Ocular prostheses: not quite an eye for an eye

Measuring quality of care and life in patients with an ocular prosthesis

PURPOSE

In patients with an anophthalmic condition, the primary determinants of success of ocular prosthetic rehabilitation are satisfaction with care and quality of life (QoL). The aim of this study is to develop a condition-specific questionnaire as a patient-reported outcome measure for patients with an ocular prosthesis.

METHODS

Observational cross-sectional prospective study. We included 100 patients (52 female, 48 male, > 18 years old) with an anophthalmic and ocular prosthetic condition existing for 2 years or more. The patients completed a pre-tested 72-item questionnaire regarding their experience on living with an ocular prosthesis in four domains of QoL: single vision and care, wearing comfort, physical appearance and motility, and psychosocial functioning. Associations with demographic factors and condition- and prosthesis-related variables were investigated with multivariate analysis. The questionnaire was reduced with principal component analysis to obtain the Global Ocular Prosthesis Score (GOPS).

RESULTS

Satisfaction scores for each QoL domain were high with a mean visual analogue score between 7.2 and 7.6. Patients were generally satisfied with the physical appearance of the artificial eye and reported adequate psychosocial functioning. Patients described the reduced peripheral visual field and socket discharge as chief complaints. The test was reduced to a 20-item questionnaire. The mean GOPS was 70.87 (median 75.00).

CONCLUSIONS

Patients with longstanding ocular prosthetic wear are satisfied with their physical appearance and report adequate psychosocial functioning. A concise 20-item questionnaire for the anophthalmic condition is a valuable tool to quantitatively measure patient-reported outcome of ocular prosthetic rehabilitation.

TRIAL REGISTRATION NUMBER

NCT04321382, 03/2020, retrospectively registered.

The UK National Artificial Eye Questionnaire Study: comparisons between cosmetic shell and artificial eye users. Part 2: maintenance, management and quality of life

AIMS

To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear.

METHODS

In this observational, cross-sectional study, the National Artificial Eye Questionnaire was employed nationwide within the National Health Service England. This second part of the study assesses daily management and care experiences, as well as visual function and quality of life aspects.

RESULTS

Overall, 951 respondents wore an AE, while 238 wore a CS. Both AE and CS respondents rated a relatively high score for a beneficial effect of prosthesis polishing, with an average score of 80.08±0.87 versus 77.17±1.73 (p=0.13, respectively). CS respondents removed and cleaned their prosthesis more frequently than AE respondents (p<0.0001, p=0.002, respectively). CS respondents instilled lubrication more frequently than AE respondents (p=0.022) with 33.3% versus 43.7% of AE and CS wearers, respectively, lubricating on at least a daily basis. The overall QOL composite score was similar in both AE and CS groups (approximately 77%, p=0.74). Social functioning was similar, and relatively high in both groups (approximately 86%, p=0.77).

CONCLUSIONS

This study characterises unique aspects of CSs versus AEs in a large national cohort. The results should provide reinforcement to the gain in popularity of CSs.

The UK National Artificial Eye Questionnaire study: predictors of artificial eye wearers' experience part 1-comfort and satisfaction

OBJECTIVES

To report associations with comfort and with appearance satisfaction in artificial eye wearers.

METHODS

Multicentre, observational, cross-sectional study, nationwide within the National Health Service England. The National Artificial Eye Questionnaire (NAEQ) was completed by 951 respondents. Multiple regressions assessed associations between the experiences of artificial eye wearers, routine management, changes over time, baseline and demographic parameters and their reported comfort, satisfaction with appearance and prosthesis motility.

RESULTS

Better comfort levels were associated with needing less lubrication (β = 0.24, p < 0.001), older age (β = 0.17, p = 0.014), less discharge (β = 0.16, p < 0.001), less frequent cleaning (β = 0.16, p = 0.043), and male gender (β = 0.06, p = 0.047). Greater satisfaction with the appearance of the artificial eye was associated with better perceived motility (β = 0.57, p < 0.001). Black ethnic origin predicted a lower satisfaction with the appearance (β = -0.17, p = 0.001). Greater satisfaction with the motility was associated with a better appearance rating (β = 0.51, p < 0.001), longer time of having an artificial eye (β = 0.13, p < 0.001), older age (β = 0.11, p = 0.042), and a shorter adjustment time (β = -0.07, p = 0.016). Of the testimonials concerning appearance aspects, the majority (21/45, 46.7%) were related to the effect on social interactions.

CONCLUSIONS

The results suggest that more attention should be given to the "dry anophthalmic socket syndrome" as a key cause of discomfort. Young patients are concerned particularly about the motility of the artificial eye. Over time satisfaction with the artificial eye movement is likely to improve.

Prevalence of Meibomian Gland Dysfunction and Its Effect on Quality of Life and Ocular Discomfort in Patients with Prosthetic Eyes

Purpose: To evaluate the influence of ocular discomfort and meibomian gland dysfunction (MGD) on quality of life in patients with an ocular prosthesis. Methods: a prospective analysis was conducted on 18 patients with a unilateral ocular prosthesis. Evaluation of ocular discomfort symptoms, lid margin abnormalities (LMA), meibomian gland expression, meibography and a psychometric evaluation using the National Eye Institute Visual Function Questionnaire (NEI VFQ), Facial Appearance subscale of the Negative Physical Self Scale (NPSS-F), Hospital Anxiety and Depression Scale (HADS) and the DAS24 to evaluate anxiety and depression. Results: the statistically significant differences observed between normal and prosthetic eyes related to ocular symptoms and the meibography score (p = 0.0003). A negative correlation was reported between NEI VFQ score and meibography score (r = −0.509; p-value = 0.022). A positive correlation was detected with NPSS (r = 0.75; p-value < 0.0001), anxiety HADS score (r = 0.912; p-value = 0.001) and depression HADS score (r = 0.870; p-value > 0.0001). Conclusion: MGD represents the most common cause of evaporative dry eye disease, due to the reduction of the thickness of the lipid layer of the tear film. The occurrence of MGD in patients with prosthetic eyes is very common. Anxiety and depression were correlated to ocular discomfort and MGD, and this could affect the quality of life in patients with an ocular prosthesis.

Recommendations for post-adaption care of an ocular prosthesis: A review

An ocular prosthesis must be maintained in a suitable state of cleanliness, fit and preservation. Otherwise its functioning may be compromised, leading to a variety of diseases. However, there is a lack of consensus on the care of such prostheses. This review assembles and attempts to update existing knowledge in this area and discusses the most appropriate care regimes.