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Case study 5

Take home message:
Loss of depth perception does not prevent you obtaining a taxi license, bus license or pilots license. Asymmetry of the socket and eye-lids can often be improved with oculo-plastic surgery.

Glossary of terms:
Meningioma : A brain tumor (usually benign) that arises from the arachnoidal cap cells of the meninges and
represents about 15% of all primary brain tumors.
Ophthalmologist : Eye surgeon
Monocular vision : Vision through only one eye
Upper lid sulcus : The hollow area under the eyebrow.
Upper lid ptosis : A drooping upper eye-lid.
Cosmesis : Refers to the correction of a disfiguring defect.

Background:
George Smith (Not his real name) is 74 years old and has worn an artificial eye since he was 17. At the time he experienced no regret over the loss of his eye; so much as relief through knowing that he had survived a meningioma which involved the optic nerve. His monocular vision was a nuisance in the early days due to the loss of depth perception which caused him to give up tennis, be turned down for compulsory military service and cause him problems when trying to park his car. George’s depth perception eventually improved and he went on work as an able administrator for insurance companies and local bodies in various towns and cities around New Zealand. George once wanted to be a bus driver but believed that his monocular vision would prevent him becoming one.

This is incorrect – anyone with monocular vision can drive any vehicle provided their remaining eye has normal vision as certified by an optometrist or ophthalmologist.
Further advice is available from the NZ Transport Agency, Ph 0800 822422 x 8089.
A pilots license is also obtainable on a case by case basis.
For further advice contact the Civil Aviation Authority, Ph (04) 560 9657.

Looking back on his full and rich life (he is married with two boys, 6 grandchildren and 5 great grandchildren), George has few regrets about his lost eye because his depth perception eventually improved. He says there is nothing he would have done differently if he had lived his life with two eyes. Even in retirement George is busy with his woodworking hobbies and singing in choral groups and the church choir.

Review of existing prosthesis:
George presented for a review of his artificial eye in November 2008. His existing prosthesis was 25 years old, discoloured and sat too low in the socket. George took the eye out every night to rest the socket and to reduce the chronic discharge he experienced. His socket was healthy but the orbital tissues had atrophied causing a deep upper lid sulcus and upper lid ptosis.

Treatment:
George’s replacement prosthesis (see photo) was made larger and more conical in shape than the previous one. This dramatically improved the cosmesis. It also provided a platform from which his volume deficient socket can be assessed and possibly corrected by surgery. For this, he was referred to his eye surgeon. George was advised to leave the prosthetic eye in place overnight and to only take it out once a month for cleaning. The discharging socket will be monitored and he will contact Keith Pine again after any socket surgery has been carried out – or if he has any problems prior. On-going care will include annual checks of the prosthesis and repolishing. The cost of George’s treatment was fully subsidised by the Ministry of Health.

Best wishes George, and may your arias ring out boldly for many years to come.

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