Follow Ups | Post Followup | Back to Discussion Board | VegSource
See spam or
inappropriate posts?
Please let us know.

From: TSS ()
Subject: Tonometer prism sterilisation: A local and UK national survey (TSE)
Date: August 24, 2007 at 1:24 pm PST

1: Cont Lens Anterior Eye. 2007 Aug 17; [Epub ahead of print]

Tonometer prism sterilisation: A local and UK national survey.

Chandra A, Barsam A, Hammond CJ. West Kent Eye Centre,
Princess Royal University Hospital, Orpington, Kent
BR6 8ND, UK.

PURPOSE: First to audit local adherence to a protocol of use of an alcohol
wipe for each tonometry, and secondly to assess current practice nationally
in the UK. METHOD: The audit was carried out at two units: The West Kent Eye
Centre at the Princess Royal University Hospital (Orpington, UK) and Queen
Mary's Hospital (Sidcup, UK). The standard set for this audit was 100%
sterilisation. During a 1-week period in November 2005, the number of
alcohol wipes was counted in each consultation room after outpatient
clinics, with the doctors being assessed blind to the survey. The number of
Goldman applanation tonometry intra-ocular pressures recorded by each
clinician was counted by inspection of the medical records of patients seen.
Secondly, departments listed in the UK Directory of Training Posts were
contacted by telephone and the senior nurse was interviewed. They were asked
directly about their department's tonometer prism sterilisation and
management. RESULTS: The local audit showed only 54% of tonometry
measurements were associated with sterilisation using an alcohol-impregnated
wipe. The national survey included 140 of the 152 UK training departments.
Thirty-three (23.6%) departments used disposable tonometer prisms routinely.
The remaining 107 (76.4%) used non-disposable prisms. Eighty-five (60.7%)
departments provided sodium hypochlorite for prism sterilisation, with 69
(81.2%) of these departments providing more than one prism/clinician to
allow full exposure to the disinfectant. Twenty-two (15.7%) departments used
alcohol wipes. Only 8 (7.5%) of the 107 departments using non-disposable
prisms tracked these prisms, despite Royal College of Ophthalmologists
guidelines that they should be. These same 8 (7.5%) departments replaced the
non-disposable prisms as per manufacturer guidelines. 19.3% of charge nurses
were aware of a policy for tonometry in patients with, or at risk of, prion
disease. CONCLUSIONS: This study highlights that sterilisation of tonometer
prisms was inconsistent in a local audit. Nationally, practices were varied.
The majority of ophthalmology departments continued to use non-disposable
tonometer prisms, but few seemed aware of the Royal College of
Ophthalmologists' recommendation that disposable prisms are used in patients
at risk of prion disease, and few track tonometer heads or replace them
according to manufacturers guidelines. Use of disposable tonometer prisms
would seem to reduce concerns about sterilisation, as well as prevent spread
of common pathogens.

PMID: 17703987 [PubMed - as supplied by publisher]



M. Mangieri1, G. Giaccone1, L. Limido1, G. Di Fede1, S. Suardi1, R. Capobianco1, P. Fociani2, O. Bugiani1, F. Tagliavini1
1 Istituto Nazionale Neurologico Carlo Besta, Division of Neuropathology and Neurology 5, Milano, Italy and 2
Ospedale Luigi Sacco, Division of Pathology, Università di Milano, Milano, Italy


Creutzfeldt-Jakob disease (CJD) is marked by the presence of the protease-resistant prion protein
(PrPres) in the brain. Studies of the retina and optic nerve in patients with CJD are scanty and on
very small series of patients. We analysed ocular tissues of sporadic CJD patients (retina of 58 and
optic nerve of 51), representing all combinations of PRNP codon 129 polymorphisms and PrPres
types by Parchi, except VV1. Ocular tissue from 24 patients with other neurological diseases were
used as controls. The ocular tissue was collected at autopsy and the samples were fixed in Carnoy
solution or frozen. Before immunohistochemistry with 3F4 antibody, the sections were pretreated with
proteinase K and guanidine thiocyanate. In all cases of sCJD the retina showed immunoreactivity for
PrPres localized in the inner and outer plexiform layers, with a synaptic type of labelling. No
difference in the pattern of labeling was detected between CJD patients with different PRNP codon
129 polymorphisms and PrPres types in the brain. In all cases with frozen retinal tissue available (n =
18), the immunoblot was positive for PrPres . Two out of the 51 sCJD showed the deposition of
PrPres also in the optic nerve, corresponding to an immunostaining delineating stellate cells and
associated with the presence of numerous CD68- and CD45-positive cells. Our results demonstrate
the presence of the pathological form of prion protein not only in the retina of all sCJD cases
analysed, but also in optic nerve in a small subset of sCJD patients, a finding previously described
only in variant CJD and in experimental animal models. Moreover, our data suggest a correlation
between the deposition of PrPres and inflammatory changes in the optic nerve in sCJD.


----- Original Message -----
From: "Terry S. Singeltary Sr." <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, December 28, 2006 10:23 AM
Subject: Ophthalmic Surgery in Prion Diseases

Volume 13, Number 1–January 2007
Ophthalmic Surgery in Prion Diseases
Tsuyoshi Hamaguchi,*1 Moeko Noguchi-Shinohara,* Yosikazu Nakamura,†2 Takeshi
Sato,‡2 Tetsuyuki Kitamoto,§2 Hidehiro Mizusawa,¶2 and Masahito Yamada*2
*Kanazawa University Graduate School of Medical Science, Kanazawa, Japan;
†Jichi Medical University, Shimotsuke, Japan ‡National Center for Neurology
and Psychiatry, Ichikawa, Japan; §Tohoku University Graduate School of
Medicine, Sendai, Japan; and ¶Tokyo Medical and Dental University, Tokyo,

Suggested citation for this article

Eleven (1.8%) of 597 patients underwent ophthalmic surgery within 1 month
before the onset of prion disease or after the onset. All ophthalmologists
reused surgical instruments that had been incompletely sterilized to
eliminate infectious prion protein. Ophthalmologists should be aware of
prion diseases as a possible cause of visual symptoms and use disposable
instruments whenever possible.

Visual impairment occurs in 10% to 20% of patients with sporadic
Creutzfeldt-Jakob disease (sCJD) during an early stage of the disease
(Heidenhain variant) (1,2). Some patients with prion diseases may visit
ophthalmologists with visual impairment due to prion diseases or with
coexisting age-related eye diseases (3,4).

Infectious prion protein (PrPSc) was identified in the retina and optic
nerve in patients with variant CJD (vCJD) and sCJD (5,6), and CJD has been
transmitted by corneal transplantation (7,8). In the World Health
Organization (WHO) guidelines, eyes were classified as highly infectious
tissues (9).

Secondary transmission of PrPSc through ophthalmic surgery could possibly be
prevented around the onset of prion diseases, although surgery that is
performed long before the onset of prion diseases would not have that
potential. It is important to understand the current status of ophthalmic
surgery for patients with prion diseases and to clarify the clinical
features of the patients with prion diseases who undergo ophthalmic surgery.
Here, we describe the relevant data from CJD surveillance in Japan.

The Study.....snip full text ;

----- Original Message -----
From: "Terry S. Singeltary Sr." <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 27, 2006 12:21 PM

Eye procedure raises CJD concerns

November 19, 2004 United Press International by STEVE MITCHELL

A New York man who died from a rare brain disorder similar to mad cow disease in May underwent an eye procedure prior to his death that raises concerns about the possibility of transmitting the fatal disease to others, United Press International has learned.
The development comes on the heels of the announcement Thursday by U.S. Department of Agriculture officials of a possible second case of mad cow disease in U.S. herds.

Richard Da Silva, 58, of Orange County, N.Y., died from Creutzfeldt Jakob disease, an incurable brain-wasting illness that strikes about one person per million.

Richard's wife Ann Marie Da Silva told UPI he underwent a check for the eye disease glaucoma in 2003, approximately a year before his death. The procedure involves the use of a tonometer, which contacts the cornea -- an eye tissue that can contain prions, the infectious agent thought to cause CJD.

Ann Marie's concern is that others who had the tonometer used on them could have gotten infected.

A 2003 study by British researchers suggests her concerns may be justified. A team led by J.W. Ironside from the National Creutzfeldt-Jakob Disease Surveillance Unit at the University of Edinburgh examined tonometer heads and found they can retain cornea tissue that could infect other people -- even after cleaning and decontaminating the instrument.

"Retained corneal epithelial cells, following the standard decontamination routine of tonometer prisms, may represent potential prion infectivity," the researchers wrote in the British Journal of Ophthalmology last year. "Once the infectious agent is on the cornea, it could theoretically infect the brain."

Prions, misfolded proteins thought to be the cause of mad cow, CJD and similar diseases, are notoriously difficult to destroy and are capable of withstanding most sterilization procedures.

Laura Manuelidis, an expert on these diseases and section chief of surgery in the neuropathology department at Yale University, agreed with the British researchers that tonometers represent a potential risk of passing CJD to other people.

Manuelidis told UPI she has been voicing her concern about the risks of corneas since 1977 when her own study, published in the New England Journal of Medicine, showed the eye tissue, if infected, could transmit CJD.

At the time the procedure was done on Richard Da Silva, about a year before he died, she said it was "absolutely" possible he was infectious.

The CJD Incidents Panel, a body of experts set up by the U.K. Department of Health, noted in a 2001 report that procedures involving the cornea are considered medium risk for transmitting CJD. The first two patients who have a contaminated eye instrument used on them have the highest risk of contracting the disease, the panel said.

In 1999, the U.K. Department of Health banned opticians from reusing equipment that came in contact with patients' eyes out of concern it could result in the transmission of variant CJD, the form of the disease humans can contract from consuming infected beef products.

Richard Da Silva was associated with a cluster of five other cases of CJD in southern New York that raised concerns about vCJD.

None of the cases have been determined to stem from mad cow disease, but concerns about the cattle illness in the United States could increase in light of the USDA announcement Thursday that a cow tested positive on initial tests for the disease. If confirmed, this would be the second U.S. case of the illness; the first was detected in a Washington cow last December. The USDA said the suspect animal disclosed Thursday did not enter the food chain. The USDA did not release further details about the cow, but said results from further lab tests to confirm the initial tests were expected within seven days.

Ann Marie Da Silva said she informed the New York Health Department and later the eye doctor who performed the procedure about her husband's illness and her concerns about the risk of transmitting CJD via the tonometer.

The optometrist -- whom she declined to name because she did not want to jeopardize his career -- "didn't even know what this disease was," she said.

"He said the health department never called him and I called them (the health department) back and they didn't seem concerned about it," she added. "I just kept getting angrier and angrier when I felt I was being dismissed."

She said the state health department "seems to have an attitude of don't ask, don't tell" about CJD.

"There's a stigma attached to it," she said. "Is it because they're so afraid the public will panic? I don't know, but I don't think that the answer is to push things under the rug."

New York State Department of Health spokeswoman Claire Pospisil told UPI she would look into whether the agency was concerned about the possibility of transmitting CJD via tonometers, but she had not called back prior to story publication.

Disposable tonometers are readily available and could avoid the risk of transmitting the disease, Ironside and colleagues noted in their study. Ann Marie Da Silva said she asked the optometrist whether he used disposable tonometers and "he said 'No, it's a reusable one.'"

Ironside's team also noted other ophthalmic instruments come into contact with the cornea and could represent a source of infection as they are either difficult to decontaminate or cannot withstand the harsh procedures necessary to inactivate prions. These include corneal burrs, diagnostic and therapeutic contact lenses and other coated lenses.

Terry Singletary, whose mother died from a type of CJD called Heidenhain Variant, told UPI health officials were not doing enough to prevent people from being infected by contaminated medical equipment.

"They've got to start taking this disease seriously and they simply aren't doing it," said Singletary, who is a member of CJD Watch and CJD Voice -- advocacy groups for CJD patients and their families.

U.S. Centers for Disease Control and Prevention spokeswoman Christine Pearson did not return a phone call from UPI seeking comment. The agency's Web site states the eye is one of three tissues, along with the brain and spinal cord, that are considered to have "high infectivity."

The Web site said more than 250 people worldwide have contracted CJD through contaminated surgical instruments and tissue transplants. This includes as many as four who were infected by corneal grafts. The agency noted no such cases have been reported since 1976, when sterilization procedures were instituted in healthcare facilities.

Ironside and colleagues noted in their study, however, many disinfection procedures used on optical instruments, such as tonometers, fail. They wrote their finding of cornea tissue on tonometers indicates that "no current cleaning and disinfection strategy is fully effective."

Singletary said CDC's assertion that no CJD cases from infected equipment or tissues have been detected since 1976 is misleading.

"They have absolutely no idea" whether any cases have occurred in this manner, he said, because CJD cases often aren't investigated and the agency has not required physicians nationwide report all casesof CJD.

"There's no national surveillance unit for CJD in the United States; people are dying who aren't autopsied, the CDC has no way of knowing" whether people have been infected via infected equipment or tissues, he said.

Ann Marie Da Silva said she has contacted several members of her state's congressional delegation about her concerns, including Rep. Sue Kelly, R-N.Y., and Sen. Charles Schumer, D-N.Y.

"Basically, what I want is to be a positive force in this, but I also want more of a dialogue going on with the public and the health department," she said.

Cadaver corneal transplants -- without family permission
Houston, Texas channel 11 news 28 Nov 99
Reported by Terry S. Singeltary Sr.son of CJD victim

Subject: RE-The Eyes Have It (cjd) and they could be stealing them from your loved one... "pay back time"
Date: Sat, 16 Sep 2000 10:04:26 -0700
From: "Terry S. Singeltary Sr."
Reply-To: Bovine Spongiform Encephalopathy

######### Bovine Spongiform Encephalopathy #########

Greetings List Members,

I hate to keep kicking a madcow, but this still is very disturbing
to me. Not only for the recipient of the cornea's, but as well, for
the people whom would be operated on, using the same tools that
were used to put those stolen cornea's in the recipient with.
No history of this donor or his family (re-ffi), or anything
would be known, using stolen organs and or tissue's. I just think
this is not only wrong, but very dangerous to a great many other
people, as this is one of the most infectious tissues of TSE's. It seems
that this practice of stealing organ/tissue happens more than we think.
Anyway, the family of the victim which had their cornea's stolen, are
now suing. In the example I used with my Mother, if 3 months before, she
would have been in a catastrophic accident (car wreck, whatever), no
autopsy (for whatever reason), no family (for whatever reason), she lay
in the morgue, and after 4 hours, they come steal the cornea's, lot of
people could have been infected, just because of lack of medical history
of donor/family. It may be hypothetical, but very real. We need to stop
the spread of this disease.

kind regards,
Terry S. Singeltary Sr., Bacliff, Texas USA

Previous story--

Cadaver corneal transplants -- without family permission...

Sept. 15, 2000, 11:39PM

Slain woman's family sues over
missing eyes

Copyright 2000 Houston Chronicle

The family of a woman who was stabbed to death last year has
filed a lawsuit accusing the Lions Eye Bank of Houston of
removing the woman's eyes without permission and inserting
plastic discs in their place.

Daisy Diaz's relatives were horrified when they saw her body
and noticed her eyes were missing, said their lawyer, Duncan
Neblett III.

"They're a Catholic family," Neblett said. "They have strong
beliefs about the body and burial. They were really upset by

Dorey Zidrow, the eye bank's spokeswoman, said she could
not specifically discuss the Diaz case because it was in litigation.
But Zidrow said a state law allows doctors to remove corneas
-- the dime-sized lens near the eye's surface -- from a corpse
without the family's permission.

The eye bank's usual procedure calls for removing the corneas,
Zidrow said, but not the entire eyes.

"There are an awful lot of people who benefit from this program
in the state of Texas," she said.

Diaz, 25, was stabbed to death in her apartment in the 400
block of Thornton in October. Her brother-in-law, 30-year-old
Raudel Quiroz, is charged in the killing but has not been caught.

Neblett said authorities have told him Quiroz may have returned
to his native Guatemala.

Neither Diaz nor her family had given permission to donate any
of her organs, Neblett said.

Although state law allows corneas to be removed from corpses
without first gaining the family's permission, they cannot be
removed over the family's stated objection.

The eye bank is located at, and staffed by, the Baylor College
of Medicine, and receives part of its funding from the Lions

The Diaz lawsuit is the second such suit to be filed against the
eye bank in recent years.

The family of Levi Perry Jr., a Houston teacher shot to death in
MacGregor Park in 1994, also alleged in their suit that Perry's
eyes were removed. The family was awarded $345,000 from
the eye bank in April 1999.



Sec. 693.012. Removal of Corneal Tissue Permitted Under Certain

On a request from an authorized official of an eye bank for corneal
tissue, a justice of the peace or medical examiner may permit the
removal of corneal tissue if:

(1) the decedent from whom the tissue is to be removed died under
circumstances requiring an inquest by the justice of the peace or
medical examiner;

(2) no objection by a person listed in Section 693.013 is known by the
justice of the peace or medical examiner; and

(3) the removal of the corneal tissue will not interfere with the
subsequent course of an investigation or autopsy or alter the decedent's
postmortem facial appearance.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Note: This information includes legislation enacted through the 75th
Congress. The 76th session of the Texas Legislature has concluded. The
State of Texas has not yet made the new codes available to the public.
Until they do, search the bill text for any changes or amendments.

Search 1999 Legislation for: 693.012
Sec. 693.003. Consent Required in Certain Circumstances.

(a) A medical examiner or a person acting on the authority of a medical
examiner may not remove a visceral organ unless the medical examiner
or person obtains the consent of a person listed in Section 693.004.

(b) If a person listed in Section 693.004 is known and available within
four hours after death is pronounced, a medical examiner or a person
acting on the authority of a medical examiner may not remove a
nonvisceral organ or tissue unless the medical examiner or person
obtains that person's consent.

(c) If a person listed in Section 693.004 cannot be identified and
contacted within four hours after death is pronounced and the medical
examiner determines that no reasonable likelihood exists that a person
can be identified and contacted during the four-hour period, the medical
examiner may permit the removal of a nonvisceral organ or tissue.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Note: This information includes legislation enacted through the 75th
Congress. The 76th session of the Texas Legislature has concluded. The
State of Texas has not yet made the new codes available to the public.
Until they do, search the bill text for any changes or amendments.

Search 1999 Legislation for: 693.003
PLEASE NOTE; the bottom would only pertain to those who know of the
law. if you don't know about it, you cannot dispute, so in four hours,
they can legally remove body organs, as long as they don't disfigure.
and who is to know the difference? makes me wonder of some of my dead
relatives, and if they were burried with their eye's and or any of their
organs. This is very disturbing, if not for moral reasons, but for the
risk of dangerous pathogens (human TSE's, etc.) to be transmitted. only
time will tell, but i am very disturbed.
these laws are not morally correct. They should be re-written as to they
cannot so easily take your organs, with no one knowing. The Family or
Victim, must consent. There should be some kind of research
on donor/family medical history...TSS

Sec. 693.013. Persons Who May Object to Removal.

The following persons may object to the removal of corneal tissue:

(1) the decedent's spouse;

(2) the decedent's adult children, if there is no spouse;

(3) the decedent's parents, if there is no spouse or adult child; or

(4) the decedent's brothers or sisters, if there is no spouse, adult
child, or parent.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Note: This information includes legislation enacted through the 75th
Congress. The 76th session of the Texas Legislature has concluded. The
State of Texas has not yet made the new codes available to the public.
Until they do, search the bill text for any changes or amendments.

Search 1999 Legislation for: 693.013
to cover one's butt....

Sec. 693.014. Immunity From Damages in Civil Action.

(a) In a civil action brought by a person listed in Section 693.013 who
did not object before the removal of corneal tissue, a medical examiner,
justice of the peace, or eye bank official is not liable for damages on
a theory of civil recovery based on a contention that the person's
consent was required before the corneal tissue could be removed.

(b) Chapter 104, Civil Practice and Remedies Code, applies to a justice
of the peace, medical examiner, and their personnel who remove, permit
removal, or deny removal of corneal tissue under this subchapter as if
the justice of the peace, medical examiner, and their personnel were
state officers or employees.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Note: This information includes legislation enacted through the 75th
Congress. The 76th session of the Texas Legislature has concluded. The
State of Texas has not yet made the new codes available to the public.
Until they do, search the bill text for any changes or amendments.

Search 1999 Legislation for: 693.014

[[[as you can see, they knew it was wrong when they wrote the laws. or
they would not have covered the rear-ends so well...TSS]]]
thanks again,
kind regards,
Terry S. Singeltary Sr.

############ ############



Follow Ups:

Post a Followup

E-mail: (optional)


Optional Link URL:
Link Title:
Optional Image URL: