Sir,
We read with interest the article on ‘The reuse of ophthalmic minims: an unacceptable cross-infection risk?’ In the clinical study, the authors found that multiple applications of unpreserved proxymethacaine 0.5% and fluorescein 0.25% in a Minims vial intended for single application have the potential to transmit bacterial infection. In all, 17% of 41 samples grew normal flora from the conjunctiva and lid area, which are mainly coagulase-negative Staphylococci and Corynebacterium spp.1
The authors highlighted the rationale of application of single-use Minims per patient, but cited the cost that this incurred to the NHS. A box of 20 Minims is priced at £11.68 in our trust and this will cost the NHS 58 pence per patient.2 We found that the application of proxymethacaine 0.5% drops on paper fluorescein strips in the form of Fluorets by Chauvin can be a safe and cost-effective way to stain the cornea. Each box of 100 strips costs £6.64, which is equivalent to £0.07 for usage per patient. The cost of a vial of proxymethacaine 0.5% is £0.51 (£10.19 for a box of 20 vials), and if used for 10 patients, £0.05 for each patient. The total cost of using the paper Fluorets with proxymethacaine is 12 pence per patient. This is 5 times less than the cost per vial of Minims containing proxymethacaine 0.5% and fluorescein 0.25%. Apart from this, they are portable, do not need refrigeration when not in use, are environmentally friendly, and are easier to open compared with the Minims pack available.
References
Rautenbach P, Wilson A, Gouws P . The reuse of ophthalmic minims: an unacceptable cross- infection risk? Eye 2010; 24: 50–52.
Mehta DK . British National Formulary. Pharmaceutical Press: UK, 2009.
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Yap, Y., Smith, M. & Byles, D. The reuse of ophthalmic minims: an unacceptable cross-infection risk?. Eye 24, 1421–1422 (2010). https://doi.org/10.1038/eye.2010.43
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DOI: https://doi.org/10.1038/eye.2010.43