A Systematic Review Regarding Tonometry and the Transmission of Infectious Diseases

Abstract

Tonometry has been identified as a common method for measuring the intraocular pressure in patients. The direct contact between the tonometer and the eye may contribute to the risk of cross infection, especially of viral particles, from one patient to another. A systematic review was undertaken to address the likelihood of human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and prion diseases transmission through the use of tonometers. Additionally, a comparison of the current tonometer disinfection methods is provided to assist with identifying which technique effectively reduces the risk of disease transmission. An electronic literature search was conducted using the following databases: Web of Science, EMBASE, CINAHL, SCOPUS, Biosis Previews, Cochrane Library, PubMed, and Google Scholar. Dissertation indexes were also searched, and these included: Dissertations and Abstracts, and Dissertations and Abstracts - UK/Ireland. Additionally, the Clinicaltrials.gov trial registry was searched to identify any other relevant literature. Two independent reviewers critically appraised the articles retrieved through the literature search. In total, 11 unique studies were deemed relevant for this systematic review. The available evidence demonstrated that the use of tonometers contributes to the transmission of these infectious diseases in vitro. The results also demonstrated variability in determining the most effective tonometer sterilization technique against these infectious diseases in vitro. There was limited evidence available regarding the transmission of HIV, hepatitis B, hepatitis C, and prion diseases through the use of tonometers. Additionally, due to the variability regarding the most effective sterilization techniques, it is difficult to identify which sterilization technique is most effective or adequately effective against these infectious diseases. Future research studies regarding infectious disease transmission through tonometry and sterilization techniques should be completed to more adequately inform infectious disease control guidelines.

Review of Hygiene and Disinfection Recommendations for Outpatient Glaucoma Care: A COVID Era Update

“…Previous studies have reported that applanation tonometry has the potential to transmit a variety of infectious agents, including adenovirus 8 and herpes simplex virus 1, and reusable tonometer prisms could, in theory, be a mode of transmission for hepatitis B, hepatitis C, human immunodeficiency virus, and Creutzfeldt-Jakob disease. [31][32][33][34][35][36][37] A systematic review of 11 studies assessing the disinfection of Goldmann tonometers concluded that there is no definitive optimal technique or agent for the disinfection of Goldmann applanation tonometer prisms. 30,33 The AAO supports the use of diluted bleach for the disinfection of reusable tonometer tips for SARS-CoV-2 and adenovirus.…”

“…[31][32][33][34][35][36][37] A systematic review of 11 studies assessing the disinfection of Goldmann tonometers concluded that there is no definitive optimal technique or agent for the disinfection of Goldmann applanation tonometer prisms. 30,33 The AAO supports the use of diluted bleach for the disinfection of reusable tonometer tips for SARS-CoV-2 and adenovirus. If available, single use, disposable tonometer prisms provide an alternative to reusable prisms to prevent cross-contamination.…”

Prions and prion diseases: Insights from the eye

“…The presence of PrP Sc in dust particles, grass blades, and water reservoirs have prompted studies on peripheral routes of entry from the conjunctiva with positive results (Gough et al, 2015). Thus, the eye is a source of PrP Sc transmission, all be it at a much slower state (Atkins et al, 2018;Gnanajothy et al, 2013). This is an important question since horizontal spread of animal prions through corneal abrasions is a distinct possibility (Asthana et al, 2017).…”

Comparative assessment of the goldmann applanation and noncontact tonometers in intraocular pressure measurements in a sample of glaucoma patients in the Cape Coast Metropolis, Ghana

“… 7 It has also been found to pose a lower risk of cross-infection. 10 Unlike the GAT which has to be used whiles mounted on a slit lamp, the NCT exists in table-top and portable forms. 9 …”