Just by opening the eyes, headaches and fatigue disappear——such peer-reviewed data exists.
What you'll learn in this article
- PtosisPeer-reviewed data on visual field improvement rates and long-term effects of ptosis surgery
- The medical mechanism by which "opening the eyes" eliminates headaches and chronic fatigue
- Post-operative improvement data for mental health (anxiety and fear of others' perception)
- Factors that determine patient satisfaction and the importance of pre-operative consultation
- Specific criteria for insurance-covered functional ptosis (MRD values and visual field test measurements)
"Every evening my forehead and head start to ache, and I feel extremely fatigued" "My eyes feel heavy, making reading and smartphone use difficult" "People around me often mistake me and ask, 'Don't you always look sleepy?' or 'Are you angry?'"……Among our readers, some of you may have been carrying such deep concerns for many years. In fact, it is not merely fatigue from aging or insufficient sleep, nor is it a matter of your personality——it is highly likely that the underlying cause is a medical condition called "ptosis," in which the eyelids droop. Are you hesitating to take the first step toward treatment, thinking "It's just a natural part of aging, so it can't be helped" or "I'm embarrassed that eyelid surgery might be perceived as cosmetic, and it seems scary"? Ptosis not only narrows your visual field physically, but also places enormous strain on the neck and shoulder muscles, and even on the mind. This article, based on reliable and up-to-date peer-reviewed medical literature from Japan and abroad, reveals the truth and supporting data: that over 85% of patients achieve long-term satisfaction, and how dramatically ptosis surgery can transform your QOL (Quality of Life).
How much does ptosis surgery improve visual field?——peer-reviewed data
Upper visual field improvement rate (pre- and post-operative comparison)
Ptosis exerts direct and serious adverse effects on patients' visual function. The particular problem is the loss of "upper visual field." According to peer-reviewed data, when upper visual field defects reach 12 degrees or 24% or greater (Cahill et al. 2011), surgery is expected to produce extremely significant functional improvement.
MRD1 (Margin Reflex Distance 1) is the distance in millimeters measured from the center of the pupil to the edge of the upper eyelid. When MRD1 is 2 mm or less, a clear upper visual field disturbance is considered to be present, making surgery functionally indicated. In one research dataset, patients who underwent surgery showed MRD1 improvement from a pre-operative average of 0.1 mm to a post-operative average of 3.3 mm (Cahill et al. 2011).
Furthermore, in lower vision, the vertical palpebral fissure width increased significantly from a pre-operative average of 0.7 mm to a post-operative average of 3.4 mm (Cahill et al. 2011), with results showing that the visual field at close range becomes remarkably clear.
Long-term effects——5-year and 10-year data
In long-term follow-up studies using the Glasgow Benefit Inventory (GBI), at the time point when an average of 42.8 months (more than 5.5 years at maximum) had elapsed after surgery (Maycock et al. 2015), the mean GBI score indicating QOL improvement maintained a statistically highly significant high value of "+21.36" (Maycock et al. 2015). Fully 85% of patients (Maycock et al. 2015) reported continuing to experience positive benefits to their health status and quality of life even long after surgery.
"When the eyes opened, the headaches disappeared"——impact on QOL
Eyebrow elevation pattern and the relationship to headaches and shoulder stiffness
Patients with ptosis unconsciously contract the frontalis muscle strongly and lift their eyebrows forcibly to prevent the eyelids from covering the pupil and narrowing the visual field. Additionally, they commonly adopt postures such as protruding the chin upward or tilting the head backward unnaturally.
Such compensatory movements become direct causes of severe fatigue and tension in the forehead muscles, tension headaches, and serious eye strain. After surgery, reports show that the need to overuse the frontalis muscle and eyebrows is completely eliminated, and the forehead pain, fatigue, and difficulty with reading that had plagued patients for years are all resolved.
Mental health scores (correlation with anxiety and depression)
In recent research, the anxiety score that patients experienced decreased statistically significantly from a pre-operative average of 7.6 to a post-operative 4.9 (Richards et al. 2021). The social distress score related to appearance also improved from a pre-operative 30.94 to a post-operative 23.67 (Richards et al. 2021). The "fear of receiving negative evaluation from others" score also showed a statistically significant decrease from a pre-operative 34.79 to a post-operative 31.26 (Richards et al. 2021).
85% of patients who participated in this study reported that surgery had a clearly positive impact on their well-being.
How high is patient satisfaction?——post-operative follow-up studies
Factors affecting satisfaction (the importance of pre-operative consultation)
In long-term follow-up studies, 85% of patients experience positive changes. Another study showed that approximately 72.25% of patients answered "very satisfied" and 21.59% answered "satisfied," with over 90% demonstrating high satisfaction.
On the other hand, approximately 6.17% answered "unsatisfied," with the main reasons being "subjective appearance outcomes" such as loss of double eyelid lines or shallowing of the lines.
To achieve satisfactory results, careful pre-operative medical evaluation, detailed treatment planning, and counseling with sufficient time are essential. Thorough pre-operative sharing of specific expectations between the surgeon and patient regarding the changes in facial balance that surgery will bring is the greatest key to preventing post-operative mismatches and ensuring high satisfaction.
Insurance coverage criteria for ptosis
Difference between functional ptosis and cosmetic ptosis
Functional ptosis is a "medical condition" in which abnormalities in the eyelid muscles or aponeurosis cause the eyelid to droop, physically obstructing the field of vision and significantly impairing daily life. In contrast, when there is no problem with visual function and the patient wishes to improve appearance, it is considered cosmetic in nature. Public medical insurance coverage applies when a diagnosis of "functional ptosis" is made.
Visual field test and MRD value guidelines
Main criteria for determining functional indication:
In addition to these, posture with the chin held high, severe ocular discomfort or severe eye strain, and interference with occupational safety are also considered in the assessment.
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Summary of this article
- Dramatic and long-term improvement in visual field and quality of life: Surgery significantly expands the upper visual field and near vision, with effects lasting more than 5 years post-surgery.
- Fundamental resolution of chronic headaches and eye strain: Eyebrow elevation and chin-raising posture become unnecessary, providing relief from years of headaches.
- Recovery of mental health and reduction of psychological burden: Anxiety about appearance and fear of negative evaluation from others show statistically significant improvement.
- Clear insurance coverage criteria: MRD1 of 2mm or less and upper visual field defect of 12 degrees or more are general indicators for insurance coverage of functional ptosis.
If you are troubled by ptosis, please feel free to consult with us.
References
- Maycock et al. 2015. Long term patient-reported benefit from ptosis surgery. Eye. 2015 DOI
- Richards et al. 2021. Patient benefits in health-related quality of life, social dysfunction and anxiety following successful ptosis surgery. Eye. 2021 DOI
- Cahill et al. 2011. Functional Indications for Upper Eyelid Ptosis and Blepharoplasty Surgery. Ophthalmology. 2011 DOI
- Ho et al. 2011. Modified visual field test for ptosis surgery (Leicester Peripheral Field Test). Eye. 2011 DOI
Author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is involved in technical guidance and education for Zetith Beauty Clinic as a whole. He specializes in precision aesthetic medicine based on anatomical principles and pursues natural results tailored to each individual's skeletal structure and tissues.