PSYCHOLOGICAL ISSUES SURROUNDING OOKP SURGERY

Psychological issues including depression and anxiety are observed in patients receiving osteo-odonto-keratoprosthesis (OOKP) surgery, and these issues need to be assessed, monitored and where indicated, treated proactively, Angela Busuttil Psych.D told delegates at the XXXVI United Kingdom and Ireland Society of Cataract and Refractive Surgery (UKISCRS) Annual Congress.

Dr Busuttil, consultant clinical psychologist, Sussex Eye Hospital, Brighton, UK, discussed the psychological issues surrounding OOKP surgery during a dedicated session on the procedure. She said that OOKP surgery can be both physically and mentally demanding for patients as it involves multiple surgeries, living with changed appearance, adapting to living with sight yet with some uncertainty about whether sight would be maintained. There is also a commitment to lifelong follow up. Quoting research undertaken at Sussex Eye Hospital, Dr Busuttil said patients report experiencing “an emotional rollercoaster†with joy at being able to see again, but also challenges that could cause anxiety and feelings of isolation.

For example, some reported premature withdrawal of practical and emotional support from others who may assume, “Oh you can see now so you must be okâ€. This resulted in anxiety problems for a small but significant number of our patients. “It is natural to think that sight restoration is positive and it is, but patients have also reported that it may be accompanied by complex feelings. For example there is evidence that loss of ‘blindness’ is experienced by some as they miss some aspects of being blind,†Dr Busuttil commented.

Research shows that the challenges accompanying sight restoration differ for those who lose sight after late childhood when sight has been developed and the brain has learnt to effectively process visual stimuli in context, as compared to those who lost sight early in childhood, when the visual system had not fully developed, she said.

Sight restoration, for those who lost sight early, can be associated with psychological distress as the brain learns to make sense of visual stimuli. This can trigger depression and anxiety in some. There are a few documented early case reports of patients who failed to adapt to living with sight. In the most severe cases this was accompanied by depression and even suicide in a small number. Such negative outcomes have not been reported by patients at Sussex Eye Hospital or in recent case reports but it is nonetheless important to ensure that restoring good visual acuity is accompanied by appropriate support measures, she said.

Challenges for patients in this latter group, include making sense of depth perception, reflections and using sight in social contexts. “It is said that 70 per cent of our communication involves body language. If you haven’t seen or used body language you do not know how to make sense of the body language other people use, or how to use body language, eye contact and facial expressions yourself. This may lead to misunderstanding in social situations,†Dr Busuttil said.

Clinics thus need to consider providing more support and education on adapting to living with vision to adequately prepare these patients, she contended. For some patients living with OOKP the cosmetic element is an issue and we found this in about one fifth of our patients. Sussex Eye Hospital offers a cosmetic lens for suitable patients which gives a good cosmetic result, Dr Busuttil said.

Concluding, Dr Busuttil said there is a strong basis for carrying out psychological screening as part of the multidisciplinary assessment with patients before and after OOKP surgery. Combined with good patient support this is likely to lead to better outcomes.