Seeing Clearly Without The Shield; Eliminating Plastic Eye Shields Without Compromising Cataract Surgery Outcomes

There is little evidence of the benefits of plastic eye shields following uncomplicated cataract surgery, however, despite recommendations from ESCRS and a recent Royal College of Ophthalmologists' paper on sustainable cataract surgery, plastic eye shields are routinely used in the United Kingdom.  The aim of this case control study was to determine whether it is safe not to wear a plastic eye shield following uncomplicated cataract surgery.

Cases and controls were identified from the elecronic medical records (Medisight) at 60 cataract surgery centres in the United Kingdom over a 4 month period.   

Case control study was carried out through analysis of electronic medical records (Medisight) of cataract operations in 60 centres over 4 months.  Exclusions included patients undergoing sub-tenons anaesthetic, patients with advance dementia or had complicated surgery.  20,132 uncomplicated cases were identified with no plastic eye shield post operatively and compared to 26,023 controls.  The cases and controls were comparable with no significant diference in mean age (74.5 years versus 74.4 years), sex (43.5% male versus 42.9%) and presence of ocular co-morbidities. 

Primary outcomes were endophthalmitis rate, incidence of post operative ocular trauma and hypotony.  Secondary outcomes were visual outcomes and refractive outcomes.    

No difference in endophthalmitis was found between cases versus controls (0.009% versus 0.008%), post operative ocular trauma (0.00% versus 0.002%) and hypotony (no cases in either group).  There were no differences in visual outcomes (>95% in both groups obtaining better than 6/12 snellen vision) and >92% within 1 dioptre of predicted refractive outcome.  

Plastic eye shields are not required after uncomplicated cataract surgery.  This is the largest case control study assessing the safety and clinical outcomes of not using plastic eye shields and found no difference in endophthalmitis rate, post operative ocular trauma and hypotony.  Further, there were no differences in visual or refractive outcomes.

If all UK providers followed ESCRS and RCOphth recommendations and removed the unnecessary use of plastic eye shields following uncomplicated cataract surgery, 3 tonnes of plastic, the equivalent of the weight of an Asian Elephant, would be removed annualy - reducing carbon foot print and supporting the achievement of wider sustainability goals.