Eyeworld

12 | EYEWORLD | SUMMER 2026 ASCRS NEWS continued from page 10 goniolenses, and poor adherence to chemical high-level disinfection (HLD) protocols. Each workaround carries its own financial, environ- mental, and clinical costs while leaving the underlying contamination risk unaddressed. To close this gap in the standard of eyecare, we developed and validated the Saniteyes (Drop Mate) automated high-level disinfection system in a recent peer-reviewed study published in Ophthalmology. 2 This gap is most apparent with multi-dose eyedropper bottles, for which no validated method of disinfection between patients has previously existed. Microbial cultures show growth on 7–94% of eye dropper nozzles within 2 weeks of clinical use, yielding Staphylococcus aureus, Pseudomonas aeruginosa, Escherich- ia coli, viruses, and fungi. 3,4 These organisms mirror the normal flora of the conjunctiva and periocular skin, suggesting inadvertent con- tact between the nozzle and patients' ocular surfaces or provider hands. 5,6 In the absence of a validated disinfection method, this contami- nation risk has prompted many institutions to adopt self-imposed use cessation dates (SUCDs) of 1–28 days. A 2024 study found that SUCD adherence results in premature disposal of 72% of total medication volume, adding $81,000 per year in pharmaceutical waste at a single large academic practice. 7 SUCDs do not eliminate contamination risk, which can occur at any point during use. Date-based disposal is neither an evidence-based infection control measure nor a justifiable sustainability practice. The clinical impact of this contamination may extend beyond the risk of overt infection, which remains low. Repeated low-grade micro- bial transfer between patients is a plausible and underappreciated contributor to disruption of the ocular surface microbiome. This alteration is known as ocular dysbiosis and is increasingly linked to dry eye disease, meibomian gland dys- function, and chronic inflammation—conditions that destabilize the tear film, affect refractive outcomes, and cause patient pain and discom- fort. 8 Because dysbiosis develops gradually and is rarely traced to a specific exposure, its contri- bution to the growing burden of ocular surface disease largely goes unexamined. The disinfection gap is only marginal- ly better for semi-critical devices. The Joint Commission reinforced HLD mandates in 2019 for tonometer tips, goniolenses, and laser lenses following outbreaks of epidemic kerato- conjunctivitis and herpes simplex virus in eye clinics. 9 However, surveys show that fewer than 10% of practices use chemical HLD methods such as bleach, hydrogen peroxide, or glutar- aldehyde-free (0.55% ortho-phthalaldehyde) high-level disinfecting solution. These protocols require up to 10 minutes of technician time, carry a risk of iatrogenic corneal toxicity if not rinsed properly, degrade plastic and adhesives over time, and lack standardization across reg- ulators, manufacturers, and societies. 10 Rather than comply, many large institutions have transitioned to single-use disposable prisms and goniolenses. This shift can generate more than 110 kg of plastic waste annually from a single outpatient department and cost a large institu- tion more than a million dollars per decade. 11,12 The Saniteyes automated HLD system was designed to close these gaps within a single platform. It delivers germicidal ultraviolet-C (UVC) irradiation between 254–280 nm within three enclosed disinfection bays, complet- ing an automated cycle in 5 minutes without chemicals, rinsing, or workflow disruption. UVC cannot penetrate polyethylene, glass, or other ophthalmic bottle materials, leaving drug formulations unaffected. In our validation study, independent testing following ASTM standards demonstrated greater than 6-log reduction of bacteria and fungi and greater than 4-log reduction of viruses including adenovirus in both carrier and simulated use tests. All tested devices passed, including eye dropper bottles, applanation prisms, goniolenses, and YAG/SLT laser lenses from various manufacturers. 2 Deployment across 80 lanes at Stanford Health Care this summer will provide an insti- tutional case study of point-of-care UVC HLD at scale. This technology represents a meaningful step forward in the standard of care and re- solves the competing demands of patient safety, workflow efficiency, and sustainability. References (continued) 7. Tan JM, et al. Ophthalmic drop waste due to self-imposed use cessation dates. Ophthalmology. 2024;131:1345–1347. 8. Tariq F, et al. The ocular sur- face microbiome in homeostasis and dysbiosis. Microorganisms. 2025;13:1992. 9. Disinfection of tonometers and other ophthalmology devices. Joint Commission Quick Safety Newsletter. Issue 49, May 2019. 10. Junk AK, et al. Current trends in tonometry and tonometer tip disinfection. J Glaucoma. 2020;29:507–512. 11. Park EA, LaMattina KC. Economic and environmental impact of single-use plastics at a large ophthalmology outpatient service. J Glaucoma. 2020;29:1179–1183. 12. Akhtar AO, et al. A systematic review and cost-effectiveness analysis of tonometer disinfec- tion methods. Can J Ophthalmol. 2014;49:345–350. Relevant disclosures Shankar: Drop Mate Contact Shankar: vshankar@dropmatemed.com This technology … resolves the competing demands of patient safety, workflow efficiency, and sustainability.

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