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Can We Improve the Tolerance of an Ocular Prosthesis by Enhancing Its Surface Finish?

Litwin, Andre, S., F.R.C.Opth.*; Worrell, Emma, Ph.D.; Roos, Jonathan C., P., Ph.D.; Edwards, Barry, M.Sc.; Malhotra, Raman, F.R.C.Ophth.*

Ophthalmic Plastic and Reconstructive Surgery: March/April 2018 - Volume 34 - Issue 2 - p 130–135
doi: 10.1097/IOP.0000000000000891
Original Investigations

Purpose: Patients who wear an ocular prosthesis frequently suffer with dry eye symptoms and socket discharge, often on a daily basis. The aim of the study was to determine whether a smoother, optical quality polish of the prosthesis’ surface could improve symptoms and wear tolerance. The study was designed as single-center, single-masked, prospective randomized controlled trial. Eighty-eight consecutive patients undergoing annual ocular prosthesis maintenance review were approached from the prosthesis clinic. Forty-one out of 49 eligible patients were recruited.

Methods: Participants were randomized to either a standard or a higher “optical quality” polish of their prosthesis. At entry to the trial, at 1 month, and 12 months they completed a questionnaire covering cleaning, lubricant use, inflammation, discomfort, and discharge. Lower scores indicated better tolerance of the prosthesis. At each visit, the prosthesis was stained and photographed against a standard background to assess deposit build up. Primary outcome measures were 1) a subjective questionnaire score and 2) an objective assessment of surface deposit build-up on prosthetic eyes by standardized photographic grading.

Results: Forty-one patients participated in the study. The median age of their prosthesis was 36 months (range 9 months–40 years). There was no statistically significant difference in questionnaire scores or deposit build up between the 2 groups at baseline. By 12-months, the higher optical quality polish showed a statistically significant reduction in symptoms and frequency of discharge (2.19 vs. 3.85; p = 0.05—lower scores better). Scoring of the prosthesis’ deposit build-up showed a significant difference at 1 month, but this was not sustained at 12 months.

Conclusions: Creating an optical quality finish to an ocular prosthesis reduces deposit build up on artificial eyes. The authors found this modification improved patient tolerance at 12 months.

In this randomized controlled trial, enhanced polishing of ocular prostheses using aluminum oxide achieved a smoother surface, resulting in reduced deposit build-up and fewer patient-reported discomforts.

*Corneoplastic Unit, Maxillofacial Prosthetics, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, and Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, United Kingdom

Accepted for publication November 30, 2016.

Presented at the 2015 annual meeting of the British Oculoplastic Surgical Society, Belfast, UK.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Andre S. Litwin, Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex RH19 3DZ, United Kingdom. E-mail:

© 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.