Abstract

Purpose: To identify factors associated with visual function and quality of life (QOL) in cosmetic shell (scleral shell) wearers.

Methods: This nationwide, cross-sectional, multicentre study was conducted across the National Health Service England. Cosmetic shell wearers completed the National Artificial Eye Questionnaire, which incorporated 15 items from the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Multivariate regression assessed associations between QOL scores and patient experiences, routine care, demographics and clinical factors.

Results: Among 238 respondents, predictors of the QOL composite score included comfort (β=0.25, p<0.001), age 50-65 (β=-0.20, p<0.05), appearance (β=0.20, p<0.05), perceived polishing benefit (β=-0.15, p<0.05) and congenital aetiology (β=0.15, p<0.05). Comfort was positively associated with all VFQ subscales (p<0.05). Lesser discharge predicted better near vision (β=0.19), and non-visible discharge predicted better social function (β=0.14). Appearance was associated with mental health (β=0.19), role difficulties (β=0.17) and dependency (β=0.27). Motility showed no association. Age 30-50 predicted worse dependency (β=-0.18); congenital aetiology predicted better mental health (β=0.19) and cancer worse role difficulties (β=-0.16). A greater perceived polishing benefit was linked to worse role difficulties (β=-0.16) and dependency (β =-0.12).

Conclusions: This is the first study to evaluate QOL predictors in cosmetic shell wearers. While some factors overlap with artificial eye users, key differences underscore the distinct needs of this group.