Ophthalmic Prosthetic Maintenance
Ophthalmic Prosthetic FAQs
Ophthalmic Prosthetic Frequently Asked Questions
An ocularist is a trained technician skilled in the arts of fitting, shaping, and painting ocular prosthetics. In addition to creating the prosthesis, the ocularist also instructs the patient how to handle and care for their prosthetic, and provides long-term care through routine examinations.
The American Society of Ocularists (ASO) is a professional organization, which was established by a group of skilled American Ocularists in 1957. Their purpose was to promote high standards through research and education, in the field of ophthalmic prosthetics. Today, the ASO maintains quality ocularistry through its formal education, training and continuing educational programs.
The National Examining Board of Ocularists (NEBO) is an independent entity, whose directors come from the following participating organizations:
- American Academy of Ophthalmology
- American Board for Certification of Orthotics and Prosthetics
- American Society of Ocularists
- Canadian Society of Ocularists
- Public Members
NEBO awards the title of Board Certified Ocularist (BCO), to those ocularists who successfully complete a comprehensive two-part written and practical examination. All BCOs must complete continuing education requirements, and be recertified by NEBO every six years.
The ocular prosthesis, like hard contact lenses, needs to be polished regularly in order to restore the acrylic finish, and insure the health of the surrounding tissues. It is generally recommended that infants be seen ASAP, and return for visits every 3 months. All other patients are recommended to be scheduled for bi-annual visits. Each individual case, so you and your ocularist will develop a routine for scheduling.
Artificial eye making has been practiced since ancient times. The first ocular prostheses were made by Roman and Egyptian priests, as early as the fifth century B.C. In those days, artificial eyes were made of painted clay attached to cloth, and worn outside the socket.
It took many centuries for the first in-socket artificial eyes to be developed. At first, these were made of gold with colored enamel. Then, in the later part of the sixteenth century, the Venetians started making artificial eyes out of glass. These early glass eyes were crude, uncomfortable to wear, and very fragile. Even so, the Venetians continued making them, and kept their methods secret until the end of the eighteenth century. After that, the center for artificial eye making shifted to Paris for a time; but by the mid-nineteenth century, German glass blowers had developed superior techniques, and the center for glass eye making moved to Germany.
Shortly thereafter, glass eye making was introduced in the United States. During World War II, the imported German glass used for glass prostheses became unavailable in this country. As a result of this shortage, the U.S. Government, in conjunction with a number of American firms, popularized the techniques for making artificial eyes out of acrylic plastic.
The popularity of this method has continued to increase over the years, and today the vast majority of patients wear ocular prostheses made of acrylic.
"stock" or "ready-made" ocular prostheses are mass-produced. Since a "stock eye" is not made for any particular person, it doesn't fit any particular patient. A "custom fitted" ocular prosthesis on the other hand, is made by your ocularist to fit you, and you alone. No Board Certified Ocularist associated with the A.S.O. will fit a patient with a stock prosthesis.
Gradual physical changes in the eye socket tissues, and natural deterioration of the plastic and pigments, will necessitate a new prosthesis. It is often the obligation of the ophthalmologist or ocularist to inform you of these facts. This is also why it is important for regular "Follow-up" visits with an ocularist every 6 months to once a year.
The acrylic prosthesis should be replaced as needed, to maintain a healthy socket and satisfactory cosmetic appearance. The lifetime of a prosthetic eye will vary with each patient, and the chemistry of the socket. Five years is around average useful life, however many patients are able to go for longer periods with no problem, and some less due to change and age.
If the artificial eye is three or more years old, it should be evaluated for proper size, alignment and color. The surface should be examined for roughness and delamination. Delamination commonly occurs at the edge, or around the iris. It appears as a fine, dark line that progressively develops into complete separation, as the plastic fatigues. This is often the cause of eyelid irritation and increased secretion from the socket. Delamination may also occur in the pigment layers, and may appear as a "cataract" in the pupil, or as a silvery reflection in the region of the iris. Changes may also occur in the pigments themselves; the colors become either lighter or darker, or more commonly, develop a bleached, yellowish tint with brown spots. Because the deterioration of the prosthesis is gradual, you may not be aware of the possible serious consequences of these changes. If physical damage to the socket has occurred from irritation by a deteriorating prosthesis, it may become impossible to provide the wearer with the good cosmetic effect they once enjoyed. Therefore, it behooves you to have your prosthesis checked periodically, and have your socket examined, to prevent unnecessary problems. Most ocularists recommend that you have your prosthesis checked every six to twelve months.
In the United States, the current cost for an artificial eye ranges from $2,500 to $8,300. The cost of a Scleral Shell prosthesis ranges from $2,700 to $8,300. The fee may be more or less depending on where you live, and the work required. It should be understood that it is very difficult for any ocularist to quote a fee without first examining the patient. The majority of ocularists offer the initial consultation visit without obligation, and the charges will be explained at the time of your consultation visit.
If insurance coverage is available, most ocularist offices will assist you in every possible way to obtain full benefits of your policy. However, it should be noted that the patient, or in the case of children, a parent or guardian is always responsible for payment. And, in the case of HMO'S, it is always necessary to obtain a referral before work can begin.
Patients often ask, why does my artificial eye tear more than my normal eye? The first and most obvious answer is that after enucleation, the whole inside of the socket is mucus membrane, similar to the inside of your nostril. Due to this, there is just more fluid producing tissue in the anophthalmic socket, (absent of an eye) than in a normal eye.
Also, you must consider that the artificial eye as smooth as it may be, is not as wet and soft to the lids as a natural eye. Plastic is not the most absorbing material for tear film to maturate, and it takes a combination of tears, mucus and oil from your tear layer, to cause the surface of the artificial eye to become wet (hydrophilic).
As you wear an ocular prosthesis it can dry out because of low humidity, air conditions, and wind factors, which in turn requires the socket to produce more tears to lubricate the prosthetic surface. As this increase in tear flow takes place, sometimes the tears will spill out onto the cheek due to irregular eyelid function. Most patients do not realize that they don't have lid-to-lid contact on their prosthetic side. One of our main points to all patients’ young and elderly, is always "THINK BLINK". Many patients find eye drops helpful on dry days and it is a good idea to have some close by just off chance. Some of the best advice is to use a substance with an oil base for lubrication, (Tears Again Night Time Ointment, OcuSil).
An ocular prosthetic can generally be worn without fear of being dislodged while participating in almost any sport, including golf, tennis, running and even football, etc. Although when swimming, due to many people automatically wiping their faces and rubbing their eyes when coming out of the water, it is highly recommended that you be very careful not to pull on your lower eyelid.
Always remember that the most common way of dislodging an artificial eye is by pulling down and out on the lower eyelid. If you are rubbing your eyes in a circular fashion, this will also cause the eye to want to dislodge. Another good idea is to always keep your eyelids closed under water. If swim goggles are worn, they may prevent the dislodging of the prosthesis from the socket. This is especially true if you plan to go into the ocean. Once a prosthesis is lost in heavy surf, it is extremely unlikely that it would ever be found.
However, regardless of what you do, take care to protect your prosthesis with some of the suggestions listed above. The last thing you want is to come out of the water without your prosthesis. Most ocularists will be happy to work with you to deal with your sport activity needs, and if there are any questions don't hesitate to ask your ocularist.