1. 9. Juni 2016HS-Präsentation1 Tonometer Prisms Disposable versus reusable

2. 9. Juni 2016HS-Präsentation2 Contents Goldmann measuring prisms Clinical research Tonosafe Workshop Tonosafe Quiz Not for sale in the US

3. Critical questions regarding prisms 9. Juni 2016HS-Präsentation3 How many measuring prisms do you have in your department? How old are they? What condition are they in? How often are they checked or audited? How often are they replaced? Do you “use them, till you loose them – then replace them”?

4. Most common problems regarding prisms 9. Juni 2016HS-Präsentation4 Scratches on contact surface Sharp edges on contact surface Damaged edges Cracks Leaks Defective filling Contamination Age of the prism

5. 9. Juni 2016HS-Präsentation5 Most common problems regarding prisms The surface of the prism which is in contact with the human eye is destroyed. Why? Wrong disinfectant Use of alcohol or acetone!

6. 9. Juni 2016HS-Präsentation6 Most common problems regarding prisms The protective glass of the prism is broken off. Why? Build of pressure inside the housing. Great differences in temperature mostly trough use of alcohol.

7. 9. Juni 2016HS-Präsentation7 Most common problems regarding prisms The conical part of the prism is full of cracks. The filling is defective. Why? Mechanical effect from outside Age of the prism. (In this specific case the prism is to old)

8. 9. Juni 2016HS-Präsentation8 Most common problems regarding prisms The prism filling is damaged resulting in a leaky prism. Why? Improper handling of the prism. (Refer to the instructions for use)

9. 9. Juni 2016HS-Präsentation9 Life span of Haag-Streit applanation tonometer prisms Though having a life span of 5 years, the prism should have a maximum usable period of two years!

10. Disinfection of Goldmann tonometer prisms – current practice 9. Juni 2016HS-Präsentation10 Since mid of 2010 the HAAG-STREIT Measuring Prisms are delivered in a box containing the instructions for use with general information, a table of disinfectants and a process sheet on how to disinfect the prism. The latest table of disinfectants as well as the process sheet are available at: www.haag-streit.com

11. 9. Juni 2016HS-Präsentation11 Disinfection of Goldmann tonometer prisms The following slide shows a list of those disinfectants which HAAG- STREIT have tested & approved. The disinfection list can be found at: www.haag-streit.com We do not accept responsibility for damage caused by the use of other disinfectants.

12. 9. Juni 2016HS-Präsentation12 List of recommended disinfectants HAAG-STREIT recommends the following disinfectants for use with the measuring prisms: Sodium Hypochlorite Sodium Hydroxide Hydrogen Peroxide Acrylan Almyrol ® Cidex ® plus Dakin's Solution Deconex 53 Instrument Deconex 53 Plus Endo Septol FF Gigasept ® AF Gigasept ® AF forte Gigasept ® FF NEW Hibitane ® Jiaen 6% "Yoshida" Mucocit ® -T NU-CIDEX ® PeraSafe ® Peraxylens ® Perfektan ® TB Sekusept ® Activ Sekusept ® Activ NEW Sekusept ® forte S Sekusept ® PLUS Stabimed ® Sterihyde ® L Find out more about the concentration in the disinfectant list at: www.haag-streit.com www.haag-streit.com

13. 9. Juni 2016HS-Präsentation13 How to disinfect Goldmann tonometer prisms HAAG-STREIT recommends the use of a disinfecting process sheet which is available in seven languages at: www.haag-streit.com

14. 9. Juni 2016HS-Präsentation14 Issues regarding reusable measuring prisms? In many countries strict guide lines regarding disinfection procedures of reusable measuring prisms have been issued by the government. These guidelines are difficult to adhere to in routine practice due to the procedures involved and time needed for effective disinfection. As discussed, general use and the disinfection process slowly destroys prisms by producing ‘tension rip’ damage, making them liable to provide inaccurate readings, along with the possibility of infecting and damaging the patients’ eyes.

15. 9. Juni 2016HS-Präsentation15 Checking service offered by “company name” “company name” is now offering a new FREE Goldmann prism checking service: Our fully qualified service engineers will check your prisms and indicate which ones need to be replaced. This FREE service is available to all “company name” customers.

16. 9. Juni 2016HS-Präsentation16 HAAG-STREIT developed Tonosafe, a low cost disposable prism. Tonosafe was specifically designed to: Eliminate issues relating to the disinfection of reusable measuring prisms Reduce the risk of cross infection when performing contact tonometry Tonosafe – disposable prisms

17. 9. Juni 2016HS-Präsentation17 Tonosafe – clinical research “We conclude that disposable prism tonometry provides a reliable, effective, and safe alternative to Goldmann tonometry with the advantages of eliminating the need for chemical disinfection and eliminating the risk of cross infection” S. M Salvi et al (2005), Eye “The disposable prism is considered reliable and ensures aseptic conditions of tonometry” K. Kontogiorgi et al Tonosafe is reliable!

18. 9. Juni 2016HS-Präsentation18 Tonosafe – clinical research “To completely eradicate the risk of transmission of prion protein (CJD), disposable prism tips should be used” S. Z Amin et al (2003), Br J Opthalmology (p1361) “IOP measurements with Tonosafe are not so different from that with standard prisms, and Tonosafe is useful for preventing infection” T Harada et al (1997) Japanese Glaucoma Society Tonosafe prevents cross infection!

19. 9. Juni 2016HS-Präsentation19 Tonosafe – clinical research “The Tonosafe disposable tonometer takes accurate IOP measurements, even at elevated pressure levels.” “There is a high level of correlation between the Goldmann tonometer prism and that of the Tonosafe disposable prisms” S. Z Amin et al P Kim (2004), Clinical & Experim. Ophthalmology Tonosafe is accurate!

20. 9. Juni 2016HS-Präsentation20 Tonosafe – simple to use 1.2.3. 4.5.6. 7.8.9.

21. 9. Juni 2016HS-Präsentation21 Tonosafe – Quiz Question 1 Tonosafe eliminates the risk of cross infection by being? 1.Reusable 2.Single Use - Disposable 3.Put into quarantine Answer = 2. Single Use - Disposable

22. 9. Juni 2016HS-Präsentation22 Tonosafe – Quiz Question 2 Research has shown that Tonosafe can be used for? 1.Making custom designed jewellery 2.Screening only 3.Both screening and routine clinical work Answer = 3. Both screening and routine clinical work

23. 9. Juni 2016HS-Präsentation23 Tonosafe – Quiz Question 3 Tonosafe is the perfect disposable tonometry solution by being? 1.Simple to use, completely safe, consistently reliable and accurate 2.Supplied with its own cleaning solution 3.Able to dematerialise after use Answer = 1. Simple to use, completely safe, consistently reliable and accurate

24. 9. Juni 2016HS-Präsentation24 Thank You!