I currently work at the Eye Center at UCHealth alongside providers specializing in plastic surgery and repair around the eye and enucleation. I've spoken to a lot of the providers previously about enucleation. Most have come to the consensus that enucleation is preferred to a "dead eye" visually. Our standards are to only perform enucleation if the eye is painful or if there is no vision within the eye (though the patient may fill out consent if there is very little light perception). However, should we enucleate if there is no hope to restore the eye now that there is hope to restore some function of the retina via the Argus II prosthetic? So the Argus II prosthetic is quite situational in that a patient would need a healthy retina and would have to have functioning vision in the past to use it, however, it can provide hope to those who suffer from retinal pigmentosa, which is a degenerative genetic condition that affects the retina's rods and cones. Similar to age-related macular degeneration, there are many genetic factors or genes that could put you at risk of retinal pigmentosa. Hence, there is no cure for the syndrome, and there have only been a few studies conducted that show vitamin A can slow the progression of the genetic disease. Although most providers would take a conservative stance on surgical intervention, they generally would usually advocate for enucleation when there is no light perception in the eye for aesthetic reasons as well as safety from future diseases affecting the eye. With new advancements in medicine such as prosthetics that can give back light perception via electrical pulses / flashing light which can restore some functional vision via light perception, it has been shown to make a difference in giving higher independence who have previously central and peripheral vision due to retinal pigmentosa. So then should policies at hospitals change to only allow for enucleation if the eye is causing the patient severe pain, and should we still advocate for enucleation if there is hope to restore vision via prosthetics later on in life, despite the aesthetic and possibly preventative benefits it can bring?
Here are some sources I used to form your own opinion:
https://www.aao.org/eye-health/diseases/what-is-retinitis-pigmentosa
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005308/
I never knew what enucleation was until I read this post! The thought of losing an eye is truly terrifying and this kind of relates to the thought process behind extracting teeth. In both fields, the question comes down to weighing the long-term benefits of preservation versus immediate removal for health or aesthetic reasons. Just as some providers advocate for saving the eye despite current limitations, dentists may recommend treatments that preserve the tooth structure rather than opting for extraction, especially if future advances could restore function. Both decisions involve considering the patient's quality of life, future prospects, and the potential risks of holding onto something damaged.
ReplyDeleteI initially read your post and it made me think a lot about the ethics behind enucleation, and more so, between traditional practices and new technologies. I think a really important question that we must consider for each patient and when considering policy changes is their well-being and quality of life. Enucleation may be quite useful and a great option for patients who are experiencing immense pain and would continue having negative impacts on their life with their current eye. However, I feel that it makes a lot of sense for Argus II to be a treatment option (and maybe even have higher priority than enucleation) for patients who fit the requirements, may be quite young, and to whom enucleation would be highly damaging to their life and future. I think its very important to consider other options because when you completely surgically remove an eye, there are tons of physical, emotional, and physiological implications on the patient and the people around them. Thank you for bringing your experience to our blog, it really challenges our perception of treatments and helps bring to light what people have been experiencing outside of our little bubble at Regis.
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