Regulators in the US and elsewhere have increasingly cited clinics for not applying high-level disinfection to Goldmann tonometer tips, gonioscopy lenses, laser lenses and similar devices. A task force of ophthalmic societies reviewed the evidence and surveyed more than 1,000 ophthalmologists. The resulting policy statement was approved by the American Academy of Ophthalmology board and endorsed by four subspecialty societies.
The task force found no published evidence that these devices transmit sight-threatening infection, or that high-level disinfection reduces transmission compared with lower-level methods. Most respondents used alcohol wipes for tonometer tips and alcohol or soap and water for lenses. Reported transmission was very rare and mostly self-limiting adenoviral conjunctivitis, while many using chemical high-level disinfection reported ocular surface toxicity and damaged devices. The paper argues that the Spaulding classification wrongly groups the ocular surface with heavily contaminated mucous membranes.
The position is that high-level disinfection should be discretionary, for example after use on a patient with suspected infection, rather than routine. It is a professional position paper, not a regulatory change, so clinics must still meet whatever their local regulator or accreditation body currently requires.
- Follow your current local regulatory and accreditation requirements; this paper does not change them.
- Clean devices thoroughly between patients with the method your policy specifies.
- Apply enhanced disinfection after use on any patient with suspected adenoviral or other infection.
- Check for chemical residue on devices after high-level disinfection to avoid surface toxicity.
- Inspect tonometer tips and lenses regularly for damage from repeated chemical exposure.
Why it matters
Routine chemical disinfection carries its own harms to patients and devices without evidence that it prevents infection.
Don't overread it
A professional position paper is not a change in regulation; local requirements still apply.
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