The Impact of Custom Ocular Prosthesis on Self-esteem, Appearance and Quality of Life in Adults: A Prospective Study.

PURPOSE: To assess changes in self-esteem, appearance and vision-related quality of life (VRQoL) following custom ocular prosthesis wear and its relationship with demographic characteristics and clinical factors.

METHODS

Three hundred and twenty-one first-visit adults (≥18 years of age) visiting the ocular prosthesis clinic for a custom ocular prosthesis between 2019 and 2021 completed four questionnaires: the self-esteem rating scale (SERS), facial appearance (FA) of the negative physical self-scale, Impact of Vision Impairment (IVI) scale (measure of VRQoL) and Derriford Appearance scale before and 3-4 months following ocular prosthesis wear. Rasch analysis optimised the measurement properties of questionnaires and generated interval-level estimates of the corresponding latent trait at both time points, anchoring the instruments to their baseline measurement characteristics. Primary outcome measures included changes in self-esteem, FA, VRQoL and social anxiety and avoidance. Correlational analysis determined associations between outcome measures and sociodemographic variables.

RESULTS

Mean age was 34.6 years (71% male). The majority were married (49%), working (60%) and had obtained at least secondary school education (77%). Minor modifications in questionnaires enabled adequate fit to the Rasch model. Following prosthesis wear, patients reported significantly large improvements in self-esteem (effect size: 0.88; p < 0.001), FA (0.94; p < 0.001), VRQoL (0.36-0.38; p < 0.001) and social anxiety and avoidance (0.93; p < 0.001). Females reported larger improvements in self-esteem (p = 0.02), while younger age was related to greater levels of social anxiety and avoidance (r = -0.15, p = 0.01). Participants reported a significant reduction in feelings of shame, sadness, preoccupation with hiding the disfigured eye, insecurity, inferiority and anger after ocular prosthesis wear.

CONCLUSIONS

Custom ocular prosthesis wear is associated with significant large improvements in psychological functioning and VRQoL in adults. Additionally, it reduces social anxiety and avoidance. These findings support early prosthetic rehabilitation as a critical component of holistic anophthalmic care, particularly in younger patients at higher psychosocial risk.