Quality of life with anophthalmia: a systematic review.
Clinical Snapshot
PICO Framework
| P — Population | Adults with congenital or acquired anophthalmia resulting from enucleation, evisceration, or exenteration |
| I — Intervention | Anophthalmia (surgical or congenital absence of the eye) and associated rehabilitation or prosthetic interventions |
| C — Comparator | Pre-operative baseline, normative population data, or between-group comparisons where reported (no universal active comparator) |
| O — Outcomes | Health-related quality of life (HRQoL; primarily SF-36), vision-related quality of life (VRQoL; primarily NEI VFQ-25), and psychosocial outcomes including anxiety, depression, and appearance-related concerns |
Bottom Line
This systematic review of 42 studies encompassing 4,544 patients provides the most comprehensive synthesis to date of quality-of-life outcomes following anophthalmia. The evidence confirms that vision-related quality of life — particularly depth perception, peripheral vision, and driving — remains persistently impaired after enucleation, evisceration, or exenteration, regardless of partial recovery in general health-related quality of life over time. While mean anxiety and depression scores often fall within normal ranges at the group level, a clinically significant subset of patients experiences enduring psychological distress and appearance-related concerns that are not captured by group averages alone. The review is methodologically sound in its registration, search strategy, and risk-of-bias assessment, but the absence of meta-analytic pooling and GRADE ratings limits the precision and certainty of conclusions. For Australian clinicians, the key practice implication is clear: patients undergoing ocular removal surgery require anticipatory counselling about long-term functional and psychosocial sequelae, and access to integrated multidisciplinary rehabilitation — including ocularist, psychological, and social support services — should be embedded in post-surgical care pathways. Routine use of validated QoL instruments in follow-up would strengthen future evidence generation in this under-researched population.
Key Findings
P Value: Not reported at the review level
Effect Size: Not quantified — narrative synthesis only; no pooled effect sizes reported
Primary Outcome: Health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) in adults with anophthalmia. Early postoperative reductions in HRQoL were frequently observed, with partial recovery over time. VRQoL remained persistently impaired, particularly for depth perception, peripheral vision, and driving.
Nnt Or Sensitivity: Not applicable — descriptive/observational synthesis; mean anxiety and depression scores were often within normal ranges, but a substantial subset of patients experienced ongoing psychological distress and appearance-related concerns
Confidence Interval: Not reported — no meta-analytic pooling performed
Clinical Application
The clinical recommendations — anticipatory counselling and integrated multidisciplinary rehabilitation — are feasible within tertiary ophthalmology and oculoplastic services. Implementation requires coordinated input from ophthalmologists, ocularists, psychologists, and social workers. Routine QoL assessment using validated instruments (NEI VFQ-25, SF-36) is achievable in specialist settings but may be resource-intensive in general practice. In Australia, anophthalmia management falls within the scope of oculoplastic surgery and ocular oncology services at major tertiary centres (e.g., Royal Victorian Eye and Ear Hospital, Sydney Eye Hospital, Royal Adelaide Hospital). Ocular prostheses are partially subsidised through state-based schemes and the NDIS for eligible patients, though access varies by jurisdiction. The RACGP does not have specific guidelines for anophthalmia rehabilitation; however, the findings support integration of psychological screening into post-surgical follow-up pathways consistent with RACGP chronic disease management frameworks. The NEI VFQ-25 and SF-36 are not routinely used in Australian general practice but are available in specialist settings. TGA-approved ocular prosthetic devices are available through registered ocularists. Multidisciplinary care coordination aligns with MBS item numbers for chronic disease management plans (GP Management Plans, Team Care Arrangements). Adults with acquired anophthalmia following enucleation (55.1% of cases), evisceration, or exenteration; predominantly unilateral (59.6%); mean age approximately 50 years. Findings are most directly applicable to patients undergoing surgery for ocular malignancy, trauma, or end-stage ocular disease. Applicability to congenital anophthalmia and paediatric populations requires caution.
Abstract
PURPOSE: Anophthalmia due to enucleation, evisceration, or exenteration, results in permanent vision loss that may have profound functional, psychological, and social consequences. The purpose of this study is to evaluate health-related quality of life, vision-related quality of life, and psychosocial outcomes among adults with anophthalmia. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (ID: CRD420251274476). MEDLINE, Embase, and CENTRAL were searched from inception to September 9, 2025. Eligible studies included participants with congenital or acquired anophthalmia and reported outcomes related to quality of life or psychosocial health. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and Joanna Briggs Institute critical appraisal tools for observational studies and results were synthesized narratively. RESULTS: Forty-two studies (1999-2025) including 4544 patients (56.0% male; mean age 49.9 years) were included. Enucleation was the most common procedure (55.1%), and most cases were unilateral (59.6%). Health-related quality of life was commonly assessed using the SF-36 and vision-related quality of life using the NEI VFQ-25. Early postoperative reductions in health-related quality of life were frequently observed, with partial recovery over time. Vision-related quality of life remained persistently impaired, particularly for depth perception, peripheral vision, and driving. While mean anxiety and depression scores were often within normal ranges, a substantial subset of patients experienced ongoing psychological distress and appearance-related concerns. CONCLUSIONS: Acquired anophthalmia is associated with enduring vision-specific and psychosocial challenges, supporting the need for anticipatory counseling and integrated multidisciplinary rehabilitation in clinical practice.
References
- 1.Osba, A. A., Verma, A., Ibrahim, A., Hendy, A. E. A., Bondok, M., Deans, A., Ing, E., & Hussain, A. (2026). Quality of life with anophthalmia: a systematic review. Quality of Life Research. https://doi.org/10.1016/j.preteyeres.2025.101337
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