Custom ocular prosthesis-related concerns: patient feedback survey-based report vis-à-vis objective clinical grading scales

Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings

AIM

To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients.

METHODS

Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made.

RESULTS

Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003).

CONCLUSIONS

Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.

Magnification of Iris through Clear Acrylic Resin in Ocular Prosthesis

The study on the magnification of the clear acrylic resin in prosthetic dentistry is important but lacking. Hence, this research aimed to investigate the magnification of the iris in the ocular prosthesis with various thicknesses of clear heat cure acrylic resin. A total of 60 ocular prostheses were divided into six groups with various thicknesses of clear heat cure acrylic resin over the iris; T0 (control): no acrylic resin, T1: 2, T2: 4, T3: 6, T4: 8, and T5: 10 mm of clear acrylic resin over the iris. Each ocular prosthesis was manufactured from white acrylic, with a 10.250 mm iris. Then, the clear heat cure resin was placed over the iris, cured, then polished. The final diameter of the iris was measured with a vernier caliper. The sizes of the iris were compared among various groups using one-way ANOVA, and a significant level was chosen at p value = 0.01. The mean sizes of iris were T0 = 10.25, T1 = 10.92, T2 = 11.26, T3 = 11.91, T4 = 12.75, and T5 = 13.43 mm. The size of the iris was significantly different among the group (p < 0.0001). The magnification of the iris for different groups was 1.06 for T1, 1.10 for T2, 1.16 for T3, 1.24 for T4, and 1.31 for T5. The magnification of the iris increased as the thickness of clear heat cure acrylic resin over the iris is increased on the ocular prosthesis.

Assessing the results of anophthalmic prostheses

Purpose

Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon's experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success.

Methods

This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18-89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness.

Results

The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1-10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients' perceptions of the overall cosmetic result and those of the examiners.

Conclusion

The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.