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.