Eye Was There

Psychology of Organ Loss Losing an eye can be devastating, both emotionally and physically. Whether the surgery to remove an eye was done on an emergency basis or was preplanned and performed on an elective basis, no one is ever prepared to lose an eye. A process of grieving is necessary to lead to the eventual acceptance of losing a part of the body. However, the extremes of avoiding grief altogether and excessive preoccupation with the loss can also create psychological disturbances. As with any significant loss, such as the loss of a loved one, patients who have an eye removed often go through five predictable stages of grieving: denial, anger, bargaining, grief, and acceptance. Not everyone passes through these in order, but eventually the goal is for all grieving persons to reach acceptance. Eye doctors may only observe their patients as they experience the initial denial phase and seem to be handling life with only one eye very well. Patients may be reluctant to express feelings of anger to their doctor—whether the anger is directed toward the person who may have caused the injury or even at the doctor for not being able to “save the eye.” The bargaining phase occurs as people may try to negotiate with their supreme being (God) to restore sight in the lost eye or help create an eye transplant that would restore sight, in exchange for promising to, for example, better control their blood sugar from diabetes. The grief stage is where people begin to realize that their life is forever changed, and they may experience deep sadness and anguish. This stage can often mimic or lead to depression. Patients should be closely monitored to watch for signs of suicidal or even homicidal thoughts. Referral to a mental health professional is imperative in these cases. Most people experience two types of grief following the loss of an eye: loss of body image and loss of function. Loss of body image refers to the emotions that people experience in reaction to the way others perceive them. Some people may feel embarrassed, ashamed, or anxious around family members and friends. These emotions are strongest in the weeks immediately following surgery—for example, the time when an artificial eye cannot yet be fitted because postoperative healing continues. Even with a well-made ocular prosthesis in place with a wide range of movement, some people may have a sense of being different and a fear of strangers staring and finding out that their eye is not real. When greeting someone face to face, someone with one eye may avoid making eye contact and therefore may fear that he or she is being perceived as vulnerable and submissive. Rarely, the grief may lead to depression, anxiety, and sexual problems. In these cases, one should seek the guidance of a professional psychologist or psychiatrist in order to deal with these kinds of problems. After a prosthesis is put in place, around 90 percent of patients are satisfied with the way they look. In fact, 80 percent of those patients say others cannot even tell that they have only one eye. The final stage is acceptance. People are then at peace with living a monocular life. They realize that they can return to doing and seeing almost everything they were able to before they lost an eye. Loss of function refers to an alteration in sensation. Certainly with the loss of one eye, a person will notice some changes in their visual perception. Some describe noticeable changes in their side vision and their depth perception. Typically, over time the brain and body adapt to being monocular. People may bump into objects while walking as they learn new cues for depth. Extended head movements to the side of the lost eye will help compensate for the reduced peripheral vision to that side. Eventually the brain will develop a two-dimensional depth perception by watching the changes in object size or by observing the positional changes of an object as one approaches or moves away from the object. These maneuvers will help compensate for a reduction in depth perception. Others may reach for something multiple times before finally grasping it. Placing an object, such as a glass, on the edge of a table may be more difficult than it appears when there is a loss of depth perception. Driving can be especially tricky. In all states, driving with one eye is legal. Most states require that one eye has a visual acuity equal to or better than 20/40 and must have a normal peripheral field of vision. Each person should check with their state’s Department of Motor Vehicles to verify the laws and regulations. Even though a person meets their state requirements and may be legal to drive, precautions should be taken to make sure that person feels safe enough driving on the road. Many people need extra time to learn how to compensate for a loss of depth perception when they lose an eye. A simple extended turn of their head to the left or right can significantly increase their field of vision. They may also need to relearn how to judge the distance of a car in front of them, or when to start slowing down for a traffic light or traffic sign. Some state laws may require that one-eyed persons repeat driving tests more frequently to ensure that the visual acuity in the remaining eye is strong enough and continues to meet driving criteria. After becoming acclimated to having one eye, the vast majority of people typically return to all of their previously enjoyed activities without even realizing they have a prosthesis. People with severely decreased or absent vision, whether in one or both eyes, can experience something called Charles-Bonnet syndrome. In this syndrome, vivid, complex visual hallucinations are seen, even though the person is mentally sound. Many are embarrassed to tell others about what they are seeing for fear they will be called insane. These are strictly visual hallucinations; there are no other sensory hallucinations such as hearing, tasting, or smelling things that are not present. People can perceive a wide variety of shapes, faces, animals, flowers, or even cartoon characters. The hallucinations are believed to be the brain making up images because the eye is no longer providing them. Treatment is rarely necessary; the hallucinations typically last for a year or two before disappearing as suddenly as they began.