Abstract
Purpose :
To assess changes in self-esteem, appearance, and vision-related quality of life (VRQoL) of anophthalmic patients after wearing a prosthetic eye and its relationship with demographic characteristics and clinical factors.
Methods :
Anophthalmic adults (18 years and older) scheduled for fitting of a prosthetic eye (porous polyethylene implant) following evisceration between January 2019 and January 2021 were administered a pack containing a demographic sheet including self-reported feelings of shame, sadness and anger and 4 questionnaires: 40-item Self-esteem rating scale (SERS), 12-item Facial appearance of the negative physical self-scale (FA), 28-item Impact of Vision Impairment (IVI) – measure of VRQoL), and 24-item Derriford Appearance scale (DAS24 – measure of social anxiety and avoidance) prior (T1) to and 3-4 months (T2) following use of prosthetic eye. Rasch analysis was performed to assess the measurement performance of questionnaires and generate interval-level estimates of the corresponding latent trait at both time points, anchoring the instruments to their baseline measurement characteristics. ANOVA, Chi-square and unpaired t-tests were used for descriptive and comparative analyses between sub-groups. Change in questionnaire scores was represented by effect size (ES): small (≤ 0.2), moderate (0.3–0.7), and large (≥ 0.8).
Results :
321 adults (mean [SD] age, 34.6 [14.15] years; 71% male) were included. The majority were married (49%), working (50%), and had less than college level of education (60%). Minor modifications were required in questionnaires to enable adequate fit to the Rasch model. Patients reported significant and large improvements in self-esteem (ES: 1.48; P<0.001), facial appearance (1.74; P<0.001), VRQoL (1.50 -1.98; P<0.001), and social anxiety and avoidance (2.51; P<0.001) following wearing the prosthetic eye. Females reported larger improvements in self-esteem compared to males (P=0.04) and younger age was related to greater levels of social anxiety and avoidance (r=-0.15, P=0.009). Patients reported significant reduction in feelings of shame, sadness, preoccupation with hiding the disfigured eye, insecurity, inferiority and anger after wearing the prosthetic eye.
Conclusions :
Prosthesis wear offers significant improvements in psychological functioning and VRQoL for patients with anophthalmia. It also reduces their social anxiety and avoidance especially for young adults.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.