Add full Eye Care (ophthalmology) specialty clinical suite.

Mirror Emergency/Blood Bank depth with stages, workspace tabs, workflow/analytics services, reports/print, demo clinical seed, and feature tests. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-19 15:19:04 +00:00
parent 5d9d333170
commit 1d3db4f803
20 changed files with 1454 additions and 28 deletions
@@ -0,0 +1,211 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use App\Services\Care\Ophthalmology\OphthalmologyAnalyticsService;
+use App\Services\Care\Ophthalmology\OphthalmologyWorkflowService;
+use App\Services\Care\SpecialtyClinicalRecordService;
+use App\Services\Care\SpecialtyModuleService;
+use App\Services\Care\SpecialtyShellService;
+use App\Services\Care\SpecialtyVisitStageService;
+use Illuminate\Http\RedirectResponse;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+
+class OphthalmologyWorkspaceController extends Controller
+{
+    use ScopesToAccount;
+
+    protected function assertOphthalmologyAccess(Request $request, SpecialtyModuleService $modules): void
+    {
+        $organization = $this->organization($request);
+        abort_unless($modules->memberCanAccess($organization, $this->member($request), 'ophthalmology'), 403);
+    }
+
+    protected function assertOphthalmologyManage(Request $request, SpecialtyModuleService $modules): void
+    {
+        $organization = $this->organization($request);
+        abort_unless($modules->memberCanManage($organization, $this->member($request), 'ophthalmology'), 403);
+    }
+
+    protected function assertVisit(Request $request, Visit $visit): void
+    {
+        abort_unless($visit->organization_id === $this->organization($request)->id, 404);
+        $this->authorizeBranch($request, (int) $visit->branch_id);
+    }
+
+    public function setStage(
+        Request $request,
+        Visit $visit,
+        SpecialtyModuleService $modules,
+        SpecialtyVisitStageService $stages,
+    ): RedirectResponse {
+        $this->authorizeAbility($request, 'consultations.manage');
+        $this->assertOphthalmologyManage($request, $modules);
+        $this->assertVisit($request, $visit);
+
+        $validated = $request->validate([
+            'stage' => ['required', 'string', 'max:32'],
+        ]);
+
+        try {
+            $stages->setStage(
+                $this->organization($request),
+                $visit,
+                'ophthalmology',
+                $validated['stage'],
+                $this->ownerRef($request),
+                $this->actorRef($request),
+            );
+        } catch (\InvalidArgumentException $e) {
+            return back()->with('error', $e->getMessage());
+        }
+
+        return redirect()
+            ->route('care.specialty.workspace', ['module' => 'ophthalmology', 'visit' => $visit, 'tab' => 'overview'])
+            ->with('success', 'Visit stage updated.');
+    }
+
+    public function saveProcedure(
+        Request $request,
+        Visit $visit,
+        SpecialtyModuleService $modules,
+        SpecialtyClinicalRecordService $clinical,
+        SpecialtyVisitStageService $stages,
+        OphthalmologyWorkflowService $workflow,
+    ): RedirectResponse {
+        $this->authorizeAbility($request, 'consultations.manage');
+        $this->assertOphthalmologyManage($request, $modules);
+        $this->assertVisit($request, $visit);
+
+        $organization = $this->organization($request);
+        $owner = $this->ownerRef($request);
+
+        $payload = (array) $request->input('payload', []);
+        foreach ($clinical->fieldsFor('ophthalmology', 'eye_procedure') as $field) {
+            if (($field['type'] ?? '') === 'boolean') {
+                $payload[$field['name']] = $request->boolean('payload.'.$field['name']);
+            }
+        }
+        $request->merge(['payload' => $payload, 'tab' => 'treat']);
+
+        $validated = $request->validate(array_merge([
+            'tab' => ['required', 'string'],
+        ], $clinical->validationRules('ophthalmology', 'eye_procedure')));
+
+        $record = $clinical->upsert(
+            $organization,
+            $visit,
+            'ophthalmology',
+            'eye_procedure',
+            $clinical->payloadFromRequest($validated),
+            $owner,
+            $owner,
+            OphthalmologyWorkflowService::STAGE_TREATMENT,
+            SpecialtyClinicalRecord::STATUS_COMPLETED,
+        );
+
+        try {
+            $stages->setStage(
+                $organization,
+                $visit,
+                'ophthalmology',
+                OphthalmologyWorkflowService::STAGE_TREATMENT,
+                $owner,
+                $owner,
+            );
+        } catch (\InvalidArgumentException) {
+            // Stage already treatment or map empty.
+        }
+
+        if ($workflow->shouldCompleteVisit($record->payload ?? [])) {
+            try {
+                $stages->setStage(
+                    $organization,
+                    $visit,
+                    'ophthalmology',
+                    OphthalmologyWorkflowService::STAGE_COMPLETED,
+                    $owner,
+                    $owner,
+                );
+            } catch (\InvalidArgumentException) {
+            }
+
+            $visit->refresh();
+            if ($visit->status !== Visit::STATUS_COMPLETED) {
+                $visit->update([
+                    'status' => Visit::STATUS_COMPLETED,
+                    'completed_at' => $visit->completed_at ?? now(),
+                ]);
+            }
+
+            $appointment = $visit->appointment;
+            if ($appointment && $appointment->status !== \App\Models\Appointment::STATUS_COMPLETED) {
+                $appointment->update([
+                    'status' => \App\Models\Appointment::STATUS_COMPLETED,
+                    'completed_at' => $appointment->completed_at ?? now(),
+                ]);
+            }
+        }
+
+        return redirect()
+            ->route('care.specialty.workspace', ['module' => 'ophthalmology', 'visit' => $visit, 'tab' => 'treat'])
+            ->with('success', 'Procedure / treatment saved.');
+    }
+
+    public function reports(
+        Request $request,
+        SpecialtyModuleService $modules,
+        SpecialtyShellService $shell,
+        OphthalmologyAnalyticsService $analytics,
+    ): View {
+        $this->authorizeAbility($request, 'consultations.view');
+        $this->assertOphthalmologyAccess($request, $modules);
+
+        $organization = $this->organization($request);
+        $branchScope = app(\App\Services\Care\OrganizationResolver::class)->branchScope($this->member($request));
+
+        $report = $analytics->report(
+            $organization,
+            $this->ownerRef($request),
+            $branchScope,
+            $request->query('from'),
+            $request->query('to'),
+        );
+
+        return view('care.specialty.ophthalmology.reports', [
+            'moduleKey' => 'ophthalmology',
+            'definition' => $modules->definition('ophthalmology'),
+            'shellNav' => $shell->navItems('ophthalmology'),
+            'report' => $report,
+            'currency' => strtoupper((string) config('care.billing.currency', config('care.currency', 'GHS'))),
+        ]);
+    }
+
+    public function printSummary(
+        Request $request,
+        Visit $visit,
+        SpecialtyModuleService $modules,
+        SpecialtyClinicalRecordService $clinical,
+    ): View {
+        $this->authorizeAbility($request, 'consultations.view');
+        $this->assertOphthalmologyAccess($request, $modules);
+        $this->assertVisit($request, $visit);
+
+        $visit->loadMissing(['patient', 'appointment.practitioner', 'branch']);
+
+        return view('care.specialty.ophthalmology.print', [
+            'visit' => $visit,
+            'patient' => $visit->patient,
+            'refraction' => $clinical->findForVisit($visit, 'ophthalmology', 'refraction'),
+            'exam' => $clinical->findForVisit($visit, 'ophthalmology', 'eye_exam'),
+            'investigation' => $clinical->findForVisit($visit, 'ophthalmology', 'eye_investigation'),
+            'plan' => $clinical->findForVisit($visit, 'ophthalmology', 'eye_plan'),
+            'procedure' => $clinical->findForVisit($visit, 'ophthalmology', 'eye_procedure'),
+        ]);
+    }
+}
@@ -153,6 +153,7 @@ class SpecialtyModuleController extends Controller
                'dentistry' => 'odontogram',
                'emergency' => 'triage',
                'blood_bank' => 'requests',
+                'ophthalmology' => 'refraction',
                default => (collect(array_keys($shellTabs))
                    ->first(fn (string $tab) => $clinical->recordTypeForTab($module, $tab) !== null)
                    ?? 'clinical_notes'),
@@ -210,7 +211,7 @@ class SpecialtyModuleController extends Controller
                } catch (\InvalidArgumentException) {
                    // Stage map may be empty for some modules.
                }
-            } elseif ($nextStage && in_array($visit->specialty_stage, ['waiting', 'arrival', 'request'], true)) {
+            } elseif ($nextStage && in_array($visit->specialty_stage, ['waiting', 'arrival', 'request', 'check_in'], true)) {
                try {
                    $stageService->setStage($organization, $visit, $module, $nextStage, $owner, $owner);
                    $visit = $visit->fresh();
@@ -224,6 +225,7 @@ class SpecialtyModuleController extends Controller
            'dentistry' => 'odontogram',
            'emergency' => 'triage',
            'blood_bank' => 'requests',
+            'ophthalmology' => 'refraction',
            default => (collect(array_keys($shellTabs))
                ->first(fn (string $tab) => $clinical->recordTypeForTab($module, $tab) !== null)
                ?? 'clinical_notes'),
@@ -356,6 +358,57 @@ class SpecialtyModuleController extends Controller
            }
        }

+        if ($module === 'ophthalmology' && in_array($recordType, ['refraction', 'eye_exam', 'eye_investigation', 'eye_plan'], true)) {
+            $workflow = app(\App\Services\Care\Ophthalmology\OphthalmologyWorkflowService::class);
+            $stageService = app(\App\Services\Care\SpecialtyVisitStageService::class);
+            $suggested = match ($recordType) {
+                'refraction' => $workflow->stageFromRefraction($record->payload ?? []),
+                'eye_exam' => $workflow->stageFromExam($record->payload ?? []),
+                'eye_investigation' => \App\Services\Care\Ophthalmology\OphthalmologyWorkflowService::STAGE_INVESTIGATION,
+                'eye_plan' => $workflow->stageFromPlan($record->payload ?? []),
+                default => null,
+            };
+            $current = $visit->specialty_stage;
+            $early = ['check_in', 'history', 'waiting', null, ''];
+            if ($suggested && (! $current || in_array($current, $early, true))) {
+                try {
+                    $stageService->setStage(
+                        $organization,
+                        $visit,
+                        'ophthalmology',
+                        $suggested,
+                        $this->ownerRef($request),
+                        $this->ownerRef($request),
+                    );
+                } catch (\InvalidArgumentException) {
+                }
+            } elseif ($suggested && $suggested !== $current) {
+                $order = [
+                    'check_in' => 0,
+                    'history' => 1,
+                    'refraction' => 2,
+                    'exam' => 3,
+                    'investigation' => 4,
+                    'plan' => 5,
+                    'treatment' => 6,
+                    'completed' => 7,
+                ];
+                if (($order[$suggested] ?? 0) > ($order[$current] ?? 0)) {
+                    try {
+                        $stageService->setStage(
+                            $organization,
+                            $visit,
+                            'ophthalmology',
+                            $suggested,
+                            $this->ownerRef($request),
+                            $this->ownerRef($request),
+                        );
+                    } catch (\InvalidArgumentException) {
+                    }
+                }
+            }
+        }
+
        return redirect()
            ->route('care.specialty.workspace', [
                'module' => $module,
@@ -749,6 +802,13 @@ class SpecialtyModuleController extends Controller
        $bloodBankTransfusion = null;
        $bloodBankStageCodes = [];
        $bloodBankStageFlow = [];
+        $ophthalmologyRefraction = null;
+        $ophthalmologyExam = null;
+        $ophthalmologyInvestigation = null;
+        $ophthalmologyPlan = null;
+        $ophthalmologyProcedure = null;
+        $ophthalmologyStageCodes = [];
+        $ophthalmologyStageFlow = [];
        $activeTab = (string) $request->query('tab', array_key_first($shell->workspaceTabs($module)) ?: 'overview');
        $clinical = app(SpecialtyClinicalRecordService::class);

@@ -855,6 +915,16 @@ class SpecialtyModuleController extends Controller
                $bloodBankStageFlow = app(\App\Services\Care\BloodBank\BloodBankWorkflowService::class)->stageFlow();
            }

+            if ($module === 'ophthalmology') {
+                $ophthalmologyRefraction = $clinical->findForVisit($workspaceVisit, 'ophthalmology', 'refraction');
+                $ophthalmologyExam = $clinical->findForVisit($workspaceVisit, 'ophthalmology', 'eye_exam');
+                $ophthalmologyInvestigation = $clinical->findForVisit($workspaceVisit, 'ophthalmology', 'eye_investigation');
+                $ophthalmologyPlan = $clinical->findForVisit($workspaceVisit, 'ophthalmology', 'eye_plan');
+                $ophthalmologyProcedure = $clinical->findForVisit($workspaceVisit, 'ophthalmology', 'eye_procedure');
+                $ophthalmologyStageCodes = collect($shell->stages('ophthalmology'))->pluck('code')->all();
+                $ophthalmologyStageFlow = app(\App\Services\Care\Ophthalmology\OphthalmologyWorkflowService::class)->stageFlow();
+            }
+
            if ($patientHeader !== null) {
                $patientHeader['clinical_alerts'] = $clinicalAlerts;
            }
@@ -940,6 +1010,13 @@ class SpecialtyModuleController extends Controller
            'bloodBankTransfusion' => $bloodBankTransfusion,
            'bloodBankStageCodes' => $bloodBankStageCodes,
            'bloodBankStageFlow' => $bloodBankStageFlow,
+            'ophthalmologyRefraction' => $ophthalmologyRefraction,
+            'ophthalmologyExam' => $ophthalmologyExam,
+            'ophthalmologyInvestigation' => $ophthalmologyInvestigation,
+            'ophthalmologyPlan' => $ophthalmologyPlan,
+            'ophthalmologyProcedure' => $ophthalmologyProcedure,
+            'ophthalmologyStageCodes' => $ophthalmologyStageCodes,
+            'ophthalmologyStageFlow' => $ophthalmologyStageFlow,
            'queueStubs' => $modules->queueStubsFor($organization, $module),
            'branchId' => $branchId,
            'branchLabel' => $branchLabel,
@@ -1014,6 +1014,7 @@ class DemoTenantSeeder

        $this->seedDentistryClinicalDemo($organization, $ownerRef);
        $this->seedBloodBankInventoryDemo($organization, $ownerRef);
+        $this->seedOphthalmologyClinicalDemo($organization, $ownerRef);

        return $count;
    }
@@ -1113,6 +1114,134 @@ class DemoTenantSeeder
        ];
    }

+    /**
+     * Seed refraction + eye exam (+ optional plan) on open ophthalmology visits.
+     */
+    private function seedOphthalmologyClinicalDemo(Organization $organization, string $ownerRef): void
+    {
+        $branchIds = Branch::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->pluck('id');
+
+        if ($branchIds->isEmpty()) {
+            return;
+        }
+
+        $departmentIds = Department::owned($ownerRef)
+            ->whereIn('branch_id', $branchIds)
+            ->where('type', 'ophthalmology')
+            ->where('is_active', true)
+            ->pluck('id');
+
+        if ($departmentIds->isEmpty()) {
+            return;
+        }
+
+        $appointments = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('department_id', $departmentIds)
+            ->whereIn('status', [Appointment::STATUS_WAITING, Appointment::STATUS_CHECKED_IN])
+            ->whereNotNull('visit_id')
+            ->with('visit')
+            ->orderBy('branch_id')
+            ->orderBy('id')
+            ->get();
+
+        if ($appointments->isEmpty()) {
+            return;
+        }
+
+        $clinical = app(SpecialtyClinicalRecordService::class);
+        $index = 0;
+
+        foreach ($appointments as $appointment) {
+            $visit = $appointment->visit;
+            if (! $visit) {
+                continue;
+            }
+
+            $elevated = $index === 0;
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'ophthalmology',
+                'refraction',
+                [
+                    'va_od' => $elevated ? '6/60' : '6/9',
+                    'va_os' => $elevated ? '6/36' : '6/6',
+                    'va_od_near' => 'N8',
+                    'va_os_near' => 'N6',
+                    'sphere_od' => $elevated ? '-2.50' : '-0.75',
+                    'cylinder_od' => '-0.50',
+                    'axis_od' => '90',
+                    'sphere_os' => $elevated ? '-1.75' : '-0.50',
+                    'cylinder_os' => '-0.25',
+                    'axis_os' => '85',
+                    'add' => '+1.50',
+                    'pd' => 62,
+                    'notes' => 'Demo refraction for eye care suite.',
+                ],
+                $ownerRef,
+                $ownerRef,
+                'refraction',
+            );
+
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'ophthalmology',
+                'eye_exam',
+                [
+                    'chief_complaint' => $elevated ? 'Blurry vision and headache' : 'Routine eye exam',
+                    'history' => $elevated
+                        ? 'Gradual reduction in vision over 2 weeks; intermittent haloes.'
+                        : 'Annual review; no acute symptoms.',
+                    'va_od' => $elevated ? '6/60' : '6/9',
+                    'va_os' => $elevated ? '6/36' : '6/6',
+                    'iop_od' => $elevated ? 32 : 16,
+                    'iop_os' => $elevated ? 28 : 15,
+                    'pupils' => 'Equal, reactive',
+                    'extraocular' => 'Full',
+                    'anterior_segment' => $elevated ? 'Quiet; possible early cataract OD' : 'Quiet',
+                    'fundus' => $elevated ? 'Cup:disc elevated OD; review for glaucoma' : 'Healthy discs',
+                    'findings' => $elevated
+                        ? 'Elevated IOP with reduced acuity — urgent glaucoma work-up.'
+                        : 'Normal examination; refraction updated.',
+                ],
+                $ownerRef,
+                $ownerRef,
+                'exam',
+            );
+
+            if ($elevated) {
+                $clinical->upsert(
+                    $organization,
+                    $visit,
+                    'ophthalmology',
+                    'eye_plan',
+                    [
+                        'diagnosis' => 'Suspected primary open-angle glaucoma',
+                        'laterality' => 'OU',
+                        'plan' => 'Start topical IOP-lowering drops; arrange OCT and visual fields.',
+                        'medications' => 'Latanoprost 0.005% OU nocte',
+                        'procedure_planned' => false,
+                        'follow_up' => '2 weeks',
+                        'advice' => 'Return sooner if vision worsens or severe eye pain.',
+                    ],
+                    $ownerRef,
+                    $ownerRef,
+                    'plan',
+                );
+            }
+
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $elevated ? 'plan' : 'exam']);
+            }
+
+            $index++;
+        }
+    }
+
    private function seedDentistryClinicalDemo(Organization $organization, string $ownerRef): void
    {
        // Specialty departments are provisioned without organization_id; scope via branches.
@@ -0,0 +1,169 @@
+<?php
+
+namespace App\Services\Care\Ophthalmology;
+
+use App\Models\Appointment;
+use App\Models\Bill;
+use App\Models\BillLineItem;
+use App\Models\Organization;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyShellService;
+use Carbon\Carbon;
+use Illuminate\Support\Collection;
+
+class OphthalmologyAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     elevated_iop_open: int,
+     *     diagnosis_breakdown: Collection,
+     *     procedure_breakdown: Collection,
+     *     avg_los_minutes: ?float,
+     *     revenue_by_service: Collection,
+     *     from: string,
+     *     to: string
+     * }
+     */
+    public function report(
+        Organization $organization,
+        string $ownerRef,
+        ?int $branchId = null,
+        ?string $from = null,
+        ?string $to = null,
+    ): array {
+        $todayStart = now()->startOfDay();
+        $rangeFrom = $from ? Carbon::parse($from)->startOfDay() : now()->startOfMonth();
+        $rangeTo = $to ? Carbon::parse($to)->endOfDay() : now()->endOfDay();
+
+        $departmentIds = $this->shell->departmentIds($organization, 'ophthalmology', $ownerRef, $branchId);
+
+        $appointmentBase = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->when($departmentIds !== [], fn ($q) => $q->whereIn('department_id', $departmentIds))
+            ->when($departmentIds === [], fn ($q) => $q->whereRaw('1 = 0'))
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId));
+
+        $arrivalsToday = (clone $appointmentBase)
+            ->where('checked_in_at', '>=', $todayStart)
+            ->count();
+
+        $completedToday = (clone $appointmentBase)
+            ->where('status', Appointment::STATUS_COMPLETED)
+            ->where('completed_at', '>=', $todayStart)
+            ->count();
+
+        $visitIds = (clone $appointmentBase)->whereNotNull('visit_id')->pluck('visit_id');
+
+        $openVisitIds = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->pluck('id');
+
+        $elevatedIopOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ophthalmology')
+            ->where('record_type', 'eye_exam')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->get()
+            ->filter(function (SpecialtyClinicalRecord $r) {
+                $iopOd = (float) ($r->payload['iop_od'] ?? 0);
+                $iopOs = (float) ($r->payload['iop_os'] ?? 0);
+
+                return $iopOd >= 24 || $iopOs >= 24;
+            })
+            ->count();
+
+        $planRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ophthalmology')
+            ->where('record_type', 'eye_plan')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $diagnosisBreakdown = $planRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['diagnosis'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $diagnosis) => [
+                'diagnosis' => $diagnosis,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $procedureRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ophthalmology')
+            ->where('record_type', 'eye_procedure')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $procedureBreakdown = $procedureRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['procedure'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $procedure) => [
+                'procedure' => $procedure,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $completedVisits = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->where('status', Visit::STATUS_COMPLETED)
+            ->whereBetween('completed_at', [$rangeFrom, $rangeTo])
+            ->whereNotNull('checked_in_at')
+            ->whereNotNull('completed_at')
+            ->get();
+
+        $avgLos = null;
+        if ($completedVisits->isNotEmpty()) {
+            $avgLos = round($completedVisits->avg(function (Visit $visit) {
+                return $visit->checked_in_at->diffInMinutes($visit->completed_at);
+            }), 1);
+        }
+
+        $serviceLabels = collect($this->shell->provisionedServices($organization, 'ophthalmology'))
+            ->pluck('label')
+            ->filter()
+            ->values()
+            ->all();
+
+        $revenueByService = BillLineItem::query()
+            ->where('owner_ref', $ownerRef)
+            ->where('source_type', 'specialty_service')
+            ->whereIn('description', $serviceLabels ?: ['__none__'])
+            ->whereBetween('created_at', [$rangeFrom, $rangeTo])
+            ->whereHas('bill', function ($q) use ($organization, $visitIds) {
+                $q->where('organization_id', $organization->id)
+                    ->whereIn('visit_id', $visitIds->isEmpty() ? [0] : $visitIds)
+                    ->whereNotIn('status', [Bill::STATUS_VOID]);
+            })
+            ->selectRaw('description, count(*) as total, sum(total_minor) as amount_minor')
+            ->groupBy('description')
+            ->orderByDesc('amount_minor')
+            ->get();
+
+        return [
+            'arrivals_today' => $arrivalsToday,
+            'completed_today' => $completedToday,
+            'elevated_iop_open' => $elevatedIopOpen,
+            'diagnosis_breakdown' => $diagnosisBreakdown,
+            'procedure_breakdown' => $procedureBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,105 @@
+<?php
+
+namespace App\Services\Care\Ophthalmology;
+
+/**
+ * Map eye-care clinical progress onto ophthalmology visit stages.
+ */
+class OphthalmologyWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_HISTORY = 'history';
+
+    public const STAGE_REFRACTION = 'refraction';
+
+    public const STAGE_EXAM = 'exam';
+
+    public const STAGE_INVESTIGATION = 'investigation';
+
+    public const STAGE_PLAN = 'plan';
+
+    public const STAGE_TREATMENT = 'treatment';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * Suggested stage after a refraction / VA payload is saved.
+     *
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromRefraction(array $payload): string
+    {
+        $vaOd = trim((string) ($payload['va_od'] ?? ''));
+        $vaOs = trim((string) ($payload['va_os'] ?? ''));
+
+        if ($vaOd !== '' || $vaOs !== '') {
+            return self::STAGE_REFRACTION;
+        }
+
+        return self::STAGE_HISTORY;
+    }
+
+    /**
+     * Suggested stage after an eye exam payload is saved.
+     *
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromExam(array $payload): string
+    {
+        $findings = strtolower((string) ($payload['findings'] ?? ''));
+        if (str_contains($findings, 'oct')
+            || str_contains($findings, 'field')
+            || str_contains($findings, 'imaging')
+            || str_contains($findings, 'investigate')) {
+            return self::STAGE_INVESTIGATION;
+        }
+
+        return self::STAGE_EXAM;
+    }
+
+    /**
+     * Suggested stage after a diagnosis/plan payload is saved.
+     *
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromPlan(array $payload): string
+    {
+        if (! empty($payload['procedure_planned'])) {
+            return self::STAGE_TREATMENT;
+        }
+
+        return self::STAGE_PLAN;
+    }
+
+    /**
+     * Whether a procedure payload should close the visit episode.
+     *
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed');
+    }
+
+    /**
+     * Default stage progression for action buttons.
+     *
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_HISTORY, 'label' => 'Start history'],
+            self::STAGE_HISTORY => ['next' => self::STAGE_REFRACTION, 'label' => 'Move to VA / refraction'],
+            self::STAGE_REFRACTION => ['next' => self::STAGE_EXAM, 'label' => 'Move to examination'],
+            self::STAGE_EXAM => ['next' => self::STAGE_INVESTIGATION, 'label' => 'Move to investigations'],
+            self::STAGE_INVESTIGATION => ['next' => self::STAGE_PLAN, 'label' => 'Move to diagnosis & plan'],
+            self::STAGE_PLAN => ['next' => self::STAGE_TREATMENT, 'label' => 'Move to treatment'],
+            self::STAGE_TREATMENT => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}
@@ -249,6 +249,52 @@ class SpecialtyClinicalRecordService
            }
        }

+        if ($moduleKey === 'ophthalmology' && in_array($recordType, ['eye_exam', 'refraction'], true)) {
+            $iopOd = isset($payload['iop_od']) ? (float) $payload['iop_od'] : null;
+            $iopOs = isset($payload['iop_os']) ? (float) $payload['iop_os'] : null;
+            if (($iopOd !== null && $iopOd >= 30) || ($iopOs !== null && $iopOs >= 30)) {
+                $alerts[] = [
+                    'code' => 'eye.critical_iop',
+                    'severity' => 'critical',
+                    'message' => 'Critical IOP (≥30 mmHg) — urgent glaucoma / acute review.',
+                ];
+            } elseif (($iopOd !== null && $iopOd >= 24) || ($iopOs !== null && $iopOs >= 24)) {
+                $alerts[] = [
+                    'code' => 'eye.elevated_iop',
+                    'severity' => 'warning',
+                    'message' => 'Elevated IOP (≥24 mmHg).',
+                ];
+            }
+
+            foreach (['va_od', 'va_os'] as $vaKey) {
+                $va = strtolower(trim((string) ($payload[$vaKey] ?? '')));
+                if ($va === '') {
+                    continue;
+                }
+                if (preg_match('/\b(cf|hm|pl|nlp|counting|hand\s*motion|perception)\b/i', $va)
+                    || preg_match('/^6\/(60|90|120)\b/', $va)
+                    || preg_match('/^20\/(200|400)\b/', $va)) {
+                    $alerts[] = [
+                        'code' => 'eye.low_vision',
+                        'severity' => 'warning',
+                        'message' => 'Low visual acuity recorded ('.$vaKey.').',
+                    ];
+                    break;
+                }
+            }
+        }
+
+        if ($moduleKey === 'ophthalmology' && $recordType === 'eye_procedure') {
+            $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+            if (str_contains($outcome, 'complication') || str_contains($outcome, 'aborted')) {
+                $alerts[] = [
+                    'code' => 'eye.procedure_concern',
+                    'severity' => 'warning',
+                    'message' => 'Procedure outcome needs review (complication or aborted).',
+                ];
+            }
+        }
+
        return $alerts;
    }

@@ -270,7 +270,7 @@ class SpecialtyShellService
        ) {
            $code = (string) ($stage['code'] ?? '');

-            if (in_array($moduleKey, ['dentistry', 'emergency', 'blood_bank'], true) && $visitIds->isNotEmpty()) {
+            if (in_array($moduleKey, ['dentistry', 'emergency', 'blood_bank', 'ophthalmology'], true) && $visitIds->isNotEmpty()) {
                $count = Visit::owned($ownerRef)
                    ->where('organization_id', $organization->id)
                    ->whereIn('id', $visitIds)
@@ -300,6 +300,7 @@ class SpecialtyShellService
        $clinicalOpen = match ($moduleKey) {
            'emergency' => $clinical->countOpenByType($organization, 'emergency', 'triage', $branchScope),
            'blood_bank' => $clinical->countOpenByType($organization, 'blood_bank', 'blood_request', $branchScope),
+            'ophthalmology' => $clinical->countOpenByType($organization, 'ophthalmology', 'eye_exam', $branchScope),
            'dentistry' => \App\Models\DentalPlanItem::query()
                ->whereHas('plan', function ($q) use ($organization, $ownerRef) {
                    $q->owned($ownerRef)
@@ -96,6 +96,14 @@ class SpecialtyVisitStageService
                : ($stages[1] ?? ($stages[0] ?? null));
        }

+        if ($moduleKey === 'ophthalmology') {
+            $stages = $this->allowedStages($moduleKey);
+
+            return in_array(\App\Services\Care\Ophthalmology\OphthalmologyWorkflowService::STAGE_HISTORY, $stages, true)
+                ? \App\Services\Care\Ophthalmology\OphthalmologyWorkflowService::STAGE_HISTORY
+                : ($stages[1] ?? ($stages[0] ?? null));
+        }
+
        $stages = $this->allowedStages($moduleKey);
        foreach (['chair', 'in_care', 'exam', 'assessment', 'treatment'] as $preferred) {
            if (in_array($preferred, $stages, true)) {