Glaucoma specialists deal with numerous routine considerations on a daily basis. Andrew Iwach, MD, enumerated some of these consideration and discussed the bright spots and the pitfalls.
Dr. Iwach is executive director, Glaucoma Center of San Francisco; associate clinical professor of ophthalmology, University of California San Francisco; co-chairman of Glaucoma 360; and chairman of the Glaucoma Symposium.
Disinfection of the applanation tonometer tip
The possibilities for this task include the use of alcohol, bleach, or disposable tips.
This has become a discussion topic because of a 2017 publication that concluded that sodium hydrochloride-diluted bleach disinfection is effective. However, some small adenoviruses remain refractory to the disinfection with later transmission possible.
Another complication is that extended exposure to bleach can cause the breakdown of the tip with potential for infection by other pathogens. The article precipitated a discussion of the pros and cons of the various disinfection approaches that included a protocol for use of bleach: wipe the reusable tonometer tip, soak in 10% bleach for 5 minutes, rinse with water and allow it to dry, check for cracks at each use using 16 times magnification.
A subsequent discussion touted the use of disposable tips, thus eliminating the need for bleach and alcohol, according to Dr. Iwach.
In actuality, “there is a global transmission risk in our offices, which includes the to-nometry tip, but other factors are present,” he noted. These include many surfaces in offices. Moving from alcohol to bleach may introduce other different factors.
Dr. Iwach pointed out that major outbreaks have not occurred to this point because of global risk management.
“We already are taking steps well beyond just addressing cleaning the tonometry tip,” he said. Dr. Iwach suggested that physicians include a statement in their office manuals that states that the practice has addressed risk management, and that alcohol, if used, has worked.