Is anyone on this list not placing a shield over the eye immediately after cataract surgery? I generally do but instruct my patients to remove it in order to place their antibiotic and anti-inflammatory drops. It is then removed the morning after surgery with instructions to use it for a week only when sleeping.

I am considering not placing a shield immediately after surgery but am concerned about the expected high rate of patients who forget to place it over the eye the night of surgery.

David Richardson, M.D.
San Gabriel, Calif.

I may be old-fashioned, but I still use the shield. My patients receive IV sedation, and I want to remind them not to rub or touch their eye. I also want something to say “I have had surgery.” We also see our patients same day post-op instead of at one day and continue to have them leave the shield on until the next day.

J. E. “Jay” McDonald, M.D.
Fayetteville, Ark.

I’m with you, Dr. McDonald. We remove the shield on the first post-op day, and the patient wears it at bedtime for two weeks. Why risk the patient rubbing his eye in his sleep?

Anita Nevyas-Wallace, M.D.
Bala Cynwyd, Pa.

Maybe I’m old-fashioned, too. I reason that the shield is there as part of the pack, it’s “free,” and really, do you know two hours later if the wound is truly self-sealing as the hydration wears off (unless you’re a same-day checker)? I like them to wear the shield the first night until I verify a sealed incision and normal IOP the next day.

On the other hand, for tape allergies, I skip the shield.

Mitchell Gossman, M.D.
St. Cloud, Minn.

I am tarnished by the fact the retinal doctor in my community has had a post-op patient not wearing his shield fall while getting out of bed and strike his eye, essentially losing his eye. This was many years ago but seemed to established a “local standard of care.”

I also almost always rub my eyes the first thing when I wake up without thinking about it.

I have no problem with those who do not use shields, and it is enticing for me to stop as well.

J. E. “Jay” McDonald, M.D.

For quite a while now, I have not used shields immediately post-op for cataract surgery patients unless I think they’re going to be big eye rubbers. So far I haven’t had any problems. I think the cataract wound is just as likely to open from a rub as a LASIK flap is to wrinkle with a rub, yet we don’t send LASIK patients out the door with shields on. I like that when the family members come to the post-op area, their relative doesn’t look like they’ve had surgery at all. Of course, we instruct them to put the shields on before sleeping, but I think the microincisional wounds are pretty strong, and even if the eye gets a little rubbed, it shouldn’t cause problems.

David A. Goldman, M.D.
Palm Beach Gardens, Fla.

I do not place a shield after cataract surgery and haven’t done so in 15 years. I’ve never had a problem with it.

Steven Safran, M.D.
Lawrenceville N.J.

A 28-year-old patient had uneventful ICL surgery three months previously. The lens clearance in the right eye was about 100 to 150 microns; therefore, the next ICL was moved to a larger size, with a better clearance of 350 microns. There is clearly no touch at this juncture.

The uncorrected visual acuity in both eyes is 20/20. Slitlamp examination reveals no cataract. On accommodation, the ICL get remarkably close to the human lens in the right eye. Is this a case for early intervention?

And here’s how other participants replied: My general rule is to leave them alone with a low vault. I have seen cases 10 years out that are actually resting on the lens, with no cataract. On the other hand, I will carefully follow a high vault and consider taking those out.

Stephen Slade, M.D.
Houston

I have several ICL patients I am following for at least a year with a vault of less than 100 microns. I spoke with Roberto Zaldivar [M.D., Mendoza, Argentina] about this about a year ago, sharing the concerns expressed on this discussion list. He also counseled simple observation. The interesting (and disturbing) thing is that the several anterior subcapsular cataracts that I have seen with ICLs did not occur in these cases, but rather in what seemed like completely normal, average vault situations.

J. Trevor Woodhams, M.D.
Atlanta

As long as the vault and the patient do not demonstrate any particular problems, leave it alone. Your observation of the lens during accommodation is interesting.

J. E. “Jay” McDonald, M.D.
Fayetteville, Ark.