Royan, Jeyarine Monica Joan Poopal
(2018)
Evaluation of the psychological effect and vision related quality of life enucleated/eviscerated patients with prosthetic eyes.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction:
Patients with acquired anophthalmia post evisceration or enucleation surgeries are confronted
with the loss of an eye as well as the pathological process which led to the surgery being
performed. The regular use of prosthetic eyes in these patients has helped them to achieve a
reasonable cosmetic outcome post operatively. Psychological sequelae of anopthalmia and
prosthetic eye wear is often not addressed by the treating physician. Thus, identification of
such sequelae may be helpful to these patients and others in the future so that they may
referred to the appropriate channels for further evaluation.
Objective:
The aim of our study was to evaluate the levels of anxiety, depression and vision related
quality of life in patients with prosthetic eyes post evisceration or enucleation and to
determine the potential predictors associated with it.
Methods:
A cross sectional study was conducted between March 2017 and March 2018 involving
patients with prosthetic eyes post evisceration or enucleation attending eye clinics of two
tertiary hospitals in Malaysia; Hospital Selayang and Hospital Universiti Sains Malaysia.The
patients were given two validated questionnaires: The National Eye Institute Visual Function
Questionnaire – (NEI-VFQ) and the Hospital Anxiety and Depression (HADS) questionnaire.
After completion, the questionnaires were calculated and scored, and statistical analysis was
done using Statistical Package for the Social Science (SPSS Inc Version 22).
Results:
A total of 54 patients with acquired anophthalmia with prosthetic eyes participated in the
study. The demographic and clinical variables that were assessed were age, gender, race,
marital status, highest education level, monthly household income, reason for
enucleation/evisceration and duration of prosthesis wear.
The mean composite visual related quality of life was reduced with a score of 75.97. The
minimum composite score was 18.75 and the maximum composite score was 100.
The mean HADS (D) depression score was 1.94 with a range of scores from 0 to 8. 53
patients had normal scores and only one had a score of more than 8. The mean HADS(A)
Anxiety score was 3.61 with a range of scores from 0-10.48 patients had normal scores, and 6
patients had scores of more than 8. A score of more than 8 represents mild depression or
anxiety. There were no significant associations between the demographic and clinical
variables with vision related quality of life and depression levels based on the simple and
multiple linear regression formulas (p>0.05 for all variables tested). There were significant
associations between demographic and clinical variables with increased anxiety levels where
p<0.05 for the variables of younger age, female gender, reduced duration of prosthesis wear
and anopthalmia secondary to trauma. Anxiety scores decreased with every 1-year increase in
a patients’ age. Female patients had on average 1.49 points higher in anxiety scoringcompared to males. Patients with prolonged wear of prosthesis of more than 5 years had
lower anxiety scores than those with less than 1 year of use. Patients with traumatic
anophthalmia scored higher anxiety scores than those who acquired anophthalmia secondary
to tumours, infections, or painful blind eyes.
Conclusion:
This study showed that the mean vision related quality of life scores in patients with
prosthetic eyes post enucleation/evisceration was reduced however the mean anxiety and
depression scores in these patients were within the normal range.
The predictors for increased anxiety levels in anophthalmic patients with prosthetic eyes was
gender, age, duration of prosthesis wear, and the cause for anophthalmia. There were no
potential predictors for vision related quality of life or for depression.
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