TILGANGA - A CENTER OF EXCELLENCE Dr. Sanduk Ruit

Eye care service delivery in Nepal - Last four phases 1980-1990 National Blindness Survey Infrastructure Human Resource 1991-2000 Quality Service Technology 2011 - 2020 Sub specialty Trainings Research & Documentation Monitoring & Evaluation Sustainability Quality Assurance 2001-2010 Service Coverage

EYE CARE High Quality Affordable Accessible Sustainable

MODERN CATARACT SURGERY TO THE COMMUNITY OUR MISSION– 20 Yrs INITIATIVE TO PROVIDE SUFFICIENT SUCCESSFUL SUSTAINABLE MODERN CATARACT SURGERY TO THE COMMUNITY

BARRIERS COST OF HIGH QUALITY IOLS ADAPTATION OF GOOD QUALITY SURGICAL TECHNIQUE COST & COMPLEXITY OF EQUIPMENTS

1992 – LEADERS IN THE COMMUNITY CONCEPTUALISED TILGANGA EYE CENTER SEED FUND OF Rs. 28000.00

Innovative Strong Team Good Base Positive Advocacy

Opened on June 7th, 1994 Model Set Up To Deliver High Quality Eye Care Efficiently Manufacture of World Class Intraocular Lenses Eye Bank Community Outreach Activity Training

ADAPTATION OF GOOD QUALITY SURGICAL TECHNIQUE 5 YRS SIMPLIFIED, ADAPTED & TESTED TRAINING GLOBALLY – POPULAR SOP MANUALS FRED HOLLOWS FOUNDATION & THE HIMALAYAN CATARACT PROJECT

DELIVERY SYSTEM HIGH VOLUME AMBULATORY – 1994 COST RECOVERY – SUBSIDIZED THROUGH CROSS SUBSIDY SURGICAL MODIFICATION AND PRODUCTION LINE APPROACH

INTRAOCULAR LENS INTRAOCULAR LENS – TILGANGA & FRED HOLLOWS FOUNDATION MADE IT POSSIBLE TO MANUFACTURE STATE OF THE ART IOL LOCALLY

INTRAOCULAR LENS COST CAME DOWN TO US $4 FROM US $100 - HISTORY CONTINUOUS AND DYNAMIC INTO NEWER PRODUCTS TYPE OF SURGERY NOW CAME WITHIN THE REACH OF POORER COMMUNITY

4 MILLION LENSES TO 80 COUNTRIES! QUALITY ASSURANCE 4 MILLION LENSES TO 80 COUNTRIES!

IMPACT OF HIGH QUALITY AND AFFORDABLE COST IOL AVAILABLE IN NEPAL % Year

ACADEMIC AND TRAINING PROGRAM 2. Modular Training programs 1. Academic Programs 3. Exposure Training program Hospital Based (SICS, OPAL ,Glaucoma, Theatre Nurse, etc) - Community Based (Eye Health Worker, Primary Health care, PST, DR,TH, FCHV, etc Elective medical students, MBBS, Optometrist, Nursing, Orthoptician Health Care students etc - MD OA Fellowship

ACADEMIC & TRAINING Description 1994-2014 During 2015 Remarks MD Residents 42 13* Academic *including III yr residents Fellowship 13 4 Ophthalmic Assistant 132 40 Ophthalmologist (SICS, Glaucoma, Retina) 354 17 Modular Allied Health (Theatrenursing, Glaucoma, Investigation, Refraction etc..) 295 5 (Community based HP/SHP in charge, FCHV, PST, DR, THs) 3732 - Integrated Medical Students (Nursing, MBBS, HA, etc) 4406 426 Exposure Others 16 Total 8,948 492

REFRACTIVE SURGERY UNIT Refractive Surgery till now 2404

Number Year

CORNEA EXCISION CENTRE

GRIEVED RELATIVES

SUB-SPECIALLITY Cornea & External Vitreoretinal Glaucoma Oculoplasty Uveitis Pediatric Neuro ophthalmology Refractive Surgery Community Ophthalmology

COMMUNITY EYE CENTERS 2014 2014 Name of CEC Male Female Total Dhading 5647 9114 14761 Nuwakot 7112 9283 16395 Rasuwa 1054 1438 2492 Sindhu 3714 5410 9124 Okhaldhunga 2830 3789 6619 Rolpa 3744 4072 7816 Ramechhap 4071 5928 9999 Solu 3320 4793 8113 Bhaktapur 7441 9400 16841 Dolakha 3762 6167 9929 Mustang 1290 1540 Swyambhu 1515 1987 3502 Manang (Est. 2014 Nov) 116 115 231 Sub Total of CECS 45,616 63,036 1,08,652

Tilganga Institute of Ophthalmology Rasuwa CEC Ramechhap CEC Dhading Nuwakot Okhaldhunga CEC Rolpa Hetauda CEH Bhaktapur CEC Tilganga Institute of Ophthalmology Sindhu Tilganga Eye Centre Manang CEC

HETAUDA: MODEL EYE CENTRE

COMMUNITY EYE HOSPITAL - HETAUDA 2014 Target 2014 Achievement OPD 41000 47060 Outreach OP 10000 11055 School Screening 4000 3529 CEC OPD 1300 2570 No. of Screening Camps 45 44 Surgery 3600 4032 Optical User 12000 15000

RESEARCHES Ongoing Proposed Jiri Eye Study Hyperopic Smile Bhaktapur Retina Study Corneal Ulceration Study Review of Diabetic retinopathy Cataract surgical outcome monitoring Pediatric Ocular diseases study Vision related QoL for sight threatening DR Eye Health system Analysis Comparison of outcome of phaco vs SICS

N=115

OPD

SURGERY

INTERNATIONAL COMMITMENT CHINA TAR QINGHAI JIANGXY Sudan TILGANGA EYE CENTRE JIANGXY DPR KOREA Ghana Eritrea Ethopia PAKISTAN MYANMAR INDIA KALIMPONG SIKKIM DARJEELING MANGARH VIETNAM CAMBODIA THAILAND BANGLADESH BHUTAN INDONESIA

TEAM