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An investigation into discharge, visual perception, and appearance concerns of prosthetic eye wearers



We investigate prosthetic eye wearers’ initial and current concerns about mucoid discharge, visual perception, and appearance, and the reasons for their concerns. A retrospective, cross-sectional study of private practice patients was designed. Participants were 217 experienced prosthetic eye wearers, aged at least 16 years. An anonymous questionnaire was e-mailed or mailed to participants. Descriptive and inferential statistics were used to investigate differences or correlations between variables. Content analysis was used to analyze participants’ open responses. Participants were equally concerned about discharge, visual perception, and appearance during the first three months following eye loss and at least 2 years later, even though their concerns decreased. Older participants were less concerned about appearance, while females were more concerned about current discharge and appearance. The greater the frequency and volume of discharge, the greater was the concern. Participants’ initial discharge concern was due to a negative interpretation of what it meant, but later, it was due to discomfort from wiping, and how discharge looked to others. Loss of depth perception and reduced visual range were equally concerning. Initial appearance concerns related to disguisability of the prosthesis, but over time, changes to the socket and eyelids became more important. Loss of self-image is commonly considered to be the major concern of anophthalmic patients, but discharge and visual perception concerns are of equal importance. Reasons given for these concerns provide greater insight into patients’ personal experience of eye loss.
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An investigation into discharge, visual perception,
and appearance concerns of prosthetic eye
Nicola S. Pine, Ian de Terte & Keith R. Pine
To cite this article: Nicola S. Pine, Ian de Terte & Keith R. Pine (2017): An investigation into
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An investigation into discharge, visual perception, and appearance concerns of
prosthetic eye wearers
Nicola S. Pine
, Ian de Terte
, and Keith R. Pine
School of Psychology, Massey University, Wellington, New Zealand;
School of Optometry and Vision Science, University of Auckland,
Auckland, New Zealand
We investigate prosthetic eye wearersinitial and current concerns about mucoid discharge, visual
perception, and appearance, and the reasons for their concerns. A retrospective, cross-sectional
study of private practice patients was designed. Participants were 217 experienced prosthetic eye
wearers, aged at least 16 years. An anonymous questionnaire was e-mailed or mailed to partici-
pants. Descriptive and inferential statistics were used to investigate differences or correlations
between variables. Content analysis was used to analyze participantsopen responses. Participants
were equally concerned about discharge, visual perception, and appearance during the first three
months following eye loss and at least 2 years later, even though their concerns decreased. Older
participants were less concerned about appearance, while females were more concerned about
current discharge and appearance. The greater the frequency and volume of discharge, the
greater was the concern. Participantsinitial discharge concern was due to a negative interpreta-
tion of what it meant, but later, it was due to discomfort from wiping, and how discharge looked
to others. Loss of depth perception and reduced visual range were equally concerning. Initial
appearance concerns related to disguisability of the prosthesis, but over time, changes to the
socket and eyelids became more important. Loss of self-image is commonly considered to be the
major concern of anophthalmic patients, but discharge and visual perception concerns are of
equal importance. Reasons given for these concerns provide greater insight into patientsperso-
nal experience of eye loss.
Received 2 December 2016
Accepted 28 May 2017
Concerns; ocular prosthesis;
prosthetic eye wearers;
psychological impact
Previous research investigating the psychological adjust-
ment of patients living with an ocular prosthesis has
focused on appearance-related issues.
The research, as
far as the authors are aware, has not yet addressed the
psychological impact of other important issues, such as
visual perception changes brought about by acquired
monocular vision and coping with mucoid discharge
from the eye socket. However, at least one investigation
has suggested these areas of concern are of significance to
experienced prosthetic eye wearers.
This study aims to further investigate the concerns of
prosthetic eye wearers to determine which concern
(appearance, discharge experience, or visual perception)
is more important than the others and to report on the
reasons given for these concerns.
Participants were over 16 years old and had worn an
ocular prosthesis for more than 2 years. Once the
Massey University Human Ethics Committee
granted ethics approval, the New Zealand
clinics throughout New Zealands North Island)
invited potential participants to complete an online
or hard-copy questionnaire. If questions raised psy-
chological difficulties for participants, contact
details of psychological support organizations were
provided. The questionnaire was completed by 217
participants (40% response rate).
CONTACT Nicola S. Pine School of Psychology, Massey University, Wallace Street, Mt Cook, Wellington 6021, New Zealand.
Supplemental data for this article can be accessed at
© 2017 Taylor & Francis
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The questionnaire contained 29 questions and five psy-
chological scales across four main categories (demo-
graphics, concerns, feelings and problems,
psychological scales). This article covers the first two
sections of the questionnaire (see the online supple-
mentary material).
Data analysis
Quantitative data were analysed using the Statistical
Package for the Social Sciences for Mac (version 23).
One-way analyses of variance investigated differences
between both initial and current concerns, reasons for
discharge and appearance concerns, and discharge con-
cerns relative to discharge frequency. Paired-samples
t-tests investigated differences between initial and cur-
rent levels of concern, and independent-samples t-tests
explored differences between concerns according to
gender and reasons for visual perception concerns.
Pearson correlations investigated relationships
between concern levels and participantscurrent age
and age at time of eye loss. A linear regression analysis
determined the relationship between discharge volume
and current discharge concerns.
Qualitative responses were subject to content analy-
sis to identify descriptive themes within the data and
their frequencies.
Participantsaverage age was 58 years and their average
prosthetic eye wearing time was 27 years. The majority
were male (67%), and ethnicities were New Zealand
European (76%), Maori (13%), other (7%), Asian
(3%), and Pacific Islander (1%).
There were no significant differences in levels of con-
cern for discharge, visual perception, and appearance
during the initial period following eye loss or after at
least 2 years. Over time, concerns about discharge,
visual perception, and appearance decreased signifi-
cantly (Table 1).
Demographic variables and concerns
The older participants were when they lost their eye,
the lower was their current concern about appearance
(r=0.19, p= 0.007), and the greater was their initial
concern about visual perception (r= 0.22, p= 0.003).
Table 1. Differences between initial and current concerns of prosthetic eye wearers, including gender differences between initial and current mean levels of concern.
Mean level of
difference Significance
Initial mean level of
Initial mean
difference Significance
Current mean level of
Current mean
difference Significance
Discharge Initial 2.52 .583 .000* Female 2.65 .212 .191 2.22 .425 .003*
Current 1.92 Male 2.44 1.80
Appearance Initial 2.52 .497 .000* Female 2.66 .203 .251 2.25 .330 .025*
Current 2.03 Male 2.45 1.92
Visual perception Initial 2.32 .377 .000* Female 2.32 .023 .892 1.94 .031 .824
Current 1.91 Male 2.30 1.91
*The mean difference is significant at the 0.05 level.
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Older participants were less concerned about their cur-
rent appearance (r=0.32, p< 0.001), while females
were more concerned about current discharge and
appearance compared to males (Table 1).
Discharge concerns
Eighty percent of participants experienced discharge,
48% at a moderate to severe level. Those experien-
cing it hourly were significantly more concerned (M
= 3.05, SD = .85) than those experiencing it daily (M
= 2.05, SD = .927, p< 0.001) or weekly (M = 1.70,
SD = .83, p< 0.001). Greater discharge volume also
led to greater concerns about discharge (R
= 0.61, F
(1, 189)
At the present time, participants were equally con-
cerned about discharge drawing attention to their
prosthesis (M = 2.57, SD = 0.98), about having to
continually wipe their eye (M = 2.69, SD = 0.92),
and about discharge discomfort (M = 2.52, SD =
1.03) (p> 0.05).
Visual perception concerns
At the present time, participantswere equally con-
cerned about judging distance (M = 2.34, SD = 0.96)
and reduced peripheral vision (M = 2.45, SD = 0.88,
Appearance concerns
Current levels of concern regarding appearance were
the look of prosthesis relative to good eye (M = 2.43,
SD = 0.94), how I appear to myself (M = 2.28, SD =
1.03), and how I appear to others (M=2.67, SD= 0.89).
Current concerns about how participants appeared to
others were greater compared with how they appeared
to themselves (mean difference = 0.39, p= 0.002)
Reasons for concerns
The initial reason for discharge concerns was partici-
pants’“negative interpretationof what the discharge
meant (18.5%) (Was my experience normal?), includ-
ing being worried about infectionand cleanliness (It
always seemed like I hadnt washed my eye). This was
followed by physical complaintscaused by the dis-
charge (16.7%), including pain around inner eyelid,
itchiness,irritation from wiping the eye, and the
consequences of discharge on eye functioning (With
the crusting, my eyelid would close;It stops my eye
blinking). Lastly, 13% of participants indicated that
volume and frequency of discharge were reasons for
their concern.
Current reasons for discharge concerns were phy-
sical complaints(33%) (Skin irritation;Gets really
tacky at times and hard to blink), followed by others
noticing the discharge(13.3%) (I notice people focus-
ing on my eye when I talk with them and I begin to
wonder if there is any discharge or crusting visible and
I feel uncomfortable). Lastly, participants were con-
cerned about their eye rotating in the socket when
wiping discharge (10%) (I am concerned if I rub my
eye that it will rotate in the socket, so I often use a
mirror or the selfie view on phone camera to check
Visual perception
Initial reasons for participantsvisual perception con-
cerns were perception difficulties (36%), including
depth perception (Pouring hot water from the urn or
the teapothard to judge the distance), peripheral
vision (I often hurt myself walking into open doors
or cupboards), and cognitive factors (Visual ghost
images from my lost eyeand loss of 3D vision).
Adaptive behavior (11.7%) referred to acceptance and
the development of compensatory strategies (Getting
used to having to look around a lot more;If I am
walking with a new person, I let them know I need to
walk on the left side). Functional impact (10.4%)
referred to the negative impact that visual perception
difficulties had on sport and work [The loss of full
vision directly (and permanently) affected my work
prospects;Had a huge impact on any ball games I
could play as judgment of distances impaired].
Current reasons for participantsvisual perception
concerns were difficulties with depth perception and
peripheral vision (37%), followed by specific difficulties
regarding driving and/or nighttime vision (27.4%)
(Have lost independence and no longer able to drive,
also night vision is not at all good), and finally adap-
tive behavior (19.4%) (Experience and time improves
Initial reasons for appearance concerns were about
disguisability (23%) (Always worried the eye would
turn and be obvious to others;The pupil did not
dilate at night making the prosthesis more noticeable;
Looked obvious in photographs). Some participants
were fine with their appearance(17%) because they
were either happy that the prosthesis matched their
companion eye (An excellent match, so not a lot of
people realised it was prosthetic) or believed their
prosthetic eye improved their appearance
(Appearance has never been an issue in fact a great
change from my previously damaged eye). Others
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responses(15.6%) referred to other people staring (I
was very self-conscious of people staring at me), ask-
ing questions (Having to answer questions early on
was hard as I didnt want to talk about it), and being
teased (School teasing very badcalled cross-eyed;I
didnt want to go out in public because I thought
people would say things about it and laugh, which
people did and still do).
Current reasons for appearance concerns were ana-
tomical factors (29%) (Eye socket sunk in;Eyelid
droop), acceptance of their appearance (22%) (It
doesnt stress me out, but its just there. I am not
angry or upset;I accepted what happened a long
time ago;At my age it doesnt worry me what others
think. Im past catching women) and disguisability
(14.6%) (Biggest psychological barrier).
Loss of self-image is commonly considered to be the
major concern of anophthalmic patients, but this study
has found that discharge and visual perception con-
cerns are of equal importance. McBain et al.
edged this possibility when noting that their study was
limited to appearance factors only. Other investigators
have stressed the need for research into all aspects of
prosthetic eye wear, not just appearance.
The finding that older participants were less concerned
about their appearance is consistent with the idea that
older adults become more focused on physical function-
ing and although they experience body dissatisfaction
their priorities may move away from their outward
It is also possible that eye loss impacts
less on older peoples sense of identity or when self-
esteem is already established. For example, during teenage
years (1318 years), establishing ones identity and fitting
into social groups is a key developmental task.
Women are more concerned about their appearance
than men
because society appears to judge them more
by their appearance.
This may account for the heigh-
tened concerns women expressed about appearance
and discharge in this study.
A high percentage of participants (80%) experienced
discharge, and it is not surprising that levels of concern
were correlated with frequency and volume of dis-
charge. However, the finding that many patients were
concerned about the meaning of the discharge (e.g., an
infection, poor hygiene, abnormal) suggests that clin-
icians should inform patients early on about the like-
lihood of socket discharge and explain its annoying
but essentially harmless nature. This would avoid unne-
cessary distress due to patientsnegative interpretation
of discharge.
The primary deficits of acquired monocular vision
are reduced visual range and impaired depth
These deficits can cause problems with
daily activities such as sports and driving, as well as
the ability to perform in some work environments,
leading to distress. However, over time, participants
developed strategies to compensate for their deficits
and were able to resume previous work and daily activ-
ities. McLean
suggested that adaptation following
sudden eye loss normally takes one year or less.
Participants in this study were significantly more
concerned with how they appeared to others compared
with how they appeared to themselves. They identified
disguisability as an important factor that caused parti-
cular concern when their prosthesis did not move in
concert with or match their companion eye, or when
anatomical factors affected their facial symmetry. The
visibility of an individuals condition can have a sig-
nificant psychological impact and create difficulties
with body image, self-esteem, and quality of life, as
well as social interactions.
The main function of a
prosthetic eye is to restore facial harmony, and when
this is ineffective, patients fear that the truthwill be
discovered and they will be exposed to ridicule.
is the same for people with other visible
A major source of stress for those with facial disfig-
urement is the unavoidability of having to share their
condition with others,
with the most common dif-
ficulties falling within the area of social interaction.
The finding that initial concerns about discharge,
visual perception, and appearance decrease signifi-
cantly over time is reassuring for patients who have
recently lost an eye. This decrease may be due to the
passage of time itself (adapting to a new normal)
and to the development of coping strategies.
Having good social skills is associated with success-
ful adjustment,
and such skills as educating
others, remaining calm, and assertively confronting
negative reactions
develop over time. It is the
individualsinterpretation of themselves, their disfig-
urement, and their interactions with others that
influences their adjustment process, and in turn
their level of distress associated with their
Having a supportive family and
social environment is an important factor when cop-
ing with disfigurement.
Over time, wearers often develop individualized
cleaning routines to minimize the volume or frequency
of discharge, meaning less distress. Compensatory stra-
tegies and behaviors to cope with acquired monocular
vision take time to learn and put into practice, but once
these are perfected, the negative functional impact and
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associated concerns are likely to decrease. Over time,
prosthetic eye wearers naturally get older, which can
have an effect on coping ability, as older adults cope
better with their disfigurement compared to younger
The results of this study provide greater insights
into anophthalmic patientsexperiences and feelings
when they receive their first prosthesis and over the
ensuing years. These insights help inform the advice
provided by clinicians and highlight areas for future
research, particularly regarding the impact of less
explored socket discharge and visual perception
Disclosure statement
The participants in this study were recruited from the NZ
Prosthetic Eye Service, which is owned and operated by Keith
This research was supported in part by funding from Massey
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... Most studies on prosthetic eye wearers focus on the concerns of anophthalmic patients, anxiety, stress, depression, or other quality of life affecting issues. [1][2][3][4][5][6][7][8][9][10][11][12][13] The circumstances surrounding eye loss, the health of the fellow eye, potential discharge from the anophthalmic socket, dry socket symptoms, altered visual perception, and changes of appearance, as well as anxiety, stress and depression disorders, have been reported as relevant quality of life affecting factors for prosthetic eye wearers in these studies. Prosthetic eye wearers have various multifactorial, very special psychological, mental, social, and physical burdens and concerns due to eye loss. ...
... The socio-demographic data of the consecutively included prosthetic eye wearers was very similar to data collected in previous studies conducted at the same institute. [1][2][3][4][5][6][7][8][9][10][11][12][13] This suggests that the enrolled patients are representative for the German anophthalmic population. However, the monocenter design of this study is a significant limitation in addition to the relatively low proportion of patients with retained disfigured globes and patients with eviscerations in relation to enucleated patients. ...
... A further limitation might be that patients with very low HL did not participate in the study because they do not regularly attend ocularistic and ophthalmological clinics. [1][2][3][4][5][6][7][8][9][10][11][12][13] Also, it is not clear why over 10% of all participants had more than two non-answered values in the HLS-EU-Q16. In addition, the exact reasons why migration background influences health literacy negatively remain unclear which is also a limitation of this study. ...
Purpose: To investigate general and electronic health literacy (HL) levels in prosthetic eye wearing patients, to define factors associated with reduced HL, and to identify a potential healthcare gap. Methods: In this prospective cross-sectional study 148 prosthetic eye wearers were screened using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the 8-item electronic Health Literacy Scale (eHEALS). HLS-EU-16 and eHEALS scores were correlated to health levels, vision functioning, and sociodemographic factors. Results: A total of 85 patients (57%) had adequate, 38 (26%) problematic, and 9 (6%) inadequate general HL, while 16 (11%) had no valid HLS-EU-Q16 score. General HL was positively correlated with physical health (p = 0.009) and negatively with a migration background (p = 0.023). There was a positive correlation between electronic HL and educational level (p < 0.001), social status (p = 0.048), and mental health (p = 0.013). Higher age was associated with lower electronic HL (p < 0.001). Conclusions: More than 30% of the prosthetic eye wearers had problematic or even inadequate general HL, suggesting a significant health care gap. To identify patients with reduced HL, a standardized screening tool should be implemented as part of routine clinical care. Within integrated care, patients with insufficient HL should be offered barrier-free advisory services and information brochures in various languages.
... The loss of an eye is a major challenge for ones' mental health [1,2]. Besides psychological issues, sudden acquired monocular vision requires adaptation to impaired depth perception, reduced peripheral visual field, [3,4] mucoid discharge, tearing, foreign body sensation, pruritus, and irritation [5]. It is reported that wearing and maintaining a prosthetic eye can reinstate appearance, comfort, and daily routine [6]. ...
... Studies have also postulated that a well fabricated prosthesis, a positive experience from the previous prosthesis [9] and giving time to adjust and accept the prosthesis [10] help improve the concerns of anophthalmic patients. Pine, et al. [4], Korani, et al. [7] and Shapira, et al. [8] have reported commonly experienced concerns in populations wearing poly methyl methacrylate prosthetic eyes and Rokohl, et al. [9] have summarised common concerns in populations wearing glass prosthetic eyes. Pine, et al. [4] (New Zealand) and Rokohl, et al. [9] (Germany) emphasised concerns about the health of the good eye whereas Korani, et al. [7] emphasized concerns towards watering crusting, discharge in India and Shapira, et al. [8] reported particular concerns towards motility and discomfort in study populations in the United Kingdom (UK). ...
... Pine, et al. [4], Korani, et al. [7] and Shapira, et al. [8] have reported commonly experienced concerns in populations wearing poly methyl methacrylate prosthetic eyes and Rokohl, et al. [9] have summarised common concerns in populations wearing glass prosthetic eyes. Pine, et al. [4] (New Zealand) and Rokohl, et al. [9] (Germany) emphasised concerns about the health of the good eye whereas Korani, et al. [7] emphasized concerns towards watering crusting, discharge in India and Shapira, et al. [8] reported particular concerns towards motility and discomfort in study populations in the United Kingdom (UK). Concerns related to prosthesis fitting; general and prosthesis related appearance in all these countries reduced over time [5,[7][8][9]. ...
... The application of ocular prosthesis helps to overcome many psychosocial problems; however, there are various consequences and concerns connected to the use of ocular prosthesis. [11] This study showed reduction in depression followed by anxiety after the prosthetic wear. The reason for the higher prevalence of depression and anxiety in this sample could be attributed to the poor financial status of the participants, which may have created a great deal of confusion and apprehension for one's own health or future. ...
... The most prevalent prosthetic-related issues were discharge accompanied by watering, which seems to be concurrent with previous studies. [10,11] Profuse watering and discharge can be caused if the surfaces of the prosthesis are rough and the edges are sharp. Therefore, the patients should have a yearly check up of the prosthesis and polish the shell if needed. ...
Full-text available
Purpose: The aim is to determine the psychological factor, driving capability, and the influence of the device among working professionals based on questionnaire. Methods: A qualitative questionnaire-based cross-sectional study was conducted among participants of a tertiary eye care center in Chennai from March 2020 to August 2020. The questionnaire consisted of participant demographics, psychological care, driving, and prosthetic support and maintenance-related questions. The responses were recorded over telephone and analysed using SPSS Statistics. Result: About 30 participants of age 9 years and above were included after obtaining consent. The average age was found to be 38.8 ± 12.7 years with 46.7% (n = 14) males and 53.3% (n = 16) females. Anophthalmic participants exhibit a substantial change in psychological feelings following ocular prosthesis. Participants found to be motivated after the cosmetic change brought about by prosthesis, and therefore had a higher output on work factor. In terms of driving, 90% of the subjects were comfortable using protective devices for safety measures. They found greater satisfaction in customised manually built prosthesis than computerised prosthesis. The former had smooth edge finish with reduced prosthetic motility, which has made the patient gain satisfaction, improving care and maintenance, and the handling of ocular prosthesis. Conclusion: The use of ocular prosthesis was found to decrease depression, insecurity, inferiority complex with minimal difficulty in activities of daily living, and no difficulty in driving with prosthesis. The quality of life improved with the use of customised prosthetic shells.
... Therefore, we did not use the calculation of sample size, but collected samples of existing patients for experiment and analysis. At the same time, in order to compare the differences of ocular surface flora among ocular prosthesis patients in multiple dimensions, we further divided all participants of OP group into (1) Gender term: Male group (n = 11) and Female group (n = 8); (2) Age term: Under 25 (n = 8) and over 25 (n = 11); Since the number of anophthalmic patient is very small, and the inducements leading to anophthalmia widely occur in the adult population, so that we did not use the traditional threshold of 18 years old as the age, but used the threshold of 25 years old as the age group, which was also reflected in other research reports (Pine et al., 2017;Rokohl et al., 2018). And from our data collection, there was only one patient who was below 18 years old. ...
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PurposeTo explore the changes of bacterial flora in anophthalmic patients wearing ocular prosthesis (OP) and the microbiome diversity in conditions of different OP materials.MethodsA cross-sectional clinical study was conducted, involving 19 OP patients and 23 healthy subjects. Samples were collected from the upper, lower palpebral, caruncle, and fornix conjunctiva. 16S rRNA sequencing was applied to identify the bacterial flora in the samples. The eye comfort of each OP patient was determined by a questionnaire. In addition, demographics information of each participant was also collected.ResultsThe diversity and richness of ocular flora in OP patients were significantly higher than that in healthy subjects. The results of flora species analysis also indicated that in OP patients, pathogenic microorganisms such as Escherichia Shigella and Fusobacterium increased significantly, while the resident flora of Lactobacillus and Lactococcus decreased significantly. Within the self-comparison of OP patients, compared with Polymethyl Methacrylate (PMMA), prosthetic material of glass will lead to the increased colonization of opportunistic pathogens such as Alcaligenes, Dermabacter and Spirochaetes, while gender and age have no significant impact on ocular flora.Conclusions The ocular flora of OP patients was significantly different from that of healthy people. Abundant colonization of pathogenic microorganisms may have an important potential relationship with eye discomfort and eye diseases of OP patients. PMMA, as an artificial eye material, demonstrated potential advantages in reducing the colonization of opportunistic pathogens.
... According to the research progress at home and abroad, different scholars have also conducted cooperative research on gait evaluation of prosthetic wearers and debugging of intelligent prostheses. Pine et al. investigated initial and current concerns of prosthetic eye wearers about mucous secretions, visual perception, and appearance, and the reasons for their concerns, and designed a retrospective cross-sectional study of patients in private practice [1]. Zhao et al. redesigned the prosthetic fall protection and management system from the perspective of man-machine integration, including fall warning and fall protection control. ...
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The main purpose of developing intelligent lower limb prostheses is to improve the quality of life of the disabled and promote the development of medical care. At the same time, the research of robotic intelligent lower limb prosthesis is a research direction that has been widely concerned in the field of robotics and biomedical engineering technology in recent years. This paper aims to research and discuss the 5G virtual reality system based on the gait evaluation of prosthetic wearers and its application in the debugging of intelligent prostheses. First, this paper analyzes the combination of the concept of lower extremity rehabilitation and virtual reality. Virtual reality technology is a means of exercise rehabilitation for patients with lower extremity hemiplegia, which plays an auxiliary role in the rehabilitation process. Then, the recognition and pre-method of human lower limb motion state are described. In the field of intelligent prosthetic state recognition, in addition to neural network recognition methods, there are hidden Markov (HMM) recognition methods, auxiliary vector machines (SVM), and so on. Finally, the lower limb state phase detection experiment and the prosthetic control experiment based on state phase detection are studied. The results of this experimental study showed that, for the same experimenter, changes in pace and gait did not affect the percentage of standing and swing phases. That is, the standing phase accounts for about 60% of the entire gait cycle, while the swing phase accounts for 40% of the entire gait cycle. This rule has been verified in other experiments.
... In addition to the functional disability with vision and visual field loss, cosmetic and aesthetic aspects are one of the most important concerns after enucleation [1][2][3]. The PESS is one of the main reasons for a bad appearance with a prosthetic eye [1][2][3][4][5]. ...
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Background The last definition of the post-enucleation socket syndrome (PESS) by Tyers and Collin—formulated almost 40 years ago in 1982—is predominantly based on the clinical characteristics and does not include the insights of newer studies into the pathophysiological mechanism of the PESS. Methods A systematic PubMed literature review regarding the pathophysiological mechanism of the PESS was performed, and results were comprised to give an overview of the current knowledge of the PESS including the exact pathophysiological mechanism. Results The primarily postulated pathophysiological mechanism of the PESS was the atrophy of orbital tissues, especially of fat, resulting in variable clinical findings. Newer studies using high-resolution computed tomography and magnetic resonance imaging or performing histopathological analyses found no orbital fat atrophy but rather a rotatory displacement of the orbital tissues from superior to posterior and from posterior to inferior together with the retraction of the extraocular muscles and a possible volume loss of the orbital implant by resorption if it is manufactured from hydroxyapatite. PESS results in a backward tilt of the superior fornix, a deep superior sulcus, a pseudo-ptosis, a lower eyelid elongation and laxity, a shallower inferior fornix, as well as enophthalmos and may lead to an inability of wearing ocular prostheses. Conclusions A novel and comprehensive definition of the PESS is proposed: PESS is a multifactorial and variable syndrome caused by a rotatory displacement of orbital contents together with the retraction of the extraocular muscles and possible resorption of the orbital implant if it is manufactured from hydroxyapatite.
The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.
Various surgical techniques are available for the extirpation of an eye, depending on the underlying disease. Typical indications encompass tumors, inflammatory and infectious processes, glaucoma, trauma as well as congenital malformations. Surgical procedures include evisceration (resection of the intraocular space with preservation of the sclera), enucleation (extirpation of the entire eyeball including sclera and cornea) and exenteration (resection of the complete orbital soft tissue). The early detection of postoperatively manifesting complications, such as implant extrusion, conjunctivitis, postenucleation socket syndrome as well as the development of enophthalmus or ptosis, is of particular relevance in the context of postoperative care regarding functional, esthetic and social outcome. Special attention must be paid to ensuring a complication-free rehabilitation process, including the supply of a suitable, precisely fitting prosthesis or epithesis. This ensures the patient’s psychosocial reintegration, in which an integrated interdisciplinary cooperation with ocularists and psychologists is essential. The latter play a particularly important role, as the psychological stress resulting from the procedure is often associated with a considerable reduction in the quality of life.
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Purpose To compare tear film osmolarity (TFO) values and matrix metalloproteinase 9 (MMP-9) levels between anophthalmic sockets and healthy fellow eyes and to assess the use of the MMP-9 and TFO as objective biomarkers for the dry anophthalmic socket syndrome (DASS). Methods In this prospective single-center study, the anophthalmic sockets and healthy fellow eyes of 98 unilateral anophthalmic patients were assessed using the ocular surface disease index (OSDI) questionnaire, InflammaDry® MMP-9 point-of-care immunoassay, TFO with TearLab™ Osmolarity System, and clinical conjunctival inflammation. MMP-9 concentration and conjunctival inflammation were graded semi-quantitatively. Differences between anophthalmic sockets and the healthy fellow eyes for OSDI scores, MMP-9, TFO values, clinical conjunctival inflammation, and eyelid abnormalities as well as the correlation between these factors and demographic data were evaluated. Results Patients had significantly higher OSDI, MMP-9, and TFO values, as well as higher conjunctival inflammation on the anophthalmic side, compared to the healthy side ( p ≤ 0.002, respectively). For anophthalmic sockets, there was a significant positive correlation between OSDI scores and TFO values ( p = 0.007), between the grade of posterior blepharitis and TFO values ( p = 0.026), and between the conjunctival inflammation and MMP-9 values ( p < 0.001), as well as between MMP-9 levels and time since eye loss ( p = 0.004). Conclusions Measuring MMP-9 and TFO may be helpful tools as efficient, quantifiable biomarkers, disease course parameters, or predictors for treatment response in the clinical management of patients with DASS or future therapy studies. Ophthalmologists should consider the updated diagnosis criteria including TFO and the definition for DASS proposed in this study.
Purpose: This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses. Methods: The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated. Results: For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively. Conclusions: Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.
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Objective: Many patients are satisfied with their ocular prosthesis, but some describe problems with social interactions, body image and self-esteem. Although both clinical practice and research suggest that the severity of a disfiguring condition does not predict distress, there has been little research with patients living with an ocular prosthesis. The objective was to explore the psychological impact of living with an artificial eye or cosmetic shell and determine the relationship between psychological well-being and clinical and psychosocial factors. Methods: A cross-sectional study between March and September 2008 at the ocular prosthesis clinic of Moorfields Eye Hospital, UK. The primary outcome measures were mood as measured by the Hospital Anxiety and Depression Scale (HADS) and appearance-related social anxiety and social avoidance, as measured by the Derriford Appearance Scale (DAS24). Results: Mean scores on the HADS and DAS24 were within normal range, but a considerable proportion of participants were experiencing significant levels of distress. Psychosocial adjustment was unrelated to most clinical and demographic variables, but was associated with a series of cognitive processes. Conclusions: Psychological variables, rather than clinical or demographic factors, are associated with how a patient adjusts to wearing an ocular prosthesis. Such factors might be amenable to change through psychosocial intervention.
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This article explores three different approaches - content analytic, biographical and discursive - to analysing the same data set (women with breast cancer talking about causes, and Blaxter’s classic work on ‘lay aetiology’). It compares these three approaches in relation to the key epistemological problems of ‘context’, ‘footing’ and ‘multiple versions’ - and concludes that a discursive approach offers better solutions to these problems than do the other two approaches. Finally, it suggests that both feminist psychology and health psychology would benefit from increased use of discursive approaches, particularly in relation to theorizing ‘experience’.
This is the first textbook to offer a comprehensive account of ocular prosthetics and the evidence that underpins and supports this field of healthcare. It does so by bringing together information from ophthalmology, prosthetic eye and contact lens literature and from experts working in these fields. The book describes the psychological, anatomical and physiological aspects of eye loss as well as surgical procedures for removing the eye, patient evaluation, making and fitting prosthetic eyes (including prosthetic and surgical techniques for dealing with socket complications), the socket’s response to prosthetic eye wear, prosthetic eye maintenance and the history of prosthetic eyes. The book is written primarily for ocular, maxillofacial and anaplastology prosthetists, ophthalmologists, ophthalmic nurses, optometrists and students of these disciplines. The book is also a useful resource for other health workers and family members who care for prosthetic eye patients and for those patients who require a deeper understanding of the issues affecting them.
The problems of facial dis® gurement are becoming more widely understood as infor- mation from different research areas becomes better integrated. This paper reviews this research, describing the problems faced by people who have a dis® gurement and the results of intervention studies. Thepackage' of care provided to this population by a lay-led organization is described, and a framework proposed which integrates the development of coping skills with the more traditional role of providing support and information. This framework uniquely recognizes the potential therapeutic role of the ex-patient for the population served, and builds this role into the package. It is proposed as a potentially useful model for health professionals providing a service in other health care settings.
Age, gender, and gender role differences on a set of variables including concern with eating, body weight, and physical appearance, global self-esteem, and appearance self-esteem were examined in a sample of subjects consisting of 639 visitors to a participatory science museum. Their ages ranged from 10 to 79 years. Results showed that females are more concerned than males about eating, body weight, and physical appearance and have lower appearance self-esteem. More important, these gender differences are generally apparent at all ages. The importance of gender differences across the life span in appearance concern and appearance self-esteem is discussed.
This study examined the dimensional structure and correlates of body satisfaction among middle-aged and older adult men (n = 471) and women (n = 383) who were participants in the Activity Counseling Trial. Correlates were grouped as (1) fitness parameters, (2) demographic characteristics, and (3) components of subjective well-being. Factor analyses demonstrated that body function and body appearance were independent components of satisfaction in this population. Body composition and cardiorespiratory fitness were directly related to satisfaction with body appearance; however, satisfaction with body function was most strongly related in expected directions to measures of subjective well-being. Age was positively related to both measures of body satisfaction, whereas data on race revealed that blacks were more satisfied with their body appearance and function than whites. The observed relationships for body satisfaction suggest that older adults may value body function more than body appearance. Furthermore, the associations of race and age with body satisfaction have important implications for intervention research.