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Dear Readers,
With rapid and continuous development of technology the delivery of eye care services is becoming increasingly sophisticated and expensive. The purpose of this SiteNews is to provide you an overview of how to make this complex task relatively simple. As you purchase equipments the art of buying provide you with insights on practical tips to bear in mind before you purchase. Is the investment you are making worth it, we provide you with tools to accomplish this difficult task in a matter of minutes in an objective manner. A variety of equipments seem to be needed for the eye hospital but what exactly is their purpose? Whether one is providing service at the primary, secondary or tertiary eye care level we are able to provide you with the list of equipments required at each level. To increase the life of the equipments it is necessary that they are taken care of well. Today there are a number of manufacturers of ophthalmic equipments, instruments and consumables, and we provide an overview of them. It is also necessary to have trained staff whether at the technician level or ophthalmologist to take care of equipments, but do you know where training facilities are available? Vision 2020 Technology Working Group is our collaborating partner and the Head ?? Catherine Cross has clearly the articulated their plans and achievements.
We look forward to your continuous support of our website as well as recommendation of materials that we can add to this storehouse of management resources in eye care. With your support this resource site will continue to grow and be of relevance!
Wish you a productive reading!

Happy reading!
Regards,
Vision 2020 e-resource team
The Issue Features...
Ophthalmic Equipment and Instruments
Vol. 2 No. 10 October 2005
•   Art of buying
•   Tools for purchase decision and pricing
•   Ophthalmic Equipment and Instruments
•   Standard list of Equipment
and Instruments

   •  Vision centre
   •  Secondary eye care
   •  Tertiary eye care centers
•   Care and Maintenance
   •   CDs
•   List of Manufacturer(Equipment,Instruments,Consumable)
•   Equipment Maintenance training
•   Collaborating Partner

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  • Be clear about the investment to be made and the equipment to be procured at different stages of development of Eye Hospital.
  • Ophthalmic instruments are sophisticated and should be long lasting. So always opt for the quality products.
  • The identification of supplier is very crucial part. Check the following in a supplier
    1. Background of the supplier.
    2. Fair dealing (avoid commissions to individuals this may lead to hindrance in providing quality service)
    3. After service support has to be efficient
  • Dont change the suppliers unless otherwise situation arises. Have a good rapport with the suppliers.
  • It is better to get the service from the suppliers it will lead to having good rapport with them.
  • A service provider should be prompt to queries
  • At the time of purchasing the equipment
  1. ECONOMICS OF OPHTHALMIC EQUIPMENT

  2. Abstract:
    This article illustrates the various economic aspects to be considered in the procurement of ophthalmic equipment using the Excimer Laser for Lasik Surgery as a representative case example.
    Source:
    Dr. P. Balakrishnan , Managing Director, Aurolab

  3. EQUIPMENT AND HIGH QUALITY

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Ophthalmic equipment is a major resource required for delivery of quality eye care at an appropriate cost. This resource should be selected carefully and once purchased it should be maintained and used efficiently in order to generate adequate return on the investment. The typical economic issues that need to be addressed to adequately justify this investment are the following:

  1. Appropriate charges for the procedure
  2. Anticipated revenue per year
  3. Estimated expenses per year
  4. Volume required for break even
  5. Estimated financial returns over multiyear period
To find out the pay back period and workload for the investment made on the instruments and equipments we have these tools
  1. INVESTMENT ANALYSIS FOR GENERAL EQUIPMENTS
    Abstract:
    With the advent of modern technology, in order to provide quality eye care the hospitals are forced to purchase several equipments. Purchasing of equipments not only involves capital cost of the equipment but also the cost for supporting facilities like air-conditioning, special foundations and construction. It also involves some recurring costs like salaries to technicians, annual service contract charges, cost of spares, consumables, interest and depreciation charges. Due to all these costs many of the charity hospitals find it difficult to invest in new technology. In this context, the hospitals face a situation as to how to mobilize resources (money) to procure the necessary equipments and also whether to charge patients and if so what would be the amount they would charge?
    Source:
    Mr. S. Saravanan

  2. INVESTMENT ANALYSIS FOR PHACO & YAG LASER
    Abstract:
    With the advent of modern technology, in order to provide quality eye care the hospitals are forced to purchase several equipments. Purchasing of equipments not only involves capital cost of the equipment but also the cost for supporting facilities like air-conditioning, special foundations and construction. It also involves some recurring costs like salaries to technicians, annual service contract charges, cost of spares, consumables, interest and depreciation charges. Due to all these costs many of the charity hospitals find it difficult to invest in new technology. In this context, the hospitals face a situation as to how to mobilize resources (money) to procure the necessary equipments and also whether to charge patients and if so what would be the amount they would charge?
    Source:
    Mr. S. Saravanan

  3. RETURN ON INVESTMENT - WEB BASED FINANCIAL PLANNING TOOL FOR PAEDIATRIC DEPARTMENT
    Abstract:
    To find out the pay back period for the investment made on the paediatric eye department based on its workload and also helps you to estimate the annual patient load required to sustain the project.
    Source:
    Mr. R. D. Thulasiraj, Mr. S. Saravanan

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A wide range of ophthalmic equipment is available for diagnosis and treatment of eye disorders. The purpose of each of these ophthalmic equipments varies, this section basically provides an overview of its use in the field of ophthalmology.

  1. TORCH LIGHT
  2. OPHTHALMOSCOPE
  3. RETINOSCOPE
  4. INDIRECT OPHTHALMOSCOPE
  5. SLIT LAMP

  6. SLIT LAMP - SOME ASPECTS OF USE IN CLINICAL EXAMINATION
    Abstract:
    This article deals with the relationship between the numerical aperture of the objective lens and the various aspects of the image formed in a slit lamp microscope like magnification and field of view, resolution and contrast, brightness, depth of field and stereopsis is described. The effect on quality of the image due to change in the magnification of the eyepiece, without changing the total magnification of the microscope is pointed out.
    Source:
    Prof. V. Srinivasan, Consultant, Instruments and Maintenance Department - Aravind Eye Care System.

  7. OTHER OPTICAL EQUIPMENT:

  8. VISION ENHANCEMENT SYSTEMS - CLOSED CIRCUIT TELEVISION SYSTEM - THE ARAVIND MODEL
    Abstract:
    This article introduces the concept and advantages of Closed Circuit Systems and their use as low vision aids, it details the different types available and also describes the cost-effective system designed and being used at the Aravind Eye Care System
    Source:
    Dr. Ilango, Mr. A. Manikanda Selvan, Mr. T. Saravana Kumar, Prof.V. Srinivasan

  9. "RUNNING LIGHTS" - A USE IN OPHTHALMOLOGY
    Abstract:
    This article explains how common decorative lights can be used in vision exercises to help children who do not have visual fixation.
    Source:
    Dr. P. Vijayalakshmi, Mr. A. Manikanta Selvan, Mr. T. Saravanakumar, Prof.V.Srinivasan

  10. PACE MAKER AND PHACO SURGERY
    Abstract:
    This article analyses the cons of undergoing phaco surgery for patients with Pacemaker and also gives some precautionary measures that should be adopted for those who undergo phaco surgery with pacemaker
    Source:
    Dr. Banushree, Er. Shree Vidhya, Prof. V.Srinivasan

  11. RETINOSCOPY AND TROUBLESHOOTING
    Abstract:
    This article identifies the various problems that may be encountered in retinoscopy and provides suggestions for troubleshooting
    Source:
    Prof. Sukumaran, Head- Dept of Optometry, Aravind Eye Care System

  12. DIRECT OPHTHALMOSCOPES - A COMPARISON
    Abstract:
    This article provides the basic differences between various types of ophthalmoscopes that exist and their degrees of usefulness.
    Source:
    Ms. A.S. Meenachi, Instruments Maintenance Department, Aravind Eye Care System

  13. CLOSED CIRCUIT TELEVISION SYSTEM
    Abstract:
    This booklet explains the use of Closed Circuit Television system for low vision patients for reading text, to see the time in watches, to load the insulin syringes etc. It also explains how to use the CCTV scanner, arrangements required and also the troubleshooting techniques.


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Vision Centre:

Vision centers are started with the main objective to create permanent access to the rural communities to increase the uptake for eye care services. This centre offers primary eye care services with the help of trained ophthalmic technician at an affordable cost. The centre is connected with the base hospital through internet services to enable direct patient consultation and interaction with the ophthalmologist. In order to make health behavioral changes in the community it advocates awareness programs to promote better eye health practices. Community ownership is important to sustain the activities of the centre and hence village volunteers are identified and trained to create link between the community and the centre. For the effective reach of the community concrete efforts have been taken to network with Government, NGOs and other prominent leaders in the area.
  1. REQUIRED MATERIALS FOR VISION CENTER
    Abstract:
    The tool contains Instruments and equipments required for setting up vision center.
Secondary eye care:

Secondary eye care services refers to providing a mix of preventive, curative and rehabilitative eye care interventions with a greater focus on curative services within the basket so as to bring about a significant reduction in blindness and ocular morbidity in its service area. Since most of the blindness can be prevented or treated with secondary level interventions, it is important that this level remains most cost effective.
  1. EQUIPMENTS NEEDED FOR SETTING UP A SECONDARY HOSPITAL
    Abstract:
    This worksheet gives you required equipments for a seconday eye hospital with the type, model, cost and location of the equipment etc.
    Source:
    Mr. R.D. Thulasiraj and Mr. Jeyachandran

  2. Standard List of Medicines, Equipment, Instruments, Optical Supplies and Educational Resources for Primary and Secondary Level Eye Care Services 2004 / 2005- secondary centres
    Abstract:
    The list has been produced to assist project managers and medical personnel who are involved in providing eye care services. It aims to cover the essential equipment, instruments and supplies for primary and secondary (district) level eye care.
Tertiary eye care centers:
Tertiary eye care provides the complete spectrum of sub-specialty eye care services and has the expertise to handle complicated cases. Tertiary health center also plays a vital role in training; deployment and professional updating of all categories of eye care personnel.
  1. EQUIPMENTS NEEDED FOR SETTING UP SPECIALITY CLINICS
    Abstract:
    This worksheet gives you required equipments for a Speciality clinin with the type, model, cost and location of the equipment etc.
    Source:
    Mr. R.D. Thulasiraj and Mr. Jeyachandran

  2. EQUIPMENTS NEEDED FOR SETTING UP A PAEDIATRIC EYE CARE UNIT
    Abstract:
    A worksheet giving required equipments for a paediatric unit with the type, model, cost and purpose of the equipment etc.
    Source:
    Mr. R.D. Thulasiraj, Mr.S. Saravanan, Ms. Sheela Devi

  3. STANDARD CATARACT SURGICAL KIT secondary
    Abstract:
    This cataract kit contains the minimum and desirable equipments and medicines needed for five surgeries. The Items needed, their brand option, manufacturer, category&use, and quantity for ECCE and SICS for preoperative, intraoperative and postoperative care is given in detail that enables the user to prepare for a surgery.
    Source:
    Dr. P. Balakrishnan

  4. VISION 2020 - STANDARD LIST FOR LOW VISION SERVICES tertiary
    Abstract:
    This standard list gives the different kind of instruments and equipments like Ophthalmic, Vision Assessment, Optical, CCTV and Computer devices needed for the Low Vision clinic.
    Source:
    WHO/ IAPB Low Vision Working Group Journal of Community Eye Health

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The quality and efficiency of medical service provided in any hospital depends very much on the proper functioning of the equipment and instruments used by the doctors and other clinical staff. Even under normal and careful use, instruments fail to function properly. The frequency of such failures can be considerably reduced by proper care, maintenance and timely repair. Hence we are providing you with resources which will be help for Care and Maintenance of Ophthalmic Instruments and Equipments.
  1. OPHTHALMIC INSTRUMENT AND EQUIPMENT - A HANDBOOK ON CARE AND MAINTENANCE
    Abstract:
    This manual provides information on the general maintenance of the ophthalmic instruments and equipments, its management, maintenance protocol with some simple electrical calculations.
    Source:
    Prof. V. Srinivsan, Mr. R.D. Thulasiraj

  2. MAKING THE EQUIPMENT LAST LONGER AND FUNCTION BETTER - NEED FOR IN-HOUSE MAINTENANCE
    Abstract:
    This articles deals with the procedures to be followed in maintaining the ophthalmic equipment and provides some tips in maintaining them.
    Source:
    Mr. A. Manikanda Selvan, Ms. A.S. Meenachi, Prof. V. Srinivasan, Mr. R.D. Thulasiraj and Dr. P. BalaKrishnan

  3. STERILISATION IN OPHTHALMIC PRACTICE
    Abstract:
    Provides an overview of the role and importance of sterilization and its different types as well as presents details of equipment-specific sterilization techniques, best practices, precautions and policies relating to sterilization in the Operating rooms and tips on how to prevent infections from spreading in hospital units.
    Source:
    Dr. Lalitha Prajna, Ms. R. Charu Priya, Ms. Sharmila Noor

  4. STERILIZATION FOR INSTRUMENTS
    Abstract:
    This protocol deals with how to sterilize the equipments and instruments to avoid infections or another problems during treatment with these instruments. Sterilizing the equipments and instruments is very difficult job to maintain. It invlolves how to sterilize the instruments during surgery, how to sharpen them etc.
Sterilization CDs:

STERILISATION AND ASEPTIC PRACTICES in an Ophthalmic Operation Theatre
Author: Dr. Lalitha Prajna
Dr. Annapurna Chavali
Price: Rs 200/-
The Manual and CD contains information about the common practices followed in maintaining the sterility of the operation theatre (OT) complex. The central sterile supplies department is responsible for the sterilization of equipment instruments, surgical supplies, etc. The manual is aimed towards all who are involved in maintaining the sterile conditions in an ophthalmic operation theatre. It lists down the basic and acceptable practices followed.

To purchase contact:stores@aravind.org s

Basic Concepts in Operating Room Asepsis:
Author:Dr Sharma S
Year of Publication: 2002
Modern aseptic techniques help maintain total asepsis in the Operating Room. It is important to cast a vigilant eye on several factors that contribute to maintaining optimal asepsis. The factors that are presented in the video include: appropriate operating room attire, pre-operative preparation of the patient, surgical scrub technique, procedure of gowning and gloving, surgical draping, removal of soiled attire, cleaning, disinfecting and sterilizing surgical instruments and materials, disposing operating room waste, cleaning and maintenance of the Operating Room environment.
TRT: 20:56 minutes
Price: Rs 800/-

Contact Address:
Email:mshoba@lvpei.org

Instrument Care During Decontamination and Sterilization:
Author: Ms.Watts Karen
Produced in association with ORBIS International, New York
Duration: 23:00minutes
Price: Rs.500/-
Properly maintained instruments last longer, contribute to efficient surgery and enhance the surgical outcome by minimizing the spread of microorganisms between patients. This video illustrates the proper care of surgical instruments after surgery. It reviews the decontamination and common sterilization processes for instruments. It also demonstrates the cleaning of specific ophthalmic instruments viz., the phacoemulsification hand piece, irrigation/aspiration hand piece and light pipes.

Contact Address:
Email:mshoba@lvpei.org


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We have compiled the following list of Global manufacturers of Ophthalmic Instruments, Equipments and consumables for use in Secondary and Tertiary Eye Care. This list was collected through various websites and other sources. Most of the Manufacturers have websites or accessible through E-mail, we have also listed the products they manufacture.

  1. INSTRUMENT AND EQUIPMENT MANUFACTURERS LIST
    This worksheet gives you some of the Global Instruments and Equipments manufacturers with there address, website and the type of product they manufacture.

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  1. Equipment and Instruments: Maintenance Courses
    The six-week maintenance courses run in LAICO (Lions Aravind Institute of Community Ophthalmology), Aravind Eye Care System, Madurai, India aims to teach the skills needed for equipment and instruments maintenance. The courses have been organised since 1996. As of this date, we have conducted 27 such courses, training 151 technicians. Thirty-seven technicians (almost 25%), are from 14 developing countries outside India - Jamaica, Ghana, Nigeria, Uganda, Kenya, Malawi, Zambia, Zanzibar, Pakistan, Philippines, Nepal, Papua New Guinea, Indonesia, and Bangladesh.

  2. COURSE ON INSTRUMENTS MAINTENANCE - TECHNICIAN'S COURSE
    Course content:
    Organizational management, General maintenance, Maintenance of electrical and electronic instruments, Maintenance of Optical instruments, Maintenance of mechanical parts of equipment, Anatomy of eye and its parts, Common refraction defects and the remedy, Common eye diseases and their treatment, Working principles of the common instruments used in an eye hospital.

  3. INSTRUMENTS MAINTENANCE COURSE FOR OPHTHALMOLOGISTS
    Course content:
    Proper use of equipment, General maintenance, Maintenance of electrical and electronic instruments, Maintenance of optical instruments and Maintenance of mechanical parts of equipment.

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Vision 2020 Technology Working Group

The Global Initiative for the Elimination of Avoidable Blindness (World Health Organization ,1997), which is VISION 2020's base document, emphasizes the need for an appropriate and affordable technology for the delivery of eye care on a global scale. The past ten years have already seen initiatives which have immeasurably increased access to eye care in developing countries, the outstanding achievement being the mass production of low cost high quality intra-ocular lenses, first by Aurolab in India, and then by the Fred Hollows Foundation. These lenses, now widely distributed, have substantially reduced the cost of IOLs on the world market and brought high quality cataract surgery within the reach of millions more people.

In October 2001 the International Agency for the Prevention of Blindness (IAPB) decided to set up a working group on technology. The first meeting took place in April 2002 in Sydney, Australia, and twenty four people representing 15 organizations attended.

The terms of reference of the Working Group are to:

  1. Act as focal point for IAPB regarding all matters to do with technology, including information technology, in support of Vision 2020 objectives.
  2. Improve the flow of information concerning appropriate, high quality, and affordable equipment, consumables, and resource materials essential for the delivery of eye care services. Regularly update the Vision 2020 Standard List of Medicines, Equipment and Resources and make it available in web and print versions. Develop other resources to assist the establishment of Vision 2020 eye care services.
  3. Promote the use of high quality equipment and consumables within national eye care programmes, and encourage the use of appropriate national standards and the development of monitoring systems.
  4. Encourage the development of new, appropriate, high quality, and affordable items and support the transfer of technologies to developing countries to make equipment affordable and accessible.
  5. Encourage the training of medical and support personnel in the care, maintenance, and repair of eye care equipment and instruments to ensure optimal and uninterrupted delivery of services.
  6. Promote cost-effectiveness through collaboration in purchasing, standardization, and, where appropriate, distribution centers.
  7. Encourage the production of key resource materials in major international languages for the benefit of non-English speakers.
  8. Encourage the liaison with WHO and other organizations concerned with medical technology for developing countries.
Activities so far include:

    Joint purchasing by major NGOs supplying equipment to hospitals in developing countries. This has significantly reduced the cost of a number of consumables needed in high volume. Distribution and purchasing centers. The Hong Kong Society for the Blind, with NGO support, has established a highly successful depot for the purchasing of high quality, affordable low vision devices. The address is www.hksb.org.hk A similar initiative is currently under consideration for spectacles.
  • Updating information available. The 2006/7 edition of the Vision 2020 Standard List for a Vision 2020 Eye Care Service Unit: medicines, equipment, instruments, optical supplies, and educational resources will be available before the end of 2005 on www.v2020.org and in print in early 2007 from:
    International Resources Centre
    International Centre for Eye Health
    London School of Hygiene and Tropical Medicine
    Keppel Street
    London WC1E 7HT
    UK
    Fax: +44 020 7958 8317
    E-mail:sue.stevens@lshtm.ac.uk
  • Improving information. A new resource, Technology Guidelines for Establishing a District Eye Care Programme, will be available from the above addresses in 2006. It aims to provide guidance on the equipment and consumables needed for setting up a district eye care programme, by function: base eye unit, outreach, health centre, school and community. It also provides advice on ordering and stock control.
  • Equipment care and maintenance training. From the initiative taken by Aravind Eye Hospitals in the 1990s, to set up regular training courses in care and maintenance of instruments and equipment for doctors and support staff, a number of similar programmes have developed, with assistance from Aravind. These include the West Africa training programme in Nigeria, and more recently courses in East Africa and the Caribbean.
  • Ophthalmic instruments and equipment their care and maintenance. This new CD is described elsewhere and will be a valuable resource for eye care personnel. We are currently exploring the possibility of a French and a Hindi version.
  • Language. The Community Eye Health Journal, produced by the International Centre for Eye Health, London, is now available in French and Chinese, and translation of some key texts into French is underway to meet the need for community eye health material particularly in West Africa. The first of these will be available in 2006.
  • Technology workshops. Recognizing the importance of technology to the delivery of eye care, and the advantages of collaboration between service providers, regional workshops have taken place in Pakistan, attended by representatives of five countries within the region, and also in West Africa.
There is much still to be done to ensure that Vision 2020 is supported by appropriate, affordable, and properly functioning technology, and the Technology Working Group welcomes information from and collaboration with others working in this field.

Catherine Cross
Sight Savers International
Email:ccross@sightsavers.org