The College of Optometrists

The re-use of contact lenses and ophthalmic devices

B63
If an instrument has been used on a patient it must be disinfected or sterilised.
B64
There is a remote theoretical risk, identified by the Department of Health (DH), of transmitting prion proteins, which are associated with transmissible spongiform encephalopathies (TSEs) and are implicated in Creutzfeldt-Jakob Disease (CJD) and variant CJD (vCJD), through re-useable ophthalmic devices and trial contact lenses. However, there is no evidence that this has occurred,164 and this risk has been questioned.165 The anterior eye has been designated as low risk.164  
B65
You should follow the advice of your local infection control team if available. If this is not available:
  • You should use single patient use lenses and devices contacting the surface of the eye where practicable.
  • You should not re-use a lens or device that is intended by the manufacturer for single use.
  • When single use lenses and devices are not practicable, you should:
    • balance the benefits that patients receive from contact lenses and ophthalmic devices against the transmission of disease, and
    • apply appropriate decontamination procedures. These should include the use of sodium hypochlorite solution where possible, see para B61.164

 

Definitions of contact lenses

B66
You should note these definitions of contact lenses:
  1. trial contact lens: a lens that is used to assess fitting following which it is either disposed of by the clinician or dispensed to the patient. Currently the majority of contact lens patients are fitted with single patient use lenses of various types
  2. special complex lens: a lens used by the clinician to assess performance of the design on the eye, which may be necessary where there is disease or abnormality of the lid, cornea or ocular surface. These lenses may be re-used.
B67
The above definitions can apply to the following categories of lenses:
  1. hydrogel lenses
  2. silicone hydrogel lenses
  3. hybrid lenses, and
  4. rigid lenses, including:
    • corneal
    • sclera
    • scleral shells, and
    • ocular prostheses.
B68
Special complex lenses may be of any type. If you use these lenses you should:
  1. use them only within your premises and they must be under your control or that of another clinician at all times
  2. carry out appropriate decontamination
  3. keep full records to show the usage of each lens, and
  4. inform the patient of the risks and benefits associated with contact lens fitting. See section on Fitting contact lenses.

Definitions of ophthalmic devices

B69
An ophthalmic device is any instrument which comes into contact with the ocular surface, including:
  1. tonometer
  2. contact pachymeter
  3. gonioscope, or
  4. other lens to aid diagnosis of disease.
B70
Where it is practicable you should use single use devices, such as disposable tonometer heads or tips.
B71
Some devices are not able to withstand decontamination: in these cases you should use your professional judgement, bearing in mind that undetected disease may have sight- or life-threatening consequences.
B72
You must explain to the patient the risks and benefits of re-using a device.

 

How to decontaminate

B73
The following advice reduces the potential risk of iatrogenic transmission of CJD/vCJD via contact devices.
B74
You should not use alcohol wipes alone to decontaminate contact devices as they are ineffective against many organisms, and may fix prion proteins to the surface of the instrument.164
B75
Prion proteins adhere strongly to materials including smooth surfaces. You should ensure that the device is thoroughly cleaned to remove adhered debris as the potential for the transmission of cellular and proteinaceous debris via tonometer prisms has been demonstrated.166, 167
B76
You must not use agents or procedures capable of binding proteins to surfaces e.g. isopropyl alcohol, glutaraldehyde or autoclaving, unless you decontaminate devices first, following the process outlined in para B78-B79
B77
You should use 1% sodium hypochlorite solution to decontaminate. The concentration advised has been reduced to a level which is:164 
  1. appropriate for inactivating infectious agents such as bacteria and viruses, and
  2. less harmful to the eye than stronger concentrations if it accidentally comes into contact with it.
B78
You need the following equipment for decontamination of contact lenses or ophthalmic devices:
  1. water for irrigation BP, or sterile normal saline
  2. cleaning solution, such as liquid soap or detergent, and
  3. sodium hypochlorite solution 1% (10,000 ppm of available chlorine).
B79
You should follow this process to decontaminate contact lenses or an ophthalmic device:

StepACDP TSE WG, 2011 recommendation164Notes
When to decontaminate immediately after use immediately decontaminate the item, and if this is not possible, keep it in a container of water for irrigation BP or sterile normal saline, until it can be decontaminated.
Do not dry do not allow to dry  
Rinse in water for irrigation BP/sterile normal saline for at least 30 sec  
Clean rubbing with liquid soap or detergent thoroughly clean the item (including by rubbing) to remove cellular debris and adherent protein
Decontaminate using sodium hypochlorite
1% (10,000 ppm of available chlorine) for 10 min

decontaminate it by using sodium hypochlorite
Rinse in water for irrigation BP/sterile normal saline for at least 10 min with 3 changes of water/saline thoroughly rinse off the sodium hypochlorite, which is toxic to the eye, before re-use
Dry shake off excess, dry with tissue, re-use immediately or store dry return the item to its dedicated case, if it has one
Further steps if necessary, since hypochlorite is not effective against all spores or cysts follow with conventional disinfection

References

164 Managing CJD/vCJD risk in ophthalmology Annex L In: Department of Health. Advisory Committee on Dangerous Pathogens Transmissible Spongiform Encephalopathy (ACDP TSE) Risk Management Subgroup (2011) Guidance on prevention of CJD and vCJD [Accessed 2 Nov 2017]
165  Buckley R (2010) Decontamination. Optometry in Practice 11(1), 25-29 [Accessed 15 Nov 2017]
166 For cellular debris: Lim R, Dhillon B, Kurian KM et al (2003) Retention of corneal epithelial cells following Goldmann tonometry: implications for CJD risk. British Journal of Ophthalmology 87(5), 583-586
167 For proteinaceous debris: Amin SZ, Smith L, Luthert PJ et al (2003) Minimising the risk of prion transmission by contact tonometry. British Journal of Ophthalmology 87(11), 1360-1362

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