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Tilganga Institute of Ophthalmology

Abhishek Subedi June 10, 2020

Tilganga Institute of Ophthalmology is the implementing body of the Nepal Eye Program, a non- profit community based organization. The hospital was opened in 1994. It was opened to support the prevention and control of blindness in the country. With an aim to act as a model for treatment, research and training, one of the active members of Apex body for eye health, Ministry of Health Nepal and working in cooperation with all other eye care centres in Nepal. It played a key role to help, define and adapt a practical, safe and affordable technique of intraocular lens implant for cataract surgery in developing countries. Another key achievement in the early days was the establishment of the country’s first eye bank, in conjunction with Tissue Banks International in Baltimore, USA and Lions International. 

Tilganga Institute of Ophthalmology

Tilganga Institute of Ophthalmology has helped to run unique projects empowering local physicians to alleviate the suffering caused by blindness, including skills transfer education, cost- recovery, research and the creation of a network of eye care facilities. Tilganga Institute of Ophthalmology is one of the leading eye care and training institutes with well-equipped infrastructures for qualified ophthalmologists and allied health workers as it has been providing comprehensive eye care services throughout the country. The Institute includes a fully equipped examination room, operation theatre, investigation, and subspecialty clinics as well as well-equipped computerized Tiliganga Zeiss Education Centre. The centre runs MD residency and certificates in Ophthalmology programs. TIO provides modern medical and surgical techniques in almost sub- specialties of eye care. 

Services of Tilganga Institute of Ophthalmology

Tilganga Institute of Ophthalmology has been providing a wide range of services to the people of the community in order to combat blindness in Nepal. The hospital has modern technologies and services for the treatment of eye disease and surgery of the eye.

1. General Services

An OPD service is where modern ophthalmic care is given to the general public. The hospital has modalities and interventions to treat and provide cure to the problems like modern cataract, corneal transplant, glaucoma surgeries, vitreo- retinal surgeries, orbital surgeries, strabismus surgery and refractive surgery. Most recently, uvea clinics, ocular oncology and 24 hours emergency services have been added to the services. The list of services provided under the general services area are

Surgery

  • Cataract/ IOL including Phacoemulsification
  • Yag Laser Treatment
  • Laser Eye Surgery/ Penetrating Keratoplasty
  • Squint Correction Surgery
  • Lid Surgery
  • Vitreo retinal surgery with Intraocular Gases, Silicon Oil and Endo Laser
  • Diode laser
  • Orbital Surgeries

They also run investigations such as auto refraction, automated visual fields, A- scan/ B- scan, keratometry, pachymetry, corneal topography, anterior segment photography, pentacam and 100 Hue test. It also has pathology investigations like haematology, biochemistry, microbiology and serology.

2. Speciality services

This special type of clinic deals with the eye diseases caused by lifestyle diseases like diabetes and hypertension. These problems are associated with increase in vitreo- retinal problems leading to blindness.  The vitreo- retinal setup at this hospital has the necessary infrastructure, well trained personnel and the capacity to handle a large number of patients suffering from retinal problems. The following diagnostic procedures are available at the hospital’s vitreo retinal clinic

  • Fundus Photography
  • Diagnostic Ophthalmic Ultrasonography
  • Fundus Fluorescein Angiography
  • Optical Coherence Tomography
  • Electrophysiological tests

The clinic also provides other services like laser therapy, intravitreal injections of steroids and anti- vascular endothelial growth factor and state of the art modern vitreo- retinal surgery for various VR conditions.

3. Paediatric Ophthalmology Clinic

The clinic was established with the establishment of the hospital. In early 2012 the clinic was renovated as child- centered facilities and two dedicated paediatric ophthalmologists are actively involved in the clinic. It focuses on early diagnosis and treatment of the different types of amblyopia- refractive, anisometropic, stimulation deprivation and strabismic amblyopia. Surgical management of strabismus, paediatric cataract, penetrating and perforating injuries in children are all managed under general anaesthesia.  Through this clinic regular community outpatient and school screen services are conducted throughout Nepal. 

4. Laser Eye Surgery

Located in the former Tiliganga outpatient clinic, the unit is equipped with world class lasers and offers the same high quality surgery found in the developed world. It is the first public hospital in Nepal to create a dedicated laser facility for the treatment of refractive error. Treatments include laser- assisted in situ Keratomileusis and photo refractive keratectomy (PRK). It is staffed by the dedicated team of specialists including an ophthalmologist and technician trained in the United Kingdom by project partner London Vision Clinic. The new service also forms an important part of the hospital’s cost recovery model, whereby the fees from those who can afford laser surgery will indirectly subsidize eye treatment of the poor who cannot afford it.

5. Extended Service

The hospital began an extended hospital service about a decade ago and its popularity has ensured its continuation. The service is held from 3:30 pm to 7:30 pm Monday to Friday to allow for patients unable to attend during regular outpatients hours because of work, business or school commitments. These clinics are run by four ophthalmologists with support staff. The charges are slightly higher than the morning clinics.

6. Eye Bank

The concept of the Eye Bank was supported by the International Federation of Eye and Tissue Banks. As the only Eye Bank in Nepal it has the responsibility to carry out various important functions such as 

  • Harvesting corneas
  • Processing and preserving corneas
  • Blood testing
  • Distribution of corneas
  • Conducting public awareness campaigns
  • Maintaining the records of patients who are waiting for corneal transplants

7. Research Centre

This hospital is a leading organization in eye health research and contributes to the national and international community to do practice based on evidence. The research department of the TIO is leading the nation towards Excellence in Ophthalmic Research. It always strives to share the rich knowledge and experience acquired at our research through services, products and academic and training activities.

8. Academic and Training Centre

TIO is one of the nation leading centres for the development of all levels of eye health. It believes that continuous medical education maintains improvements in patient health care by supporting medical education programs that inform ophthalmologists of the most current and advanced level of medical knowledge. Students not only from neighbouring Asian countries but also from Africa, Australia, the United States and Europe come here for the better education. This has enhanced an ophthalmologist’s expertise and competence to deliver the highest possible level of medical care to patients.

9. Outreach Microsurgery Eye Clinics

The hospital provides a unique service to people in the most remote areas of the country. It has developed an outreach program for eye examination and cataract surgery delivery. The hospital conducts this clinic in difficult to access and hard to reach areas by providing comprehensive eye care service on a temporary basis. These clinics evolve around eye examination and cataract surgery delivery. Patients are screened and treated with a post operative follow up and discharge instructions for postoperative care.

 Those patients requiring special eye surgeries or further investigation can be referred to the nearest community hospital. It also gives TIO an opportunity to provide eye medicines and glasses to people who need them free of cost or at the cost that poor people can afford. There are about 20 Outreach Microsurgery Eye Clinics conducted each year in remote areas of Nepal alone. Regular OMECs are held in Tibet, Bhutan, North Korea, Bangladesh, Burma, India, Ghana, Ethiopia and Indonesia.

Programs run by Tilganga Hospital

There are two major programs run under the hospital. The hospital has focused on the both community based care and hospital based care. It has various eye centres in the different parts of the districts.

1. Community Eye Centre (CEC )

In the context of the hospital’s commitment to Vision 2020 and the saying ” Prevention is not only better but also cheaper than cure” it is offering comprehensive eye care in rural areas of the country. For this purpose, the hospital has established 15 community eye centres till date. These eye centres provide comprehensive screening, minor surgery, referral services at community further various eye health education and awareness.  The CEC centres of the hospital are Dhading, Ramechhap, Solu, Nuwakot, Sindhuli, Bhaktapur, Rasuwa, Okhaldhunga, Rolpa, Mustang, Dolakha, Swayambhu, Manang, Jiri and Charikot.

2. Hetauda Community Eye Hospital

This hospital in Makwanpur was established with the TIO’s support and that of its partner, the Himalayan Cataract Project (HCP).  It provides comprehensive quality eye care to the rural communities of Makwanpur and its neighbouring districts in Nepal. The hospital also serves as a training facility for primary health care workers within the hospital’s territories. It also helps co- ordinate prevention and elimination of blindness efforts within the government and non- government health networks of Nepal.

3. WHO Collaborating Centre

The World Health Organization ( WHO ) has recognized the hospital; an implementing body of the Nepal Eye Program, as its collaborating centre for ophthalmology in Nepal. The hospital is the second institute in Nepal to receive this designation after SAARC Tuberculosis and HIV/AIDS centre but the first Nepalese health agency to receive the recognition.

The hospital is the true pioneer in providing best and qualitative care regarding the eye. It has set its example in the International level with its many achievements in the path of ophthalmology. 

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