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Ramesh PV, Ramesh SV, Gopalakrishnan ST, Pannerselvam P, Ganga S, Ravidass G. Commentary: The time-honored practice of tonometry disinfection - Our ultimate strength or a chink in our anti-glaucoma armor? Indian J Ophthalmol 2023; 71:1938-1940. [PMID: 37203061 PMCID: PMC10391472 DOI: 10.4103/ijo.ijo_293_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Prasanna Venkatesh Ramesh
- Medical Officer, Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Shruthy Vaishali Ramesh
- Medical Officer, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Sai Thaejesvi Gopalakrishnan
- Junior Resident, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Pavithra Pannerselvam
- Junior Resident, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - S Ganga
- Junior Resident, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Geetha Ravidass
- Fellow, Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
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Abstract
PRECIS A survey among members of the American Glaucoma Society (AGS) and the American Optometry Association (AOA) on tonometer preference and tonometer disinfection indicates a shift to disposable tonometer tips compared with 1987. PURPOSE This survey's purpose was to determine how eye care providers responded to the 2008 Centers of Disease Control (CDC) tonometer disinfection guidelines, which recommend 10% hypochlorite (dilute bleach) for reusable tonometers. Tonometers measure the eye pressure when they touch the cornea, an essential part of the eye examination. METHODS AGS and AOA members were surveyed on tonometer preference, tonometer use, disinfection process, disinfectants, disinfection timing, and tonometer damage. RESULTS Survey responses from 79 AOA members and 197 AGS members are included. The Goldmann tonometer is considered most accurate (70, 89% AOA and 161, 82% AGS). It is preferred by 54 (70%) AOA and 193 (98%) AGS members. Many providers (165) use reusable Goldmann tonometer tips (77, 79% AOA, 88, 45% AGS), and most clean with 70% isopropyl alcohol wipes 59 (77%) AOA and 54 (61%) AGS. In summary, 126 of 276 participants (8, 10% AOA and 118, 60% AGS) follow CDC guidelines by using disposable tips (2 AOA and 109 AGS) or disinfecting reusable tips with 10% hypochlorite (6 AOA and 9 AGS). CONCLUSIONS The majority of AGS providers follow current CDC tonometer disinfection guidelines by shifting to disposable Goldmann tonometer tips. Only a minority of providers who use reusable tonometer tips disinfect with dilute bleach. Continued education on proper tonometer disinfection is critical to prevent eye-care related infection due to improper disinfection.
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Almazyad EM, Ameen S, Khan MA, Malik R. Guidelines and Recommendations for Tonometry Use during the COVID-19 Era. Middle East Afr J Ophthalmol 2020; 27:73-78. [PMID: 32874038 PMCID: PMC7442084 DOI: 10.4103/meajo.meajo_237_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 11/10/2022] Open
Abstract
The novel coronavirus disease COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a substantial change in eye care and clinical practice. There has been conflicting information and weak evidence on the virus's transmission through tears. Yet, virus detection on cornea and conjunctiva surface as a gateway for infection is not well-studied. Moreover, there have been no reported cases of SARS-CoV-2 transmission through tonometry to date. Thus, this uncertainty has urged this review on evidence-based guidelines and recommendations on tonometer use in the COVID-19 era. The aim of this article is to provide ophthalmologists with recommendations for tonometry practice based on current evidence and best practice guidelines.
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Affiliation(s)
- Enmar M. Almazyad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sally Ameen
- Western Eye Hospital, Imperial NHS Foundation Trust, London, UK
| | - Mohammad A. Khan
- Department of Microbiology, Prince Mohammed Bin Abdul Aziz Hospital, Riyadh, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Samuel M, Thomasy SM, Calderon AS, Kass PH, Collins K, Murphy CJ. Effects of 5% sodium chloride ophthalmic ointment on thickness and morphology of the normal canine cornea. Vet Ophthalmol 2018; 22:229-237. [PMID: 29927055 DOI: 10.1111/vop.12582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effect of 5% sodium chloride ophthalmic ointment (5% NaCl) on thickness and morphology of the normal canine cornea using ultrasonic pachymetry (USP), in vivo confocal microscopy (IVCM), and Fourier-domain optical coherence tomography (FD-OCT). METHODS Five healthy laboratory Beagles received ophthalmic examinations including USP, IVCM, and FD-OCT prior to and at fixed intervals following treatment. The right and left eyes were treated with 5% NaCl and artificial tears ophthalmic ointment (AT), respectively, every 2 hours for 4 treatments/d (days 2-9), and then hourly for 7 treatments/d (day 10). Treatment groups were statistically compared using mixed-effects linear regression. RESULTS Treatment with 5% NaCl resulted in a 12 μm decrease in corneal thickness from baseline (P < .001), while there was no significant difference in corneal thickness between values obtained at baseline and following treatment with AT (P = .82). Epithelial cell density significantly increased from baseline (530 ± 52 cells/mm2 ) to 577 ± 43 and 567 ± 15 cells/mm2 with 5% NaCl and AT, respectively (P = .003 and .005, respectively). However, keratocyte cell density in the anterior and posterior stroma and endothelial cell density did not significantly differ following treatment with 5% NaCl or AT ointment (P > .05). CONCLUSIONS Short-term topical treatment with 5% NaCl decreased corneal thickness in normal dogs with no observable changes in corneal morphology or signs of ocular toxicity.
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Affiliation(s)
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.,Department of Ophthalmology & Vision Science, UC Davis Eye Center, School of Medicine, University of California, Davis, CA, USA
| | - Allison S Calderon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine and School of Medicine, University of California, Davis, CA, USA
| | | | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.,Department of Ophthalmology & Vision Science, UC Davis Eye Center, School of Medicine, University of California, Davis, CA, USA
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Junk AK, Chen PP, Lin SC, Nouri-Mahdavi K, Radhakrishnan S, Singh K, Chen TC. Disinfection of Tonometers. Ophthalmology 2017; 124:1867-1875. [DOI: 10.1016/j.ophtha.2017.05.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
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Dependability of posterior-segment spectral domain optical coherence tomography for measuring central corneal thickness. Cornea 2015; 33:1219-24. [PMID: 25211358 DOI: 10.1097/ico.0000000000000253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the intersession and interobserver reliability of central corneal thickness (CCT) measurements using a posterior-segment spectral domain optical coherence tomography (SD-OCT). METHODS Sixty patients were examined with a posterior-segment SD-OCT system (Topcon 3D-OCT). To analyze intersession reproducibility, 1 examiner measured CCT in 60 eyes 2 times 1 week apart, and to study interobserver reproducibility, a second examiner obtained another measurement during the first session. Within-subject reproducibility, coefficient of reproducibility (CR), and intraclass correlation coefficients (ICC) were calculated. Agreement between Topcon 3D OCT and ultrasound pachymetry (USP) was also assessed. RESULTS Posterior-segment SD-OCT showed an intersession reproducibility of 12.7 μm (CR = 2.4%) and an excellent ICC (0.96). No systematic difference between sessions was found (average difference, 1.7 μm; P = 0.15). We found no significant bias between observers (mean difference, -1.5 μm; P = 0.29). The interobserver reproducibility was 16.4 μm (CR = 3.1%), and the ICC was 0.94. Topcon 3D OCT CCT values were lower than USP readings (mean difference, 7.6 ± 8.1 μm; 95% confidence interval, 9.9-5.3 μm; P < 0.001). CONCLUSIONS With a commercially available retinal SD-OCT system, reliable intersession and interobserver CCT measurements can be feasibly obtained. The criteria for a significant change, which would be the one exceeding the reproducibility, indicate that intersession and interobserver variations in CCT of more than 13 and 16 μm, respectively, may reflect true corneal change with this particular device. These estimates should help investigators and clinicians differentiate actual CCT modification from measurement random error. The slight CCT underestimation with respect to USP is within the range of other OCT devices.
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López-Miguel A, Nieto JC, Díez-Cuenca M, Piñero DP, Maldonado MJ. Agreement of non-contact pachymetry after LASIK: comparison of combined scanning-slit/Placido disc topography and specular microscopy. Eye (Lond) 2009; 24:1064-70. [PMID: 19786958 DOI: 10.1038/eye.2009.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the interchangeability of central corneal thickness (CCT) measurements between combined scanning-slit/Placido disc topography (Orbscan-II) and specular microscopy (Topcon SP-2000P) in patients who underwent laser in situ keratomileusis (LASIK) for myopia. PATIENTS AND METHODS We recruited 118 consecutive patients who underwent LASIK for myopia. The CCT was measured using Orbscan-II and Topcon SP-2000P randomly. Orbscan-II and Topcon SP-2000P CCT data were analysed using the paired-sample t-test and the limits of agreement (LoA) were calculated with the method described by Bland-Altman. RESULTS The average CCT measurements by Orbscan-II and Topcon SP-2000P were 447.55+/-49.78 microm and 461.38+/-35.35 microm, respectively (P<0.0001; mean difference, 13.83+/-22.31 microm; 95% confidence interval, 9.77-17.09 microm). The Bland-Altman plot showed an inverse association between the average and the difference between the devices: Topcon-Orbscan-II=174.23 -0.353xAverage (P<0.01). The widths of the crude and regression-based 95% limits of agreement were 87.45 and 63.72 microm, respectively. CONCLUSIONS Orbscan-II measurements of CCT after myopic LASIK were significantly lower than those obtained using Topcon SP-2000P. The limits of agreement between the two devices were too broad and, therefore, both pachymetric values cannot be used interchangeably. Further, the tendency towards comparably Orbscan-II readings in thinner corneas precludes that one technique can directly replace the other. This is important for the adequate medium- and long-term follow-up of the growing LASIK patient population.
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Affiliation(s)
- A López-Miguel
- Departamento de Oftalmología, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
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Maldonado MJ, Nieto JC, Piñero DP. Advances in technologies for laser-assisted in situ keratomileusis (LASIK) surgery. Expert Rev Med Devices 2008; 5:209-29. [PMID: 18331182 DOI: 10.1586/17434440.5.2.209] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laser-assisted in situ keratomileusis (LASIK) has become the most widely used form of refractive surgery today. The objective of this surgical technique is to modify the anterior corneal shape by ablating tissue from the stroma by means of the excimer laser after creating a hinged corneal flap. This way, we are able to change the refractive status of the patient, providing better unaided vision. Continuous improvements in the original technique have made the surgical procedure safer, more accurate and repeatable. These progressions are due to the development of novel technologies that are the responsible for new surgical instrumentation, which makes the surgical procedure easier for the surgeon, and better excimer laser ablation algorithms, which increase the optical quality of the ablation and thus the safety of the vision correction procedure. This article aims to describe the more relevant advances in LASIK that have played an important role in the spread and popularity of this technique.
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Affiliation(s)
- Miguel J Maldonado
- Department of Ophthalmology, Clínica Universitaria, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain.
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Dubois P, Zemmouri J, Rouland JF, Elena PP, Lopes R, Puech P. A new method for Intra Ocular Pressure in vivo measurement: first clinical trials. ACTA ACUST UNITED AC 2008; 2007:5763-6. [PMID: 18003322 DOI: 10.1109/iembs.2007.4353656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Glaucoma is an ocular disease clinically manifested by an abnormal rise of the Intra Ocular Pressure (IOP) that causes lesions of the optic nerve and can lead to blindness. Ophthalmologists currently use applanation tonometers whose utilization induces multiple constraints. We propose an investigative method being at one and the same time atraumatic and ambulatory. This original device, taking profit of a physical relation between frequency of mechanical vibration of the ocular globe and IOP, involves vibrometry by laser interferometry and spectral analysis of a mechanical impulse using a temporal micro hammer. The laser energy delivered to the eye by the device was confirmed to be safe and in full agreement with the authorized security norms. After preliminary in vitro experiments performed using enucleated animal eyes, we made a clinical study on 25 volunteers to evaluate the innocuity and the reliability of this device and to quantify the reproducibility of measurements. All patients declared that discomfort is comparable with that felt during similar tests. Reliability is good and the intra individual reproducibility reveals a high value (R > or = 0.93). These works will be carried on to check the correlation between the variation of measured values (resonance frequency of the eye-ball) and the variation of reference (IOP) values.
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Affiliation(s)
- Patrick Dubois
- INSERM U 703, Institut de Technologie Médicale, CHRU Lille France.
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Hillier RJ, Kumar N. Tonometer disinfection practice in the United Kingdom: A national survey. Eye (Lond) 2007; 22:1029-33. [PMID: 17464301 DOI: 10.1038/sj.eye.6702831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess current tonometer disinfection practice in the UK, and compare with published recommendations. METHODS Every ophthalmology unit with training recognition in the UK was contacted (n=155). A senior nurse at each institution completed a telephone questionnaire regarding local tonometer disinfection practice. RESULTS The response rate was 100%. Thirty-five units (23%) reported exclusive use of disposable tonometer heads and were excluded from further analysis. One hundred and twenty units (77%) used either reusable or a combination of reusable and disposable tonometer heads. Where reusable heads were used, 80 units (67%) immersed them in a chlorine-based solution such as sodium hypochlorite or sodium dichloroisocyanurate. Others used isopropyl alcohol (18 units), hydrogen peroxide (12 units), chloramine (5 units), chlorhexidine (4 units) and peracetic acid (1 unit). Where a chlorine-based agent was used, the concentration of available chlorine ranged from 125 to 30 000 p.p.m., with 50 units (63%) using a concentration of less than 5 000 p.p.m. (i.e., inadequate based on published recommendations). Where the tonometer head was immersed in disinfectant between patients (n=101), 29 units (29%) provided just one tonometer head per practitioner, making adequate soak time between patients unlikely. Every unit replenished the disinfectant at least daily, deemed sufficient for most agents. However, hydrogen peroxide solutions should be replenished twice daily, which did not take place in nine units. CONCLUSION This survey reveals disparity between current tonometer disinfection practice and published international recommendations, with some institutions using practices that may render patients susceptible to transmissible infection.
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Affiliation(s)
- R J Hillier
- Ophthalmology Department, Aintree University Hospitals NHS Foundation Trust, Walton Hospital, Liverpool, UK.
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Cillino S, Casuccio A, Giammanco GM, Mammina C, Morreale D, Di Pace F, Lodato G. Tonometers and infectious risk: myth or reality? Efficacy of different disinfection regimens on tonometer tips. Eye (Lond) 2006; 21:541-6. [PMID: 16456585 DOI: 10.1038/sj.eye.6702269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the adequacy of common disinfection regimens for disposable tonometer tips and assess if disinfection of reusable prisms or the use of disposable tips is preferable. METHODS We used disposable tonometer tips, using the same material and tip diameter of standard Goldmann tonometer prism. Strains of Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilisand Candida albicanswere tested according to the European standard guidelines for disinfectants test. Antimicrobial effectiveness of the following disinfection practices has been assessed: dry wipe, Minuten wipes (Alpro), soaking in 3% hydrogen peroxide, 0.5% benzalkonium chloride, and 0.5% Pantasept for 1, 5, and 15 min. All tests have been performed three times and all conditions tested in duplicate. RESULTS Dry wiping and 1 min soak in 3% hydrogen peroxide were ineffective on all microrganisms. Minuten wipes, 1 min soak in 0.5% benzalkonium chloride or 3% hydrogen peroxide were ineffective on B. subtilis. 0.5% Pantasept soak was effective in 1 min for all microrganisms tested, whereas 3% hydrogen peroxide and 0.5% benzalkonium chloride soaks were effective when performed for at least 5 min. B. subtiliswas the most resistant organism to disinfectant regimes at 1 min time. CONCLUSIONS Results of our study demonstrate a relative disinfection efficacy for the different evaluated regimens, provided that correct exposure times are adopted for the chosen disinfectants, a condition difficult to ensure in a busy clinic setting. We conclude that disposable prism tonometry provides a safe alternative to Goldmann tonometry.
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Affiliation(s)
- S Cillino
- Dipartimento di Neurologia, Oftalmologia, Otorinolaringoiatria e Psichiatria, Sezione di Oftalmologia, Università degli Studi di Palermo, Palermo, Italy.
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