Regulators in the United States and elsewhere are increasingly citing clinics for not using high-level disinfection on applanation tonometer tips, gonioscopy lenses, laser lenses and similar reusable devices. A multisociety task force reviewed the question and found no published evidence that these devices transmit sight-threatening infection, or that high-level disinfection lowers transmission compared with lower-level methods.
Its survey of more than 1,000 ophthalmologists found alcohol wiping most common for tonometer tips and alcohol wiping or soap and water for lenses. Many who used chemical disinfection reported ocular surface toxicity or device damage. Reported transmission was exceedingly rare and generally limited to self-limited adenoviral conjunctivitis. The task force agreed with the 88% of respondents who said high-level disinfection should not be required routinely, and kept it as a discretionary step in higher-risk circumstances such as after use in patients with suspected infection.
The statement was approved by the American Academy of Ophthalmology Board of Trustees and endorsed by four subspecialty societies. It is a position paper and does not change what a regulator or local infection-control policy requires. Follow your own jurisdiction's rules until they change.
- The task force found no published evidence that these devices transmit sight-threatening infection.
- Reported transmission was rare and generally self-limited adenoviral conjunctivitis.
- Chemical disinfection was reported to cause ocular surface toxicity and device damage.
- It proposes high-level disinfection as discretionary after use in suspected infection.
- Local regulations and infection-control policy still apply.
Why it matters
Clinics are being asked to adopt a costly step that the specialty says is unsupported by evidence.
Don't overread it
A position paper based on a literature search and survey does not change regulation, and adenovirus risk still justifies care with suspected infection.
The statistics, in plain English
A survey of clinicians shows what they do and have noticed, not what is true. Absence of published transmission is not proof of safety, but the authors found no evidence either that stronger disinfection reduces infection.
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