The Relationship Of Vision-Related Quality Of Life And Negative Appearance Evaluation With Mood Status After Eye Removal

Aims:Patients after eye removal are faced with changes of both physical and mental health, because of visual function and facial appearance being affected. The aims of this study were to evaluate vision-related quality of life, negative appearance evaluation, and level of anxiety and depression of eye-amputated patients, and to investigate the relationship of demographic, clinical and psychosocial variables with anxiety and depression.Methods:This cross-sectional study included 195 eye-amputated patients who visited Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University as case group, and 100 individuals who accompanied an ophthalmic patient as control group, between July 2014 and February 2016. Demographic data of both groups, as well as clinical data and feelings of shame, sadness and anger of case group, were collected.Both groups completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale and the Hospital Anxiety and Depression Scale. Comparison analysis of vision-related quality of life, negative appearance evaluation, and level of anxiety and depression between the two groups were made. Multivariant stepwise regression models were used to identify the association of demographic, clinical and psychosocial variables (independent variables) with level of anxiety and depression (dependent variables) of case group.Results:Compared with control group, the vision-related quality of life was poorer (median (interquartile range):91.9 (85.6-95.9) vs 71.8 (58.1-83.7), P< 0.001) and the level of appearance concerns was greater (1.2 (0.5-1.9) vs 0.4 (0.1-0.8), P< 0.001) in case group. The proportion of patients dissatisfied with their facial appearance was 23.1%, which was higher than that of healthy controls. The duration of prosthesis wear and the similarity of the prosthesis to the normal eye were related to the level of appearance concerns. The proportion of patients with anxiety was 11.8% and depression 13.8%, which was higher than that of controls. Stepwise regression analysis revealed that more anxiety and depression were related to poorer vision-related quality of life (anxiety:β=-0.506, P< 0.001; depression:β=-0.346, P< 0.001) and greater level of appearance concerns (anxiety:β= 0.359, P< 0.001; depression:β= 0.152, P< 0.05). Younger age was associated with greater level of anxiety (β=-0.140, P< 0.05). Less educated patients (β=-0.221, P< 0.001) and those feeling more angry about losing an eye (β= 0.217, β= 0.001) were more likely to experience depression. Clinical variables were irrelevant to anxiety or depression.Conclusions:The proportion of eye-amputated patients with anxiety or depression was high. Psychosocial rather than clinical characteristics were related to anxiety and depression. For patients with poorer vision-related quality of life or greater level of appearance concerns, clinicians might need to provide timely mental health services. Before interventions to improve mood status are developed, longitudinal studies need to be conducted to further elucidate the factors influence the mood status of eye-amputated patients.