key: cord-346846-yle3z5z2
authors: Murnain, Kaila L; Ooi, Ju‐Lee; Sharma, Neil S
title: Evaluation of the Slit Lamp Shield to reduce droplet exposure
date: 2020-05-25
journal: Clin Exp Optom
DOI: 10.1111/cxo.13096
sha: 
doc_id: 346846
cord_uid: yle3z5z2

nan

EDITOR: The current COVID-19 global pandemic has brought infection control measures to the forefront of international attention. Patients with SARS-CoV-2 infection may be asymptomatic but infectious. The face-to-face proximity of clinicians and patients during slitlamp examination potentially places eyecare providers at a high risk of aerosolised particles from respiratory droplets. 1 Similarly, patients may be at risk from an unknowingly infected clinician, which could have disastrous consequences, especially in a busy clinic with a large proportion of elderly patients.

Recognising this potential risk, we recently designedand had urgently manufactured the Slit Lamp Shield, made in Australia from clear acrylic (plexiglass). Our Slit Lamp Shield is distinct from other slitlamp breath guards by having angled side-wing panels that provide a large physical barrier while still allowing access to the slitlamp controls.

The use of slitlamp barriers has become increasingly common during the current COVID-19 global pandemic. The American Academy of Ophthalmology has recommended the use of commercially manufactured barriers that can be regularly disinfected. 2 We decided to evaluate the ability of the Slit Lamp Shield to reduce potential droplet exposure. In our simulation (Video S1), a clinician attired in personal protective equipment including surgical mask and face shield was positioned in the examination position. A staff member in the patient position executed a single release of a commercially available fluorescent dye spray (VeriClean; Diversey Inc, Fort Mill, SC, USA). This was performed both without and with the Slit Lamp Shield.

Without the shield, dye was found on the clinician's face shield, mask, gown, gloves, desk and the machine itself. When the experiment was repeated with the shield in position, most of the dye was located on the outside of the shield, with smaller amounts on the clinician gloves, desk and machine ( Figure 1) . Importantly, there was no dye on the clinician's face shield or mask. We repeated the experiment on several occasions and obtained similar results.

We acknowledge the limitations of our methodology including that it is not validated for the projectile direction, speed and turbulence of a true cough and is performed in an artificial experimental setting. Nevertheless, this demonstration illustrates the potential benefit of using a barrier shield during slitlamp examination. It is important to remember to continue to use other personal protective equipment as guided by local protocols, and that frequent disinfection of the shield, equipment and surfaces is still required.

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Additional supporting information may be found in the online version of this article at the publisher's website:Video S1. A simulated evaluation of the effectiveness of the Slit Lamp Shield.