UK National Artificial Eye Questionnaire study: comparisons between cosmetic shell and artificial eye users. Part 1: demographics, comfort and satisfaction.

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 (NAEQ) was employed nationwide within the National Health Service England. The proportions or mean values of the aetiology of sight or eye loss, demographics, length of prosthesis wear, reported adjustment time to the prosthesis, comfort, discharge and satisfaction of appearance were compared between AE and CS respondents. RESULTS: Overall, 951 respondents wore an AE, while 238 wore a CS. In both, trauma was the leading cause for the prosthesis (47.6% and 44.1%, respectively); however, these groups differed in the proportions of the other aetiologies (p<0.0001). AE respondents were generally older (p=0.002) and had longer overall prosthesis wear (p<0.0001) compared with CS respondents. The overall comfort score was similarly, relatively high in both AE and CS respondents (80.4±0.73 vs 81.41±1.45; p=0.51). The discharge-related patient satisfaction ranking was relatively low, in both groups, with a small trend towards worse discharge scores among AE wearers (59.41±0.76 vs 62.26±1.52, p=0.094). Self-reported length of time that has taken to adjust to wearing the prosthesis was not significantly different (p=0.17). Appearance of the eye (p=0.032) and motility of the prosthesis (p<0.0001) were ranked superior by CS respondents compared with AE. CONCLUSIONS: This study characterises unique aspects of CS versus AE in a large national cohort. The results should provide reinforcement to the gain in popularity of CS.

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1: Anophthalmic Patients' Aetiology, Opinions, and Attitudes.

PURPOSE: Ocular prostheses are constructed to aid cosmetic, functional, and psychological rehabilitation of anophthalmic patients. Part-1 of this study aimed to evaluate anophthalmic patients' opinions, attitudes, and experience about aspects related to their postfit ocular prostheses. METHODS: One hundred sixty questionnaires were delivered to anophthalmic patients inquiring about different information such as age, gender, occupation, eye-loss cause, prosthesis type, prosthesis-wearing frequency, prosthesis-cleaning frequency, and problems encountered. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software (P <0.05). RESULTS: The patients were 74 males and 52 females (57.55 years ±â€Š17.57). Almost 50% of the patients lost their eye due to trauma that was the highest among other causes (P <0.05). High proportion clean their prosthesis daily (37.4%) which was the highest among other cleaning regimes (P <0.05). Almost 30.3% experienced having problems with their prosthetic eye. Patients who clean their prosthetic eye every 6 months have experienced more problems (P <0.05). Majority of patients wear their prosthetic eyes 24 hours (92%) (P <0.05). Half of patients who received a prosthetic eye for the first time experienced problems with it (P <0.05) such as excess discharge (45%), infection (25%), and soreness (20%). However, the problems were independent of prosthesis-type (P >0.05). CONCLUSIONS: Trauma is the most common cause of anophthalmic patients in the North-West of England. Anophthalmic patients are likely to experience problems with their prosthetic eye if they have lost their natural eye due to disease; it is their first prosthesis; or if they clean it once every 6 months.

Head mounted DMD based projection system for natural and prosthetic visual stimulation in freely moving rats.

Novel technologies are constantly under development for vision restoration in blind patients. Many of these emerging technologies are based on the projection of high intensity light patterns at specific wavelengths, raising the need for the development of specialized projection systems. Here we present and characterize a novel projection system that meets the requirements for artificial retinal stimulation in rats and enables the recording of cortical responses. The system is based on a customized miniature Digital Mirror Device (DMD) for pattern projection, in both visible (525 nm) and NIR (915 nm) wavelengths, and a lens periscope for relaying the pattern directly onto the animal's retina. Thorough system characterization and the investigation of the effect of various parameters on obtained image quality were performed using ZEMAX. Simulation results revealed that images with an MTF higher than 0.8 were obtained with little effect of the vertex distance. Increased image quality was obtained at an optimal pupil diameter and smaller field of view. Visual cortex activity data was recorded simultaneously with pattern projection, further highlighting the importance of the system for prosthetic vision studies. This novel head mounted projection system may prove to be a vital tool in studying natural and artificial vision in behaving animals.

Ocular Defect Rehabilitation Using Photography and Digital Imaging: A Clinical Report.

Ocular disorders occasionally necessitate surgical intervention that may lead to eye defects. The primary objective in restoring and rehabilitating such defects with an ocular prosthesis is to enable patients to cope better with associated psychological stress and to return to their accustomed lifestyle. A series of detailed steps for custom-made ocular prosthesis fabrication using the advantages of digital photography to replace the conventional oil paint and monopoly iris painting technique are presented in this article. In the present case, a digital photograph of the patient's iris was captured using a digital camera and manipulated on a computer using graphic software to produce a replica of the natural iris. The described technique reduces treatment time, increases simplicity, and permits the patient's natural iris to be replicated without the need for iris painting and special artistic skills.

Ocular prostheses in the last century: a retrospective analysis of 8018 patients.

PURPOSE: To analyze the clinical characteristics of patients with ocular prosthesis to assess the causes of eye loss in the different genders and age groups, and their incidence over the years. METHODS: We retrospectively examined the rates of ocular prosthesis application and related causes in the period from 1927 to 2011 in a referral center in Rome, Italy, and compared them over time. We also compared the results within the population in terms of age and gender. RESULTS: Of 8018 ocular prosthesis wearers, 63% were males and 37% were females, with a mean age of 29 years. The most frequent cause of ocular prosthesis application was a traumatic event (54%), with work-related eye injuries being the most frequent single cause of ocular trauma reported. Other frequent causes were end-stage ocular diseases, tumors, and malformations, without significant differences in gender. Tumors and malformations showed a slight increasing trend over time, while end-stage ocular diseases and work-related injuries remained unchanged, and other traumatic events decreased. CONCLUSION: The constantly high frequency of ocular prosthesis application for work-related injuries and end-stage ocular diseases suggests that preventive measures for these events have not been addressed accordingly, and might represent a neglected public-health issue.

Biosocial profile of New Zealand prosthetic eye wearers.

AIM: To describe the biosocial profile of New Zealand (NZ) artificial eye wearers and establish a basis for future research and international comparison. METHODS: This retrospective study surveyed 431 NZ artificial eye wearers to investigate their ethnicity, gender, age, causes of eye loss, age of current prosthesis, ocular prosthetic maintenance regimes and the extent and severity of discharge associated with prosthesis wear. RESULTS: Approximately 3000 people wear artificial eyes in NZ. Accidents were the main cause of eye loss prior to 1990 and medical conditions have been the main cause since. In the 1960s, the ratio of men to women losing an eye from accidents was 5:1, but during the past decade the ratio was 1.4:1. Socket discharge occurred at least twice daily for one-third of the study group. CONCLUSIONS: Approximately 1 in 1440 people wear artificial eyes in NZ. Decline of eye loss due to accidents is consistent with decreasing workplace and traffic accidents and may be due to improved medical management, workplace safety standards and safer roads. Mucoid discharge is prevalent in the anophthalmic population of NZ and an evidence based treatment protocol for discharge associated with prosthesis wear is needed. Research into this distressing condition is planned.

The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.

PURPOSE: Anophthalmia is associated with a range of psychosocial difficulties and hydroxyapatite orbital implant insertion and prosthesis wearing is the predominant rehabilitation therapy for anophthalmia. However, few articles have compared preoperative and postoperative psychosocial outcomes using standardized questionnaires. This study aimed to investigate the psychosocial benefits of hydroxyapatite orbital implant insertion and prosthesis wearing in this patient population. METHODS: In all, 36 participants were tested preoperatively and 6-months postoperatively using standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and social avoidance (Derriford Appearance Scale-Short Form), and quality of life (World Health Organization Quality of Life Scale-Short Form). RESULTS: Before treatment, levels of depression were comparable with population norms; however, levels of general anxiety were slightly raised, levels of social anxiety, social avoidance, and quality of life were significantly poorer than population norms. Treatment resulted in significant improvement in psychosocial adjustment with improvements in all study variables for the participant group as a whole. CONCLUSION: Hydroxyapatite orbital implant insertion and prosthesis wearing offers significant improvements in psychological and physical functioning for patients with anophthalmia.

[Analysis of ocular prosthetic care on the territory of Russia].

The results of ocular prosthetic help analysis in different regions of the country is presented based on estimation of number of patients who need ocular prostheses; analysis of quality and quantity of produced prostheses in the country; evaluation of demand for glass and plastic prostheses and price determination; study of regulations.

The pediatric patient at a maxillofacial service: Eye prosthesis.

Congenital absence or loss of the ocular globe during childhood causes psycho-social and cosmetic disorders and compromise the normal development of the orbital region. The literature relating to congenital or acquired etiology, due to trauma or disease, demonstrates the necessity of prevention and early detection in order to minimize the sequelae and disturbances in orbital growth. Installation of an eye prosthesis is essential to the rehabilitation process, so as to produce satisfactory development of the region. In order to characterize a profile of the child patient with this condition, a survey was carried out at the Prosthetic Eye sector, Out-patient Clinic, Discipline of Maxillofacial Prosthodontics, School of Dentistry, University of São Paulo (FOUSP), during the period from 1988 to 2003. The 124 (14.02%) patients within the age group of 0-13 years registered for ocular prosthesis were divided into a first group of 64 patients (51.62%) with 0-7 years, and a second group of 60 patients (48.38%) with 8-13 years. Fifty nine were girls and 65 were boys. No statistical significance was observed regarding the distribution of genders in the two analyzed age groups (p = 0.069). However, there was statistical significance at the level of 0.01 in relation to etiology, with higher prevalence of congenital and pathological disturbances in the younger group and traumatic occurrences in the older group. The etiology also presented variation according to the gender, at the significance level of 0.05, where girls presented three times less trauma than boys in the older age group. The necessity of prosthetic ocular repair was evenly distributed along the childhood period and the eye losses that required prosthetic treatment equally affected both genders. However, the etiology of eye loss varied according to the considered gender and age bracket.

The pediatric patient at a maxillofacial service: eye prosthesis / O paciente pediátrico em um serviço de prótese bucomaxilofacial: prótese ocular

Congenital absence or loss of the ocular globe during childhood causes psycho-social and cosmetic disorders and compromise the normal development of the orbital region. The literature relating to congenital or acquired etiology, due to trauma or disease, demonstrates the necessity of prevention and early detection in order to minimize the sequelae and disturbances in orbital growth. Installation of an eye prosthesis is essential to the rehabilitation process, so as to produce satisfactory development of the region. In order to characterize a profile of the child patient with this condition, a survey was carried out at the Prosthetic Eye sector, Out-patient Clinic, Discipline of Maxillofacial Prosthodontics, School of Dentistry, University of São Paulo (FOUSP), during the period from 1988 to 2003. The 124 (14.02 percent) patients within the age group of 0-13 years registered for ocular prosthesis were divided into a first group of 64 patients (51.62 percent) with 0-7 years, and a second group of 60 patients (48.38 percent) with 8-13 years. Fifty nine were girls and 65 were boys. No statistical significance was observed regarding the distribution of genders in the two analyzed age groups (p = 0.069). However, there was statistical significance at the level of 0.01 in relation to etiology, with higher prevalence of congenital and pathological disturbances in the younger group and traumatic occurrences in the older group. The etiology also presented variation according to the gender, at the significance level of 0.05, where girls presented three times less trauma than boys in the older age group. The necessity of prosthetic ocular repair was evenly distributed along the childhood period and the eye losses that required prosthetic treatment equally affected both genders. However, the etiology of eye loss varied according to the considered gender and age bracket.

A ausência congênita ou a perda do bulbo ocular na infância acarretam distúrbios estéticos e psico-sociais e comprometem o desenvolvimento normal da região orbitária. A literatura relacionada à etiologia congênita ou adquirida, devido a trauma ou doença, demonstra a necessidade da prevenção e da detecção precoce para minimizar as seqüelas e os distúrbios de crescimento orbital. A reabilitação implica a instalação de uma prótese ocular visando favorecer o desenvolvimento harmonioso da região. Com o objetivo de caracterizar o perfil do paciente infantil foi realizado um levantamento junto ao Setor de Prótese Ocular do Ambulatório da Disciplina de Prótese Bucomaxilofacial da FOUSP abrangendo o período de 1988 a 2003. As 124 (14,02 por cento) crianças registradas encontravam-se distribuídas em 64 (51,62 por cento) na faixa etária de 0 a 7 anos e 60 (48,38 por cento) na de 8 a 13 anos de idade, sendo 59 meninas e 65 meninos. A análise estatística revelou que a variação das ocorrências dos gêneros masculino e feminino nas faixas etárias não é significante (p = 0.069). Entretanto, a etiologia da perda variou segundo as faixas etárias consideradas, com um nível de significância de 0,01, apresentando uma maior prevalência de distúrbios congênitos e patológicos na faixa etária mais jovem e trauma na mais velha. A etiologia alterou-se de acordo com os gêneros com uma significância de 0,05, tendo as meninas apresentado três vezes menos trauma que os meninos na faixa etária mais velha. A necessidade de tratamento protético apresentou-se igualmente distribuída ao longo da infância e as perdas oculares que implicam reabilitação protética ocorreram igualmente nos gêneros masculino e feminino. Entretanto, a etiologia da perda ocular variou em função do gênero e da faixa etária considerada.

A survey of satisfaction in anophthalmic patients wearing ocular prosthesis.

PURPOSE: The purpose of this study was to evaluate patient satisfaction with ocular prosthesis after evisceration or enucleation and to determine which variables were correlated to their satisfaction in order to find out how to increase patient satisfaction. METHODS: A satisfaction questionnaire was given to consecutive anophthalmic patients who visited Korea University Hospital from March 2002 through August 2002. Many kinds of variables such as age, gender, type of implant, pegging, and postoperative ocular symptoms that might influence patient satisfaction were evaluated by correlation analysis and multivariate analysis to find the determinants of patient satisfaction. RESULTS: The overall rate of satisfaction with ocular prosthesis was 71.8%. The variables significantly correlated to patient satisfaction were economic status, other people's response, and insertion of motility coupling post or motility peg. CONCLUSION: Patient satisfaction with ocular prosthesis was relatively high. Successful peg insertion to improve the prosthesis movement may be one way for surgeons to increase patient satisfaction.

Estudo sobre as causas mais freqüentes de perdas oculares / A study on the most frequent causes of ocular losses

As perdas oculares são constrangedoras ao portador por comprometer a face que é parte do corpo humano que possue os órgãos essenciais para o relacionamento humano. Foram avaliados no presente estudo prontuários de 53 pacientes da clínica de prótese buco-maxilo-facial do Centro de Oncologia Bucal da UNESP de Araçatuba, que tiveram a região ocular comprometida, sendo classificadas em ordem de prevalência as causas das perdas oculares. O glaucoma foi responsável por 37 por cento das perdas oculares, seguido por traumas ou acidentes com 32 por cento. Muitas são as causas das perdas oculares, sendo o glaucoma o principal responsável. As próteses oculares foram criadas com o intuito de devolver a função e a estética comprometidas pela ausência de parte ou total do globo ocular

Anophthalmic ptosis: investigation of the mechanisms and statistical analysis.

PURPOSE: To investigate the mechanisms producing ptosis in anophthalmic patients by comparing potential risk factors among patients with ptosis with a control group. Specific techniques for achieving optimal aesthetic results in the surgical correction of anophthalmic ptosis are recommended. METHODS: Data from 94 anophthalmic patients with ptosis and 44 control patients without ptosis were retrospectively collected and analyzed. Potential risk factors for ptosis were compared between the two groups of patients by using 2-sample binomial exact tests. Univariate and multivariate logistic regression analyses were also used. RESULTS: A direct relation between percent volume replacement by the primary implant and the occurrence of ptosis was noted (P=0.057; age adjusted, P=0.037). Those patients who had secondary implant surgery were more likely to have levator surgery for ptosis (P=0.005; age adjusted, P=0.039). A greater number of years of prosthesis wear was associated with clinical and intraoperative evidence of levator dehiscence (P=0.061). No relation was observed between the occurrence of trauma (as a reason for enucleation) and the occurrence of levator dehiscence. Thirty percent of patients with ptosis who had secondary intraconal or extraconal implants and no other surgical intervention for ptosis had improvement in ptosis. CONCLUSIONS: The mechanisms producing anophthalmic ptosis should be assessed carefully before surgical repair to achieve optimal aesthetic results. Correction of volume deficiency should be offered before levator surgery for patients with anophthalmic ptosis. The patient should be advised that tilt of the prosthesis is a possible outcome of levator repair and may reflect overcorrection or insufficient volume replacement.

Emprego do gel de poliacrilamida no tratamento da enoftalmia em usuários de prótese ocular / Application of polyacrylamide gel in enophthalmos treatments in ocular prosthesis users

O objetivo deste estudo foi o de avaliar o efeito da injeção do gel de poliacrilamida em 21 pacientes com órbita enoftálmica e usuários de prótese ocular seguidos no Ambulatório de Cirurgia Plástica Ocular do HC-FMUSP. Foram estudadas as causas da perda ou atrofia do globo ocular, cirúrgia(s) anterior(es), tempo de uso e o volume da prótese ocular antes e após o tratamento. Foram realizadas documentação fotográfica, exoftalmometria e tomografia computadorizada para cálculo do volume orbitário antes e após a aplicação do gel. Os pacientes receberam injeção do gel de poliacrilamida no cone muscular da órbita. O volume injetado variou de 1,0 a 3,5 ml. Os defeitos órbito-palpebrais foram corrigidos em todos os casos. O gel de poliacrilamida demonstrou ser um produto seguro, econômico, de fácil obtenção e aplicabilidade / The object of this study was evaluating the effect of polyacrylamide gel injection in 21 patients presenting unilateral enophthalmic orbit with ocular prosthesis, assisted in the Oculoplastic Surgery Ambulatory of HC-FMUSP. Causes of ocular globe loss or atrophy, previous surgeries and length of use of ocular prosthesis and its volume have been evaluated. Photograph documentation, exophthalmometry and computerized tomography were studied for calculating the orbital volume before and after the application. Patients received injection of polyacrylamide gel in the muscular cone of the orbit. Volume injected varied from 1,0 ml to 3,5 ml. Orbito-palpebral defects have been corrected in all cases. The use of polyacrylamide gel has shown that it is a product which is safe, cost-effective, easy to obtain and to apply...

Maxillofacial prosthetics: vital signs.

A maxillofacial prosthetics survey was designed to record the response rate of prosthodontists regarding the frequency of maxillofacial procedures and insurance coverage in 1991. The survey explored variability with respect to membership in professional organizations, region, education, primary activity, and age of the prosthodontist. A total of 342 survey instruments were received from a total of 690 mailed. A total of 18,410 maxillofacial procedures were performed by the survey population. Members of the American Academy of Maxillofacial Prosthetics performed procedures at a significantly higher rate than did the members of the American College of Prosthodontists. A greater procedure rate was observed for prosthodontists in the South Midwest and Southwestern regions; the hospital setting; with 2 plus 1 year additional postgraduate maxillofacial training; and the 45- to 54-year age group. Insurance covered most maxillofacial procedures, but was not uniformly distributed within predictor variables nor between procedures.