Eyeworld

28 | EYEWORLD | WINTER 2026 ASCRS NEWS Specialists (ASRS), and the Outpatient Ophthal- mic Surgery Society (OOSS). Co-chaired by the two of us, the HLD Task Force thought it was important to conduct a survey to better under- stand and document ophthalmologists' current practices and their opinions about reprocessing tonometry tips and diagnostic and laser contact lenses. Each of the participating societies was asked to share the link to this online survey with their members, and more than 1,000 ophthal- mologists completed the entire questionnaire. The results of the survey were published in the October issue of the Journal of Cataract and Refractive Surgery. 1 Most respondents (73%) wiped tonometry tips with an alcohol swab or pad. More than 80% of respondents used either an alcohol wipe or swab or a combination of soap and water for laser and diagnostic lenses. The HLD Task Force survey also asked respondents to report in an anonymous manner how often they had observed infections that they thought were transmitted by these devic- es. Although survey data are not equivalent to prospective scientific evidence, it was notable that 99% of respondents reported never having observed an infection transmitted by applana- tion tonometry or by diagnostic or laser contact lens use, consistent with a very low risk of infection transmission. The few reported infec- tions involved isolated, self-limited adenovirus conjunctivitis. These findings were particularly important and reassuring because any recom- mendation regarding device reprocessing must prioritize patient safety. Tonometry tips have commonly been im- plicated by non-ophthalmic personnel investi- gating outbreaks. However, without genotypic analysis, they have not been proven to be the source of infection arising in outpatient care. Adenovirus circulates in the community and survives on fomites as well as the hands of patients, staff, and doctors. Assuming ophthal- mic equipment to be the cause of a nosocomial infection could be incorrect for this reason. Despite low reported adoption of HLD, about 20% of respondents reported having observed direct ocular surface chemical injury from use of HLD on these devices. In totality, these reports suggest that HLD-related ocular surface toxicity could pose a more tangible clinical risk than the hypothetical benefit of reducing microbial cross-contamination. After reviewing the literature and survey results, the HLD Task Force reached consensus on several conclusions, which were summarized in a multisociety position statement released on October 1, 2026. There is no evidence that sight-threatening infections are transmitted by these devices that contact the ocular surface. There also is no evidence that HLD reduces infection transmission compared with the most commonly used reprocessing methods—alcohol wiping for tonometry tips, and either alcohol wiping or soap and water for diagnostic and laser contact lenses. 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. In addition, chemical soaking agents, such as dilute bleach, have been associated with ocular surface toxicity and can damage the de- vice surfaces, potentially affecting patient care. The five major ophthalmic societies repre- sented on the Task Force formally endorsed this position statement, which calls on regulatory agencies, accrediting organizations, manufac- turers, and other policymakers to revise current requirements mandating routine HLD repro- cessing for these common reusable ophthalmic devices, and to instead allow greater physi- cian discretion in selecting the most clinically appropriate reprocessing method. Apart from higher-risk situations, such as for patients with signs and symptoms of possible ocular surface infection, current evidence supports neither the benefit nor the necessity of routine HLD for tonometry tips, A- and B-scan ultrasound probes, or diagnostic or laser contact lenses. The position statement is posted on the ASCRS website, as well as on the EyeSustain website, www.eyesustain.org, under "Position Papers." Editors' note: The HLD Task Force is co-chaired by David F. Chang, MD, and Irene C. Kuo, MD, and includes Sarah W. DeParis, MD, Jacob D. Grodsky, MD, Eliesa A. Ing, MD, Francis S. Mah, MD, Nick Mamalis, MD, Mahsaw Mansoor, MD, Cathleen M. McCabe, MD, Michael X. Repka, MD, MBA, Alan L. Robin, MD, Emily M. Schehlein, MD, Oliver D. Schein, MD, MPH, MBA, and Aakriti G. Shukla, MD. continued from page 24 Reference 1. Chang DF, et al. Current practice patterns for cleaning tonometry tips and diagnostic or laser lenses. J Cataract Refract Surg. 2026;52:959–964.

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