Update on Fluorescein Strips

25 June 2013

Current advice is that, when the supply of Bausch & Lomb Fluorets runs out later this summer, optometrists, contact lens opticians and dispensing opticians should use 1% minims for diagnosis, contact lens fitting and tear film work in accordance with the College of Optometrists guidelines. 

Professional Concerns

However, many practitioners have concerns about this, highlighting that fluorescein sodium solution is more difficult to deliver to the surface of the eye in appropriate quantities from a minim.

Like strips, minims are also licensed as single-use products, which means they can only be used on one patient at a given point in time and then have to be discarded.  Reusing minims on more than one patient raises a serious risk of cross-infection and increased risk of pseudomonas keratitis.

In view of both these issues, practitioners have a clear preference for the use of alternative CE-marked single-use impregnated paper strips, however it is unclear whether such strips may legally be used by community practitioners. 

Clinical Consensus

To help clarify the position with regard to CE-marked strips, the Optical Confederation is convening a panel of academics and experienced clinicians to develop a consensus ‘peer view’ on these issues. 

The panel will take account of all available information, their own clinical experience and knowledge, and seek to reach a consensus view on what to do and not do in the circumstances, including a decision on the use of alternative fluorescein products. It is envisaged that this work will take about three weeks to complete and the consensus opinion should be available towards the end of July.

The Optical Confederation, the College of Optometrists, the General Optical Council and BCLA are arranging a round table meeting to discuss concerns about the use of minims.  

In the meantime, if Optical Confederation members are running short of supplies of Fluorets and have doubts about what to do in particular cases, they should contact their Optical Confederation representative body for advice:

The Optical Confederation is also working closely with colleagues in ECOO and the Republic of Ireland to seek to resolve this.

Notes for Editors

  1. The Optical Confederation has been working closely with the BCLA, General Optical Council (GOC) and the College of Optometrists on the problem of supply of fluorescein strips since Bausch & Lomb announced they would be ceasing manufacture of Fluorets on a worldwide basis earlier this year. 
  2. Fluorets are currently the only fluorescein strip product with a medicinal licence for use by optometrists and opticians in the UK. 
  3. The Medicines and Healthcare products Regulatory Authority (MHRA) has granted an import licence for a CE-marked fluorescein strip and announced that it will not take further regulatory action until the European Medicines Agency (EMA) reviews the overall EU position later this year. 
  4. Previous statements on the use of fluorescein strips:  GOC statement (21 Mar 13): http://www.optical.org/en/news_publications/news_item.cfm/goc-statement-on-fluorets%20; Optical Confederation statement (22 Mar 13): http://www.opticalconfederation.org.uk/news/latest-news/post/59-bausch--lomb-cease-production-of-fluorets ; BCLA statement (22 Mar 13): http://www.bcla.org.uk/en/news/index.cfm/Fluorets ; College of Optometrists guidance (26 Mar 13): http://www.college-optometrists.org/en/utilities/document-summary.cfm/docid/CDF0FC76-D7A2-428F-B75D9BFB1DE99914 ; BCLA statement (8 Apr 13): http://www.bcla.org.uk/en/news/index.cfm/fluorescein ; Joint statement (11 Apr 13): http://www.college-optometrists.org/en/knowledge-centre/news/index.cfm/joint%20statement ; GOC update (24 May 13): http://www.optical.org/en/news_publications/news_item.cfm/update-on-fluorescein ; College of Optometrists update (28 May 13): http://www.college-optometrists.org/en/knowledge-centre/news/index.cfm/fluorescein%20update%20May%202013
  5. For further information, please contact: Harjit Sandhu - harjit@fodo.com; Anne Grenyer - annegrenyer@aop.org.uk; Michael Potter - mpotter@abdo.org.uk