Eyeworld

24 | EYEWORLD | WINTER 2026 ASCRS NEWS EYESUSTAIN UPDATE by David F. Chang, MD, and Irene C. Kuo, MD heavily contaminated mucous membranes such as those lining the bronchi, anus, and vagina. Adhering to this classification system, advisory and regulatory agencies categorize devices that contact the ocular surface as semi-critical items that require HLD or sterilization. We became aware of one ambulatory sur- gery center cited by CMS for deficient Nd:YAG laser lens disinfection that was required to notify every potentially exposed patient about a "safety breach." As a result, facilities have had to purchase multiple additional tonometry tips and diagnostic or laser contact lenses to enable autoclaving or chemical disinfection after each use. To maintain clinic efficiency, other facilities employ the wasteful practice of using dispos- able gonio lenses and tonometry tips that are discarded after a single use. To address this issue, EyeSustain convened a multisociety HLD Task Force with represen- tatives from ASCRS, the American Academy of Ophthalmology (AAO), American Glaucoma Society (AGS), American Society of Retina ASCRS endorses multisociety position statement arguing against mandatory high-level disinfection for ophthalmic diagnostic devices continued on page 28 Ophthalmologists routinely reuse tonometry tips, gonioscopy lenses, and laser contact lenses between patients. What method of disinfection is actually necessary to protect our patients? In this EyeSustain Update, David F. Chang, MD, and Irene C. Kuo, MD, discuss the evidence behind current reprocessing practices, findings from a recent multisociety survey of more than 1,000 ophthalmologists, and a newly released po- sition statement endorsed by five major ophthal- mic societies. This position statement is critical in encouraging regulatory bodies and other orga- nizations that mandate high-level disinfection (HLD) to reconsider these requirements and allow ophthalmologists to use appropriate clinical judg- ment in selecting safe, evidence-based reprocessing methods for these commonly used devices. —Emily Schehlein, MD EyeSustain Update Guest Editor R egulatory and accrediting organiza- tions such as The Joint Commission and the Centers for Medicare & Medicaid Services (CMS) are in- creasingly citing clinics and surgical facilities for inadequate disinfection of tonom- etry tips, diagnostic (e.g., gonio) lenses, and laser (e.g., Nd:YAG) contact lenses after each use. As a result, many facilities are required to perform high-level disinfection (HLD) of these ophthalmic devices that contact the ocular surface between patient encounters. Interna- tional regulatory agencies, such as in Western Europe, are also citing facilities for not routinely reprocessing devices with HLD. This mandate for HLD is based on a nearly century-old system devised to categorize the level of disinfection needed for reusable medical devices, based on the estimated risk of infection transmission to the next patient. However, given that the Spaulding classification system was developed prior to the advent of modern ophthalmic equip- ment and has never been updated, it categorizes the ocular surface as being of comparable risk to Requiring routine HLD for these reusable devices therefore imposes substantial and unnecessary burdens, including increased costs, reduced clinical efficiency and productivity, and greater chemical and plastic waste.

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