tag:blogger.com,1999:blog-57536012951409077942024-03-13T23:16:39.251-07:00scleral tonometryA blog to discuss the advantages of scleral tonometry.Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-5753601295140907794.post-68667406193445703022011-10-04T18:08:00.000-07:002011-10-04T18:08:47.899-07:00Glaucoma research soc.of Canada grant on 24hr Scleral tonometry in miceResearch to be performed at Toronto Western Hospital by Optomertist Dr.J.G.FLANAGAN PhD Optom (UK U.Ashton) & Dr.A.Dracopoulos PhD<br />
<br />
(Scleral tonometry, avoiding local anaesthetic, coming back into fashion with Russian DIATON & Bausch & Lomb PROVIEW. Corneal contact probe Finnish iCare tonometer also does not need anaesthesia.)Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5753601295140907794.post-13115566257571990532011-07-09T07:28:00.000-07:002011-07-09T07:28:31.682-07:00Transmission of PRIONS through contact Tonometry<div id="header"><div id="mast-head"><div id="logo"><a href="http://bjo.bmj.com/" jquery1310221491031="36"><img alt="British Journal of Ophthalmology" id="site-logo" src="http://bjo.bmj.com/site/icons/logo.gif" title="British Journal of Ophthalmology" /></a> </div><div id="main-search"><a href="" id="site-search" jquery1310221491031="37" name="site-search"></a><form action="/search" id="searchform" jquery1310221491031="5" method="get" name="searchform"><fieldset><label class="hide" for="header-qs-input" id="header-qs-search-label">Search this site</label><input class="text" id="header-qs-input" jquery1310221491031="4" maxlength="255" name="fulltext" style="color: #a0a0a0;" /><input name="submit" type="hidden" /><input class="button" src="http://group.bmj.com/bmjpg/images/icon-search.gif" type="image" /></fieldset></form><a href="http://bjo.bmj.com/search" jquery1310221491031="38">Advanced search</a> </div></div><div id="strap-line"><span>A peer review journal for health professionals and researchers in ophthalmology</span> </div></div><div id="main-nav-wrap"><ul id="main-nav"><li id="main-nav-online-first"><a href="http://bjo.bmj.com/content/early/recent" jquery1310221491031="39"><span>Online First</span></a></li>
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<li><span class="bc-sep">> </span><a href="http://bjo.bmj.com/content/87/11.toc" jquery1310221491031="55">Volume 87, Issue 11</a></li>
<li class="lastcrumb"><span class="bc-sep">> </span>Article </li>
</ul><div id="rss"><a href="http://bjo.bmj.com/rss" jquery1310221491031="56"><img alt="rss" src="http://bjo.bmj.com/site/icons/rss-icon.gif" /></a></div><div id="content"><div id="main-body"><div class="body-copy" id="content-block"><div id="slugline"><cite><span id="article-slug-jnl-abbr"><abbr class="slug-jnl-abbrev" title="British Journal of Ophthalmology"><abbrev-journal-title abbrev-type="publisher" xmlns:nlm="http://schema.highwire.org/NLM/Journal">Br J Ophthalmol</abbrev-journal-title></abbr> </span><span class="slug-pub-date">2003;</span><span class="slug-vol">87<span class="cit-sep cit-sep-after-article-vol">:</span></span><span class="slug-pages">1360-1362 </span><span class="slug-doi" title="10.1136/bjo.87.11.1360">doi:10.1136/bjo.87.11.1360 </span></cite></div><ul class="subject-headings"><li>Clinical science <ul class="subject-sub-headings last-child"><li>Extended reports</li>
</ul></li>
</ul><div class="article abstract-view" sizcache="11" sizset="0"><h1 id="article-title-1">Minimising the risk of prion transmission by contact tonometry</h1><div class="contributors" sizcache="10" sizset="0"><ol class="contributor-list" id="contrib-group-1"><li id="contrib-1"><span class="name"><a class="name-search" href="http://bjo.bmj.com/search?author1=S+Z+Amin&sortspec=date&submit=Submit" jquery1310221491031="57">S Z Amin</a></span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-1" id="xref-aff-1-1" jquery1310221491031="58">1</a>, </li>
<li id="contrib-2"><span class="name"><a class="name-search" href="http://bjo.bmj.com/search?author1=L+Smith&sortspec=date&submit=Submit" jquery1310221491031="59">L Smith</a></span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-2" id="xref-aff-2-1" jquery1310221491031="60">2</a>, </li>
<li id="contrib-3"><span class="name"><a class="name-search" href="http://bjo.bmj.com/search?author1=P+J+Luthert&sortspec=date&submit=Submit" jquery1310221491031="61">P J Luthert</a></span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-1" id="xref-aff-1-2" jquery1310221491031="62">1</a>, </li>
<li id="contrib-4"><span class="name"><a class="name-search" href="http://bjo.bmj.com/search?author1=M+E+Cheetham&sortspec=date&submit=Submit" jquery1310221491031="63">M E Cheetham</a></span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-1" id="xref-aff-1-3" jquery1310221491031="64">1</a>, </li>
<li id="contrib-5"><span class="name"><a class="name-search" href="http://bjo.bmj.com/search?author1=R+J+Buckley&sortspec=date&submit=Submit" jquery1310221491031="65">R J Buckley</a></span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-2" id="xref-aff-2-2" jquery1310221491031="66">2</a><span class="xref-sep">,</span><a class="xref-aff" href="http://bjo.bmj.com/content/87/11/1360.abstract#aff-3" id="xref-aff-3-1" jquery1310221491031="67">3</a></li>
</ol><div class="affiliation-list-reveal"><a class="view-more" href="http://bjo.bmj.com/content/87/11/1360.abstract#" jquery1310221491031="174">+</a> Author Affiliations</div><ol class="affiliation-list hideaffil"><li class="aff"><a href="" id="aff-1" jquery1310221491031="68" name="aff-1"></a><address><sup>1</sup>Institute of Ophthalmology, Department of Pathology, Bath Street, London EC1V 9EL, UK </address></li>
<li class="aff"><a href="" id="aff-2" jquery1310221491031="69" name="aff-2"></a><address><sup>2</sup>Moorfields Eye Hospital, City Road, London EC1V 2PD, UK </address></li>
<li class="aff"><a href="" id="aff-3" jquery1310221491031="70" name="aff-3"></a><address><sup>3</sup>Department of Optometry and Visual Science, City University, Northampton Square, London EC1V 0HB, UK </address></li>
</ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label"></span>Correspondence to: Professor R J Buckley 57A Wimpole Street, London W1G 8YP, UK; <a href="mailto:RJBcityaol.com" jquery1310221491031="71">mailto:RJBcityaol.com</a></li>
</ol><ul class="history-list"><li class="accepted" hwp:start="2003-03-03" xmlns:hwp="http://schema.highwire.org/Journal"><span class="accepted-label">Accepted </span>3 March 2003 </li>
</ul></div><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="p-1"><strong>Aims:</strong> The unknown prevalence of variant Creutzfeldt-Jakob disease (vCJD) in the UK population has led to fears of horizontal transmission through routine medical procedures. The potential risk of transmission via contact tonometry was examined. </div><div id="p-2"><strong>Methods:</strong> The total amount of protein carried over by tonometer tips after applanation of patients was assessed. </div><div id="p-3"><strong>Results:</strong> Tonometer tips had an inherent ability to carry proteinaceous material. There was a large variability in the load carried over between individual patients. Rinsing tonometer tips in water reduced protein carryover. Wiping the tonometer tips also reduced carriage, though less dramatically. </div><div id="p-4"><strong>Conclusion:</strong> There is a small theoretical risk of transmission of vCJD by contact tonometry through reuse, but this should be reduced if the prisms are washed and wiped. In the light of these findings a protocol for the management of reusable tonometer prisms is recommended. </div></div></div></div></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5753601295140907794.post-68410231351418779012011-07-09T06:43:00.000-07:002011-07-09T06:43:12.800-07:00Damage to Goldmann applanation tonometer tips:ACTA OPHTHALMOLOGICA<div id="banner" sizcache="1" sizset="3" style="background-image: url(http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1755-3768/asset/olbannerwallpaper.gif?v=1&s=f7633343c7f90212d0ee3e20535fd5c1eb120c84);" xmlns:ol="http://www.wiley.com/namespaces/ol/xsl-lib" xmlns="http://www.w3.org/1999/xhtml"><a href="" shape="rect" sizcache="1" sizset="3"><img class="center" src="http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1755-3768/asset/olbannercenter.gif?v=1&s=baf172706d8b0315485b0acf45bb6cfebe7a6ecc" /></a></div><div id="mainContent" sizcache="1" sizset="4"><div class="citation articleInformationHeader" id="titleMeta" sizcache="1" sizset="4" xmlns="http://www.w3.org/1999/xhtml"><div id="articleDesc" sizcache="1" sizset="4"><div embargounit="" id="articleTitle"><span class="freeAccess" title="You have full text access to this OnlineOpen article">You have full text access to this OnlineOpen article</span> <h1 class="articleTitle">Clinical alert: damage to Goldmann applanation tonometer tips</h1></div><div id="articleMeta"><ol id="authors"><li id="cr1"><span style="font-size: x-small;">Christoph Kniestedt</span><sup><span style="font-size: xx-small;">1,2,3,*</span></sup><span style="font-size: x-small;">, </span></li>
<li id="cr2"><span style="font-size: x-small;">Jörg Stürmer</span><sup><span style="font-size: xx-small;">3</span></sup><span style="font-size: x-small;">, </span></li>
<li id="cr3"><span style="font-size: x-small;">Robert L. Stamper</span><sup><span style="font-size: xx-small;">2</span></sup></li>
</ol><div id="publishedOnlineDate">Article first published online: 27 JAN 2005</div><div id="doi">DOI: 10.1111/j.1600-0420.2005.00360.x</div></div><div id="articleParent" sizcache="1" sizset="4"><div class="articleCategory">Issue </div><div class="journal" id="cover" sizcache="1" sizset="4"><div class="imgShadow" sizcache="1" sizset="4"><img alt="Acta Ophthalmologica Scandinavica" src="http://onlinelibrary.wiley.com/store/10.1111/aos.2005.83.issue-1/asset/cover.gif?v=1&s=af332667d1415290837efae9f43562c738ea362f" title="Acta Ophthalmologica Scandinavica" /></div></div><div id="metaData"><h2 id="productTitle">Acta Ophthalmologica Scandinavica</h2><div id="issueDetails"><div class="articleDetails"><a href="http://onlinelibrary.wiley.com/doi/10.1111/aos.2005.83.issue-1/issuetoc" shape="rect"><span id="volumeNumber"><strong><span style="color: #007e8b;">Volume 83</span></strong></span><span style="color: #007e8a;">, </span><span id="issueNumber"><strong><span style="color: #007e8b;">Issue 1</span></strong></span><span style="color: #007e8a;">, </span></a><span id="issuePages"><strong><span style="color: #007e8b;">pages 129–130</span></strong></span>, <span id="issueDate"><strong><span style="color: #007e8b;">February 2005</span></strong></span></div></div></div></div></div><div id="additionalInformation"><div class="articleCategory">Additional Information<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#" jquery1310218792281="20"><span style="color: #007e8a;">(Show All)</span></a></div><div id="toggleAddInfo"><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#" jquery1310218792281="15">How to Cite</a><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#" jquery1310218792281="17">Author Information</a><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#" jquery1310218792281="19">Publication History</a></div><div style="clear: left;"><div id="howToCite" jquery1310218792281="14"><h4>How to Cite</h4><div id="citation">Kniestedt, C., Stürmer, J. and Stamper, R. L. (2005), Clinical alert: damage to Goldmann applanation tonometer tips. Acta Ophthalmologica Scandinavica, 83: 129–130. doi: 10.1111/j.1600-0420.2005.00360.x</div></div><div id="authorsDetail" jquery1310218792281="16"><h4>Author Information</h4><ol id="authorsAffiliations"><li class="affiliation"><sup>1</sup> Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland</li>
<li class="affiliation"><sup>2</sup> Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA</li>
<li class="affiliation"><sup>3</sup> Department of Ophthalmology, Cantonal Hospital Winterthur, Winterthur, Switzerland</li>
</ol><div id="correspondence">*Correspondence: Christoph Kniestedt, </div><div id="correspondence">*Correspondence: Christoph Kniestedt MD Cantonal Hospital Winterthur Brauerstrasse 15 8400 Winterthur Switzerland Tel: +41 52 266 39 62 Fax: + 41 52 266 45 11 Email: <!--TODO: clickthrough URL--><a href="mailto:Christoph@Kniestedt.ch" shape="rect" title="Link to email address"><span style="color: #007e8a;">Christoph@Kniestedt.ch</span></a></div></div><ul id="footnotes"><span style="color: #007e8a;"></span></ul><div id="publicationHistoryDetails" jquery1310218792281="18"><h4>Publication History</h4><ol><li>Issue published online: 16 FEB 2005 </li>
<li>Article first published online: 27 JAN 2005</li>
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</ul></div><div class="viewFullArticleAndPdf" xmlns:doc="urn://wiley-online-library/content/document" xmlns:ol="http://www.wiley.com/namespaces/ol/xsl-lib" xmlns="http://www.w3.org/1999/xhtml"><div class="viewFullArticleAndPdfOptions"><a class="pdfLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/pdf" shape="rect" title="Article in pdf format"><strong><span style="color: #007e8a; font-size: x-small;">Get PDF (588K)</span></strong></a></div></div><div id="fulltext" sizcache="12" sizset="0" xmlns="http://www.w3.org/1999/xhtml"><div class="section" id="s1-1" sizcache="12" sizset="0"><div class="para">Sir,</div><div class="para">When Goldmann first presented his new applanation tonometer in 1955, he emphasized that cross-infection by corneal contact with the methylmethacrylate-covered biprism might occur and that appropriate disinfection should be carried out (<a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b1" jquery1310218792281="3" rel="references:#b1" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Goldmann 1955</span></a>).</div><div class="para"><a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b6" jquery1310218792281="4" rel="references:#b6" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Schmidt & Lebek 1971</span></a> recommended soaking the tip in 5% formaldehyde as the safest procedure for the tip with the highest efficacy of pathogen elimination. In the mid-1980s, as evidence emerged that HIV may be found in human tears and conjunctival and corneal epithelium and after the successful lacrimal isolation of HBV, HCV, HSV and adenoviruses, more aggressive disinfection methods were warranted. Guidelines were established to address the disinfection issue without paying much attention to longterm effects on the tonometer tip. Soaking the tonometer head for 5 minutes in 3% hydrogen peroxide, 0.5% sodium hypochlorite or 70% isopropyl alcohol meets the guidelines published by the <a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b3" jquery1310218792281="5" rel="references:#b3" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Center for Disease Control and Prevention (CDC) (1985</span></a>) and the American Academy of Ophthalmology (AAO) (<a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b4" jquery1310218792281="6" rel="references:#b4" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Lichter 1989</span></a>). However, wiping the tip with a 70% isopropyl alcohol swab is also described as being as effective in virus elimination as disinfectant immersion (<a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b5" jquery1310218792281="7" rel="references:#b5" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Smith & Pepose 1999</span></a>).</div><div class="para">Our institutions are currently soaking tonometer tips once a day in 0.5% sodium hypochlorite solution for 15 minutes. Between patients, the tonometer tips are wiped with 70% isopropyl alcohol swabs. After noticing that one of our tonometer tips was cracked and distorted, we examined all remaining tips. Those that had been in use for a year or more showed some combination of sharply broken or roughened rim edges and cracked applanation surfaces. Relatively new tips showed such cracks only on the surface. As the tips aged, the cracks expanded to the rim, where a crumbled appearance was noted (<a class="figureLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#f1" rel="references:#f1 #f2" shape="rect" title="Link to figures"><span style="color: #007e8a;">Figs 1 and 2</span></a>). In order to achieve a smooth alignment of the two fluorescein hemirings and an accurate pressure reading, an evenly distributed tear film along the biprism margin is crucial (<a class="referenceLink" href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#b9" jquery1310218792281="8" rel="references:#b9" shape="rect" title="Link to bibliographic citation"><span style="color: #007e8a;">Goldmann & Schmidt 1957</span></a>). Obtaining appropriate fluorescein distribution around the applanation area (and thus reliable pressure readings) with a damaged tip is questionable. The accuracy of the Goldmann applanation tonometer (GAT) could be at least as dependent on the tip's shape as on corneal thickness.</div><div class="figure hh" id="f1" sizcache="12" sizset="0"><div class="caption" id="f1_caption"><span class="label"><strong>Figure 1. </strong></span>Rim view of a brand new GAT tip.<br />
<div class="downloadToPowerpoint"><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/figure.pptx?figureAssetHref=image_n/AOS_360_f1.gif" shape="rect"><span style="color: #007e8a;">Download figure to PowerPoint</span></a></div></div><a class="figZoom" href="http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00360.x/asset/image_n/AOS_360_f1.gif?v=1&t=gpwmfvtn&s=811cc105c87c685b492fbc9ed3685dc2996c3a47" jquery1310218792281="1" shape="rect" sizcache="12" sizset="0" title="Link to full-size figure"><span style="color: #007e8a;"><img alt="image" id="f1_img" src="http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00360.x/asset/image_t/AOS_360_f1_thumb.gif?v=1&t=gpwmfvto&s=846ad8e472af1ca63b577295af838689b0a7a591" /></span></a></div><div class="figure hh" id="f2" sizcache="12" sizset="1"><div class="caption" id="f2_caption"><span class="label"><strong>Figure 2. </strong></span>Used GAT tip) approximately 2 years old, showing cracked surface area with a sharply broken rim. Original magnification × 40.<br />
<div class="downloadToPowerpoint"><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/figure.pptx?figureAssetHref=image_n/AOS_360_f2.gif" shape="rect"><span style="color: #007e8a;">Download figure to PowerPoint</span></a></div></div><a class="figZoom" href="http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00360.x/asset/image_n/AOS_360_f2.gif?v=1&t=gpwmfvtp&s=dc10f129c07dce37e25254914d9d43e082533fc4" jquery1310218792281="2" shape="rect" sizcache="12" sizset="1" title="Link to full-size figure"><span style="color: #007e8a;"><img alt="image" id="f2_img" src="http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00360.x/asset/image_t/AOS_360_f2_thumb.gif?v=1&t=gpwmfvtq&s=31b958d5fbd83d6debf7b06beacad734b7c99066" /></span></a></div><div class="para">In addition, formation of cracks might allow the disinfectant to get into the interior of the surface of the tip. These cracks might irritate the cornea while tonometry is taking place or even cause a corneal abrasion.</div><div class="para">Moreover, cracked tips may harbour virulent microbes that are difficult to eradicate during disinfection and represent potential risks for cross-infection. Even a microdamaged tip may injure corneal epithelium enough to make it more susceptible to corneal infection. The damage noted could be due to mechanical abrasion from the alcohol swabs, soaking the tips in the sodium hypochlorite solution or some combination of both. Whatever the cause, these observations strongly suggest that GAT tip damage could be a source of inaccuracy in intraocular pressure readings and may present a potential safety hazard. We recommend checking the GAT tips at the slit-lamp microscope on a regular basis and replacing those that show significant damage.</div></div><div class="section" id="ss1"><div class="headingCont"><select class="jumpSelect" jquery1310218792281="22" style="visibility: visible; width: 144px;"><option jquery1310218792281="24" value="jumpTo">Jump to…</option><option jquery1310218792281="26" value="#leftBorder">Top of page</option><option jquery1310218792281="28" value="#ss1">Acknowledgement</option><option jquery1310218792281="30" value="#ss2">References</option></select> <h3>Acknowledgement</h3></div><ol class="jumpList" jquery1310218792281="31" style="display: none;"><li><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#leftBorder" shape="rect"><span style="color: #007e8a;">Top of page</span></a> </li>
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</ol><div class="para">The authors are financially supported by the Swiss National Fond, Bern and the Alfred Vogt Fund, Zurich, Switzerland.</div></div><div class="bibliography" id="ss2"><div class="headingCont"><select class="jumpSelect" jquery1310218792281="32" style="visibility: visible; width: 144px;"><option jquery1310218792281="33" value="jumpTo">Jump to…</option><option jquery1310218792281="34" value="#leftBorder">Top of page</option><option jquery1310218792281="35" value="#ss1">Acknowledgement</option><option jquery1310218792281="36" value="#ss2">References</option></select> <h3>References</h3></div><ol class="jumpList" jquery1310218792281="37" style="display: none;"><li><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00360.x/full#leftBorder" shape="rect"><span style="color: #007e8a;">Top of page</span></a> </li>
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