Special Considerations

Glasses for Physical Protection

The anophthalmic patient must be especially careful to protect the remaining normal eye. For this reason, many ophthalmologists recommend the use of glasses to physically protect the normal eye, as well as to maximize visual acuity. Thus, the use of glasses is recommended even in cases where vision in the normal eye is excellent. If the goal is maximum physical protection, the best material for lenses is polycarbonate since it is relatively unbreakable. The style of glasses should take into consideration the goal of physical protection, e.g., wrap-around styles may offer better protection than the less full-framed styles. However, it is important that large, opaque frames be avoided, since they may interfere with peripheral vision which is already compromised in the monocular patient; thin-rimmed or wireless glasses are preferred.

Glasses for Even Slight Improvement in Vision

In cases where vision in the normal eye is only slightly imperfect, the patient may still benefit from vision correction, since there is no longer the option of allowing the companion eye to compensate for imperfect vision. This is especially true when the dominant eye has been lost. Any imperfections in vision in the monocular patient have greater consequences than in binocular patients, and so the criteria for determining the need for visual correction must be more strict.

More Frequent Exams

In order to prevent disease and minimize loss of visual acuity, the anophthalmic patient should be seen on a more regular basis than the normal patient, especially if the patient’s normal eye is still at risk from the circumstances or disease that led to the removal of the companion eye. Some have suggested that monocular patients be given a vision test as often as every 4 months, in addition to an annual cleaning or adjustment by an ocularist and an (at least) biannual general exam by an ophthalmologist.

Cosmetic Optics

The final cosmetic result following an enucleation, evisceration, or secondary implantation depends on a number of factors: facial reconstruction following severe trauma can have quite variable results, orbits irradiated as a treatment for cancer may not heal well and may be difficult to fit with an artificial eye, the surgeon may have left inadequate fornices or anterior chamber depth for the ocularist, the lid or socket muscles may have atrophied, etc. Fortunately, some of the cosmetic problems created by these factors can be minimized by strategic fitting of glasses by a well-informed optometrist or optician. Generally, the lens over the artificial eye should be of the same power as that over the normal eye so that both eyes have the same appearance. In special cases, lenses of different powers are used to enhance or cover certain features of the orbit containing the artificial eye. Lens tinting or frosting can also be used for this purpose. An experienced ocularist can be quite helpful in suggesting cosmetic modifications when fitting the anophthalmic patient.