Classification of Eye Care Providers in Nepal

 Classification of Eye Care Providers

The health institutions that provide eye health services have been classified into different grades according to the level of care they provide, equipment and human resources available. This classification is developed by the Nepal Netra Jyoti Sangh (NNJS) in 2020 AD.

1. Eye care center

Eye care centers provides the following services:

·        Diagnosis and management of common ocular diseases and disorders

·        Vision assessment, refraction and optical dispensing

·        Measurement of intra-ocular pressure

·        Syringing

·        Foreign body removal

·        Minor procedures like epilation, dressing, etc

·        Pharmacy

·        School screening and

·        Providing eye health education

·        Referral

 

2. Surgical center

This is also the eye care center but with additional facility of periodic eye surgeries by the ophthalmologists sent from the base hospital.  The surgeries includes cataract surgeries and other common surgeries like chalazion, pterygium, etc. The referral cases sent from the community programs are also seen here.

3. Secondary eye hospital

The eye center which has at least one ophthalmologist working on a daily basis and which provides at least cataract surgery facility and emergency care is said to be a secondary eye hospital. This center should also have pharmacy, optical, and laboratory for basic pathology and microbiology.

 

4. Tertiary eye hospital

The secondary eye hospital is said to be a tertiary when it has at least three specialty clinics: cornea, glaucoma, pediatric, vitreo-retina, oculoplasty, neuro-ophthalmology, uvea, etc.  The special clinic should also provide the related surgery facilities. The specialist surgeon will be there working full-time and will be staying in the special OPDs equipped with basic relevant equipment. It also has contact lens, low vision and orthoptic services. The laboratory should be equipped with microbiology, biochemistry and hematology services.

5. Center of excellence

Center of excellence should have all the services provided by tertiary eye hospital plus at least five specialty clinics running regularly with related surgery services. The laboratory should be equipped with microbiology, biochemistry, serology, hematology and histopathology services. This center should also have research department and research activities going on a regular basis, and it should also have the cornea retrieval facilities.  

Besides these, there is also a referral center which is just a center (health post or a PHC) that refers the patient to eye hospitals or eye care centers by grossly observing the eyes or testing the vision. No eye care personnel (Eye health worker, Ophthalmic Assistant, Optometrist or Ophthalmologist) is posted there. 

As we can clearly see, these definitions are ophthalmology-focused and are fully adopted by all NNJS eye hospitals of Nepal. Moreover, these definitions are acceptable to many other eye care institutions and NGOs with a little or no modification because more or less they are concerned with doing the surgeries. Since, an holistic eye care is not wholly focused on surgeries, a new approach of classifying an eye care provider should be explored.

BVFN Classification of vision care provider

A vision center is the first stop for patients with refractive care needs. Our philosophy is that patients need not visit a hospital and undergo a tedious, time-consuming process to get a pair of spectacles. Currently in Nepal, the private optical shops do not have standard refractive care services. This has led to ‘distrust’ in services provided by the optical shops which in turn drive patients with refractive errors to visit an eye hospital. We want to change this concept among our patients by providing timely and excellent refractive care services through a vision center. Therefore, our vision centers need not be located only in the rural hard-to-reach communities but also in the city and town centers. Also, the vision centers that we have proposed may not always be equivalent to the current ‘primary eye care centers’ of Nepal. With growth and population needs, we aim to develop the vision centers to secondary or tertiary levels. We wish to redefine the current classification of eye care centers which is based on the ophthalmological point of view, largely based on presence or absence of cataract surgery services. Our proposed levels of vision centers are as follows:

Primary Vision Center: General vision and eye assessment, refraction, dispensing, primary low vision care and basic contact lens services (without a corneal topographer). This will also have a pharmacy with common ocular medications.

Secondary Vision Center: All services of primary vision center plus services including advanced contact lens services (soft, rigid, scleral and orthokeratology), Vision therapy services, pediatric optometry care and low vision services which may not include services such as Orientation and Mobility training.

Tertiary Vision Center: All services of primary and secondary center plus advanced low vision services including advanced rehabilitation and vocational skills such as orientation and mobility training; research and academic activities.

References:

1. Guideline on the grading of NNJS eye hospitals, 2020.

2. Better Vision Foundation Nepal (BVFN) Vision Center Model, 2021.

Have any query? Write me: [email protected], Rabindra Adhikary

Key words:

Eye Hospitals of Nepal

Referral center

Eye care Center

Primary eye care center

Secondary eye care center

Tertiary eye care center

Center of excellence 

Secondary eye hospitals of Nepal

Tertiary eye hospital of Nepal

Types of eye hospitals in Nepal

Classification of eye care provider

Classification of eye hospital in Nepal