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)) {
@@ -282,6 +282,7 @@ return [
        'specialty_emergency' => 'Emergency document',
        'specialty_blood_bank' => 'Blood bank document',
        'specialty_dentistry' => 'Dental document',
+        'specialty_ophthalmology' => 'Eye care document',
        'other' => 'Other',
    ],

@@ -26,9 +26,11 @@ return [
        'dentistry' => [
        ],
        'ophthalmology' => [
-            'exam' => 'eye_exam',
            'refraction' => 'refraction',
-            'clinical_notes' => 'clinical_note',
+            'exam' => 'eye_exam',
+            'investigations' => 'eye_investigation',
+            'plan' => 'eye_plan',
+            'treat' => 'eye_procedure',
        ],
        'physiotherapy' => [
            'assessment' => 'pt_assessment',
@@ -184,18 +186,13 @@ return [
        'dentistry' => [
        ],
        'ophthalmology' => [
-            'eye_exam' => [
-                ['name' => 'chief_complaint', 'label' => 'Chief complaint', 'type' => 'text', 'required' => true],
+            'refraction' => [
                ['name' => 'va_od', 'label' => 'Visual acuity OD', 'type' => 'text', 'required' => true],
                ['name' => 'va_os', 'label' => 'Visual acuity OS', 'type' => 'text', 'required' => true],
-                ['name' => 'iop_od', 'label' => 'IOP OD (mmHg)', 'type' => 'number'],
-                ['name' => 'iop_os', 'label' => 'IOP OS (mmHg)', 'type' => 'number'],
-                ['name' => 'pupils', 'label' => 'Pupils', 'type' => 'text'],
-                ['name' => 'anterior_segment', 'label' => 'Anterior segment', 'type' => 'textarea', 'rows' => 2],
-                ['name' => 'fundus', 'label' => 'Fundus / posterior segment', 'type' => 'textarea', 'rows' => 2],
-                ['name' => 'findings', 'label' => 'Key findings', 'type' => 'textarea', 'required' => true, 'rows' => 3],
-            ],
-            'refraction' => [
+                ['name' => 'va_od_near', 'label' => 'Near VA OD', 'type' => 'text'],
+                ['name' => 'va_os_near', 'label' => 'Near VA OS', 'type' => 'text'],
+                ['name' => 'pinhole_od', 'label' => 'Pinhole OD', 'type' => 'text'],
+                ['name' => 'pinhole_os', 'label' => 'Pinhole OS', 'type' => 'text'],
                ['name' => 'sphere_od', 'label' => 'Sphere OD', 'type' => 'text'],
                ['name' => 'cylinder_od', 'label' => 'Cylinder OD', 'type' => 'text'],
                ['name' => 'axis_od', 'label' => 'Axis OD', 'type' => 'text'],
@@ -206,11 +203,45 @@ return [
                ['name' => 'pd', 'label' => 'Pupillary distance (mm)', 'type' => 'number'],
                ['name' => 'notes', 'label' => 'Refraction notes', 'type' => 'textarea', 'rows' => 2],
            ],
-            'clinical_note' => [
-                ['name' => 'history', 'label' => 'History of present illness', 'type' => 'textarea', 'required' => true, 'rows' => 4],
-                ['name' => 'examination', 'label' => 'Examination', 'type' => 'textarea', 'rows' => 3],
-                ['name' => 'working_diagnosis', 'label' => 'Working diagnosis', 'type' => 'text'],
-                ['name' => 'plan', 'label' => 'Plan', 'type' => 'textarea', 'rows' => 3],
+            'eye_exam' => [
+                ['name' => 'chief_complaint', 'label' => 'Chief complaint', 'type' => 'text', 'required' => true],
+                ['name' => 'history', 'label' => 'History of present illness', 'type' => 'textarea', 'rows' => 3],
+                ['name' => 'va_od', 'label' => 'Visual acuity OD', 'type' => 'text'],
+                ['name' => 'va_os', 'label' => 'Visual acuity OS', 'type' => 'text'],
+                ['name' => 'iop_od', 'label' => 'IOP OD (mmHg)', 'type' => 'number'],
+                ['name' => 'iop_os', 'label' => 'IOP OS (mmHg)', 'type' => 'number'],
+                ['name' => 'pupils', 'label' => 'Pupils', 'type' => 'text'],
+                ['name' => 'extraocular', 'label' => 'Extraocular movements', 'type' => 'text'],
+                ['name' => 'anterior_segment', 'label' => 'Anterior segment', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'fundus', 'label' => 'Fundus / posterior segment', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'findings', 'label' => 'Key findings', 'type' => 'textarea', 'required' => true, 'rows' => 3],
+            ],
+            'eye_investigation' => [
+                ['name' => 'modality', 'label' => 'Modality', 'type' => 'select', 'required' => true, 'options' => ['OCT', 'Visual fields', 'Fundus photo', 'Fluorescein angiography', 'Biometry / A-scan', 'B-scan ultrasound', 'Corneal topography', 'Other']],
+                ['name' => 'eye', 'label' => 'Eye', 'type' => 'select', 'options' => ['OD', 'OS', 'OU']],
+                ['name' => 'indication', 'label' => 'Indication', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'findings', 'label' => 'Findings', 'type' => 'textarea', 'required' => true, 'rows' => 3],
+                ['name' => 'impression', 'label' => 'Impression', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'recommendations', 'label' => 'Recommendations', 'type' => 'textarea', 'rows' => 2],
+            ],
+            'eye_plan' => [
+                ['name' => 'diagnosis', 'label' => 'Diagnosis', 'type' => 'text', 'required' => true],
+                ['name' => 'laterality', 'label' => 'Laterality', 'type' => 'select', 'options' => ['OD', 'OS', 'OU', 'N/A']],
+                ['name' => 'plan', 'label' => 'Plan', 'type' => 'textarea', 'required' => true, 'rows' => 3],
+                ['name' => 'medications', 'label' => 'Medications / drops', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'procedure_planned', 'label' => 'Procedure planned', 'type' => 'boolean'],
+                ['name' => 'follow_up', 'label' => 'Follow-up', 'type' => 'text'],
+                ['name' => 'advice', 'label' => 'Patient advice', 'type' => 'textarea', 'rows' => 2],
+            ],
+            'eye_procedure' => [
+                ['name' => 'procedure', 'label' => 'Procedure', 'type' => 'text', 'required' => true],
+                ['name' => 'eye', 'label' => 'Eye', 'type' => 'select', 'required' => true, 'options' => ['OD', 'OS', 'OU']],
+                ['name' => 'indication', 'label' => 'Indication', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'anaesthesia', 'label' => 'Anaesthesia', 'type' => 'select', 'options' => ['None', 'Topical', 'Local', 'Other']],
+                ['name' => 'outcome', 'label' => 'Outcome', 'type' => 'select', 'required' => true, 'options' => ['Completed uneventfully', 'Completed with complications', 'Deferred', 'Aborted']],
+                ['name' => 'complications', 'label' => 'Complications', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'post_op_plan', 'label' => 'Post-procedure plan', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'notes', 'label' => 'Notes', 'type' => 'textarea', 'rows' => 2],
            ],
        ],
        'physiotherapy' => [
@@ -141,9 +141,13 @@ return [
        ],
        'ophthalmology' => [
            'stages' => [
-                ['code' => 'waiting', 'label' => 'Waiting room', 'queue_point' => 'waiting'],
-                ['code' => 'exam', 'label' => 'Eye exam', 'queue_point' => 'chair'],
-                ['code' => 'procedure', 'label' => 'Procedure / treatment', 'queue_point' => 'chair'],
+                ['code' => 'check_in', 'label' => 'Check-in', 'queue_point' => 'waiting'],
+                ['code' => 'history', 'label' => 'History / intake', 'queue_point' => 'waiting'],
+                ['code' => 'refraction', 'label' => 'VA / refraction', 'queue_point' => 'chair'],
+                ['code' => 'exam', 'label' => 'Examination', 'queue_point' => 'chair'],
+                ['code' => 'investigation', 'label' => 'Investigations', 'queue_point' => 'chair'],
+                ['code' => 'plan', 'label' => 'Diagnosis & plan', 'queue_point' => 'chair'],
+                ['code' => 'treatment', 'label' => 'Procedure / treatment', 'queue_point' => 'chair'],
                ['code' => 'completed', 'label' => 'Completed', 'queue_point' => null],
            ],
            'services' => [
@@ -151,12 +155,22 @@ return [
                ['code' => 'eye.refraction', 'label' => 'Refraction / glasses exam', 'amount_minor' => 4000, 'type' => 'procedure'],
                ['code' => 'eye.iop', 'label' => 'IOP / pressure check', 'amount_minor' => 3000, 'type' => 'procedure'],
                ['code' => 'eye.fundus', 'label' => 'Fundus examination', 'amount_minor' => 5000, 'type' => 'procedure'],
+                ['code' => 'eye.slit_lamp', 'label' => 'Slit-lamp examination', 'amount_minor' => 4500, 'type' => 'procedure'],
+                ['code' => 'eye.oct', 'label' => 'OCT imaging', 'amount_minor' => 18000, 'type' => 'imaging'],
+                ['code' => 'eye.visual_fields', 'label' => 'Visual fields', 'amount_minor' => 12000, 'type' => 'imaging'],
+                ['code' => 'eye.biometry', 'label' => 'Biometry / A-scan', 'amount_minor' => 10000, 'type' => 'imaging'],
+                ['code' => 'eye.foreign_body', 'label' => 'Foreign body removal', 'amount_minor' => 15000, 'type' => 'procedure'],
+                ['code' => 'eye.yag', 'label' => 'YAG laser', 'amount_minor' => 25000, 'type' => 'procedure'],
+                ['code' => 'eye.procedure', 'label' => 'Ocular procedure', 'amount_minor' => 20000, 'type' => 'procedure'],
+                ['code' => 'eye.cataract_assess', 'label' => 'Cataract assessment', 'amount_minor' => 8000, 'type' => 'consultation'],
            ],
            'workspace_tabs' => [
                'overview' => 'Overview',
-                'exam' => 'Eye exam',
-                'refraction' => 'Refraction',
-                'clinical_notes' => 'Clinical notes',
+                'refraction' => 'VA / refraction',
+                'exam' => 'Examination',
+                'investigations' => 'Investigations',
+                'plan' => 'Diagnosis & plan',
+                'treat' => 'Treatment',
                'orders' => 'Orders',
                'billing' => 'Billing',
                'documents' => 'Documents',
@@ -0,0 +1,107 @@
+<!DOCTYPE html>
+<html lang="en">
+<head>
+    <meta charset="utf-8">
+    <title>Eye care summary · {{ $patient->fullName() }}</title>
+    <style>
+        body { font-family: system-ui, sans-serif; color: #0f172a; margin: 2rem; }
+        h1 { font-size: 1.25rem; margin: 0 0 .25rem; }
+        h2 { font-size: .95rem; margin: 1.25rem 0 .5rem; border-bottom: 1px solid #e2e8f0; padding-bottom: .25rem; }
+        .meta { color: #64748b; font-size: .875rem; }
+        dl { display: grid; grid-template-columns: 10rem 1fr; gap: .35rem .75rem; font-size: .875rem; }
+        dt { color: #64748b; }
+        dd { margin: 0; font-weight: 500; }
+        @media print { .no-print { display: none; } }
+    </style>
+</head>
+<body>
+    <p class="no-print"><a href="{{ route('care.specialty.workspace', ['module' => 'ophthalmology', 'visit' => $visit]) }}">Back</a></p>
+
+    <h1>{{ $patient->fullName() }}</h1>
+    <p class="meta">
+        {{ $patient->patient_number }}
+        · Visit #{{ $visit->id }}
+        · Stage {{ $visit->specialty_stage ?? '—' }}
+        · {{ $visit->checked_in_at?->format('d M Y H:i') ?? '—' }}
+    </p>
+
+    <h2>Visual acuity / refraction</h2>
+    @if ($refraction)
+        <dl>
+            <dt>VA OD / OS</dt><dd>{{ $refraction->payload['va_od'] ?? '—' }} / {{ $refraction->payload['va_os'] ?? '—' }}</dd>
+            <dt>Near VA</dt><dd>{{ $refraction->payload['va_od_near'] ?? '—' }} / {{ $refraction->payload['va_os_near'] ?? '—' }}</dd>
+            <dt>OD Rx</dt>
+            <dd>
+                Sph {{ $refraction->payload['sphere_od'] ?? '—' }}
+                Cyl {{ $refraction->payload['cylinder_od'] ?? '—' }}
+                Axis {{ $refraction->payload['axis_od'] ?? '—' }}
+            </dd>
+            <dt>OS Rx</dt>
+            <dd>
+                Sph {{ $refraction->payload['sphere_os'] ?? '—' }}
+                Cyl {{ $refraction->payload['cylinder_os'] ?? '—' }}
+                Axis {{ $refraction->payload['axis_os'] ?? '—' }}
+            </dd>
+            <dt>Add / PD</dt><dd>{{ $refraction->payload['add'] ?? '—' }} / {{ $refraction->payload['pd'] ?? '—' }}</dd>
+            <dt>Notes</dt><dd>{{ $refraction->payload['notes'] ?? '—' }}</dd>
+        </dl>
+    @else
+        <p class="meta">No refraction recorded.</p>
+    @endif
+
+    <h2>Examination</h2>
+    @if ($exam)
+        <dl>
+            <dt>Chief complaint</dt><dd>{{ $exam->payload['chief_complaint'] ?? '—' }}</dd>
+            <dt>History</dt><dd>{{ $exam->payload['history'] ?? '—' }}</dd>
+            <dt>IOP OD / OS</dt><dd>{{ $exam->payload['iop_od'] ?? '—' }} / {{ $exam->payload['iop_os'] ?? '—' }}</dd>
+            <dt>Pupils</dt><dd>{{ $exam->payload['pupils'] ?? '—' }}</dd>
+            <dt>Anterior segment</dt><dd>{{ $exam->payload['anterior_segment'] ?? '—' }}</dd>
+            <dt>Fundus</dt><dd>{{ $exam->payload['fundus'] ?? '—' }}</dd>
+            <dt>Findings</dt><dd>{{ $exam->payload['findings'] ?? '—' }}</dd>
+        </dl>
+    @else
+        <p class="meta">No examination recorded.</p>
+    @endif
+
+    <h2>Investigations</h2>
+    @if ($investigation)
+        <dl>
+            <dt>Modality</dt><dd>{{ $investigation->payload['modality'] ?? '—' }}</dd>
+            <dt>Eye</dt><dd>{{ $investigation->payload['eye'] ?? '—' }}</dd>
+            <dt>Findings</dt><dd>{{ $investigation->payload['findings'] ?? '—' }}</dd>
+            <dt>Impression</dt><dd>{{ $investigation->payload['impression'] ?? '—' }}</dd>
+        </dl>
+    @else
+        <p class="meta">No investigation recorded.</p>
+    @endif
+
+    <h2>Diagnosis &amp; plan</h2>
+    @if ($plan)
+        <dl>
+            <dt>Diagnosis</dt><dd>{{ $plan->payload['diagnosis'] ?? '—' }}</dd>
+            <dt>Laterality</dt><dd>{{ $plan->payload['laterality'] ?? '—' }}</dd>
+            <dt>Plan</dt><dd>{{ $plan->payload['plan'] ?? '—' }}</dd>
+            <dt>Medications</dt><dd>{{ $plan->payload['medications'] ?? '—' }}</dd>
+            <dt>Follow-up</dt><dd>{{ $plan->payload['follow_up'] ?? '—' }}</dd>
+        </dl>
+    @else
+        <p class="meta">No plan recorded.</p>
+    @endif
+
+    <h2>Procedure / treatment</h2>
+    @if ($procedure)
+        <dl>
+            <dt>Procedure</dt><dd>{{ $procedure->payload['procedure'] ?? '—' }}</dd>
+            <dt>Eye</dt><dd>{{ $procedure->payload['eye'] ?? '—' }}</dd>
+            <dt>Outcome</dt><dd>{{ $procedure->payload['outcome'] ?? '—' }}</dd>
+            <dt>Post-op plan</dt><dd>{{ $procedure->payload['post_op_plan'] ?? '—' }}</dd>
+            <dt>Notes</dt><dd>{{ $procedure->payload['notes'] ?? '—' }}</dd>
+        </dl>
+    @else
+        <p class="meta">No procedure recorded.</p>
+    @endif
+
+    <script>window.print();</script>
+</body>
+</html>
@@ -0,0 +1,88 @@
+<x-app-layout title="Eye care reports">
+    <div class="space-y-6">
+        <div class="flex flex-wrap items-center justify-between gap-3">
+            <div>
+                <h1 class="text-xl font-semibold text-slate-900">Eye care reports</h1>
+                <p class="mt-1 text-sm text-slate-500">Arrivals, elevated IOP, diagnoses, procedures, length of stay, and eye service revenue.</p>
+            </div>
+            <a href="{{ route('care.specialty.show', 'ophthalmology') }}" class="text-sm font-medium text-indigo-600">← Specialty home</a>
+        </div>
+
+        <form method="GET" class="flex flex-wrap items-end gap-3 rounded-2xl border border-slate-200 bg-white p-4">
+            <div>
+                <label class="block text-xs font-medium text-slate-600">From</label>
+                <input type="date" name="from" value="{{ $report['from'] ?? '' }}" class="mt-1 rounded-xl border border-slate-200 px-3 py-2 text-sm">
+            </div>
+            <div>
+                <label class="block text-xs font-medium text-slate-600">To</label>
+                <input type="date" name="to" value="{{ $report['to'] ?? '' }}" class="mt-1 rounded-xl border border-slate-200 px-3 py-2 text-sm">
+            </div>
+            <button type="submit" class="rounded-xl bg-indigo-600 px-4 py-2 text-sm font-semibold text-white">Apply</button>
+        </form>
+
+        <div class="grid gap-4 sm:grid-cols-4">
+            <div class="rounded-2xl border border-slate-200 bg-white p-4">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Arrivals today</p>
+                <p class="mt-2 text-2xl font-semibold tabular-nums text-slate-900">{{ number_format($report['arrivals_today']) }}</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-4">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Completed today</p>
+                <p class="mt-2 text-2xl font-semibold tabular-nums text-slate-900">{{ number_format($report['completed_today']) }}</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-4">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Elevated IOP open</p>
+                <p class="mt-2 text-2xl font-semibold tabular-nums text-rose-700">{{ number_format($report['elevated_iop_open']) }}</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-4">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Avg LOS (range)</p>
+                <p class="mt-2 text-2xl font-semibold tabular-nums text-slate-900">
+                    {{ $report['avg_los_minutes'] !== null ? $report['avg_los_minutes'].' min' : '—' }}
+                </p>
+            </div>
+        </div>
+
+        <div class="grid gap-4 lg:grid-cols-2">
+            <section class="rounded-2xl border border-slate-200 bg-white p-5">
+                <h2 class="text-sm font-semibold text-slate-900">Diagnoses</h2>
+                <ul class="mt-3 space-y-2 text-sm">
+                    @forelse ($report['diagnosis_breakdown'] as $row)
+                        <li class="flex justify-between gap-3">
+                            <span>{{ $row['diagnosis'] }}</span>
+                            <span class="tabular-nums text-slate-600">{{ $row['total'] }}</span>
+                        </li>
+                    @empty
+                        <li class="text-slate-500">No diagnosis records in range.</li>
+                    @endforelse
+                </ul>
+            </section>
+
+            <section class="rounded-2xl border border-slate-200 bg-white p-5">
+                <h2 class="text-sm font-semibold text-slate-900">Procedures</h2>
+                <ul class="mt-3 space-y-2 text-sm">
+                    @forelse ($report['procedure_breakdown'] as $row)
+                        <li class="flex justify-between gap-3">
+                            <span>{{ $row['procedure'] }}</span>
+                            <span class="tabular-nums text-slate-600">{{ $row['total'] }}</span>
+                        </li>
+                    @empty
+                        <li class="text-slate-500">No procedures in range.</li>
+                    @endforelse
+                </ul>
+            </section>
+        </div>
+
+        <section class="rounded-2xl border border-slate-200 bg-white p-5">
+            <h2 class="text-sm font-semibold text-slate-900">Eye care service revenue</h2>
+            <ul class="mt-3 space-y-2 text-sm">
+                @forelse ($report['revenue_by_service'] as $row)
+                    <li class="flex justify-between gap-3">
+                        <span>{{ $row->description }} <span class="text-slate-400">×{{ $row->total }}</span></span>
+                        <span class="tabular-nums">{{ $currency }} {{ number_format($row->amount_minor / 100, 2) }}</span>
+                    </li>
+                @empty
+                    <li class="text-slate-500">No billed eye care services in range.</li>
+                @endforelse
+            </ul>
+        </section>
+    </div>
+</x-app-layout>
@@ -0,0 +1,126 @@
+@php
+    $examPayload = $ophthalmologyExam?->payload ?? [];
+    $refractionPayload = $ophthalmologyRefraction?->payload ?? [];
+    $planPayload = $ophthalmologyPlan?->payload ?? [];
+    $currentStage = $workspaceVisit->specialty_stage;
+    $stageFlow = $ophthalmologyStageFlow ?? [];
+    $stageLabels = collect($stages ?? [])->pluck('label', 'code');
+    $canManage = $canAdvanceStage ?? $canConsult ?? false;
+    $vaOd = $refractionPayload['va_od'] ?? ($examPayload['va_od'] ?? null);
+    $vaOs = $refractionPayload['va_os'] ?? ($examPayload['va_os'] ?? null);
+@endphp
+
+<section class="rounded-2xl border border-slate-200 bg-white p-5">
+    <div class="flex flex-wrap items-start justify-between gap-3">
+        <div>
+            <h3 class="text-sm font-semibold text-slate-900">Eye care overview</h3>
+            <p class="mt-0.5 text-xs text-slate-500">Visual acuity, IOP, diagnosis, and visit stage for this episode.</p>
+        </div>
+        <div class="flex flex-wrap gap-3 text-sm">
+            <a href="{{ route('care.specialty.ophthalmology.print', $workspaceVisit) }}" target="_blank" class="font-medium text-indigo-600">Print summary</a>
+            <a href="{{ route('care.specialty.ophthalmology.reports') }}" class="font-medium text-indigo-600">Eye care reports</a>
+        </div>
+    </div>
+
+    <div class="mt-4 grid gap-3 sm:grid-cols-3">
+        <div class="rounded-xl border border-slate-100 bg-slate-50 px-3 py-3">
+            <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Visual acuity</p>
+            <p class="mt-1 text-sm font-semibold text-slate-900">
+                OD {{ $vaOd ?? '—' }} · OS {{ $vaOs ?? '—' }}
+            </p>
+            <p class="mt-1 text-xs text-slate-500">{{ $examPayload['chief_complaint'] ?? 'No complaint recorded' }}</p>
+        </div>
+        <div class="rounded-xl border border-slate-100 bg-slate-50 px-3 py-3">
+            <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">IOP (mmHg)</p>
+            <p class="mt-1 text-sm font-semibold text-slate-900">
+                OD {{ $examPayload['iop_od'] ?? '—' }} · OS {{ $examPayload['iop_os'] ?? '—' }}
+            </p>
+            <p class="mt-1 text-xs text-slate-500">Pupils {{ $examPayload['pupils'] ?? '—' }}</p>
+        </div>
+        <div class="rounded-xl border border-slate-100 bg-slate-50 px-3 py-3">
+            <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Diagnosis</p>
+            <p class="mt-1 text-sm font-semibold text-slate-900">{{ $planPayload['diagnosis'] ?? 'Not set' }}</p>
+            <p class="mt-1 text-xs text-slate-500">{{ $planPayload['follow_up'] ?? ($planPayload['laterality'] ?? '—') }}</p>
+        </div>
+    </div>
+
+    <div class="mt-4 rounded-xl border border-slate-100 bg-slate-50 px-3 py-3">
+        <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Visit stage</p>
+        <p class="mt-1 text-sm font-medium text-slate-900">
+            {{ $currentStage ? ($stageLabels[$currentStage] ?? ucfirst(str_replace('_', ' ', $currentStage))) : 'Not set' }}
+        </p>
+        <div class="mt-3 flex flex-wrap gap-2">
+            @foreach (($ophthalmologyStageCodes ?: ['check_in', 'history', 'refraction', 'exam', 'investigation', 'plan', 'treatment', 'completed']) as $stageCode)
+                @if ($canManage)
+                    <form method="POST" action="{{ route('care.specialty.ophthalmology.stage', $workspaceVisit) }}">
+                        @csrf
+                        <input type="hidden" name="stage" value="{{ $stageCode }}">
+                        <button type="submit"
+                            @class([
+                                'rounded-lg px-2.5 py-1 text-xs font-semibold',
+                                'bg-indigo-600 text-white' => $currentStage === $stageCode,
+                                'border border-slate-200 bg-white text-slate-700 hover:bg-slate-50' => $currentStage !== $stageCode,
+                            ])>
+                            {{ $stageLabels[$stageCode] ?? ucfirst(str_replace('_', ' ', $stageCode)) }}
+                        </button>
+                    </form>
+                @else
+                    <span
+                        @class([
+                            'rounded-lg px-2.5 py-1 text-xs font-semibold',
+                            'bg-indigo-600 text-white' => $currentStage === $stageCode,
+                            'border border-slate-200 bg-white text-slate-400' => $currentStage !== $stageCode,
+                        ])
+                        @if ($currentStage !== $stageCode) aria-disabled="true" title="View-only access" @endif
+                    >
+                        {{ $stageLabels[$stageCode] ?? ucfirst(str_replace('_', ' ', $stageCode)) }}
+                    </span>
+                @endif
+            @endforeach
+            @if ($canManage && $currentStage && isset($stageFlow[$currentStage]) && $stageFlow[$currentStage]['next'] !== $currentStage)
+                <form method="POST" action="{{ route('care.specialty.ophthalmology.stage', $workspaceVisit) }}">
+                    @csrf
+                    <input type="hidden" name="stage" value="{{ $stageFlow[$currentStage]['next'] }}">
+                    <button type="submit" class="rounded-lg bg-emerald-600 px-2.5 py-1 text-xs font-semibold text-white hover:bg-emerald-700">
+                        {{ $stageFlow[$currentStage]['label'] }} →
+                    </button>
+                </form>
+            @endif
+        </div>
+    </div>
+
+    <dl class="mt-4 grid gap-3 text-sm sm:grid-cols-2">
+        <div>
+            <dt class="text-slate-500">Key findings</dt>
+            <dd class="font-medium text-slate-900">{{ $examPayload['findings'] ?? '—' }}</dd>
+        </div>
+        <div>
+            <dt class="text-slate-500">Plan</dt>
+            <dd class="font-medium text-slate-900">{{ $planPayload['plan'] ?? '—' }}</dd>
+        </div>
+        <div>
+            <dt class="text-slate-500">Queue</dt>
+            <dd class="font-medium text-slate-900">
+                {{ $workspaceVisit->appointment?->queue_ticket_number ?? '—' }}
+                @if ($workspaceVisit->appointment?->queue_ticket_status)
+                    <span class="text-slate-500">({{ $workspaceVisit->appointment->queue_ticket_status }})</span>
+                @endif
+            </dd>
+        </div>
+        <div>
+            <dt class="text-slate-500">Checked in</dt>
+            <dd class="font-medium text-slate-900">{{ $workspaceVisit->checked_in_at?->format('d M Y H:i') ?? '—' }}</dd>
+        </div>
+    </dl>
+
+    @if (! empty($clinicalAlerts))
+        <div class="mt-4 space-y-1.5 border-t border-slate-100 pt-4">
+            <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Alerts</p>
+            @foreach ($clinicalAlerts as $alert)
+                <p class="text-sm {{ ($alert['severity'] ?? '') === 'critical' ? 'text-rose-700' : 'text-amber-800' }}">
+                    {{ $alert['message'] ?? '' }}
+                </p>
+            @endforeach
+        </div>
+    @endif
+</section>
@@ -0,0 +1,70 @@
+@php
+    $record = $ophthalmologyProcedure;
+    $payload = $record?->payload ?? [];
+    $canManage = $canManageClinical ?? $canConsult ?? false;
+@endphp
+
+<section class="rounded-2xl border border-slate-200 bg-white p-5">
+    <div class="flex flex-wrap items-start justify-between gap-3">
+        <div>
+            <h3 class="text-sm font-semibold text-slate-900">Procedure / treatment</h3>
+            <p class="mt-0.5 text-xs text-slate-500">Record ocular procedures. Completing a procedure can close the visit.</p>
+        </div>
+        <a href="{{ route('care.specialty.ophthalmology.print', $workspaceVisit) }}" target="_blank" class="text-sm font-medium text-indigo-600">Print summary</a>
+    </div>
+
+    @if ($canManage)
+        <form method="POST" action="{{ route('care.specialty.ophthalmology.procedure', $workspaceVisit) }}" class="mt-4 space-y-4">
+            @csrf
+            <input type="hidden" name="tab" value="treat">
+            <div class="grid gap-3 sm:grid-cols-2">
+                @foreach ($clinicalFields ?? [] as $field)
+                    @php
+                        $name = $field['name'];
+                        $value = old('payload.'.$name, $payload[$name] ?? '');
+                        $type = $field['type'] ?? 'text';
+                    @endphp
+                    <div @class(['sm:col-span-2' => in_array($type, ['textarea'], true)])>
+                        <label class="block text-xs font-medium text-slate-600">
+                            {{ $field['label'] }}
+                            @if (! empty($field['required'])) <span class="text-rose-600">*</span> @endif
+                        </label>
+                        @if ($type === 'textarea')
+                            <textarea name="payload[{{ $name }}]" rows="{{ $field['rows'] ?? 3 }}" @required(! empty($field['required']))
+                                class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">{{ $value }}</textarea>
+                        @elseif ($type === 'select')
+                            <select name="payload[{{ $name }}]" @required(! empty($field['required']))
+                                class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                                <option value="">Select…</option>
+                                @foreach ($field['options'] ?? [] as $option)
+                                    <option value="{{ $option }}" @selected((string) $value === (string) $option)>{{ $option }}</option>
+                                @endforeach
+                            </select>
+                        @elseif ($type === 'boolean')
+                            <label class="mt-2 inline-flex items-center gap-2 text-sm text-slate-700">
+                                <input type="checkbox" name="payload[{{ $name }}]" value="1" @checked(old('payload.'.$name, ! empty($payload[$name])))>
+                                Yes
+                            </label>
+                        @else
+                            <input type="{{ $type === 'number' ? 'number' : 'text' }}" name="payload[{{ $name }}]" value="{{ $value }}"
+                                @required(! empty($field['required']))
+                                class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                        @endif
+                    </div>
+                @endforeach
+            </div>
+            <button type="submit" class="btn-primary">Save treatment</button>
+        </form>
+    @elseif ($record)
+        <dl class="mt-4 grid gap-3 text-sm sm:grid-cols-2">
+            @foreach ($clinicalFields ?? [] as $field)
+                <div>
+                    <dt class="text-slate-500">{{ $field['label'] }}</dt>
+                    <dd class="font-medium text-slate-900">{{ $payload[$field['name']] ?? '—' }}</dd>
+                </div>
+            @endforeach
+        </dl>
+    @else
+        <p class="mt-4 text-sm text-slate-500">No procedure recorded yet.</p>
+    @endif
+</section>
@@ -52,6 +52,8 @@
            @include('care.specialty.emergency.workspace-'.$activeTab)
        @elseif ($moduleKey === 'blood_bank' && in_array($activeTab, ['overview', 'issue', 'transfusion'], true))
            @include('care.specialty.blood-bank.workspace-'.$activeTab)
+        @elseif ($moduleKey === 'ophthalmology' && in_array($activeTab, ['overview', 'treat'], true))
+            @include('care.specialty.ophthalmology.workspace-'.$activeTab)
        @elseif ($activeTab === 'billing')
            <section class="rounded-2xl border border-slate-200 bg-white p-5">
                <h3 class="text-sm font-semibold text-slate-900">
@@ -34,6 +34,9 @@
                            <a href="{{ route('care.blood-bank.admin.index') }}" class="text-slate-600 hover:text-slate-900">Admin</a>
                        @endif
                    @endif
+                    @if ($moduleKey === 'ophthalmology')
+                        <a href="{{ route('care.specialty.ophthalmology.reports') }}" class="text-slate-600 hover:text-slate-900">Reports</a>
+                    @endif
                    <a href="{{ route('care.specialty.history', $moduleKey) }}" class="text-slate-600 hover:text-slate-900">History</a>
                    @if ($canManageClinical ?? $canManageSpecialty ?? true)
                        <a href="{{ route('care.specialty.billing', $moduleKey) }}" class="text-slate-600 hover:text-slate-900">Billing</a>
@@ -41,6 +41,7 @@ use App\Http\Controllers\Care\BloodBankAdminController;
 use App\Http\Controllers\Care\BloodBankWorkspaceController;
 use App\Http\Controllers\Care\LabAdminController;
 use App\Http\Controllers\Care\EmergencyWorkspaceController;
+use App\Http\Controllers\Care\OphthalmologyWorkspaceController;
 use App\Http\Controllers\Care\SpecialtyModuleController;
 use App\Http\Controllers\Care\VisitWorkflowController;
 use App\Http\Controllers\NotificationController;
@@ -123,6 +124,7 @@ Route::middleware(['auth', 'platform.session'])->group(function () {
            Route::get('/specialty/dentistry/reports', [DentistryWorkspaceController::class, 'reports'])->name('care.specialty.dentistry.reports');
            Route::get('/specialty/emergency/reports', [EmergencyWorkspaceController::class, 'reports'])->name('care.specialty.emergency.reports');
            Route::get('/specialty/blood-bank/reports', [BloodBankWorkspaceController::class, 'reports'])->name('care.specialty.blood-bank.reports');
+            Route::get('/specialty/ophthalmology/reports', [OphthalmologyWorkspaceController::class, 'reports'])->name('care.specialty.ophthalmology.reports');
            Route::get('/specialty/{module}/workspace/{visit?}', [SpecialtyModuleController::class, 'workspace'])->name('care.specialty.workspace');
            Route::post('/specialty/{module}/workspace/{visit}/clinical', [SpecialtyModuleController::class, 'saveClinical'])->name('care.specialty.clinical.save');
            Route::post('/specialty/{module}/workspace/{visit}/documents', [SpecialtyModuleController::class, 'uploadDocument'])->name('care.specialty.documents.upload');
@@ -156,6 +158,9 @@ Route::middleware(['auth', 'platform.session'])->group(function () {
            Route::post('/specialty/blood-bank/workspace/{visit}/issue', [BloodBankWorkspaceController::class, 'confirmIssue'])->name('care.specialty.blood-bank.issue');
            Route::post('/specialty/blood-bank/workspace/{visit}/transfusion', [BloodBankWorkspaceController::class, 'saveTransfusion'])->name('care.specialty.blood-bank.transfusion');
            Route::get('/specialty/blood-bank/workspace/{visit}/print', [BloodBankWorkspaceController::class, 'printSummary'])->name('care.specialty.blood-bank.print');
+            Route::post('/specialty/ophthalmology/workspace/{visit}/stage', [OphthalmologyWorkspaceController::class, 'setStage'])->name('care.specialty.ophthalmology.stage');
+            Route::post('/specialty/ophthalmology/workspace/{visit}/procedure', [OphthalmologyWorkspaceController::class, 'saveProcedure'])->name('care.specialty.ophthalmology.procedure');
+            Route::get('/specialty/ophthalmology/workspace/{visit}/print', [OphthalmologyWorkspaceController::class, 'printSummary'])->name('care.specialty.ophthalmology.print');
            Route::get('/specialty/{module}', [SpecialtyModuleController::class, 'show'])->name('care.specialty.show');
            Route::post('/specialty/{module}/call-next', [SpecialtyModuleController::class, 'callNext'])->name('care.specialty.call-next');
            Route::post('/specialty/{module}/refer', [SpecialtyModuleController::class, 'refer'])->name('care.specialty.refer');
@@ -0,0 +1,231 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Appointment;
+use App\Models\Branch;
+use App\Models\Department;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyModuleService;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Tests\TestCase;
+
+class CareOphthalmologySuiteTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $owner;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Visit $visit;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->owner = User::create([
+            'public_id' => 'eye-owner',
+            'name' => 'Owner',
+            'email' => 'eye-owner@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->owner->public_id,
+            'name' => 'Eye Clinic',
+            'slug' => 'eye-clinic',
+            'settings' => [
+                'onboarded' => true,
+                'facility_type' => 'clinic',
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'queue_integration_enabled' => true,
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->owner->public_id,
+            'role' => 'hospital_admin',
+            'branch_id' => null,
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        app(SpecialtyModuleService::class)->activate(
+            $this->organization,
+            $this->owner->public_id,
+            'ophthalmology',
+        );
+
+        $department = Department::query()
+            ->where('branch_id', $this->branch->id)
+            ->where('type', 'ophthalmology')
+            ->firstOrFail();
+
+        $this->patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-EYE-SUITE',
+            'first_name' => 'Ama',
+            'last_name' => 'Mensah',
+            'gender' => 'female',
+            'date_of_birth' => '1990-05-12',
+        ]);
+
+        $this->visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+            'specialty_stage' => 'check_in',
+        ]);
+
+        Appointment::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'department_id' => $department->id,
+            'visit_id' => $this->visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_IN_CONSULTATION,
+            'scheduled_at' => now(),
+            'waiting_at' => now(),
+            'checked_in_at' => now(),
+            'started_at' => now(),
+        ]);
+    }
+
+    public function test_overview_and_refraction_tabs_render(): void
+    {
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.workspace', [
+                'module' => 'ophthalmology',
+                'visit' => $this->visit,
+                'tab' => 'overview',
+            ]))
+            ->assertOk()
+            ->assertSee('Eye care overview')
+            ->assertSee('Visit stage')
+            ->assertSee('Eye care reports');
+
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.workspace', [
+                'module' => 'ophthalmology',
+                'visit' => $this->visit,
+                'tab' => 'refraction',
+            ]))
+            ->assertOk()
+            ->assertSee('Visual acuity OD')
+            ->assertSee('Sphere OD');
+    }
+
+    public function test_exam_sets_stage_and_iop_alerts(): void
+    {
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.clinical.save', [
+                'module' => 'ophthalmology',
+                'visit' => $this->visit,
+            ]), [
+                'tab' => 'exam',
+                'payload' => [
+                    'chief_complaint' => 'Blurry vision',
+                    'iop_od' => 32,
+                    'iop_os' => 18,
+                    'findings' => 'Elevated IOP OD',
+                    'va_od' => '6/60',
+                ],
+            ])
+            ->assertRedirect();
+
+        $this->assertSame('exam', $this->visit->fresh()->specialty_stage);
+
+        $record = SpecialtyClinicalRecord::query()
+            ->where('visit_id', $this->visit->id)
+            ->where('record_type', 'eye_exam')
+            ->firstOrFail();
+
+        $codes = collect($record->alerts)->pluck('code')->all();
+        $this->assertContains('eye.critical_iop', $codes);
+        $this->assertContains('eye.low_vision', $codes);
+    }
+
+    public function test_stage_advance_and_procedure_completes_visit(): void
+    {
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.ophthalmology.stage', $this->visit), [
+                'stage' => 'treatment',
+            ])
+            ->assertRedirect();
+
+        $this->assertSame('treatment', $this->visit->fresh()->specialty_stage);
+
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.ophthalmology.procedure', $this->visit), [
+                'tab' => 'treat',
+                'payload' => [
+                    'procedure' => 'Foreign body removal',
+                    'eye' => 'OD',
+                    'outcome' => 'Completed uneventfully',
+                    'post_op_plan' => 'Antibiotic drops 5 days',
+                ],
+            ])
+            ->assertRedirect(route('care.specialty.workspace', [
+                'module' => 'ophthalmology',
+                'visit' => $this->visit,
+                'tab' => 'treat',
+            ]));
+
+        $this->assertSame('completed', $this->visit->fresh()->specialty_stage);
+        $this->assertSame(Visit::STATUS_COMPLETED, $this->visit->fresh()->status);
+        $this->assertDatabaseHas('care_specialty_clinical_records', [
+            'visit_id' => $this->visit->id,
+            'record_type' => 'eye_procedure',
+            'status' => SpecialtyClinicalRecord::STATUS_COMPLETED,
+        ]);
+    }
+
+    public function test_reports_and_print(): void
+    {
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.ophthalmology.reports'))
+            ->assertOk()
+            ->assertSee('Eye care reports')
+            ->assertSee('Arrivals today');
+
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.ophthalmology.print', $this->visit))
+            ->assertOk()
+            ->assertSee('Eye care summary')
+            ->assertSee($this->patient->fullName());
+    }
+
+    public function test_list_index_does_not_auto_open_patient(): void
+    {
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.show', 'ophthalmology'))
+            ->assertOk()
+            ->assertDontSee('Eye care overview');
+    }
+}
@@ -202,9 +202,11 @@ class CareSpecialtyClinicalTest extends TestCase
            ->fieldsFor('ophthalmology', 'eye_exam');
        $names = collect($fields)->pluck('name')->all();

-        $this->assertContains('va_od', $names);
+        $this->assertContains('iop_od', $names);
        $this->assertContains('iop_os', $names);
-        $this->assertNotContains('notes', $names);
+        $this->assertContains('findings', $names);
+        $this->assertContains('chief_complaint', $names);
+        $this->assertNotContains('working_diagnosis', $names);

        [$visit] = $this->activateWithVisit('ophthalmology', 'ophthalmology');

@@ -215,7 +217,7 @@ class CareSpecialtyClinicalTest extends TestCase
                'tab' => 'exam',
            ]))
            ->assertOk()
-            ->assertSee('Visual acuity OD')
+            ->assertSee('Chief complaint')
            ->assertSee('IOP OS');
    }
 }