l v d

w w w . m a s s i e - l a b s . c o m


P l e a s a n t o n , C

A ( U S A ) 9 4 5 8 8

I m a g i n g


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

4 6 M a s t e l P r e c i s i o n I n c

2 8 4 3 S a m c o R o a d

w w w . m a s t e l . c o m


l a d e s ,

R a p i d C i t y , S

D ( U S A ) 5 7 7 0 2


4 7 M D B i o t e c h I n c

5 1 1 B u r r o u g h s S t

w w w . m d b i o t e c h i n c . c o m

B i o m e t r i c R e a d e r , S c a n n e r : I r i s ,

M o r g a n t o w n , W V ( U S A ) 2 6 5 0 5

F i n g e r p r i n t , F a c i a l C o r n e a l

T o p o g r a p h y , K e r a t o m e t e r ,

O p h t h a l m o m e t e r s

4 8 M e d i A l e x a E n g i n e e r i n g C o

W a z i r a b a d R o a d

w w w . m e d i a l e x a . c o m


l a d e s ,

M o h a l l a h M u s l i m T o w n ,


U g o k i e S i a l k o t ( P a k i s t a n )

4 9 M e d i c a l I n s t r u m e n t

1 4 4 7 7 C a t a l i n a S t r e e t

w w w . m i d l a b s . c o m


l a d e s ,

D e v e l o p m e n t L a b s I n c

S a n L e a n d r o , C A ( U S A ) 9 4 5 7 7


5 0 M e d L o g i c s

2 6 0 6 1 M e r i t C i r c l e # 1 0 2

w w w . m l o g i c s . c o m

O p h t h a l m i c K n i v e s , b l a d e s ,

L a g u n a H i l l s , C A ( U S A ) 9 2 6 5 3


5 1 M e d t r o n i c

6 7 4 3 S o u t h p o i n t D r i v e N o r t h

w w w . s o

l a n . c o m


l a d e s ,

J a c k s o n v i l l e , F L ( U S A ) 3 2 2 1 6


5 2 M o r i a - L

A S I K S u r g e r y

1 5 r u e G e o r g e s B e s s e

w w w . m o r i a - s u r g i c a l . c o m


l a d e s ,

A n t o n y ( F r a n c e ) 9 2 1 6 0


5 3 N i d e k - H e a d q u a r t e r s

3 4 - 1

4 M a e h a m a

w w w . n i d e k . c o . j p

O p h t h a l m i c e q u i p m e n t

H i r o i s h i - c h o G a m a g o r i , A i c h i

( J a p a n ) 4 4 3 - 0

3 8

5 4 N o r w o o d A b b e y L t d

4 7 0 C o l l i n s S t , L e v e l 7

w w w . n o r w o o d a b b e y . c o m . a u

L a s e r : R e f r a c t i v e C o r n e a S u r g e r y ,

M e l b o u r n e , V i c t o r i a ( A u s t r a l i a ) 3 0 0 0

V I S X , L A S I K , P R

K

5 5 O a s i s M e d i c a l I n c

5 1 0 - 5 2 8 S V e r m o n t A v e

w w w . o a s i s m e d i c a l . c o m


l a d e s ,

G l e n d o r a , C

A ( U S A ) 9 1 7 4 0


5 6 O c u l u s O p t h a l m i c D i a g n o s t i c s 1 8 9 0 2 N E 1 5 0 t h S t

w w w . o c u l u s . d e

C a m e r a , r e t i n a l i m a g i n g s y s t e m

W o o d i n v i l l e , W A ( U S A ) 9 8 0 7 2

c o r n e a l t o p o g r a p h y , k e r a t o m e t e r ,

o p h t h a l m o m e t e r s F u r n i t u r e :

H o s p i t a l b e d s , e x a m t a b l e s , M

i c r o

- s c o p e s : s u r g i c a l , m

e d i c a l , v i s i o n

t e s t i n s t r u m e n t , a c u i t y e y e c h a r t s .


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a n u f a c t u r

a n u f a c t u r

a n u f a c t u r





e b s i t e

e b s i t e

e b s i t e

e b s i t e


o d u c t s

o d u c t s

o d u c t s

o d u c t s

5 7 O p h t h a l m i c T e c h n o l o g i e s I n c

3 7 K o d i a k A v e n u e

w w w . o t i - c a n a d a . c o m


U n i t 1 6 D o w n s v i e w ,

o p h t h a l m o m e t e r s e n d o s c o p y

O n t a r i o ( C a n a d a ) M 3 J 3 E 5

E q u i p m e n t , e n d o s c o p e s ,

U l t r a s o u n d : d i a g n o s t i c

o p h t h a l m i c , P a c h y m e t e r

5 8 O p t i k o n 2 0 0 0 I n t e r n a t i o n a l S p A

V i a d e l C a s a l e d i S e t t e b a g n i 1 3

w w w . o p t i k o n . c o m


R o m a I - 0

0 1 3 8

o p h t h a l m o m e t e r s ,

p h a c o e m u l s i f i c a t i o n , c o

Equip Second Manual

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