Clinical trials

Corneal ulcer is defined as the loss of corneal epithelium with underlying stromal infiltration and suppuration, accompanied by signs of inflammation, with or without hypopyon1. The condition may be caused by bacterial, fungal, viral or parasitic pathogens and carries a significant risk of corneal perforation and subsequent visual impairment2. These risks highlight the importance of timely treatment plans and consistent referral networks3. A lot of patients choose to self-medicate and postpone seeking professional assistance due either their lack of awareness or forgetfulness, which results in inadequate follow-up compliance4,5. Scheduling appointments regularly is still a significant barrier to successful treatment and visual recovery. SMS reminders have shown encouraging real-world success in improving follow-up attendance with in ophthalmology. Mobile health tools, such as the peek Community Eye Health system, have proven increased follow-up rates and improved access to eye care services in low-resource setting through automated appointment reminders and patient monitoring6. The aim of this operational research study to evaluated the feasibility, scalability, and effectiveness of SMS reminders in improving follow-up compliance among patients with corneal ulcer at the Lumbini Eye Institute and Research Center (LEIRC), Western Nepal. The findings are expected to inform the integration of cost-effective digital health strategies to strengthen patient adherence, optimize clinical outcomes, and support eye health programs in resource limited environments.

This operational research project aims to strengthen continuity of eye care delivery between community screening and hospital-based treatment in rural Assam by redesigning referral pathways from the Boko Eye Care Center (ECC) to Sri Sankaradeva Nethralaya (SSDN) base hospital. Despite active outreach in the Boko region from the Boko ECC through conducting regular outreach screenings, less than 30 percent of patients referred to the base hospital actually arrive for evaluation and less than 25 percent of those advised for surgery proceed to treatment. The proposed study addresses these gaps by examining behavioural, structural and logistical barriers to referral completion and surgical uptake, and by implementing a coordinated patient-centered referral and engagement strategy. The proposed intervention comprises of five sequential components: (1) root cause analysis to identify bottlenecks and facilitators in the current referral pathway, (2) community engagement activities to improve awareness and proactive health-seeking behaviour, (3) implementation of an integrated referral and engagement model supported by trained community team and structured referral tracking, (4) strengthening referral completion through patient navigation, scheduled transport and follow-up reminders, and (5) enhancement of surgical acceptance through standardized counseling, affordability support and social reinforcement. The outcomes will be measured prospectively, focusing on increase in hospital footfall from the Boko catchment area, proportion of referred patients who complete hospital visits, and proportion of patients who were advised for surgery and had undergone the procedure. The proposed project aims to achieve a minimum of 70 percent referral completion and 45 percent surgical conversion by the end of the 36-month study period.

The goal of this interventional comparative study is to see if one day eye health orientation to Female Community Health Volunteers will increase footfall of patients in a Vision Center. Total of 58 Female Community Health Volunteers of Dipayal Silagadhi Municipality will receive eye health education. There is one Vision Center at Dipayal Silagadhi. Similarly there is one Vision Center at Chainpur Bajhang. Here FCHV will not receive one day eye health orientation. Currently both Vision Centers provide similar number of services. We shall compare and see if there will be any change in the number of people coming to these vision center. Female Community Health Volunteers in Dipayal Silgadhi will be asked to refer eye patients to the nearest Vision Center. They will be given 1. Eye health orientation session 2. Referral slip

The Out-Patient Departments (OPD) is often the first point of contact for patients seeking healthcare services and involves the coordination of both administrative and clinical processes. High patient volume and inefficient patient flow can result in prolonged waiting time, contributing to patient dissatisfaction. We performed a root cause analysis (RCA) through group interviews with OPD patients visiting Geta Eye Hospital, Nepal to understand the factors contributing to dissatisfaction towards OPD waiting time. In addition, patient flow through OPD service points was mapped, time-in, time-out and waiting time across OPD rooms was recorded to identify operational bottlenecks for intervention. The Vision Refraction room (VRR) emerged as key contributor to prolonged waiting time. This operational research study aims to determine the reasons for delay in the VRR and develop strategies to reduce the mean waiting time and improve patient satisfaction with waiting time. This study will be conducted over a 6-8 month period using a two-phase before and after intervention design. Phase 1 will establish baseline waiting time and patient satisfaction, and identify operational challenges. Based on these findings, context-specific interventions will be developed and implemented in Phase 2, and waiting time and patient satisfaction will be reassessed.

The purpose of this study is to examine how coordination between hospital departments affects patient flow between the free ward (B1), paid ward (C1) and the operating theatre (OT) for cataract surgeries at a tertiary eye care hospital. This will be an Interventional study using both quantitative and qualitative methods conducted at Tejas Eye Hospital. Patients aged 40-85 years, scheduled for cataract surgery during the study period will be included. Two trained investigators would observe the process and collect the data in structured format from ward admission to transfer into the operating theatre. Every participant would be observed from the ward on the day of his schedule surgery till his surgery is over in operation theatre. Demographic details and personal characteristics of every participant would be recorded in data collection form. In this pathway, timings, events, errors, deviations would be recorded at different spots between ward and operation theatre in first phase of study. Data would be collected from total 364 participants selected using stratified sampling technique. The data will be analyzed using MS excel and EpInfo. Summary statistics would be calculated for different variables and listing of various events and errors would be done. Using the above analysis various delays, communication gaps and different deviation would be identified. A dissemination meeting would be organized with all involved in above processes and findings would be shared in detail. Specific intervention would be decided for execution in the second phase of this study. In second phase, predetermined interventions from analysis of first phase would be implemented and similar data collection would be carried out to see the impact of interventions. Data collection would be done from the phase one sample size and comparison would be carried out for important variables like delays to establish the final outcome of the study. Similarly reduction in frequencies of errors and deviations would also be calculated.

Pushpagiri Vitreo Retina Institute (PVRI) based in Secunderabad is a tertiary care eye hospital providing specialty eye care services since 2007. Over 15-20 preplanned surgical/clinical procedures are conducted for patients requiring care on a daily basis. They range from simple cataract surgeries or injections to detailed specialty surgeries including Vitreo-retina, glaucoma, pediatric eye care and muscular conditions of the eye. All procedures are elective procedures and are pre-planned. The current study aims to improve hospital efficiency and reduce the total appointment time for patients. The current study aims to reduce patient overall waiting time by 15-25% by introducing simple patient identification tools to help streamline all planned procedures.

This study aims to evaluate the integration of a standalone eye centre into the Provincial Government Hospital in Kalaiya, Bara District, Nepal. The integration model seeks to improve access to comprehensive eye care services by combining the specialized expertise of an eye care facility with the infrastructure and patient flow of a provincial hospital. As the burden of avoidable visual impairment remains high in Nepal, strengthening service delivery at the district level has the potential to improve early detection, timely treatment, and continuity of care. 1 A mixed-method approach will be used to assess changes in service utilization patterns for example patient volume, follow ups and referrals following the integration. Additional focus will be placed on the acceptability of the integration model among patients, eye care professionals, and the hospital staff. This study will help to generate evidence-based recommendations to guide district-level planning for integrated eye care models by 2027. Data will be collected from patient records, hospital statistics, patient and staff interviews. The findings are expected to provide evidence on the feasibility, challenges, and benefits of integrating specialized eye care units into provincial hospital systems in low-resource settings. Ultimately, the study aims to inform policy decisions, support scalable models of eye care integration, and contribute to improved eye health outcomes for underserved populations.

Cataract remains the leading cause of avoidable blindness in India despite substantial expansion of surgical services over the past two decades. While surgical coverage has improved, optimal visual outcomes depend on effective post-operative follow-up, which remains inconsistent across decentralized Vision Center-based systems, particularly in rural and semi-urban settings. Routine program data show wide variation in post-operative cataract follow-up compliance among Vision Centers operating within similar organizational and geographic contexts, suggesting the influence of facility-level determinants. This phased mixed-methods implementation study aims to identify facility-level factors influencing post-operative cataract follow-up compliance and to develop an evidence-based framework to strengthen follow-up systems. Phase 1 will involve retrospective analysis of three years of integrated Health Management Information System- Vision Centre Management Information System (HMIS-VCMIS) data from approximately 120 Vision Centers to establish empirical benchmarks and classify centers as high- or low-performing. Structured facility assessments and qualitative interviews with Vision Center staff, program managers, and post-operative patients will be conducted to identify operational practices, workflows, and contextual factors associated with follow-up performance. Phase 2 will focus on co-design, pilot testing, and early implementation of a Follow-Up Strengthening Intervention Framework in selected low-performing Vision Centers. The intervention will include standardized counselling workflows, follow-up tracking and reminder systems, role clarification, supervisory feedback mechanisms, and peer-learning support from high-performing centers. Changes in follow-up compliance will be monitored using routine data over a 12-month implementation period, alongside process evaluation to assess feasibility, fidelity, and acceptability. Findings from this study will generate practical evidence to strengthen post-operative cataract follow-up systems and inform scalable quality improvement strategies within decentralized Vision Center networks.

Glaucoma is a leading cause of irreversible blindness worldwide, with a higher burden in low- and middle-income countries such as Nepal, where public awareness and treatment adherence remain poor. Lifelong adherence to treatment is important to prevent disease progression but still non adherence remains common. This is a mixed method study which aims to evaluate the effectiveness of structured glaucoma awareness program in improving treatment adherence among glaucoma patients attending a tertiary eye hospital in Nepal. Quantitative assessment will measure changes in treatment adherence using Medication Adherence Scale at baseline and three months post intervention. A qualitative component will explore participants' perceptions of glaucoma program and suggestions for improvement through semi-structured interviews.