Concerns of anophthalmic patients—a comparison between cryolite glass and polymethyl methacrylate prosthetic eye wearers

  • Alexander C. Rokohl
  • Konrad R. Koch
  • Werner Adler
  • Marc Trester
  • Wolfgang Trester
  • Nicola S. Pine
  • Keith R. Pine
  • Ludwig M. Heindl
Oculoplastics and Orbit



To compare the concerns of experienced cryolite glass and (poly)methyl methacrylate (PMMA) prosthetic eye wearers.


One hundred six experienced cryolite glass and 63 experienced PMMA prosthetic eye wearers completed an anonymous questionnaire regarding general and specific prosthetic eye concerns at least 2 years after natural eye loss. From these independent anophthalmic populations, we identified 34 case-control pairs matched for the known influencing demographic variables of gender, occupation, age, and time since natural eye loss.


The levels of concern were significantly lower in the cryolite glass group than those in the PMMA group for the following: loss of balance (p < 0.001), phantom sight vision (p < 0.001), pain (p < 0.001), receiving good advice (p = 0.001), fullness of orbit (p = 0.001), size (p = 0.007), direction of gaze relative to the healthy fellow eye (p = 0.005), eye lid contour (p = 0.037), comfort of the prosthetic eye (p < 0.001), colour relative to the healthy fellow eye (p < 0.001), and retention of the prosthetic eye (p < 0.001). Concerns about watering, crusting, discharge, visual perception, appearance, movement of the prosthetic eye, and health of the remaining eye were not significantly different between both groups.


The results of this study showed that many general and specific levels of concern were significantly lower for cryolite glass prosthetic eye wearers than for PMMA prosthetic eye wearers. The question of why there are significant differences and to what extent the material of the prosthesis (cryolite glass or PMMA) has an impact on various concerns remains unanswered and should be addressed in a prospective comparative multicentre trial.


Ocular prosthesis Artificial eye Prosthetic eye Cryolite glass PMMA Anophthalmia Concerns Quality of life 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. All authors have full control of all primary data and they agree to allow ‘Graefe’s Archive for Clinical and Experimental Ophthalmology’ to review their data upon request.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the University of Auckland and of the University of Cologne and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pine KR, Sloan BH, Jacobs RJ (2015) Clinical ocular prosthetics, 1st edn. Springer International 325 Publishing, Berlin, p 278Google Scholar
  2. 2.
    Koch KR, Trester W, Muller-Uri N, Trester M, Cursiefen C, Heindl LM (2016) Ocular prosthetics. Fitting, daily use and complications. Ophthalmologe 113(2):133–142CrossRefPubMedGoogle Scholar
  3. 3.
    Den Tonkelaar I, Henkes HE, van Leersum GK (1991) Herman Snellen (1834–1908) and Muller’s‚ reform-auge’. A short history of the artificial eye. Doc Ophthalmol 77:349–354Google Scholar
  4. 4.
    Raizada K, Rani D (2007) Ocular prosthesis. Cont Lens Anterior Eye 30:152–162CrossRefPubMedGoogle Scholar
  5. 5.
    Baino F, Perero S, Ferraris S et al (2014) Biomaterials for orbital implants and ocular prostheses: overview and future prospects. Acta Biomater 10:1064–1087CrossRefPubMedGoogle Scholar
  6. 6.
    Feinbloom W (1937) A plastic contact lens. Am J Optom 14:41–49CrossRefGoogle Scholar
  7. 7.
    Buckel M, Bovet J (1992) The eye as an art form: the ocular prosthesis. Klin Monatsbl Augenheilkd 200:594–595CrossRefPubMedGoogle Scholar
  8. 8.
    Hanif S, Rowe F, O'Connor A (2009) A comparative analysis of monocular excursion measures. Strabismus 17(1):29–32CrossRefPubMedGoogle Scholar
  9. 9.
    Chin K, Margolin CB, Finger PT (2006) Early ocular prosthesis insertion improves quality of life after enucleation. Optometry 77(2):71–75CrossRefPubMedGoogle Scholar
  10. 10.
    Nicodemo D, Ferreira LM (2006) Questionnaire of the psychosocial profile of the patient with anophthalmia with indication of ocular prosthesis. Arq Bras Oftalmol 69(4):463–470CrossRefPubMedGoogle Scholar
  11. 11.
    Pine KR, Sloan B, Jacobs RJ (2012) Biosocial profile of New Zealand prosthetic eye wearers. NZ Med J 125(1363):29–38Google Scholar
  12. 12.
    Song JS, Oh J, Baek SH (2006) A survey of satisfaction in anophthalmic patients wearing ocular prosthesis. Graefes Arch Clin Exp Ophthalmol 244(3):330–335CrossRefPubMedGoogle Scholar
  13. 13.
    Rasmussen ML (2008) Complications from eye prosthesis. Ugeskr Laeger 170(33):2456–2458PubMedGoogle Scholar
  14. 14.
    Pine K, Sloan B, Stewart J, Jacobs RJ (2011) Concerns of anophthalmic patients wearing artificial eyes. Clin Exp Ophthalmol 39(1):47–52PubMedGoogle Scholar
  15. 15.
    Pine K, Sloan B, Stewart J, Jacobs RJ (2012) A survey of prosthetic eye wearers to investigate mucoid discharge. Clin Ophthalmol 6:707–713PubMedPubMedCentralGoogle Scholar
  16. 16.
    Pine KR, Sloan BH, Jacobs RJ (2013) A proposed model of the response of the anophthalmic socket to prosthetic eye wear and its application to the management of mucoid discharge. Med Hypotheses 81(2):300–305CrossRefPubMedGoogle Scholar
  17. 17.
    Pine NS, de Terte I, Pine KR (2017) The impact of eye loss and prosthetic eye wear on recreational, occupational and social areas of functioning. J Ophthalmol and Vis Sci 2(1):1016Google Scholar
  18. 18.
    Pine NS, de Terte I, Pine KR (2017) Time heals: an investigation into how anophthalmic patients feel about eye loss and wearing a prosthetic eye. J Ophthalmol and Vis Sci. 2(2):1018Google Scholar
  19. 19.
    Pine NS, de Terte I, Pine KR (2017) An investigation into discharge, visual perception, and appearance concerns of prosthetic eye wearers. Orbit 36(6):401–406CrossRefPubMedGoogle Scholar
  20. 20.
    Rokohl AC, Koch KR, Trester M, Trester W, Pine KR, Heindl LM (2017) Concerns of anopthalmic patients wearing cryolite glass prosthetic eyes. Ophthal Plast Reconstr Surg:
  21. 21.
    Vinger PF, Parver L, Alfaro DV 3rd, Woods T, Abrams BS (1997) Shatter resistance of spectacle lenses. JAMA 277(2):142–144CrossRefPubMedGoogle Scholar
  22. 22.
    Osborn KL, Hettler D (2010) A survey of recommendations on the care of ocular prostheses. Optometry 81(3):142–145CrossRefPubMedGoogle Scholar
  23. 23.
    Pine KR, Sloan B, Jacobs RJ (2013) The development of measurement tools for prosthetic eye research. Clin Exp Optom 96(1):32–38CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexander C. Rokohl
    • 1
  • Konrad R. Koch
    • 1
  • Werner Adler
    • 2
  • Marc Trester
    • 3
  • Wolfgang Trester
    • 3
  • Nicola S. Pine
    • 4
  • Keith R. Pine
    • 5
  • Ludwig M. Heindl
    • 1
  1. 1.Department of OphthalmologyUniversity Hospital of CologneCologneGermany
  2. 2.Department of Medical Informatics, Biometry and EpidemiologyFriedrich-Alexander University Erlangen-NürnbergErlangenGermany
  3. 3.Trester-Institute for Ocular Prosthetics and Artificial EyesCologneGermany
  4. 4.Auckland District Health BoardAucklandNew Zealand
  5. 5.School of Optometry and Vision ScienceUniversity of AucklandAucklandNew Zealand

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