To evaluate the efficacy of slit lamp breath shields to prevent droplet spray from a simulated sneeze.DESIGN: Experimental study to test the effectiveness of personal protective equipment.METHODS: The nozzle of a spray gun was adjusted to angularly disperse a mist of colored dye that approximated a patient sneezing on a dimensionally accurate cardboard slit lamp model. The designs of 6 commercially available breath shields and 1 breath shield repurposed from a plastic container lid were tested. Each breath shield was sprayed in a standardized fashion 3 times, and the amount of overspray was compared to spray with no shield and quantified. The surface area that was sprayed was calculated using a commercially available software with color range function. The average percentage of overspray of each breath shield was computed in comparison to the control.RESULTS: The breath shields ranged in surface area from 116 to 924 cm 2 , and the amount of overspray varied from 54% to virtually none. Larger breath shields offered better protection than smaller ones. Breath shields attached to the objective lens arm were better barriers than those of comparable size hung by the oculars. A repurposed plastic lid breath shield, 513 cm 2 , was slightly curved toward the examiner's face and allowed only 2% overspray. The largest breath shield (924 cm 2 ) hung near the oculars and prevented essentially all overspray.CONCLUSIONS: The performance of different designs of breath shields was variable. Even high-functioning shields should be used in conjunction with personal protective equipment including masks, goggles, and gloves and handwashing. Ideally patients should also wear a face mask during all slit lamp examinations.

The Icare HOME (TA022, Icare Oy, Vanda, Finland) is rebound tonometer recently approved by the US Food and Drug Administration in March 2017 designed for selfmeasurement of intraocular pressure (IOP). IOP remains a major modifiable risk factor for glaucoma progression; however, IOP measurements typically occur through single office measurements on Goldmann applanation tonometry (GAT) and do not always reveal the complete picture of patient's IOP patterns and daily fluctuations, which are important for accurate diagnosis and evaluation. Numerous studies have now compared the efficacy of the Icare HOME to that of GAT. The objective of this article is to review the existing literature surrounding the Icare HOME tonometer and its efficacy as a self-tonometer in comparison to GAT. The available literature has shown promising results in its accuracy of measuring IOP but suggests cautious usage in patients with central corneal thicknesses or IOP ranges that are outside of a certain range. This article will also provide details and example cases for when the Icare HOME may be most clinically useful.

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