Dr Emma Worrell

QVH Maxillofacial Prosthetist leading a nationwide survey of prosthetic eye users

Date: 22 August 2017

For the first time, Queen Victoria Hospital NHS Trust in East Grinstead is the lead site for a new national study looking at comfort and outcomes for artificial eye users. Principal Maxillofacial Prosthetist Dr Emma Worrell is the study co-ordinator. Mr. Raman Malhotra, Consultant Ophthalmologist and Oculoplastic Surgeon, also at Queen Victoria Hospital is the Chief Investigator. 

Queen Victoria Hospital’s Maxillofacial Prosthetics team see around 200 patients a year who have an ocular prosthesis, across Kent, Surrey and Sussex and also from further away, if the patient had their original surgery at the hospital.

The use of a prosthetic eye (ocular prosthesis) is almost always recommended after an eye is surgically removed due to damage or disease.  An artificial eye improves the appearance of the enucleated socket. For most people this is infinitely more preferable than wearing an eye patch. If the entire eye contents have been removed (enucleated), an ocular implant is surgically placed into the eye socket. After healing an ocular prosthesis is fabricated to match the patient’s existing eye, thus returning the eye socket to its normal volume.

Patients who wear artificial eyes often suffer with dry eye symptoms and up to 90% of patients also complain of socket discharge. Emma highlighted that there is little information or no literature available on the quality of life for patients after eye loss or adapting to monocular vision. Monocular vision decreases the patient’s field of vision, especially depth perception e.g. going down stairs, curbs, judging the speed of approaching traffic or simply pouring boiling water into a mug.

Emma has over 25 years’ experience within the maxillofacial prosthetics field and alongside her clinical work has a keen interest in research. Emma gained her PhD in Child Health in 2003, and worked at Great Ormond Street Hospital for 18 years before joining Queen Victoria Hospital as the Lead for Ocular Prosthetics. She has developed and published her ideas and concepts within the field of maxillofacial prostheses, authored and co-authored on numerous articles and is the current Editor of The Journal of Maxillofacial Prosthetics & Technologists and World Coalition of Anaplastologists Journal.

Emma said:

 “I enjoy conducting research; I find it exciting, discovering something new, it is important to keep our clinical work, knowledge and expertise up to date”.

“The most commonly referenced book for adapting to monocular vision was first published in 1972, now it’s time we find out the needs of artificial eye patients in 2017. In understanding our current population we can better provide for our patients, improve our patients’ experience. This is why we devised this study”. 

“We as clinicians need to know how life is from our patient’s viewpoint, to enable us to better answer questions, pass on our best evidence based advice and updating our knowledge through research will help us do this” 

Data will be collected via a survey available in NHS Trust clinic waiting rooms which are then placed in a secure box. No patient identifiable information is recorded and each questionnaire will be analysed purely on the data provided. All of the questions have been taken from previously published validated questionnaires.

“The aim is to get as many artificial eye patients nationwide to fill in a questionnaire, to better understand how patients’ first became artificial eye users; their cleaning regime, if they experience deposit or discharge build up, the frequency of discharge, their overall experience of prosthetic rehabilitation, through to some questions on their quality of life after losing an eye”.

The results of the study will be published and used to update patient information sheets, improve cleaning protocols and develop a best practice document. The aim is to produce a simple, readily available source for the clinical environment and  PDF available online.

“We intend for the analysed results of the study to form a new evidence base to prepare and inform any new future patients, whether through NHS clinics, GP surgeries or affiliated ocular organisations”.

So far 25 NHS sites have submitted Expressions of Interest and nine sites are already recruiting. The aim is to recruit over 500 patients but Emma believes that recruitment could be in the thousands.

“The anonymised questionnaire takes around 10 minutes to complete. This data collection method should collect data from the majority of patients who attend artificial eye clinics”.

Emma says that the key to success in research is tenacity. “I am a starter-finisher; I am interested in research especially topics that ultimately benefit patients’. Research studies can take years to get through all the ethical and HRA approval processes. There is a long pathway of paperwork and form filling, long before any actual recruitment begins, so you have to have confidence in your subject matter, that determination keeps you inspired and then you will see it through to the end”.

The study is being funded by an Ocular Award from the Institute of Maxillofacial Prosthetists and Technologists. In addition, it is a Portfolio study and is supported by the National Institute for Health Research (NIHR) Clinical Research Network Kent, Surrey and Sussex.

This study is a great example of a Trust in the south east of England taking the lead on a potentially high recruiting national study. Queen Victoria Hospital is a leading specialist centre for reconstructive surgery, oculoplastics and prosthetic rehabilitation, and is therefore in a key position to use their expertise to develop and grow research within this field.

  • Summary:
    For the first time, Queen Victoria Hospital NHS Trust in East Grinstead is the lead site for a new national study looking at comfort and outcomes for artificial eye users. Principal Maxillofacial Prosthetist Dr Emma Worrell is the study co-ordinator.
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