Time Heals: An Investigation into How Anophthalmic Patients Feel about Eye Loss and Wearing a Prosthetic Eye

Research Article

J Ophthalmol & Vis Sci. 2017; 2(2): 1018.

Time Heals: An Investigation into How Anophthalmic Patients Feel about Eye Loss and Wearing a Prosthetic Eye

Pine NS¹*, de Terte I¹ and Pine KR²

¹School of Psychology, Massey University, New Zealand

²School of Optometry and Vision Science, University of Auckland, New Zealand

*Corresponding author: Pine NS, School of Psychology, Massey University, New Zealand

Received: March 23, 2017; Accepted: April 21, 2017; Published: April 28, 2017

Abstract

Background: This study aims to explore the feelings of prosthetic eye wearers.

Methods: An anonymous questionnaire was completed by 217 anophthalmic patients who had worn a prosthetic eye for at least two years and were older than 16 years. Descriptive and inferential statistics were used to investigate participants’ feelings during the first 3 months of receiving a prosthetic eye (initial) and at the time of completing the questionnaire (current). These feelings were analyzed with age of participants when they received their first prosthetic eye, etiology of eye loss, gender, and feelings regarding appearance, mucoid discharge, and visual perception as explanatory variables.

Results: Participants initially experienced strong negative feelings, which decreased over time while positive feelings increased. Participants who lost their eye due to an accident, as opposed to a medical condition, were younger and initially had stronger negative feelings. Younger participants (especially adolescents) initially had stronger negative feelings, but at least two years later, eye loss at any age produced similar (much reduced) negative feelings. Greater appearance, visual perception and discharge concerns led to stronger negative feelings. All results reported above had a p-value of <0.05.

Conclusion: All patients can take heart from the finding that initial strong negative feelings decrease over time while positive feelings increase. Psychological intervention and support (especially for accident victims and adolescents) should be provided in the early stages following eye loss to address particular concerns about appearance, mucoid discharge, and acquired monocular vision.

Keywords: Prosthetic eye wearers; Feelings; Psychology; Concerns; Ocular prosthesis; Anophthalmia; Psychological difficulties

Introduction

The loss or disfigurement of an eye and the subsequent use of an ocular prosthesis is due to a wide variety of accident, medical and congenital causes. A prosthetic eye is used to replace a missing natural eye, while sclera shell prosthesis fits over a disfigured nonfunctioning eye [1].

Every part of the human body holds significance and function; however, the face is particularly unique. It is principally how individuals are recognized and what is recalled when the person is absent. The face communicates perceptions, intensity of emotion, awareness, and ideas. Eyes in particular convey understanding and insight, and have an important role in non-verbal communication and self-expression. A number of studies have explored appearance related feelings of individuals following eye loss [2-4].

As well as self-image issues, anophthalmic patients must also contend with acquired monocular vision and the inconvenience of mucoid discharge associated with wearing a prosthetic eye. This study explores the emotional effects of living with a prosthetic eye

with particular attention to appearance, mucoid discharge and altered visual perception. It covers two periods of time - the first three months after receiving their first prosthetic eye and the present time, at least two years later.

The feelings and experiences of prosthetic eye wearers is an important area of study which has received little research attention in the past. The findings will provide clinicians with a greater understanding of the psychological impact of eye loss and enable them to reduce anophthalmic patients’ potential distress.

Materials and Methods

Recruitment

Participants were recruited from the database of the New Zealand Prosthetic Eye Service, which is a private practice with clinics spread over the North Island of New Zealand. Participants had worn an ocular prosthesis for at least 2 years and were aged 16 years or above. The method of recruitment and the questionnaire was granted ethics approval by the Massey University Human Ethics Committee. Participants were provided with an information sheet and informed that completion of the questionnaire implied consent. Of the 540 potential participants contacted about the research, 217 completed the questionnaire (40% response rate).

Questionnaire

The questionnaire included 29 questions and 5 psychological scales across 4 main categories (demographics, concerns, feelings and problems, psychological scales). This paper covers the feelings section of the questionnaire. That is, respondents were asked to rate the extent to which they felt positive and negative feelings on a 4-point Likert scale (0 = none and 3 = a great deal) with respect to the first three months of receiving their first prosthetic eye (initial) and at the time of completing the questionnaire (current). Negative feelings included: shame, insecurity, inferiority, sadness, blame, anger, shyness, fear, and preoccupation with hiding the disfigurement [5]. Positive feelings included: happiness, relief, and acceptance. This paper also reports participants’ concerns regarding appearance, mucoid discharge, and visual perception, as well as demographic information gathered (age, gender, age when first prosthesis received, etiology of eye loss).

Data analysis

The Statistical Package for the Social Sciences for Mac (version 23) was used to analyse the quantitative data. Paired samples t-tests were used to investigate differences between participants’ initial and current intensity of feelings. Independent t-tests were used to analyse differences between: the ages at which participants received their first prosthetic eye and etiology of eye loss; the strength of both initial and current feelings and etiology of eye loss; the strength of negative feelings and levels of concern (discharge, appearance, visual perception); and strength of feelings according to gender.

Pearson correlations were conducted to investigate relationships between the age of participants when they received their first prosthetic eye and initial and current intensity of feelings, while multiple regressions were used to explore relationships between both initial and current concerns and strength of feelings.

Results

Participants

The majority of participants were male (67%) and ethnicities were: New Zealand European (76%), Maori (13%), other (7%), Asian (3%), and Pacific Islander (1%). The mean age of participant’s was 58 years and their mean prosthetic eye wearing time was 27 years.

The gender ratio on 67% of men in the study population roughly aligns with the 59% of men in a larger survey of prosthetic eye wearers in New Zealand [6]. The representation of New Zealand Europeans (76%) and Pacific Islanders (1%) aligns with that in the general New Zealand population (75% and 0.08% respectively) [7]. However, there is an under representation of Maori (13%) and Asian (3%) ethnicities compared to the general population (16% and 12% respectively) [7], possibly because it was an English language questionnaire.

Feelings

Table 1 illustrates the intensity of participants’ positive and negative feelings with respect to the first three months of receiving a prosthetic eye (initial) and at the time of completing the questionnaire (current). The intensity of negative feelings significantly decreased over time, while feelings of happiness and acceptance significantly increased.