Factors Affecting Ocular Prosthetic Use Amongst Anophthalmic Patients: A Retrospective Review with Patient Interviews

To evaluate the rate of ocular prosthesis use amongst anophthalmic patients following eye removal surgery and to investigate the influence of socioeconomic factors on prosthesis acquisition.

A retrospective chart review was conducted for adults undergoing enucleation or evisceration by two surgeons at two urban trauma centers and a private practice between December 2013 and February 2024. Patients were identified using Current Procedural Terminology (CPT) codes for primary and secondary eye removal procedures. Demographic, clinical, and socioeconomic data were collected, including insurance status, employment at the time of surgery, and estimated household income by zip code. Chart data was supplemented by patient telephone interviews which assessed current prosthesis use and barriers to acquisition. Statistical analyses included chi-squared, Fisher's exact, t-tests, and multivariate logistic regression to identify factors associated with prosthesis use.

Among 152 patients screened, 138 patients were included (mean age 52; 55.8% male; 60.1% Black), and 81 (59%) obtained a prosthesis by last follow-up. Most patients (82%) had government-sponsored insurance. Employment and longer follow-up duration were significantly associated with prosthesis use (p=0.036; p<0.001). In multivariate analysis, female sex (adjusted OR=2.06, [1.0; 4.27], P=0.052) and private insurance (adjusted OR=2.70, [0.84; 8.7], P=0.097) trended toward higher rates of prosthesis utilization but were not statistically significant. Among 41/138 (30%) interview participants, 30/41 (73%) had a prosthesis, with 26 of these 30 (87%) reporting positive impacts on quality-of-life. Cost was the most cited barrier among those without a prosthesis.

This study uniquely combines clinical data with direct patient interviews to provide new evidence on real-world barriers to prosthesis access among anophthalmic patients. Ocular prosthesis utilization remains limited, with fewer than 60% of anophthalmic patients obtaining prostheses despite high insurance coverage rates. Employment status and consistent follow-up care were significantly associated with prosthesis acquisition, while cost appeared as a primary barrier. Future efforts should leverage emerging technologies and integrated care pathways to improve access for all anophthalmic patients.